Browsing by Subject "Life"

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    Open Access
    ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle
    (2016) Bousquet, J; Hellings, P W; Agache, I; Bedbrook, A; Bachert, C; Bergmann, K C; Bewick, M; Bindslev-Jensen, C; Bosnic-Anticevitch, S; Bucca, C; Caimmi, D P; Camargos, P A M; Canonica, G W; Casale, T; Chavannes, N H; Cruz, A A; De Carlo, G; Dahl, R; Demoly, P; Devillier, P; Fonseca, J; Fokkens, W J; Guldemond, N A; Haahtela, T; Illario, M; Just, J; Keil, T; Klimek, L; Kuna, P; Larenas-Linnemann, D; Morais-Almeida, M; Mullol, J
    Abstract The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.
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    Children’s route choice during active transportation to school: difference between shortest and actual route
    (2016) Dessing, Dirk; de Vries, Sanne I; Hegeman, Geertje; Verhagen, Evert; van Mechelen, Willem; Pierik, Frank H
    BackgroundThe purpose of this study is to increase our understanding of environmental correlates that are associated with route choice during active transportation to school (ATS) by comparing characteristics of actual walking and cycling routes between home and school with the shortest possible route to school.MethodsChildren (n = 184; 86 boys, 98 girls; age range: 8–12 years) from seven schools in suburban municipalities in the Netherlands participated in the study. Actual walking and cycling routes to school were measured with a GPS-device that children wore during an entire school week. Measurements were conducted in the period April–June 2014. Route characteristics for both actual and shortest routes between home and school were determined for a buffer of 25m from the routes and divided into four categories: Land use (residential, commercial, recreational, traffic areas), Aesthetics (presence of greenery/natural water ways along route), Traffic (safety measures such as traffic lights, zebra crossings, speed bumps) and Type of street (pedestrian, cycling, residential streets, arterial roads). Comparison of characteristics of shortest and actual routes was performed with conditional logistic regression models.ResultsMedian distance of the actual walking routes was 390.1m, whereas median distance of actual cycling routes was 673.9m. Actual walking and cycling routes were not significantly longer than the shortest possible routes. Children mainly traveled through residential areas on their way to school (>80% of the route). Traffic lights were found to be positively associated with route choice during ATS. Zebra crossings were less often present along the actual routes (walking: OR = 0.17, 95 % CI = 0.05–0.58; cycling: OR = 0.31, 95 % CI = 0.14–0.67), and streets with a high occurrence of accidents were less often used during cycling to school (OR = 0.57, 95% CI = 0.43–0.76). Moreover, percentage of visible surface water along the actual route was higher compared to the shortest routes (walking: OR = 1.04, 95 % CI = 1.01–1.07; cycling: OR = 1.03, 95 % CI = 1.01–1.05).DiscussionThis study showed a novel approach to examine built environmental exposure during active transport to school. Most of the results of the study suggest that children avoid to walk or cycle along busy roads on their way to school.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0373-y) contains supplementary material, which is available to authorized users.
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    Drivers and uncertainties of future global marine primary production in marine ecosystem models
    (2015) Laufkötter, C; Vogt, M; Gruber, N; Aita-Noguchi, M; Aumont, O; Bopp, L; Buitenhuis, E; Doney, S C; Dunne, J; Hashioka, T; Hauck, J; Hirata, T; John, J; Le Quéré, C; Lima, D I; Nakano, H; Seferian, R; Totterdell, I; Vichi, M; Völker, C
    Past model studies have projected a global decrease in marine net primary production (NPP) over the 21st century, but these studies focused on the multi-model mean and mostly ignored the large inter-model differences. Here, we analyze model simulated changes of NPP for the 21st century under IPCC's high emission scenario RCP8.5 using a suite of nine coupled carbon–climate Earth System Models with embedded marine ecosystem models with a focus on the spread between the different models and the underlying reasons. Globally, five out of the nine models show a decrease in NPP over the course of the 21st century, while three show no significant trend and one even simulates an increase. The largest model spread occurs in the low latitudes (between 30° S and 30° N), with individual models simulating relative changes between −25 and +40%. In this region, the inter-quartile range of the differences between the 2012–2031 average and the 2081–2100 average is up to 3 mol C m-2 yr-1. These large differences in future change mirror large differences in present day NPP. Of the seven models diagnosing a net decrease in NPP in the low latitudes, only three simulate this to be a consequence of the classical interpretation, i.e., a stronger nutrient limitation due to increased stratification and reduced upwelling. In the other four, warming-induced increases in phytoplankton growth outbalance the stronger nutrient limitation. However, temperature-driven increases in grazing and other loss processes cause a net decrease in phytoplankton biomass and reduces NPP despite higher growth rates. One model projects a strong increase in NPP in the low latitudes, caused by an intensification of the microbial loop, while the remaining model simulates changes of less than 0.5%. While there is more consistency in the modeled increase in NPP in the Southern Ocean, the regional inter-model range is also very substantial. In most models, this increase in NPP is driven by temperature, but is also modulated by changes in light, macronutrients and iron as well as grazing. Overall, current projections of future changes in global marine NPP are subject to large uncertainties and necessitate a dedicated and sustained effort to improve the models and the concepts and data that guide their development.
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    Unravelling the factors decisive to the implementation of EPODE-derived community approaches targeting childhood obesity: a longitudinal, multiple case study
    (2016) van der Kleij, Maria Rianne; Crone, Mathilde; Reis, Ria; Paulussen, Theo
    Abstract Background Implementation of intersectoral community approaches often fails due to a translational gap between the approach as intended and the approach as implemented in practice. Knowledge about the implementation determinants of such approaches is needed to facilitate future implementation processes. Methods The implementation of five EPODE-derived intersectoral community approaches was studied longitudinally. Semi-structured interviews were held with 189 community stakeholders from four sectors to elucidate which determinants influenced implementation, and if an to which extent determinants differed across communities, sectors and over time. A framework approach was used to analyze our data. Results Twenty-two key determinants of implementation were identified. Facilitators named were mostly proximal (stakeholder level), and barriers were mostly distal (context level). Key determinants varied greatly across sectors and over time, especially between the educational & health care sector and the private, welfare & sports sector. Only ‘perceived importance of IACO goals’ was identified as an universal implementation facilitator. Conclusions Striking differences in determinants were found across sectors and over time. Also, stakeholders expressed that possibilities to adapt the approach to the local context were needed to improve implementation. We therefore propose to develop sector- and time specific leads for implementation, which should be approved and amended (over time) by stakeholders. This so-called ‘mutual adaptation’ allows for the use of both scientific insights and practice-based knowledge, enabling program management and community stakeholders to collaboratively improve their implementation efforts.