We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log 10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

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Objective: To investigate the level of agreement of the behavioural mapping method with an accelerometer to measure physical activity of hospitalized patients. Design: A prospective single-centre observational study. Setting: A university medical centre in the Netherlands. Subjects: Patients admitted to the hospital. Main measures: Physical activity of participants was measured for one day from 9 AM to 4 PM with the behavioural mapping method and an accelerometer simultaneously. The level of agreement between the percentages spent lying, sitting and moving from both measures was evaluated using the Bland–Altman method and by calculating Intraclass Correlation Coefficients. Results: In total, 30 patients were included. Mean (±SD) age was 63.0 (16.8) years and the majority of patients were men ( n = 18). The mean percentage of time (SD) spent lying was 47.2 (23.3) and 49.7 (29.8); sitting 42.6 (20.5) and 40.0 (26.2); and active 10.2 (6.1) and 10.3 (8.3) according to the accelerometer and observations, respectively. The Intraclass Correlation Coefficient and mean difference (SD) between the two measures were 0.852 and –2.56 (19.33) for lying; 0.836 and 2.60 (17.72) for sitting; and 0.782 and −0.065 (6.23) for moving. The mean difference between the two measures is small (⩽2.6%) for all three physical activity levels. On patient level, the variation between both measures is large with differences above and below the mean of ⩾20% being common. Conclusion: The overall level of agreement between the behavioural mapping method and an accelerometer to identify the physical activity levels ‘lying’, ‘sitting’ and ‘moving’ of hospitalized patients is reasonable.

Objective The aim of this study was to explore perceived factors of influence on the implementation of Hospital in Motion (HiM), a multidimensional and multidisciplinary implementation project to improve inpatients’ movement behavior. Methods This qualitative study was conducted on four wards. Per ward, a tailored action plan was implemented consisting of multiple tools and interventions to stimulate the integration of inpatient physical activity in usual care processes. After implementation, semi-structured interviews were performed with healthcare professionals and patients to explore perceived factors of influence on the implementation of the HiM project. A content analysis was performed using the framework of the Medical Research Council for complex interventions as guidance for the identification of categories and themes. Results In total 16 interviews were conducted with healthcare professionals and 12 with patients. The results were categorized into the three key components of the Medical Research Council framework: implementation, mechanisms of impact and context. An important factor of influence within the theme “implementation” was the iterative and multidisciplinary approach. Within the theme “mechanisms of impact” continuous attention and the interaction of multiple interventions, tailored to the target group and targeting multiple dimensions (individual, inter-professional, community and society), were perceived as important. Within the theme “context” the intrinsic motivation and inter-professional, community and societal culture towards physical activity was perceived to be of influence. Conclusion Impact can be achieved and maintained by creating continuous attention to inpatient physical activity and by the interaction between different interventions and dimensions during implementation. To maintain enough focus, the amount of activities at one time should be limited. Impact To improve inpatients’ movement behavior, implementation project teams should be multidisciplinary and they should implement a small set of tailored interventions which target multiple dimensions. Intermediate evaluation of the implementation process, strategies and interventions is recommended.