Receiving and providing informal care:Does context matter?

Boer, A.H. de [Promotor]Woittiez, I.B. [Copromotor

De grens van extramuralisering is nog niet bereikt

Het kabinet is voornemens steeds minder ouderen met beperkingen naar een tehuis te laten verhuizen, maar hen thuis zorg te geven. Dit artikel biedt eerste aanknopingspunten om de groep zorgbehoevenden voor wie thuiszorg een reëel alternatief is voor tehuiszorg, te identificeren op basis van hun kenmerken. We maken gebruik van de gegevensbestanden Aanvullend Voorzieningengebruikonderzoek (AVO’07) en Ouderen in Instellingen (OII’08). Met behulp van een regressieanalyse wordt voor elke persoon de kans voorspeld op het gebruik van een bepaald type zorg. Een negende tot een vijfde van de tehuisbewoners had vergelijkbare kenmerken als mensen die thuiszorg krijgen. Deze tehuisbewoners zijn vaak jonger dan de overige tehuisbewoners, zijn hoger opgeleid, hebben een hoger inkomen en hebben lichtere beperkingen. De prevalentie van dementie is aanmerkelijk lager onder deze groep. De alternatieven voor tehuiszorg moeten vooral gezocht worden in de huishoudelijke hulp, vaak in combinatie met persoonlijke verzorging en verpleging. De functie begeleiding kan eveneens een alternatief voor tehuiszorg bieden, maar kon niet worden opgenomen in dit onderzoek. Er zal echter altijd een groep ouderen zijn die het beste en meest efficiënt geholpen is in een intramurale setting. Het is van belang dat verblijfszorg voor deze groep beschikbaar blijft

Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study

Contains fulltext : 208064.pdf (publisher's version ) (Open Access

Increased activation of blood neutrophils after cigarette smoking in young individuals susceptible to COPD

Background: Cigarette smoking is the most important risk factor for Chronic Obstructive Pulmonary Disease (COPD). Only a subgroup of smokers develops COPD and it is unclear why these individuals are more susceptible to the detrimental effects of cigarette smoking. The risk to develop COPD is known to be higher in individuals with familial aggregation of COPD. This study aimed to investigate if acute systemic and local immune responses to cigarette smoke differentiate between individuals susceptible or non-susceptible to develop COPD, both at young (18-40 years) and old (40-75 years) age. Methods: All participants smoked three cigarettes in one hour. Changes in inflammatory markers in peripheral blood (at 0 and 3 hours) and in bronchial biopsies (at 0 and 24 hours) were investigated. Acute effects of smoking were analyzed within and between susceptible and non-susceptible individuals, and by multiple regression analysis. Results: Young susceptible individuals showed significantly higher increases in the expression of Fc gamma RII (CD32) in its active forms (A17 and A27) on neutrophils after smoking (p = 0.016 and 0.028 respectively), independently of age, smoking status and expression of the respective markers at baseline. Smoking had no significant effect on mediators in blood or inflammatory cell counts in bronchial biopsies. In the old group, acute effects of smoking were comparable between healthy controls and COPD patients. Conclusions: We show for the first time that COPD susceptibility at young age associates with an increased systemic innate immune response to cigarette smoking. This suggests a role of systemic inflammation in the early induction phase of COPD

Induction of labor with Foley catheter and risk of subsequent preterm birth: follow-up study of two randomized controlled trials (PROBAAT-1 and -2)

Objective: To evaluate the rate of preterm birth (PTB) in a subsequent pregnancy in women who had undergone term induction using a Foley catheter compared with prostaglandins. Methods: This was a follow-up study of two large randomized controlled trials (PROBAAT-1 and PROBAAT-2). In the original trials, women with a term singleton pregnancy with the fetus in cephalic presentation and with an indication for labor induction were randomized to receive either a 30-mL Foley catheter or prostaglandins (vaginal prostaglandin E2 in PROBAAT-1 and oral misoprostol in PROBAAT-2). Data on subsequent ongoing pregnancies &gt; 16 weeks’ gestation were collected from hospital charts from clinics participating in this follow-up study. The main outcome measure was preterm birth &lt; 37 weeks’ gestation in a subsequent pregnancy. Results: Fourteen hospitals agreed to participate in this follow-up study. Of the 1142 eligible women, 572 had been allocated to induction of labor using a Foley catheter and 570 to induction of labor using prostaglandins. Of these, 162 (14%) were lost to follow-up. In total, 251 and 258 women had a known subsequent pregnancy &gt; 16 weeks' gestation in the Foley catheter and prostaglandin groups, respectively. There were no differences in baseline characteristics between the groups. The overall rate of PTB in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38–2.24), and the rate of spontaneous PTB was 5/251 (2.0%) vs 5/258 (1.9%) (RR, 1.03; 95% CI, 0.30–3.51). Conclusion: In women with term singleton pregnancy, induction of labor using a 30-mL Foley catheter is not associated with an increased risk of PTB in a subsequent pregnancy, as compared to induction of labor using prostaglandins.</p

Induction of labor with Foley catheter and risk of subsequent preterm birth : follow‐up study of two randomized controlled trials (PROBAAT‐1 and ‐2)

Acknowledgements We thank all the women who participated in the PROBAAT trials and all participating institutions and their staff for their contribution to this follow-up study. Funding The original PROBAAT-2 trial was funded by FondsNutsOhra. For the PROBAAT-1 trial and this follow-up study, no funding was received. MV received a doctoral grant for teachers by the Netherlands Organisation for Scientific Research (023.011.051). BM is supported by a NHMRC Practitioner Fellowship (GNT1082548). Funding sources had no role in design, execution, analyses, interpretation, or decision to submit results.Peer reviewedPublisher PD

Campaign For Hyperspectral Data Validation In North Atlantic Coastal Waters

The high photosynthetic productivity of the Mausund bank on the coast of mid-Norway has given the area important economic and ecologic value. Monitoring chlorophyll-a (chl-a) production can assist in managing the local aquaculture and ecosystem. Hyperspectral imagers (HSIs), with frequent revisit times when used on a small satellite, have the potential to detect chl-a over large regions. Moreover, our hypothesis is that HSIs can classify spectral signatures of different functional groups of plankton. The data must, however, first be validated to be interpreted in accordance with in situ data.Recently, a HSI validation campaign was performed. HSIs on a small satellite and drones, unmanned surface and underwater vehicles with chl-a detectors, and numerical simulations were used to monitor local phytoplankton blooms. These measurements were validated with in situ water sampling. Each measurement technique and an outline of the campaign is described, showing the feasibility of such a coordinated mission.acceptedVersio

Vertical R1 margins are not always associated with residual neoplasia after endoscopic resection of Barrett's neoplasia:a nationwide cohort with dedicated pathology reassessment

BACKGROUND: To evaluate the proportion of patients with residual neoplasia after endoscopic resection (ER) for Barrett's neoplasia with confirmed tumor-positive vertical resection margin (R1v).METHODS: Retrospective cohort study including all patients treated with ER for Barrett's neoplasia with histologically documented R1v since 2008 in the Dutch Barrett Expert Centers. R1v was defined as cancer cells touching the vertical resection margin and Rx as not assessable margins. Reassessment of R1v specimen was performed by experienced pathologists until consensus was reached regarding vertical margins.RESULTS: 101/110 included patients had macroscopically complete resections (T1a n=17, T1b n=84), of which 99/101 (98%) ER specimens were reassessed. Reassessment confirmed R1v in 74 (75%) patients and found Rx in 16% and R0 in 9%. Presence of residual neoplasia could be assessed in 66/74 patients during endoscopic reassessment (n=52) and/or in the surgical resection specimen (n=14), of whom 33/66 (50%)had residual neoplasia. Residual neoplasia detected during endoscopy was always endoscopically visible and biopsies from a normal appearing ER-scar did not detect additional neoplasia. Twenty-five patients with no residual neoplasia during endoscopic reassessment underwent endoscopic follow-up for median 37 months(IQR 12-50), in which 4 developed a local recurrence(16.0%), all detected as visible abnormalities.CONCLUSIONS: Histological evaluation of ER margins appears challenging as 75% of documented R1v cases were confirmed during reassessment. After ER with R1v, 50% of the patients had no residual neoplasia. Endoscopic reassessment 8-12 weeks after ER seems accurately able to detect residual neoplasia and help to determine the most appropriate strategy for patients with R1v.</p

Temporizing management vs immediate delivery in early-onset severe preeclampsia between 28 and 34 weeks of gestation (TOTEM study) : An open-label randomized controlled trial

Peer reviewedPublisher PD

A single nucleotide C3 polymorphism associates with clinical outcome after lung transplantation

Background: Development of chronic rejection is still a severe problem and causes high mortality rates after lung transplantation (LTx). Complement activation is important in the development of acute rejection (AR) and bronchiolitis obliterans syndrome, with C3 as a key complement factor. Methods: We investigated a single nucleotide polymorphism (SNP) in the C3 gene (rs2230199) in relation to long-term outcome after LTx in 144 patient-donor pairs. In addition, we looked at local production of donor C3 by analyzing bronchoalveolar lavage fluid (BALF) of 6 LTx patients using isoelectric focusing (IEF). Results: We demonstrated the presence of C3 in BALF and showed that this is produced by the donor lung based on the genotype of SNP rs2230199. We also analyzed donor and patient SNP configurations and observed a significant association between the SNP configuration in patients and episodes of AR during 4-years follow-up. Survival analysis showed a lower AR-free survival in homozygous C3 slow patients (p = 0.005). Furthermore, we found a significant association between the SNP configuration in donors and BOS development. Patients receiving a graft from a donor with at least one C3 fast variant for rs2230199 had an inferior BOS-free survival (p = 0.044). Conclusions: In conclusion, our data indicate local C3 production by donor lung cells. In addition, a single C3 SNP present in recipients affects short-term outcome after LTx, while this SNP in donors has an opposite effect on long-term outcome after LTx. These results could contribute to an improved risk stratification after transplantation