Vitamin D Status Is Positively Correlated with Regulatory T Cell Function in Patients with Multiple Sclerosis

In several autoimmune diseases, including multiple sclerosis (MS), a compromised regulatory T cell (Treg) function is believed to be critically involved in the disease process. In vitro, the biologically active metabolite of vitamin D has been shown to promote Treg development. A poor vitamin D status has been linked with MS incidence and MS disease activity. In the present study, we assess a potential in vivo correlation between vitamin D status and Treg function in relapsing remitting MS (RRMS) patients.Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured in 29 RRMS patients. The number of circulating Tregs was assessed by flow-cytometry, and their functionality was tested in vitro in a CFSE-based proliferation suppression assay. Additionally, the intracellular cytokine profile of T helper cells was determined directly ex-vivo by flow-cytometry. Serum levels of 25(OH)D correlated positively with the ability of Tregs to suppress T cell proliferation (R = 0.590, P = 0.002). No correlation between 25(OH)D levels and the number of Tregs was found. The IFN-gamma/IL-4 ratio (Th1/Th2-balance) was more directed towards IL-4 in patients with favourable 25(OH)D levels (R = -0.435, P = 0.023).These results show an association of high 25(OH)D levels with an improved Treg function, and with skewing of the Th1/Th2 balance towards Th2. These findings suggest that vitamin D is an important promoter of T cell regulation in vivo in MS patients. It is tempting to speculate that our results may not only hold for MS, but also for other autoimmune diseases. Future intervention studies will show whether modulation of vitamin D status results in modulation of the T cell response and subsequent amelioration of disease activity

Aesthetic of Friction for Exercising Motivation: A Prototyping Journey

Despite an intention to exercise, it remains a challenge for many people to establish a workout routine over a period of time. Amongst identified barriers and enablers to exercise, getting dressed for a workout is considered as one of the tipping points of actually going. Implementing the Aesthetic of Friction in this specific context, could imply the right course of action for the user, while it also allows freedom and encourages meaning-making. In this Research-through-Design project, we designed an interactive shrinking hanger, that implements these key principles, to encourage exercise motivation. We followed an iterative process focusing on the aesthetics of the interaction to find out how a careful consideration of the look and feel of an interactive artefact influences the acceptance of the implemented friction. We document the design process of this aesthetics of friction exemplar, and reflect on how to implement friction in design. © 2021 Owner/Author

Quality of care in the intensive care unit from the perspective of patient's relatives: development and psychometric evaluation of the consumer quality index 'R-ICU'

Contains fulltext : 170082.pdf (publisher's version ) (Open Access)BACKGROUND: The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement. METHODS: The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis. RESULTS: Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (alpha = .80) and 'Participation' (alpha = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient. CONCLUSIONS: The CQI 'R-ICU' evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI 'R-ICU' led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire

Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis

BACKGROUND: Multiple Sclerosis is associated with low serum levels of 25-hydroxyvitamin D (25(OH)D). We investigated the association between serum levels of 25(OH)D and 1,25-dihydroxyvitamin D (1,25(OH)2D), the biologically active metabolite, and clinical MS severity as expressed by EDSS-score and relapse rate. STUDY-DESIGN: Cross-sectional study. PATIENTS AND METHODS: Serum samples from 267 MS patients were collected for 25(OH)D and 1,25(OH)2D measurement. Clinical MS parameters at the date of serum sampling were determined. Results: Both metabolite levels were significantly lower in the progressive forms compared to the relapsing remitting (RR)MS phenotype. In RRMS patients (disease course < or = 5 years), high 25(OH)D levels were associated with a high chance of remaining relapse-free. Low 25(OH)D levels were associated with high EDSS-scores. 1,25(OH)2D was not directly associated with relapse rate or EDSS-score, and was dependent of age and 25(OH)D level. CONCLUSION: Serum levels of 25(OH)D were associated with both relapse rate and disability in MS patients. These results are suggestive for a disease modulating effect of the serum concentrations of 25(OH)D on MS. The low circulating 1,25(OH)2D levels in progressive MS are due to older age and lower 25(OH)D levels. The potential consequences for vitamin D supplementation in MS will be discussed

Effects of vitamin B12 supplementation on cognition, depression, and fatigue in patients with lacunar stroke

We read the review by Moore et al . (2012), recently published in this journal, with great interest and compliment the authors for their thorough review of cognitive impairment and its relation to vitamin B12

Leren samenwerken met ouders in een grootstedelijke omgeving

Het college van de gemeente Amsterdam en de wethouder van Onderwijs vinden het belangrijk dat kinderen en jongeren zich optimaal kunnen ontwikkelen, dat ze hun talenten leren ontdekken en die ook kunnen ontplooien. Dit vraagt iets van het Amsterdamse onderwijs, de kinderen en jongeren zelf, maar ook van hun ouders. Door samen te werken en gerichte ondersteuning te bieden aan ouders, leraren en pedagogische professionals, kan een positief leer- en ontwikkelingsklimaat voor kinderen en jongeren worden gecreëerd, waarin zij kunnen genieten en optimaal profiteren van onderwijs. Lesgeven in een grote stad vraagt om specifieke vaardigheden van leraren en pedagogen. Samen met de educatieve opleidingen van de Faculteit Onderwijs en Opvoeding van de Hogeschool van Amsterdam heeft de gemeente een convenant opgesteld over hoe docenten en pedagogen beter toegerust kunnen worden om met de ouders van kinderen en jongeren in deze stad een waardevolle samenwerking aan te gaan. Wat hebben docenten in Amsterdam hiervoor nodig, wat verwachten ouders van hen en op welke manier kunnen de opleidingen daarin voorzien? Doel van het project ‘Leren samenwerken met ouders in een grootstedelijke omgeving’ was het ontwikkelen van een leerlijn ouderbetrokkenheid voor de initiële en post-initiële opleidingstrajecten van de Pabo HvA en de Universitaire Pabo van Amsterdam (UPvA), gebaseerd op wetenschappelijk onderzoek en die in samenwerking met partners uit het werkveld (ouders, leraren, pedagogen van opleidingsscholen) wordt vorm gegeven. Binnen het project is een leerlijn voor de initiële Pabo-opleiding nader uitgewerkt en zijn concrete praktijkmaterialen ontwikkeld voor een goede samenwerking tussen ouders en school. Inzet is om ‘stadsbekwame’ professionals af te leveren. Leraren en pedagogen hebben de belangrijke taak om kinderen en jongeren te begeleiden bij hun individuele ontwikkeling en te zorgen dat zij zich met veerkracht (‘resilience’) ontwikkelen in een grootstedelijke omgevingen met vertrouwen in eigen kunnen (‘self-efficacy’) hun weg kunnen vinden (Enthoven & Veldman, 2016). Belangrijke voorwaarde is dat ook de stadsbekwame professional met veerkracht en vertrouwen in eigen kunnen die taak kan vervullen. Om als leraar of pedagoog veerkrachtig en met vertrouwen in eigen kunnen adequaat te functioneren in een grootstedelijke omgeving is het van belang om tijdens de opleiding kennis en vaardigheden op te doen gericht op het herkennen van de individuele behoeften van kinderen, jongeren en hun ouders. Die vaardigheden kunnen leraren en pedagogen die al langer werkzaam zijn zich eigen maken door het volgen van post-initiële trajecten. Cruciaal daarbij is het opdoen van succeservaringen (Bandura, 1977). Het is van belang dat studenten van educatieve opleidingen voldoende gelegenheid krijgen ervaringen op te doen in de grootstedelijke context, zodat zij successen kunnen realiseren en daarmee hun zelfvertrouwen kunnen vergroten. Belangrijk daarbij is het leren en ervaren van ‘good practices’ waaraan de toekomstige professional zich kan spiegelen