The Importance of Resources and Security in the Socio-Economic Integration of Refugees. A Study on the Impact of Length of Stay in Asylum Accommodation and Residence Status on Socio-Economic Integration for the Four Largest Refugee Groups in the Netherlands

In many European countries, including the Netherlands, refugees stay in asylum accommodation pending a decision on their asylum request. While it seems evident that the lack of resources and insecurity about the future experienced during this stay will impact refugees' subsequent ability to integrate with the host society, so far this has hardly been studied in an extensive way. Also, the type of residence status granted can be a source of insecurity that impacts their integration. Previous studies on refugee integration have already shown the impact of pre-migration stressors such as traumatic experiences on mental health and integration. In this study, we use a large-scale dataset containing detailed information on about 4,000 refugees to show that also post-migration stressors affect mental health and hinder the socio-economic integration of the four largest refugee groups in the Netherlands: Afghan, Iraqi, Iranian and Somali

Peroxidized docosahexaenoic acid causes RPE dysfunction: implications for retinal ageing and AMD

The aim of this study was to gain important insights into the effects of peroxidized docosahexaenoic acid (pDHA) on the retinal pigment epithelium (RPE), and whether its effects can cause RPE cell dysfunction in a way similar to that observed in retinal ageing and the pathogenesis of age-related macular degeneration (AMD). Initially, the time-course of in vitro peroxidation of DHA was monitored, culminating in formation of products able to absorb light above 400 nm. Cultured RPE cells were then exposed to this pDHA, which was shown to be toxic, both in dark and light-exposed conditions. Various cell viability assays were carried out indicating RPE cell death after exposure to pDHA is likely to occur by apoptosis. The effects of pDHA were reduced in the presence of various agents - a-tocopherol, glutathione, N-acetylcysteine, and phosphatidylethanolamine (PE). Measurements of singlet oxygen, transient and superoxide production were carried out to determine the photosensitizing properties of pDHA. The ability of PE to reduce the production of these species was investigated but it was shown to have no effect on their yield, although singlet oxygen lifetime was reduced. Finally, lysosomal enzyme activity, lysosomal integrity and accumulation of fluorescent and undegraded material were monitored after exposure to pDHA, demonstrating that pDHA was able to disrupt the ability of the RPE to fully degrade phagocytosed material. In summary, pDHA is able to affect RPE cell viability directly when exposed extracellularly, and can also affect essential normal functions of the RPE intracellularly. In conjunction with published findings that pDHA is present in the retina - both within and around the RPE - the data presented here support the theory that pDHA can play an important role in causing RPE dysfunction, resulting in a loss of the protective role these cells play for photoreceptors, as occurs in retinal ageing and AMD

Sporting programs for inactive population groups:factors influencing implementation in the organized sports setting

BACKGROUND: The organized sports sector has received increased attention as a setting to promote health-enhancing physical activity (HEPA) to the general population. For significant public health impact, it is important that successful HEPA programs are widely adopted, implemented and continued as ongoing practice. The importance of evaluating the context in which programs are implemented has been identified as critical. However, little research has focused on understanding the organized sports implementation context, including factors facilitating and impeding implementation. In this study, the main factors influencing implementation of HEPA programs in the organized sports setting were studied. METHODS: Fourteen sporting programs in the Netherlands aimed at increasing participation in sports by inactive population groups and funded within the National Action Plan for Sport and Exercise (NAPSE) were investigated. The programs were developed by ten Dutch National Sports Federations (NSFs) and implemented by different sports clubs in the Netherlands over a 3-year implementation period (June 2008-June 2011). The qualitative research component involved yearly face-to-face interviews (i.e. fourteen interviews each year, n = 12 program coordinators) and a group meeting with the program coordinators of the NSFs (n = 8). Cross-case comparisons and thematic analyses were performed to identify and categorize important facilitating and impeding factors respectively. The quantitative research component, used to identify the most important facilitating and impeding factors across all sporting programs, consisted of ranking of factors according to importance by the program coordinators (n = 12). RESULTS: Different factors act during six identified (implementation) phases. When comparing factors across phases, several key learnings were evident. Successful implementation relied, for example, on program design and enthusiastic individuals within sporting organizations. On the other hand, inactive people were hard to reach and participation of sports clubs was not self-evident. The findings were discussed in a broader context. CONCLUSIONS: This study adds to the knowledge base concerning the implementation of sporting programs, aimed at inactive people, in the organized sports setting. The main factors facilitating and impeding implementation were identified. The results of this study can be used by sports practitioners and policy makers when developing and implementing HEPA programs in this setting

Pharmacological treatment of Lambert-Eaton Myasthenic Syndrome

Lambert-Eaton myasthenic syndrome (LEMS) is a very rare antibody-mediated autoimmune disease of the neuromuscular junction. Therapy can be divided in symptomatic treatment and immunosuppressive treatment. Symptomatic treatment with amifampridine is the only therapy currently authorized for use in LEMS patients. In the Netherlands the first choice drug is amifampridine base in an extended release formulation instead of the currently authorized amifampridine phosphate. This formulation has lower costs and is possibly safer due to lower peak concentrations. Other therapy used in LEMS patients is prescribed off-label and is based on experience in patients with myasthenia gravis. In many cases pyridostigmine is added as symptomatic treatment. In almost half of patients immunosuppressive therapy is started, mostly corticosteroids with or without azathioprine. Intravenous immunoglobulins and plasma exchange are used as emergency treatment. Currently no randomized clinical trials with new therapies are ongoing or announced in patients with LEMS, although multiple new therapies for myasthenia gravis are being investigated. These future therapies can be differentiated in symptomatic and immunomodulating drugs. The immunomodulating drugs can be further differentiated in early stage drugs which target the B-cell, later stage drugs which target the circulating antibodies and targeted therapy which have a disease-specific target. Some early and later stage immunomodulating drugs show promising results in myasthenia gravis although high cost and uncertain long term safety may be limiting for incorporating these drugs in LEMS treatment guidelines. Clinical trials in LEMS patients are lacking due to the rarity of the disease and we suggest the following requirements for future trials of potential new treatments: Sufficient power by performing multicenter or n-of-1 trials when appropriate, a cross-over design to reduce the number of patients and using a LEMS-specific quantitative primary outcome measure like the 3TUG score

SARS-CoV-2 breakthrough infections after COVID-19 vaccination in patients with inflammatory bowel disease:a systematic review and meta-analysis

Background: Patients with inflammatory bowel disease (IBD) have an attenuated serologic response to COVID-19 vaccination. It is unclear whether an impaired immune response in vaccinated IBD patients impacts the susceptibility to SARS-CoV-2 infection and occurrence of severe COVID-19. Objectives:To evaluate SARS-CoV-2 breakthrough infection rates and the disease course of COVID-19 in vaccinated IBD patients. Design: A systematic literature search and meta-analysis was performed. Data sources and methods: The search was performed in Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and CINAHIL. The articles were independently screened and selected by two reviewers. A random-effects model was used to calculate the pooled relative risk for breakthrough infections in vaccinated IBD patients and controls. Results: A total of 16 studies were included, with study periods ranging from January 2020 to October 2021 and follow-up time from 3 weeks to 6 months. The breakthrough infection rates range from 0 to 37.4% in vaccinated IBD patients. The disease course of COVID-19 was generally mild, with low hospitalization and mortality rates (0–8.7% and 0–4.3%, respectively). Vaccinated IBD patients had a significantly lower relative risk of breakthrough infection rate compared to unvaccinated controls (risk ratio: 0.07, 95% CI: 0.03–0.18). No difference was observed between IBD patients and non-IBD controls, and between partially and fully vaccinated IBD patients. The impact of immunosuppressive therapy on breakthrough infection rates differs between studies. Most studies showed no impact from immunosuppressive treatment, anti-tumour necrosis factor alpha or corticosteroids and other biologics; one study reported higher rates for patients treated with infliximab versus vedolizumab. Conclusion: Vaccination is effective to prevent COVID-19 infections in patients with IBD. Breakthrough infections do occur, but the disease course is generally mild. Available data seem to suggest a declining trend of breakthrough infections during calendar time. Registration: The protocol was published in the PROSPERO database (CRD42021292853).</p