Ethische kwesties in de mondzorg voor kwetsbare ouderen

Voor kwetsbare ouderen is vaak intensieve preventieve en curatieve mondzorg nodig ten behoeve van de kwaliteit van leven. Door fysieke en cognitieve beperkingen van de oudere kunnen behandelingen niet altijd lege artis uitgevoerd worden, wat tot praktische problemen leidt. Hieraan gerelateerd doen zich morele vragen voor. Mondzorg voor kwetsbare ouderen kan, zelfs met beperkingen, bijdragen aan hoge kwaliteit van leven als deze ethische kwesties vaker expliciet daarin betrokken worden. Daarmee zal ook de morele druk van ethische kwesties op de zorgverlener worden verlicht. Het gaat veelal om ‘alledaagse’ ethische kwesties, waarvoor de betrokkenen met elkaar oplossingen kunnen vinden in open overleg in een zorgethische benadering. Dat laatste betekent gerichtheid op ‘de goede dingen goed doen’ met inbegrip van alle relevante aspecten van de persoon en de omgeving. Voorwaarden zijn onder andere inbedding van de mondzorg in de zorg voor ouderen en voor zorgverleners betrokkenheid bij de oudere en kennis en vaardigheden om te reflecteren

The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents

Aims: To assess the impact of an oral healthcare program in nursing homes on the initial treatment backlog and residents' oral health stability. Materials and methods: The study is a longitudinal cohort study in nursing home residents in Flanders, Belgium, to evaluate the oral healthcare programme Gerodent. The program consisted of: (1) the introduction of an oral healthcare team, (2) oral health education, (3) the implementation of oral health guidelines and protocols, and (4) regular visits of a mobile dental team. Data were extracted from the oral health records of 381 residents from 21 nursing homes who received treatments from the mobile dental team between October 2010 and March 2014 (mean follow-up period of 22.5 months). Oral health and treatment need between baseline and follow-up were compared. Results: The mean age at baseline was 82.4 years and the mean number of consultations per resident was 3.61 during the follow-up period. The proportion of residents with an oral treatment need was reduced from 65.9% to 31.3%. Among residents with natural teeth, there was significantly lower prevalence of caries (from 70.5% at baseline to 36.5% at follow-up; p<0.001), residual roots (from 54.2% to 25.1%; p<0.001), and need for fillings (from 31.9% to 17.1%; p<0.001) or extractions (from 64.3% to 31.6%; p<0.001). In the group with partial or full dentures (n = 223), 38.1% needed a repair, rebasing or renewal of their existing dentures at baseline and the respective figure at follow-up was 9.0% (p<0.001). In terms of oral health stability, 53% of the residents had no incident restorative and prosthetic treatment need throughout the follow-up period. A lower number of natural teeth at baseline (p<0.001) and a shorter follow-up period (p = 0.002) were associated with higher chances of oral health stability. Conclusion: The oral healthcare program Gerodent significantly reduced the treatment backlog and contributed to a considerable proportion of residents being stable in terms of oral health without any incident treatment needs

Differential processing of RNA polymerase II at DNA damage correlates with transcription-coupled repair syndrome severity

DNA damage severely impedes gene transcription by RNA polymerase II (Pol II), causing cellular dysfunction. Transcription-Coupled Nucleotide Excision Repair (TC-NER) specifically removes such transcription-blocking damage. TC-NER initiation relies on the CSB, CSA and UVSSA proteins; loss of any results in complete TC-NER deficiency. Strikingly, UVSSA deficiency results in UV-Sensitive Syndrome (UVSS), with mild cutaneous symptoms, while loss of CSA or CSB activity results in the severe Cockayne Syndrome (CS), characterized by neurodegeneration and premature aging. Thus far the underlying mechanism for these contrasting phenotypes remains unclear. Live-cell imaging approaches reveal that in TC-NER proficient cells, lesion-stalled Pol II is swiftly resolved, while in CSA and CSB knockout (KO) cells, elongating Pol II remains damage-bound, likely obstructing other DNA transacting processes and shielding the damage from alternative repair pathways. In contrast, in UVSSA KO cells, Pol II is cleared from the damage via VCP-mediated proteasomal degradation which is fully dependent on the CRL4CSA ubiquitin ligase activity. This Pol II degradation might provide access for alternative repair mechanisms, such as GG-NER, to remove the damage. Collectively, our data indicate that the inability to clear lesion-stalled Pol II from the chromatin, rather than TC-NER deficiency, causes the severe phenotypes observed in CS.</p

Assessment of oral health in older adults by non-dental professional caregivers : development and validation of a photograph-supported oral health–related section for the interRAI suite of instruments

Objectives An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults. Methods The optimized oral health-related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not). Results Mean kappa values and percent agreement between caregivers and dentist ranged between kappa = 0.60 (80.2%) for dry mouth and kappa = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with kappa = 0.63 [95% CI: 0.56-0.70] (81.6%), while for the item palate/lips/cheeks only kappa = 0.27 [95% CI: 0.18-0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between kappa = 0.93 [95% CI: 0.79-1.00] (96.4%) for dry mouth and kappa = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not. Conclusions Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved

Circumsporozoite-specific T cell responses in children vaccinated with RTS,S/AS01 E and protection against P falciparum clinical malaria

Background:RTS,S/AS01E is the lead candidate pre-erythrocytic malaria vaccine. In Phase IIb field trials the safety profile was acceptable and the efficacy was 53% (95%CI 31%&ndash;72%) for protecting children against clinical malaria caused by P. falciparum. We studied CS-specific T cell responses in order to identify correlates of protection.Methods and Findings:We used intracellular cytokine staining (for IL2, IFN&gamma;, and TNF&alpha;), ex-vivo ELISPOTs (IFN&gamma; and IL2) and IFN&gamma; cultured ELISPOT assays to characterize the CS-specific cellular responses in 407 children (5&ndash;17 months of age) in a phase IIb randomized controlled trial of RTS,S/AS01E (NCT00380393). RTS,S/ AS01E vaccinees had higher frequencies of CS-specific CD4+ T cells producing IFN&gamma;, TNF&alpha; or IL2 compared to control vaccinees. In a multivariable analysis TNF&alpha;+ CD4+ T cells were independently associated with a reduced risk for clinical malaria among RTS,S/AS01E vaccinees (HR = 0.64, 95%CI 0.49&ndash;0.86, p = 0.002). There was a non-significant tendency towards reduced risk among control vaccinees (HR = 0.80, 95%CI 0.62&ndash;1.03, p = 0.084), albeit with lower CS-specific T cell frequencies and higher rates of clinical malaria. When data from both RTS,S/AS01E vaccinees and control vaccinees were combined (with adjusting for vaccination group), the HR was 0.74 (95%CI 0.62&ndash;0.89, p = 0.001). After a Bonferroni correction for multiple comparisons (n-18), the finding was still significant at p = 0.018. There was no significant correlation between cultured or ex vivo ELISPOT data and protection from clinical malaria. The combination of TNF&alpha;+ CD4+ T cells and anti-CS antibody statistically accounted for the protective effect of vaccination in a Cox regression model.Conclusions:RTS,S/AS01E induces CS-specific Th1 T cell responses in young children living in a malaria endemic area. The combination of anti-CS antibody concentrations titers and CS-specific TNF&alpha;+ CD4+ T cells could account for the level of protection conferred by RTS,S/AS01E. The correlation between CS-specific TNF&alpha;+ CD4+ T cells and protection needs confirmation in other datasets

Insourcen, outsourcen of backsourcen? Het geval van de Brusselse gewestelijke administratie

Sinds de jaren 1980 zijn bedrijven en openbare besturen geneigd zich op hun kernactiviteiten te focussen en taken als IT, beveiliging, catering en schoonmaak uit te besteden. De jongste jaren zien we echter een omkering van deze tendens in vele organisaties, die sommige van deze activiteiten opnieuw intern gaan uitvoeren. Een proces dat we “backsourcing” noemen. Het doel van dit artikel is om te onderzoeken in welke mate activiteiten werden uitbesteed in de Brusselse gewestelijke besturen, wat de impact daarvan is op de betrokken medewerkers en organisaties en hoe de belanghebbenden staan tegenover een eventuele backsourcing van laaggekwalificeerde banen. In het kader van een multidisciplinair project van BSI voor Talent.Brussels hebben onze bevindingen aangetoond dat beslissingen over in- en outsourcing complex en multidimensionaal zijn en dat ze niet enkel gebaseerd mogen zijn op kostenoverwegingen.Since the 1980s, there has been a trend for businesses and public administrations to focus on their core activities, outsourcing tasks such as IT, security, catering and cleaning services. However, in recent years, many organisations have been reversing the trend by insourcing, or “backsourcing”, some of these activities. The aim of this article is to study the extent to which activities have been outsourced in the Brussels regional administrations, its impact on workers and organisations involved, and the attitudes of stakeholders towards a possible re-internalisation of low-skilled jobs. Based on a multidisciplinary BSI project for Talent.Brussels, our findings show that decisions about outsourcing and insourcing are complex and multidimensional, and that they should not be based solely on monetary cost considerations. Since the 1980s, there has been a trend for businesses and public administrations to focus on their core activities, outsourcing tasks such as IT, security, catering and cleaning services. However, in recent years, many organisations have been reversing the trend by insourcing, or “backsourcing”, some of these activities. The aim of this article is to study the extent to which activities have been outsourced in the Brussels regional administrations, its impact on workers and organisations involved, and the attitudes of stakeholders towards a possible re-internalisation of low-skilled jobs. Based on a multidisciplinary BSI project for Talent.Brussels, our findings show that decisions about outsourcing and insourcing are complex and multidimensional, and that they should not be based solely on monetary cost considerations.À partir des années 1980, les entreprises et les administrations publiques ont eu tendance à externaliser des tâches, notamment les services informatiques, de sécurité, de restauration et de nettoyage, afin de se concentrer sur leurs activités principales. Cependant, ces dernières années, de nombreuses organisations ont inversé cette tendance en internalisant ou réinternalisant (« backsourcing ») certaines des tâches en question. Le présent article vise à examiner le degré d’externalisation des activités dans les administrations régionales bruxelloises, l’incidence du phénomène sur les travailleurs et les organismes concernés, ainsi que le regard porté par les parties prenantes sur l’éventualité d’une réinternalisation d’emplois peu qualifiés. Nos constatations, qui s’appuient sur un projet pluridisciplinaire mené par le BSI pour talent.brussels, font apparaître que les décisions en matière d’externalisation et d’internalisation sont complexes et multidimensionnelles, et ne devraient pas se fonder uniquement sur des considérations pécuniaires