Self-management support in community living older adults

The aim of this thesis is to contribute to the knowledge on self-management and self-management support among older adults. The concepts of self-management and self-management support were explored from the perspectives of community-living older adults and community nurses. The effects of self-management support programmes on the activities of daily living of older adults were also investigated. The first part of this thesis focuses on the effect of self-management support interventions on the physical and mental functioning and activities of daily living of community-living older adults. The results of a systematic literature review showed that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults. The second part of this thesis focused on community-living older adults’ self-management of physical and mental health. The findings of a qualitative and two quantitative studies indicated that for independently-living older adults physical and mental health is an important pre-requisite to being able to remain self-reliant and autonomous and to keep doing the things they value. Many older adults, even those who already experience decline, are positive about their current and future physical and mental health status and do not worry about extra health care or housing needs. They believe that deterioration is a normal part of getting older and adapt to their decline. Most older adults tend to keep on going with an optimistic attitude and focus on preservation of health rather than on improvement. They rely on support from their immediate network when they are no longer confident or are unable to perform daily activities and delay seeking professional care because being self-reliant and autonomous is important for their self-esteem. In addition, it became clear that older age and decreasing mental health are related to declining self-management abilities. The third part of this thesis focuses on the concept of self-management and self-management support from the perspective of community nurses. The results of a qualitative study showed that community nurses find it difficult to give a clear, definitive description of the concept of self‐management. They relate self‐management to ‘taking control of your own life’, ‘making your own choices and decisions’ and ‘being self‐reliant’. Situations in which older adults exhibit considerable or little self-direction or self-reliance can lead to dilemmas in self-management support, namely: 1) ‘striving for optimal health and well-being versus respecting older adults’ choices’, and 2) ‘stimulating self-reliance and self-direction versus accepting a dependent attitude’. Different strategies are applied to resolve these dilemmas. In the first case, strategies of ‘adapting’, ‘persuading’ and ‘taking control’ are used, and for the second case ‘empowering’, challenging’ and ‘tolerating’ are used

The Antimicrobial Peptide, LL-37, Inhibits in vitro Osteoclastogenesis

Uncoupled bone resorption leads to net alveolar bone loss in periodontitis. The deficiency of LL-37, the only human antimicrobial peptide in the cathelicidin family, in patients with aggressive periodontitis suggests that LL-37 may play a pivotal role in the inhibition of alveolar bone destruction in periodontitis. We aimed to investigate a novel function of LL-37 in osteoimmunity by blocking osteoclastogenesis in vitro. Human osteoclast progenitor cells were isolated from a buffy coat of blood samples. The cells were cultured in the presence of various concentrations of LL-37 during an in vitro induction of osteoclastogenesis. Non-toxic doses of LL-37 could block multinuclear formation of the progenitor cells and significantly diminish the number of tartrate-resistant acid-phosphatase-positive cells and the formation of resorption pits (p < 0.05), whereas these concentrations induced cellular proliferation, as demonstrated by increased expression of proliferating cell nuclear antigen. Expression of several osteoclast genes was down-regulated by LL-37 treatment. It was demonstrated that nuclear translocation of nuclear- factor-activated T-cells 2 (NFAT2) was blocked by LL-37 treatment, consistent with a significant reduction in the calcineurin activity (p < 0.005). Collectively, our findings demonstrate that LL-37 inhibits the in vitro osteoclastogenesis by inhibiting the calcineurin activity, thus preventing nuclear translocation of NFAT2. Abbreviations: CALCR, calcitonin receptor; ClC-7, chloride-proton exchanger; CTSK, cathepsin K; DAPI, 4′,6-diamidino-2-phenylindole; EGTA, ethylene glycol tetraacetic acid; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; M-CSF/CSF1, macrophage-colony- stimulating factor; MMP-9, matrix metalloproteinase-9; MTT, [3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide]; NFAT2, nuclear factor of activated T-cells 2; PBS, phosphate-buffered saline; PCNA, proliferating cell nuclear antigen; PCR, polymerase chain reaction; RANK, receptor activator of nuclear factor kappa-B; RANKL, receptor activator of nuclear factor kappa-B ligand; RT-PCR, reverse-transcription polymerase chain- reaction; TBS, Tris-buffered saline; TCIRG1, T-cell, immune regulator 1, ATPase, H+ transporting, lysosomal V0 subunit A3; TRAcP, tartrate-resistant acid phosphatase

Anti-inflammatory therapies are associated with delayed onset of anemia and reduction in transfusion requirements in critically ill patients:results from two studies

BACKGROUND: Anemia is a hallmark of critical illness, which is largely inflammatory driven. We hypothesized that the use of anti-inflammatory agents limits the development of anemia and reduces the need for red blood cell (RBC) transfusions in patients with a hyper-inflammatory condition due to COVID-19. METHODS: An observational cohort (n = 772) and a validation cohort (a subset of REMAP-CAP, n = 119) of critically ill patients with hypoxemic respiratory failure due to COVID-19 were analyzed, who either received no treatment, received steroids or received steroids plus IL-6 blocking agents. The trajectory of hemoglobin (Hb) decline and the need for RBC transfusions were compared using descriptive statistics as well as multivariate modeling. RESULTS: In both cohorts, Hb level was higher in the treated groups compared to the untreated group at all time points. In the observational cohort, incidence and number of transfused patients were lower in the group receiving the combination treatment compared to the untreated groups. In a multivariate analysis controlling for baseline Hb imbalance and mechanical ventilation, receipt of steroids remained associated with a slower decline in Hb level and the combination treatment remained associated with a slower decline of Hb and with less transfusions. Results remained the same in the validation cohort. CONCLUSION:Immunomodulatory treatment was associated with a slower decline in Hb level in critically ill patients with COVID-19 and with less transfusion. Findings point toward inflammation as an important cause for the occurrence of anemia in the critically ill.</p