Changes in admission to long-term care institutions in the Netherlands: comparing two cohorts over the period 1996–1999 and 2006–2009

Using data from two cohorts, we examine to what extent a decline in institutional care in the Netherlands is associated with changes in the need for care and/or societal factors. We compared older adults, aged 65–89, who were admitted to a long-term care (LTC) institution in the period 1996–1999 and 2006–2009. Using the Andersen model, we tested per block of predisposing, enabling and need factors, which factors were significant predictors of admission to institutional care. With a Blinder–Oaxaca decomposition regression, we decomposed the difference in admission to an LTC institution between the period 1996–1999 and 2006–2009 into a part that is due to differences in health needs and other factors such as effect of policy, social values, and technology. Between 1996 and 2006, the percentage of co-residing partners and income increased and the average level of loneliness decreased significantly. The prevalence of disability, chronic diseases, however, increased. Whereas the care by partners declined, the formal care by professionals increased. Although the observed decline in the admission rate to institutional care was relatively small across the 10 years (from5.3 %in 1996–1999 to 4.5 % in 2006–2009, a 15 % decrease), the probability of admission in 2006–2009 was relatively much lower when accounting for changes in the health and social conditions of the participants: the probability was 1.7–2.1 % point lower for adults in the period 2006–2009 compared to 1996–1999, a 32–40 % decrease. Our results show that the decline in the admission rate to LTC institutions is not the result of changes in need. The decline is suggested to be the combined effect of changes in policy, technological advances and changes in social norms

Biporous Metal-Organic Framework with Tunable CO2/CH4 Separation Performance Facilitated by Intrinsic Flexibility.

In this work, we report the synthesis of SION-8, a novel metal-organic framework (MOF) based on Ca(II) and a tetracarboxylate ligand TBAPy4- endowed with two chemically distinct types of pores characterized by their hydrophobic and hydrophilic properties. By altering the activation conditions, we gained access to two bulk materials: the fully activated SION-8F and the partially activated SION-8P with exclusively the hydrophobic pores activated. SION-8P shows high affinity for both CO2 ( Qst = 28.4 kJ/mol) and CH4 ( Qst = 21.4 kJ/mol), while upon full activation, the difference in affinity for CO2 ( Qst = 23.4 kJ/mol) and CH4 ( Qst = 16.0 kJ/mol) is more pronounced. The intrinsic flexibility of both materials results in complex adsorption behavior and greater adsorption of gas molecules than if the materials were rigid. Their CO2/CH4 separation performance was tested in fixed-bed breakthrough experiments using binary gas mixtures of different compositions and rationalized in terms of molecular interactions. SION-8F showed a 40-160% increase (depending on the temperature and the gas mixture composition probed) of the CO2/CH4 dynamic breakthrough selectivity compared to SION-8P, demonstrating the possibility to rationally tune the separation performance of a single MOF by manipulating the stepwise activation made possible by the MOF's biporous nature

Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia

BACKGROUND: We aimed at identifying variables predicting hypoglycemia in elderly type 2 diabetic patients and the relation to HbA1c values achieved. DESIGN: Prospective, observational registry in 3810 patients in primary care. Comparison of patients in different age tertiles: with an age < 60 (young, n=1,253), age 60 to < 70 (middle aged, n=1,184) to those ≥ 70 years (elderly, n=1,373). Odds Ratios (OR) with 95% confidence intervals (CI) were determined from univariable and multivariable regression analyses. RESULTS: Elderly patients had a later diabetes diagnosis, a longer diabetes duration, better glucose control and more frequent co-morbid disease conditions. Overall 10.7% of patients experienced any severity hypoglycemia within the last 12 months prior to inclusion. Higher rates of hypoglycemia were observed in the elderly than in the young after adjusting for differences in HbA1c, fasting and post-prandial blood glucose (OR 1.68; 95%CI 1.16-2.45). This was particularly true for hypoglycemic episodes without specific symptoms (OR 1.74; 95%CI 1.05-2.89). In a multivariate model stroke / transitory ischemic attack, the presence of heart failure, clinically relevant depression, sulfonylurea use and blood glucose self-measurement were associated with hypoglycemic events. CONCLUSION: Elderly patients are at an increased risk of hypoglycemia even at comparable glycemic control. Therefore identified variables associated with hypoglycemia in the elderly such as heart failure, clinically relevant depression, the use of sulfonylurea help to optimize the balance between glucose control and low levels of hypoglycemia. Asymptomatic hypoglycemia should not be disregarded as irrelevant but considered as a sign of possible hypoglycemia associated autonomic failure

Antidiabetic pharmacotherapy and anamnestic hypoglycemia in a large cohort of type 2 diabetic patients - an analysis of the DiaRegis registry

<p>Abstract</p> <p>Background</p> <p>We aimed to identify predictors of anamnestic hypoglycaemia in type-2 diabetic patients on oral mono- or dual oral combination antidiabetic pharmacotherapy.</p> <p>Methods</p> <p>DiaRegis is a prospective registry in type-2 diabetic patients in primary care. Odds ratios (OR) with 95% confidence intervals were determined from univariate logistic regression. Using multivariate logistic regression analysis with stepwise backward selection at an alpha of 0.05 independent predictors of hypoglycaemia were determined.</p> <p>Results</p> <p>3,808 patients had data on hypoglycaemia available (median age 65.9 years, 46.6% female). 10.8% had at least one anamnestic hypoglycaemic episode within the previous 12 months. Patients with hypoglycaemia received more sulfonylureas (OR 2.16; 95%CI 1.75-2.67) and less metformin (OR 0.64; 95%CI 0.50-0.82). On top of metformin, patients with thiazolidine (OR 0.50; 95%CI 0.28-0.89) and DPP-4 inhibitor use (OR 0.34; 95%CI 0.16-0.70) had a decreased risk for hypoglycaemia while it was again increased with sulfonylureas (OR 2.08; 95%CI 1.44-2.99). Age < 65 years was an independent predictor of a reduced hypoglycaemia incidence (OR 0.76; 95%CI 0.59-0.96), low Hb_A1c(OR 1.68; 95%CI 1.31-2.14), stroke/TIA (OR 1.72; 95%CI 1.08-2.72), heart failure (OR 1.77; 95%CI 1.28-2.45), and the use of sulfonylureas (OR 2.58; 95%CI 2.03-3.29) were independent predictors of increased risk.</p> <p>Conclusions</p> <p>The results indicate that the risk of hypoglycaemia might be substantially reduced by carefully selecting antidiabetic pharmacotherapy in patients with type-2 diabets in primary care.</p

Receptory Fc&#947;: potencjalne biomarkery w diagnostyce reumatoidalnego zapalenia stawów i tocznia rumieniowatego układowego?

Reumatoidalne zapalenie stawów (RZS) i toczeń rumieniowaty układowy (TRU) są autoimmunizacyjnymi chorobami, których patomechanizm nie został do końca poznany. W etiopatogenezie zarówno RZS, jak i TRU podkreśla się rolę polimorfizmu oraz zaburzonej liczby kopii genów (FCGR2A, FCGR2B, FCGR2C i FCGR3A, FCGR3B), kodujących receptory dla fragmentu Fc immunoglobuliny G (Fc&#947;R). Receptory Fc&#947;RII i Fc&#947;RIII, obecne na komórkach układu immunologicznego, wpływają na fagocytozę, przede wszystkim kompleksów immunologicznych, apoptozę, reakcję cytotoksyczności z udziałem przeciwciał, ekspresję cytokin prozapalnych czy produkcję rodników hydroksylowych u chorych na RZS i TRU. Ze względu na znaczny udział wymienionych receptorów w odpowiedzi immunologicznej tych chorób, rozważa się je jako potencjalne biomarkery RZS i TRU. Mogą być one pomocne także w ocenie przebiegu choroby, odpowiedzi organizmu na zastosowane leczenie oraz w diagnozowaniu współistniejących infekcji. Obecnie nie ma wysoce swoistych i specyficznych biomarkerów RZS i TRU w diagnostyce, leczeniu i rokowaniu tych schorzeń. Dlatego też badanie liczby i ekspresji receptorów Fc&#947; na powierzchni komórek krwi obwodowej oraz analiza obecności poszczególnych alleli genów, kodujących te receptory, mogą stać się biomarkerem wykorzystywanym rutynowo w praktyce lekarskiej. Forum Medycyny Rodzinnej 2011, tom 5, nr 1, 57-6

Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on Osteoarthritis (EPOSA)

Background: people with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity.Methods: baseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders.Results: the majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M?=?4.1, SD?=?2.4 versus M?=?3.1, SD?=?2.4; p?&lt;?0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B?=?0.37, p?=?0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe.Conclusions: weather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with O

Psoralen and ultraviolet A irradiation (PUVA) as therapy for steroid-resistant cutaneous acute graft-versus-host disease

AbstractPsoralen plus ultraviolet A irradiation (PUVA) has immunomodulatory effects and is used to treat a variety of immune-mediated dermatologic diseases. We administered PUVA to 103 patients for treatment of steroid-resistant acute graft-versus-host disease (GVHD) of the skin. Twenty-nine patients had related donors (12 HLA-mismatched) and 74 had unrelated donors (23 HLA-mismatched). The median onset of GVHD was day 13 after transplantation, and the median onset of PUVA treatment was day 46. PUVA was administered as secondary therapy for 86 patients and tertiary therapy or greater for 17 patients. The median number of treatments was 16, and the mean cumulative exposure was 41 J/cm2. PUVA was generally well tolerated with 8 patients discontinuing therapy because of toxicity. At the start of PUVA treatment, 48 patients had rash affecting >50% of their body surface area (BSA), and 91 had rash involving >25% BSA. Of 65 patients who were evaluated after 6 weeks of PUVA treatment, 11 still had rash involving >50% BSA, 24 had rash involving >25% BSA, and 24 had no rash. The mean daily dose of prednisone at the start of PUVA therapy was 1.6 mg/kg compared to 0.7 mg/kg after 6 weeks of therapy. Fifty-nine patients (57%) did not require additional therapy for skin GVHD after starting PUVA. Ninety-two percent of patients developed chronic GVHD. Fifty-three patients (51%) remain alive at 129-1883 days after transplantation. These results suggest that PUVA can be an effective therapy for steroid-resistant acute GVHD of the skin.Biol Blood Marrow Transplant 2002;8(4):206-12

Variation at GRN 3′-UTR rs5848 Is Not Associated with a Risk of Frontotemporal Lobar Degeneration in Dutch Population

Background: A single nucleotide polymorphism (rs5848) located in the 3′- untranslated region of GRN has recently been associated with a risk of frontotemporal lobar degeneration (FTLD) in North American population particularly in pathologically confirmed cases with neural inclusions immunoreactive for ubiquitin and TAR DNA-binding protein 43 (TDP-43), but negative for tau and alpha-synuclein (FTLD-TDP). Methodology/Principal Findings: In an effort to replicate these results in a different population, rs5848 was genotyped in 256 FTLD cases and 1695 controls from the Netherlands. Single SNP gender-adjusted logistic regression analysis revealed no significant association between variation at rs5848 and FTLD. Fisher's exact test, failed to find any significant association between rs5848 and a subset of 23 pathology confirmed FTLD-TDP cases. Conclusions/Significance: The evidence presented here suggests that variation at rs5848 does not contribute to the etiology of FTLD in the Dutch population