Trends in caries experience of adults in the Netherlands from 1995 to 2013

The Dutch National Health Care Institute, formerly CVZ/Ziekenfondsraad, asked TNO to investigate oral health in adults in the Netherlands 4 times in the period from 1995 to 2013 in order to monitor trends in oral health and, if necessary, to be able to adjust their policies accordingly. With the results of these 4 studies, the trends in caries experience of 25- up to and including 54-year-olds during the period 1995 to 2013 were established. In 1995, 2002, 2007 and 2013, the oral health of 25- up to and including 54-year-olds living in 's-Hertogenbosch was determined by means of a questionnaire and a clinical oral examination. In the period 1995-2013 a reduction in caries experience was found in both well- and less well-educated individuals. The outcomes for well-educated individuals were more favourable than those of their less well-educated peers. In 2012, then, oral health still has a socio-economic gradient. The debate on how to reach the high-risk group remains a matter of concern both for the dental profession and for politicians. In order to be able to keep a finger on the pulse monitoring of caries experience is of great importance.</p

Caries in deprived areas 1. Adults

In the Netherlands, little epidemiologic data is available on the oral health of the various cultural groups comprising the adult population living in deprived areas. The aim of an investigation carried out in 2013 was to obtain an impression of the extent of caries experience among less well-educated adults in deprived areas by comparison with a reference group of adults from the city of 's-Hertogenbosch. A total of 1,597 less well-educated respondents participated in this research. The reference population had the largest amount of caries experience, mostly due to a relatively large number of filled surfaces. The relatively low caries experience found in the respondents in the deprived areas with a non-Dutch cultural affiliation was due to lower numbers of filled surfaces. The differences in average filled-surface scores were statistically significant in all age categories, except the youngest. The strategy of 'extension for prevention' in caries treatment in the permanent dentition represents a possible explanation for the fact that less well-educated adults in 's-Hertogenbosch had significantly more filled surfaces than those with a non-Dutch cultural affiliation.</p

Understanding and meeting the needs of those using growth hormone injection devices

BACKGROUND: Recombinant human growth hormone (r-hGH) is used to treat: growth hormone deficiency in children and adults; children born small for gestational age; Turner's syndrome; and chronic renal failure. r-hGH is administered by daily subcutaneous injection and may be given using a number of different administration devices. The aim of this survey was, firstly, to identify which attributes of an r-hGH administration device are considered most important to physicians, teenage patients, parents of young children requiring GH and nurses who have experience of r-hGH administration, and, secondly, to determine how they rate existing devices in each of these key attributes. METHODS: The opinions of 67 individuals with experience in r-hGH administration were captured in discussion sessions. Parents, physicians and nurses were asked to rate 19 device attributes by completing a questionnaire, and to rank four different r-hGH administration devices (including a conceptual electronic device) in order of preference. RESULTS: Reliability, ease of use, lack of pain during injection, safety in use, storage, and number of steps in preparation before use, during use and after were considered to be the five most desirable attributes of an r-hGH administration device. An electronic device was preferred to an automatic, multi-dose injection device, a needle-free injection device or a manual, ready-to-use, disposable injection device. CONCLUSION: In the opinion of physicians, nurses and parents using r-hGH injection devices, an ideal device must combine reliability with simplicity, while delivering treatment with minimal pain. An electronic device, which combines many of the most useful features of existing devices with novel functions, was the preferred option for r-hGH administration

From DNA sequence to application: possibilities and complications

The development of sophisticated genetic tools during the past 15 years have facilitated a tremendous increase of fundamental and application-oriented knowledge of lactic acid bacteria (LAB) and their bacteriophages. This knowledge relates both to the assignments of open reading frames (ORF’s) and the function of non-coding DNA sequences. Comparison of the complete nucleotide sequences of several LAB bacteriophages has revealed that their chromosomes have a fixed, modular structure, each module having a set of genes involved in a specific phase of the bacteriophage life cycle. LAB bacteriophage genes and DNA sequences have been used for the construction of temperature-inducible gene expression systems, gene-integration systems, and bacteriophage defence systems. The function of several LAB open reading frames and transcriptional units have been identified and characterized in detail. Many of these could find practical applications, such as induced lysis of LAB to enhance cheese ripening and re-routing of carbon fluxes for the production of a specific amino acid enantiomer. More knowledge has also become available concerning the function and structure of non-coding DNA positioned at or in the vicinity of promoters. In several cases the mRNA produced from this DNA contains a transcriptional terminator-antiterminator pair, in which the antiterminator can be stabilized either by uncharged tRNA or by interaction with a regulatory protein, thus preventing formation of the terminator so that mRNA elongation can proceed. Evidence has accumulated showing that also in LAB carbon catabolite repression in LAB is mediated by specific DNA elements in the vicinity of promoters governing the transcription of catabolic operons. Although some biological barriers have yet to be solved, the vast body of scientific information presently available allows the construction of tailor-made genetically modified LAB. Today, it appears that societal constraints rather than biological hurdles impede the use of genetically modified LAB.

Health-related quality-of-life measures for long-term follow-up in children after major trauma

Objective: Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning using the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO). Methods: The Medline and EMBASE databases were searched in all years up to October 2007 for generic HRQL measures suitable for children aged 5-18 years old and validated in English or Dutch. Measures were reviewed with respect to the age range for which the measure was suitable and reliability, validity, and content related to the ICF. Results: The search resulted in 1,235 hits and 21 related articles. Seventy-nine papers met the inclusion criteria, describing in total 14 measures: Child Health and Illness Profile Adolescent and Child Edition (CHIP-AE/CE), Child Health Questionnaire Child and Parent Forms (CHQCF87/PF50/PF28), DISABKIDS, Functional Status II (FS II)(R), Health Utilities Index Mark 2 (HUI 2), KIDSCREEN 52/27, KINDL, Pediatric Quality of Life Inventory (PedsQL), TNO Institute of Prevention and Health and the Leiden University Hospital (TNO-AZL), TNO-AZL Children’s Quality Of Life (TACQOL), and Youth Quality of Life Instrument-Research Version (YQOL-R). Measures that were suitable for a large age range were CHQ-PF50/PF28, DISABKIDS, FS II(R), HUI 2, KIDSCREEN, PedsQL, and TACQOL. All measures had moderate to good psychometric properties, except for CHQ-PF50/PF28, KINDL, and TACQOL, which had either low internal consistency or bad test-retest reliability. The measures that covered more than six chapters of the ICF domains were CHIP-AE/CE, CHQ-CF87/PF50, DISABKIDS, KIDSCREEN-52, PedsQL, and TACQOL. Conclusions: DISABKIDS, KIDSCREEN 52, and Peds-QL are suitable for long-term follow-up measurement of HRQL in children after major trauma. They cover a large age range, have good psychometric properties, and cover the ICF substantially

Incidence and outcome of acquired demyelinating syndromes in Dutch children: update of a nationwide and prospective study

Introduction: Acquired demyelinating syndromes (ADS) are immune-mediated demyelinating disorders of the central nervous system in children. A nationwide, multicentre and prospective cohort study was initiated in the Netherlands in 2006, with a reported ADS incidence of 0.66/100,000 per year and MS incidence of 0.15/100,000 per year in the period between 2007 and 2010. In this study, we provide an update on the incidence and the long-term follow-up of ADS in the Netherlands. Methods: Children < 18 years with a first attack of demyelination were included consecutively from January 2006 to December 2016. Diagnoses were based on the International Paediatric MS study group consensus criteria. Outcome data were collected by neurological and neuropsychological assessments, and telephone call assessments. Results: Between 2011 and 2016, 55/165 of the ADS patients were diagnosed with MS (33%). This resulted in an increased ADS and MS incidence of 0.80/100,000 per year and 0.26/100,000 per year, respectively. Since 2006 a total of 243 ADS patients have been included. During follow-up (median 55 months, IQR 28–84), 137 patients were diagnosed with monophasic disease (56%), 89 with MS (37%) and 17 with multiphasic disease other than MS (7%). At least one form of residual deficit including cognitive impairment was observed in 69% of all ADS patients, even in monophasic ADS. An Expanded Disability Status Scale score of ≥ 5.5 was reached in 3/89 MS patients (3%). Conclusion: The reported incidence of ADS in Dutch children has increased since 2010. Residual deficits are common in this group, even in monophasic patients. Therefore, long-term follow-up in ADS patients is warranted

Health as a Symbolic Media Interchanging between Body and Social System

Genetics of disease, diagnosis and treatmen

Doing Office Work on the Motorway

This article takes the motorway seriously as a place where the society of traffic can be found and studied. While many kinds of activities are done by drivers and passengers in parallel with driving on the motorway, such as listening to the radio, eating lunch or caring for, or being, children, I focus here on office work. Empirical material from a video-ethnography of one driver doing paperwork and overtaking a slow-moving vehicle ahead is used to examine in detail some of the practices of combining driving and office-duties in the car while in motion. Drawing on the work of Harvey Sacks, the article examines how this mobile society is naturally organized as an architectural configuration brought to life in the practices of driving in traffic. Overlooked phenomena that are orderly stable features of being mobile are analysed, such as ‘overtaking’, ‘tailgating’ and ‘cruising’. Where other writers have used ‘speed’ to theorize the contemporary period, a brief re-specification is offered in the light of the uses, moral and otherwise, of speed within, and as made apprehensible in relation to, traffic