De Hoge Born verbindt: kwaliteiten en effecten van zorgboerderij De Hoge Born

De Hoge Born blijkt voor zorgvragers een plek te zijn 'waar je mag zijn wie je bent', waar 'je jezelf met je problemen leert accepteren' en 'zelfvertrouwen en eigenwaarde ontwikkelt'. Dit legt een basis voor hun verdere ontwikkeling. Bij de meeste zorgvragers die langere tijd zijn gevolgd met het monitoringsinstrument werden betrouwbare positieve veranderingen vastgestel

Shared Decision-Making Regarding Place of Birth–Mission Impossible or Mission Accomplished?

Aim: To explore Dutch pregnant women’s experiences of shared-decision making about place of birth to better understand this process for midwifery care purposes.Design: Qualitative exploratory study with a constant comparison/grounded theory design.Methods: We performed semi-structured interviews, including two focus groups and eight individual interviews among 16 primarous and multiparous women with uncomplicated pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The interviews were analyzed utilizing a cyclical process of coding and categorizing, following which the themes were structured based on the three-step shared-decision making model of Elwyn.Results: We identified the three themes according to Elwyn’s model: Choice talk, Option talk and Decision talk. We expanded the model with one additional theme: Decision ownership. The four themes explained women’s decision making process about place of birth. Women perceived shared-decision making about place of birth as a decision to be taken with their partner instead of with the midwife. Women and their partners regarded the decision about place of birth as a choice to be made as a couple and expecting parents; not as a decision in which the midwife needs to be actively involved. Women and their partners considered their options and developed a strong preference about where to give birth; even before the initial contact with the midwife was made. Involvement of the midwife occurred during the later stages of the decision-making process, where the women sought acknowledgement of their choice which was already made.Conclusion: Women considered their partners as the most and actively involved in the shareddecision making process regarding the place of birth. The women’s decision-making process about the place of birth did not fully occur during the antenatal care period. The midwife should ideally be involved before or during the early stages of pregnancy to facilitate the process

Zidovudine/Lamivudine for HIV-1 Infection Contributes to Limb Fat Loss

Lipoatrophy is known to be associated with stavudine as part of the treatment for HIV infection, but it is less clear if this serious side effect is also related to other nucleoside reverse transcriptase inhibitors like zidovudine. We aimed to determine whether zidovudine-sparing first-line antiretroviral therapy would lead to less lipoatrophy and other metabolic changes than zidovudine-containing therapy.Fifty antiretroviral therapy-naïve HIV-1 infected men with an indication to start antiretroviral therapy were included in a randomized single blinded clinical trial. Randomisation was between zidovudine-containing therapy (zidovudine/lamivudine+lopinavir/ritonavir) and zidovudine-sparing therapy (nevirapine+lopinavir/ritonavir). Main outcome measures were body composition assessed by computed tomography and dual-energy X-ray absorptiometry scan and lipid profile before and after 3, 12, 24 months of antiretroviral therapy. In the zidovudine/lamivudine+lopinavir/ritonavir group, from 3 months onward limb fat decreased progressively by 684+/-293 grams (estimated mean+/-standard error of the mean)(p = 0.02) up to 24 months whereas abdominal fat increased, but exclusively in the visceral compartment (+21.9+/-8.1 cm(2), p = 0.008)). In contrast, in the nevirapine+lopinavir/ritonavir group, a generalized increase in fat mass was observed. After 24 months no significant differences in high density lipoprotein and total/high density lipoprotein cholesterol ratio were found between both treatment groups, but total and low density lipoprotein cholesterol levels were higher in the nevirapine+lopinavir/ritonavir group (6.1+/-0.2 versus 5.3+/-0.2 and 3.6+/-0.1 versus 2.8+/-0.1 mmol/l respectively, p<0.05). Virologic response and safety were comparable in both groups.Zidovudine/lamivudine+lopinavir/ritonavir, but not nevirapine+lopinavir/ritonavir in antiretroviral therapy-naïve patients, is associated with lipoatrophy and greater relative intraabdominal lipohypertrophy, suggesting that zidovudine/lamivudine contributes to both these features of lipodystrophy. These findings support to no longer consider zidovudine/lamivudine as one of the preferred possible components of first-line antiretroviral therapy where alternative treatments are available.ClinicalTrials.gov NCT 00122226

An Infant Formula with Partially Hydrolyzed Whey Protein Supports Adequate Growth and Is Safe and Well-Tolerated in Healthy, Term Infants: A Randomized, Double-Blind, Equivalence Trial

The current study evaluates the safety and tolerance of a partially hydrolyzed whey protein-based infant formula (PHF) versus an in intact cow's milk protein formula (IPF). Breastfed infants were included as a reference group. In a multi-country, multicenter, randomized, double-blinded, controlled clinical trial, infants whose mothers intended to fully formula feed were randomized to PHF (n= 134) or IPF (n= 134) from <= 14 days to 17 weeks of age. The equivalence analysis of weight gain per day within margins of +/-3 g/d (primary outcome), the recorded adverse events, growth and gastro-intestinal tolerance parameters were considered for the safety evaluation. Equivalence of weight gain per day from enrolment until 17 weeks of age was demonstrated in the PHF group compared to the IPF group (difference in means -1.2 g/d; 90% CI (-2.42; 0.02)), with estimated means (SE) of 30.2 (0.5) g/d and 31.4 (0.5) g/d, respectively. No significant differences in growth outcomes, the number, severity or type of (serious) adverse events and tolerance outcomes, were observed between the two formula groups. A partially hydrolyzed whey protein-based infant formula supports adequate infant growth, with a daily weight gain equivalent to a standard intact protein-based formula; it is also safe for use and well-tolerated in healthy term infants

American Society of Clinical Oncology Summit on Addressing Obesity Through Multidisciplinary Provider Collaboration: Key Findings and Recommendations for Action

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139117/1/oby21987.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139117/2/oby21987_am.pd

Work-Related Well-Being Among Dutch Cardiologists - A National Survey

This is the first study to provide a holistic examination of cardiologists' well-being, investigating positive and negative dimensions, and its determinants. We conducted a national, multicenter, self-administered web-based questionnaire. We used frequencies to depict scores on three well-being indicators (professional fulfillment, work exhaustion and interpersonal disengagement) and performed three multiple regression analyses to elucidate their determinants. Cardiologists' mean scores (scale 1 to 5) were 3.85 (SD = 0.62) for professional fulfillment, 2.25 (SD = 0.97) for work exhaustion and 2.04 (SD = 0.80) for interpersonal disengagement. Workload, work-home interference and team atmosphere predicted the negative dimensions of well-being. Autonomy predicted cardiologists' professional fulfillment. Physician-patient interactions, person-job fit and individual resilience affected both dimensions. Dutch cardiologists score relatively high on professional fulfillment and average on work exhaustion and interpersonal disengagement. In order to foster cardiologists' well-being it is critical to increase energy providing work- and individual aspects