Attitudes of Dutch general practitioners towards vaccinating the elderly:less is more?

Background: In many European countries, vaccinations are offered to the elderly. Expanding the programme to include routine vaccination against pneumococcal disease, herpes zoster, and pertussis, for example, could reduce disease burden amongst the growing population of persons aged 50 years and older. Since most countries involve general practitioners (GPs) in the programmes, the potential success of such new vaccinations depends on the attitude of GPs towards these vaccinations. This qualitative study explores Dutch GPs' attitudes regarding vaccination in general, and their attitudes regarding the incorporation of additional vaccines in the current Dutch influenza vaccination programme. Methods: Interviews were held with ten Dutch GPs (five men and five women) that worked either in an academic hospital, in a practice based in a health center, or in individual practice. All interviews were recorded with a digital voice recorder and transcribed verbatim. Transcripts were analysed according to thematic analysis. Results: GPs perceived prevention as part as their job and believed vaccination to be effective for preventing infectious diseases. However, influenza vaccination was not always perceived as effective. Doubts regarding the usefulness of additional vaccinations were identified. If additional vaccines would be offered, this should be based on scientific evidence and the severity of the infectious disease. Selection of patients for vaccination should not be based solely on age, but more on risk factors. The GP should be the central point of contact for new vaccination campaigns; however, high workload was seen as a concern. Several GPs questioned their ability to refuse to distribute the vaccinations. Conclusions: A positive attitude towards implementing additional vaccinations is not apparent. Achieving the most health benefits seems to be the most important consideration of Dutch GPs regarding vaccinating older adults. Questions regarding the usefulness of vaccinating older adults should be taken into consideration. More research is necessary to confirm the results among a wider range of Dutch GPs

Beyond ‘witnessing’: children’s experiences of coercive control in domestic violence and abuse

Children’s experiences and voices are underrepresented in academic literature and professional practice around domestic violence and abuse. The project ‘Understanding Agency and Resistance Strategies’ addresses this absence, through direct engagement with children. We present an analysis from interviews with 21 children in the United Kingdom (12 girls and 9 boys, aged 8-18 years), about their experiences of domestic violence and abuse, and their responses to this violence. These interviews were analysed using interpretive interactionism. Three themes from this analysis are presented: a) ‘Children’s experiences of abusive control’, which explores children’s awareness of controlling behaviour by the adult perpetrator, their experience of that control, and its impact on them; b) ‘Constraint’, which explores how children experience the constraint associated with coercive control in situations of domestic violence, and c) ‘Children as agents’ which explores children’s strategies for managing controlling behaviour in their home and in family relationships. The paper argues that, in situations where violence and abuse occurs between adult intimate partners, children are significantly impacted, and can be reasonably described as victims of abusive control. Recognising children as direct victims of domestic violence and abuse would produce significant changes in the way professionals respond to them, by 1) recognising children’s experience of the impact of domestic violence and abuse; 2) recognising children’s agency, undermining the perception of them as passive ‘witnesses’ or ‘collateral damage’ in adult abusive encounters; and 3) strengthening professional responses to them as direct victims, not as passive witnesses to violence

A multifrequency study of the active star forming complex NGC6357. I. Interstellar structures linked to the open cluster Pis24

We investigate the distribution of the gas (ionized, neutral atomic and molecular), and interstellar dust in the complex star forming region NGC6357 with the goal of studying the interplay between the massive stars in the open cluster Pis24 and the surrounding interstellar matter. Our study of the distribution of the ionized gas is based on narrow-band Hhalfa, [SII], and [OIII] images obtained with the Curtis-Schmidt Camera at CTIO, Chile, and on radio continuum observations at 1465 MHz taken with the VLA with a synthesized beam of 40 arcsec. The distribution of the molecular gas is analyzed using 12CO(1-0) data obtained with the Nanten radiotelescope, Chile (angular resolution = 2.7 arcmin). The interstellar dust distribution was studied using mid-infrared data from the GLIMPSE survey and far-infrared observations from IRAS. NGC6357 consists of a large ionized shell and a number of smaller optical nebulosities. The optical, radio continuum, and near- and mid-IR images delineate the distributions of the ionized gas and interstellar dust in the HII regions and in previously unknown wind blown bubbles linked to the massive stars in Pis24 revealing surrounding photodissociation regions. The CO line observations allowed us to identify the molecular counterparts of the ionized structures in the complex and to confirm the presence of photodissociation regions. The action of the WR star HD157504 on the surrounding gas was also investigated. The molecular mass in the complex is estimated to be (4+/-2)X10^5 Mo. Mean electron densities derived from the radio data suggest electron densities > 200 cm^-3, indicating that NGC6357 is a complex formed in a region of high ambient density. The known massive stars in Pis24 and a number of newly inferred massive stars are mainly responsible for the excitation and photodissociation of the parental molecular cloud.Comment: 16 pages, 9 figures. Accepted for publication in MNRA

Modes of Multiple Star Formation

This paper argues that star forming environments should be classified into finer divisions than the traditional isolated and clustered modes. Using the observed set of galactic open clusters and theoretical considerations regarding cluster formation, we estimate the fraction of star formation that takes place within clusters. We find that less than 10% of the stellar population originates from star forming regions destined to become open clusters, confirming earlier estimates. The smallest clusters included in the observational surveys (having at least N=100 members) roughly coincide with the smallest stellar systems that are expected to evolve as clusters in a dynamical sense. We show that stellar systems with too few members N < N_\star have dynamical relaxation times that are shorter than their formation times (1-2 Myr), where the critical number of stars N_\star \approx 100. Our results suggest that star formation can be characterized by (at least) three principal modes: I. isolated singles and binaries, II. groups (N<N_\star), and III. clusters (N>N_\star). Many -- if not most -- stars form through the intermediate mode in stellar groups with 10<N<100. Such groups evolve and disperse much more rapidly than open clusters; groups also have a low probability of containing massive stars and are unaffected by supernovae and intense ultraviolet radiation fields. Because of their short lifetimes and small stellar membership, groups have relatively little effect on the star formation process (on average) compared to larger open clusters.Comment: accepted to The Astrophysical Journa

“It’s like heaven over there”: Medicine as discipline and the production of the carceral body

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background Correctional systems in several U.S. states have entered into partnerships with Academic Medical Centers (AMCs) to provide healthcare for people who are incarcerated. This project was initiated to better understand medical trainee perspectives on training and providing healthcare services to prison populations at one AMC specializing in the care of incarcerated patients: The University of Texas Medical Branch at Galveston (UTMB). We set out to characterize the attitudes and perceptions of medical trainees from the start of their training until the final year of Internal Medicine residency. Our goal was to analyze medical trainee perspectives on caring for incarcerated patients and to determine what specialized education and training is needed, if any, for the provision of ethical and appropriate healthcare to incarcerated patients. Results We found that medical trainees grapple with being beneficiaries of a state and institutional power structure that exploits the neglected health of incarcerated patients for the benefit of medical education and research. The benefits include the training opportunities afforded by the advanced pathologies suffered by persons who are incarcerated, an institutional culture that generally allowed students more freedom to practice their skills on incarcerated patients as compared to free-world patients, and an easy compliance of incarcerated patients likely conditioned by their neglect. Most trainees failed to recognize the extreme power differential between provider and patient that facilitates such freedom. Conclusions Using a critical prison studies/Foucauldian theoretical framework, we identified how the provision/withholding of healthcare to and from persons who are incarcerated plays a major role in disciplining incarcerated bodies into becoming compliant medical patients and research subjects, complacent with and even grateful for delayed care, delivered sometimes below the standard best practices. Specialized vulnerable-population training is sorely needed for both medical trainees and attending physicians in order to not further contribute to this exploitation of incarcerated patients.The University of Kansas (KU) One University Open Access Author Fun

Sex-specific Mendelian randomisation to assess the causality of sex differences in the effects of risk factors and treatment: spotlight on hypertension

Hypertension is a key modifiable risk factor for cardiovascular disease. Several observational studies have found a stronger association of blood pressure and cardiovascular disease risk in women compared to men. Since observational studies can be affected by sex-specific residual confounding and reverse causation, it remains unclear whether these differences reflect actual differential effects. Other study designs are needed to uncover the causality of sex differences in the strength of risk factor and treatment effects. Mendelian randomisation (MR) uses genetic variants as instrumental variables to provide evidence about putative causal relations between risk factors and outcomes. By exploiting the random allocation of genes at gamete forming, MR is unaffected by confounding and results in more reliable causal effect estimates. In this review, we discuss why and how sex-specific MR and cis-MR could be used to study sex differences in risk factor and drug target effects. Sex-specific MR can be helpful to strengthen causal inferences in the field of sex differences, where it is often challenging to distinguish nature from nurture. The challenge of sex-specific (drug target) MR lays in leveraging robust genetic instruments from sex-specific GWAS studies which are not commonly available. Knowledge on sex-specific causal effects of hypertension, or other risk factors, could improve clinical practice and health policies by tailoring interventions based on personalised risk. Drug target MR can help to determine the anticipated on-target effects of a drug compound and to identify targets to pursue in drug developmen

Microrint pulmonary function testing in older adults with an intellectual disability

SummaryBackgroundPulmonary function testing is not feasible in many adults with intellectual disabilities, because of difficulties with understanding and cooperation.AimsTo investigate feasibility, repeatability and reproducibility of measuring airway resistance using the interrupter technique (MicroRint) in people aged 50 years or over with a mild, moderate or severe intellectual disability.MethodSixty-seven participants were recruited through three Dutch care centres. Feasibility (percentage adequate first measurements) as well as repeatability and reproducibility were evaluated using the Intraclass Correlation Coefficient (ICC) and the within subject variation (SDw).ResultsThe group with a severe intellectual disability was too small for valid analyses and was therefore excluded. Feasibility: in 86.6% of the total study group, 88.2% of the participants with a mild and 89.7% of the people with moderate intellectual disability, the first measurement was successful. Repeatability: In the total study group, the group with a mild and the group with a moderate intellectual disability the ICC values were 0.76, 0.84 and 0.71, respectively, SDw values were 0.11kPa/l/s, 0.10kPa/l/s, 0.10kPa/l/s, respectively. Reproducibility: In the total study group, the group with a mild and the group with a moderate intellectual disability the ICC values were 0.72, 0.67 and 0.72, respectively, SDw values were 0.14kPa/l/s, 0.15kPa/l/s, 0.11kPa/l/s, respectively.ConclusionFeasibility, repeatability and reproducibility of measuring airway resistance using the MicroRint are good and acceptable in people with a mild or moderate intellectual disability aged 50 years or over