Adherence to prophylaxis and its association with activation of self-management and treatment satisfaction

Introduction Prophylactic replacement therapy (prophylaxis) in patients with haemophilia (PWH) requires lifelong, frequent (self)infusions. Prophylaxis effectiveness depends on adherence, and the drivers of treatment adherence among PWH are unclear.Aim To quantify prophylaxis adherence and associations between adherence and patients' treatment attitudes and satisfaction in a large cohort of children and adults with haemophilia.Methods In a nationwide, cross-sectional, questionnaire-based study, PWH with complete information currently using prophylaxis were selected. Validated Hemophilia Regimen Treatment Adherence Scale-Prophylaxis (VERITAS-Pro; normalised score range: 0-100, optimum 0) measured treatment adherence; the Patient Activation Measure (PAM-13; total score range 0-100, optimum 100) measured activation of self-management; Hemophilia Patient Satisfaction Scale (Hemo-Sat; range 0-100, optimum 0) measured treatment satisfaction. Groups were compared according to age (children: 18 years) and adherence levels using non-parametric tests, and correlations were assessed using Spearman's rho.Results Among 321 participants (median age 33 years, interquartile range [IQR]:15-54 years), adherence was high (median VERITAS-Pro total score 17, 89% adherent) but worsened with age, with median scores of 5, 14 and 20 in children, adolescents, adults, respectively (p < .001). Attitudes towards treatment (median 66 vs. 68) participants and treatment satisfaction (12 vs. 10) were similar between adherent and non-adherent patients. The VERITAS-Pro total score was moderately correlated with PAM-13 (r = .41) but not with Hemo-Sat (r = -.11).Discussion Prophylaxis adherence was high (89%) but decreased significantly with age and was not correlated with treatment attitude or treatment satisfaction.Thrombosis and Hemostasi

Perspectief inzicht

Development of an instrument to assess the quality of treatment in an institute for child protection / educational and occupational history of children's attendant / job satisfaction / mean age of children in attendant's group / size of group / reasons for residence in institution / kind, frequencies of therapies / opinion on effect of residence on children / contacts of attendant with parents and therapists / satisfaction with decisions on children from attendant's group. Background variables: basic characteristics/ household characteristics/ income/capital assets/ education/ religio

Cobalamin supplementation improves cognitive and cerebral function in older cobalamin deficient subjects

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Cobalamin supplementation improves cognitive and cerebral function in older, cobalamin-deficient persons

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Cobalamin supplementation improves cognitive and cerebral function in older cobalamin deficient subjects

Item does not contain fulltextBackground. Mild cobalamin (Cbl) deficiency is frequently found in older persons and is associated with cognitive and cerebral abnormalities. The effects of Cbl supplementation on these abnormalities are largely unknown. Methods. In a single-blind, placebo-controlled intervention study, 16 healthy community-dwelling elderly subjects with low plasma Cbl concentration and no cognitive impairments were studied. Subjects underwent 1 month of treatment with placebo, followed by 5 months of treatment with intramuscular injections of hydroxycobalamin. Before and after measurements of plasma cobalamin, total homocysteine (tHcy), methylmalonic acid (MMA), quantitative electroencephalograph (qEEG), and psychometric tests were taken. Results. After Cbl supplementation, plasma Cbl concentrations increased, and plasma MMA and tHcy concentrations decreased. The performance on the Verbal Word Learning Test, Verbal Fluency and Similarities improved. qEEG showed more fast activity and less slow activity. Lower plasma tHcy concentrations were related to increased fast activity on qEEG on the one hand and improved performance on the Verbal Word Learning Test and Similarities on the other. Increased fast or decreased slow activity on qEEG was associated with improved performance on the Verbal Word Learning Test, Similarities and Verbal Fluency. Conclusions. Electrographic signs of improved cerebral function and improved cognitive function were found after Cbl supplementation in older subjects with low plasma Cbl concentrations who were free of significant cognitive impairment. These improvements were related to a reduction of plasma tHcy concentration

Instrument development in childcare

Development of an instrument to assess the quality of treatment in an institute for child protection / educational and occupational history of children's attendant / job satisfaction / mean age of children in attendant's group / size of group / reasons for residence in institution / kind, frequencies of therapies / opinion on effect of residence on children / contacts of attendant with parents and therapists / satisfaction with decisions on children from attendant's group. Background variables: basic characteristics/ household characteristics/ income/capital assets/ education/ religio

Power deposition behavior of high-density transient hydrogen plasma on tungsten in Magnum-PSI

The lifetime of plasma-facing components (PFCs) will have a strong influence on the efficiency and viability of future fusion power plants. However, the PFCs suffer from thermal stresses and physical sputtering induced by edge-localized modes (ELMs). ELMs in future fusion devices are expected to occur with a high plasma density compared to current day devices such that coupling of recycling neutrals and plasma ions will be strong. Because of the scale hierarchy of future fusion devices compared to the present ones, the influence of this coupling is difficult to predict. Here, we investigate the ELM-like hydrogen plasma induced heat loads on tungsten in the linear device Magnum-PSI, producing similar to 1 ms plasma pulses with electron densities up to 3.5 x 10(21) m(-3). A combination of time-resolved Thomson scattering and coherent Thomson scattering was used to acquire plasma parameters in front of the target. Moreover, a fast infrared camera coupled to finite element thermal analyses allowed to determine the deposited heat loads on the target. We found a significant inconsistency between the plasma power calculated with a conventional collisionless sheath model and the absorbed power by the target. Moreover, plasma stagnation upstream and plasma cooling downstream were observed during the pulses. The observations are explained based on ionization and elastic collisions between the recycling neutrals and plasma ions. The results highlight the impact of plasma-neutral interaction on the power deposition behavior of ELM-like hydrogen plasma on tungsten