Adding a subjective dimension to an ICF-based disability measure for people with multiple sclerosis: development and use of a measure for perception of disabilities

OBJECTIVE: The subjective dimension of disability, the perception of disability, is a dimension missing from the International Classification of Functioning, Disability and Health (ICF), and from health-related quality of life (HRQOL) instruments. However, it is a highly relevant dimension for clinical practice as perceived disability may identify care needs. We therefore developed a measure for this subjective dimension of disability in multiple sclerosis (MS) and examined the contribution of this dimension to QOL. METHOD: A measure named the Multiple Sclerosis Impact Profile-Disability Perception (MSIP-DP) was developed to reflect a person's perception of disabilities reported using the original MSIP-disability (MSIP-D) items. MS patients (n=530) completed both MSIP sections, the medical outcome study short form questionnaire (SF-36), the World Health Organisation Quality Of Life-BREF (WHOQOL-BREF) and questions concerning disease severity. The contribution of disability perception (DP) to QOL in MS was estimated using hierarchical multiple regression analyses after controlling for MS severity. RESULTS: Confirmative factor analysis confirmed the hypothesised disability perception domains that correspond with the related disability domains in the MSIP. DP scales yielded sufficient reliability. DP explained a unique and substantial part of the variance in QOL, particularly the perception of impairments in mental functions. DISCUSSION: Results indicated that the subjective dimension of functioning and health operationalised in the MSIP-DP is a relevant concept in explaining QOL in MS. In clinical practice psychological interventions addressing a patient's perception of disability, particularly of impairments in mental functioning, may contribute to QOL

Immune modulation by helminths and the impact on the development of type 2 diabetes

The main objective of this thesis is to improve the understanding of the role of helminth infections in the development of insulin resistance, hence type 2 diabetes, and to gain insight into the immunological mechanisms underlying this possible interaction. To this end, we initiated a large scale cluster randomized controlled trial, assessing the effect of anthelmintic treatment on insulin resistance and other metabolic, as well as immunological parameters, in a rural area of Indonesia. Deworming significantly reduced the prevalence of helminths, as well as infection intensity. Although treatment did not lead to an increase of whole-body insulin resistance at the community level, a significant increase in insulin resistance was observed among helminth-infected subjects. Furthermore, by comparing immune cells of helminth-infected Indonesians before and after treatment, we gained insight into the specific cell populations that participate in the type 2 and regulatory networks, and show that treatment affects specific cell subsets in these networks. Altogether, the studies described in this thesis show that helminth infections in humans, as well as the administration of helminth molecules in obese mice, have a beneficial effect on the insulin sensitivity, and have shed light on the immunomodulatory effects of helminths. KNAWLUMC / Geneeskund

In search of dying radio sources in the local universe

Up till now very few dying sources were known, presumably because the dying phase is short at centimeter wavelengths. We therefore have tried to improve the statistics on sources that have ceased to be active, or are intermittently active. The latter sources would partly consist of a fossil radio plasma left over from an earlier phase of activity, plus a recently restarted core and radio jets. Improving the statistics of dying sources will give us a better handle on the evolution of radio sources, in particular the frequency and time scales of radio activity. We have used the WENSS and NVSS surveys, in order to find sources with steep spectral indices, associated with nearby elliptical galaxies. In the cross correlation we presently used only unresolved sources, with flux densities at 1.4 GHz larger than 10 mJy. The eleven candidates thus obtained were observed with the VLA in various configurations, in order to confirm the steepness of the spectra, and to check whether active structures like flat-spectrum cores and jets are present, perhaps at low levels. We estimated the duration of the active and relic phases by modelling the integrated radio spectra using the standard models of spectral evolution. We have found six dying sources and three restarted sources, while the remaining two candidates remain unresolved also with the new VLA data and may be Compact Steep Spectrum sources, with an unusually steep spectrum. The typical age of the active phase, as derived by spectral fits, is in the range 10^7 - 10^8 years. For our sample of dying sources, the age of the relic phase is on average shorter by an order of magnitude than the active phase.Comment: 21 pages, 17 figures, accepted by A&A. For a version with high quality figures, see http://erg.ca.astro.it/preprints/dying2007

Selectivity of C−H vs. C−F Bond Oxygenation by Homo- and Heterometallic Fe_4, Fe_3Mn, and Mn_4 Clusters

A series of tetranuclear [LM_3(HFArPz)_3OM'][OTf]_2 (M, M' = Fe or Mn) clusters that displays 3-(2-fluorophenyl)pyrazolate (HFArPz) as bridging ligand is reported. With these complexes manganese is demonstrated to facilitate C(sp^2)−F bond oxygenation via a putative terminal metal-oxo species. Moreover, the presence of both ortho C(sp^2)−H and C(sp^2)−F bonds in proximity provides an opportunity to investigate the selectivity of intramolecular C(sp^2)−X bond oxygenation (X = H or F) in these isostructural compounds. With iron as the apical metal center (M' = Fe) C(sp^2)−F bond oxygenation occurs almost exclusively, whereas with manganese (M' = Mn) the opposite reactivity is preferred

Building a corpus of spontaneous interaction

This revised version supersedes all previous versions (e.g., Field Manual 2010)

Social Presence and Use of Internet-Delivered Interventions: A Multi-Method Approach

Objective Internet-delivered interventions can effectively change health risk behaviors and their determinants, but adherence to intervention websites once they are accessed is very low. This study tests whether and how social presence elements can increase website use. Methods A website about Hepatitis A, B, and C virus infections was used in a preparatory lab-based eye-tracking study assessing whether social presence elements attract participants\u27 attention, because this is a prerequisite for affecting website use. In the following field study, 482 participants representative of the Dutch population were randomized to either a website with or a website without social presence elements. Participants completed a questionnaire of validated measures regarding user perceptions immediately after exposure to the website. Server registrations were used to assess website use. Results Participants in the experimental condition focused on the social presence elements, both in terms of frequency (F(1, 98) = 40.34, p<.001) and duration (F(1, 88) = 39.99, p<.001), but did not differ in website use in comparison with the control condition; neither in terms of the number of pages visited (t(456) = 1.44, p = .15), nor in terms of time on the website (t(456) = 0.01, p = .99). Conclusions Adding social presence elements did not affect actual use of an intervention website within a public health context. Possible reasons are limited attention for these elements in comparison with the main text and the utilitarian value of intervention websites

Broadening the scope on health problems among the chronically neurologically ill with the International Classification of Functioning (ICF)

Purpose. The aim of this study was to determine ICF items indicating health problems for patients with a chronic neurological disorder such as multiple sclerosis, Parkinson's disease and neuromuscular disease. Method. A Delphi study using three disease-specific panels composed of patients and proxies, medical and non-medical health professionals (N=98). Panels were asked to select items from the International Classification of Functioning, Disability and Health (ICF) reflecting relevant disease-specific health problems. Items appraised as relevant by the panel members were compared with items in established measures namely: the Minimal Record of Disability (MRD) and the Disability and Impact Profile (DIP). Results. Sixty-eight ICF items were considered to be the most relevant, and belonged to four ICF domains. No significant differences were found between the appraisal of items by patients/proxies and health professionals. Agreement across the disease panels appeared to be (very) strong. Differences between the three disease-specific panels were found for the 'Body Functions and Structures' domain: consensus was reached by extension of the inclusion criteria. The ICF-item selection covers almost all items of the established measures. The largest contrast was shown in the item selection for the 'participation' and 'environmental factors' domains. Conclusions. Selected items indicate a broader scope in studying health problems compared with widely used health status measures in neurology, especially for the ICF domains 'Participation' and 'Environmental Factors'

Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study

OBJECTIVE: To investigate the association between duration of rupture of membranes (ROM) and mother-to-child HIV transmission (MTCT) rates in the era of combination antiretroviral therapy (cART). DESIGN: The National Study of HIV in Pregnancy and Childhood (NSHPC) undertakes comprehensive population-based surveillance of HIV in pregnant women and children. SETTING: UK and Ireland. POPULATION: A cohort of 2398 singleton pregnancies delivered vaginally, or by emergency caesarean section, in women on cART in pregnancy during the period 2007-2012 with information on duration of ROM; HIV infection status was available for 1898 infants. METHODS: Descriptive analysis of NSHPC data. MAIN OUTCOME MEASURES: Rates of MTCT. RESULTS: In 2116 pregnancies delivered at term, the median duration of ROM was 3 hours 30 minutes (interquartile range, IQR 1-8 hours). The overall MTCT rate for women delivering at term with duration of ROM ≥4 hours was 0.64% compared with 0.34% for ROM <4 hours, with no significant difference between the groups (OR 1.90, 95% CI 0.45-7.97). In women delivering at term with a viral load of <50 copies/ml, there was no evidence of a difference in MTCT rates with duration of ROM ≥4 hours, compared with <4 hours (0.14% for ≥4 hours versus 0.12% for <4 hour; OR 1.14, 95% CI 0.07-18.27). Among infants born preterm with infection status available, there were no transmissions in 163 deliveries where the maternal viral load was <50 copies/ml. CONCLUSIONS: No association was found between duration of ROM and MTCT in women taking cART. TWEETABLE ABSTRACT: Rupture of membranes of more than 4 hours is not associated with MTCT of HIV in women on effective ART delivering at term