The effect of smoking on influenza, influenza vaccination efficacy and on the antibody response to influenza vaccination.

Department of General Practice, University Maastricht, The Netherlands. We examined the relation between cigarette smoking and (1) the occurrence of influenza, (2) the efficacy of influenza vaccination and (3) the antibody response to influenza vaccination in fifteen family practices in South-Limburg, the Netherlands, during the influenza season 1991 1992. Data were used from a randomized double-blind placebo-controlled trial into the efficacy of influenza vaccination in which smoking status was measured 10 weeks after the start of the trial. A total of 1838 subjects aged 60 years or older, of whom 1531 subjects (321 smokers, 1152 non-smokers and 58 cigar/pipe smokers) who returned the smoking questionnaire and were not previously vaccinated, were used in the analyses. The main outcome measures were serological influenza (fourfold increase of antibody titre between 3 weeks and 5 months after vaccination); clinical influenza as determined by criteria of the Dutch Sentinel Stations from self reported symptoms in postal questionnaires 10 weeks and 5 months after vaccination; increases after vaccination and decreases after 5 months in logarithmic titres of antibody against the vaccine strains. No relation between smoking and either serological or clinical influenza was found, although the risk for serological influenza was slightly (not significantly) elevated in smokers compared to non-smokers. A statistical interaction was found between smoking and vaccination when serological influenza was the outcome measure indicating that the efficacy of vaccination was greater in smokers than in non-smokers (comparison of model with and without interaction; likelihood ratio test, p < 0.0001). This finding is supported by a greater titre rise 3 weeks after vaccination for two out of four strains, but not by the antibody response after vaccination in previous studies on influenza and other infectious diseases. Also, this possible difference of immunogenicity is not reflected in a better protection for clinical influenza. The rise in antibody titre 3 weeks after vaccination was higher in smokers for A/Singapore/6/86 and B/Beijing/11/87, but not for the other two strains. Decline in titres after 5 months was similar for smokers and non-smokers. We conclude that smoking has no clinical or preventive significance for risk of influenza in the elderly. Publication Types: Clinical Trial Randomized Controlled Tria

Illegale vreemdelingen in Nederland

In Nederland bevinden zich ‘illegale vreemdelingen’, d.w.z. mensen die geen geldige verblijfstitel in Nederland hebben. Een deel van hen heeft in het verleden een geldige verblijfsvergunning gehad, van een deel is het asielverzoek afgewezen en een deel is zonder geldige verblijfstitel binnengekomen. De onbekendheid van/ met deze groep en de marginale positie ervan werken speculaties in de hand over criminaliteit door illegalen. Ook wordt een relatie verondersteld tussen illegale binnenkomst en mensensmokkel. Voor de kwantitatieve analyse is gebruik gemaakt van politieregistraties van illegale vreemdelingen die werden staandegehouden in de periode 1997-2000. De gegevens werden aangeleverd door de 25 politieregio’s en zijn de beste beschikbare bron. Deze cijfers zijn ook de basis voor de schatting van het totaal aantal illegale vreemdelingen in Nederland. Voor het kwalitatief onderzoek werd gesproken met 156 illegale vreemdelingen uit acht belangrijke herkomstlanden van arbeids- en/ of asielmigranten: China, Iran, Marokko, Somalië, Sri Lanka, Turkije, voormalig Joegoslavië en voormalige Sovjet Unie. Nieuwe groepen illegale vreemdelingen, die niet kunnen terugvallen op legale landgenoten in Nederland, verkeren in een zeer kwetsbare positie op de huisvestings- en arbeidsmarkt. Zij lijken daardoor vatbaarder voor vormen van ‘overlevingscriminaliteit’. In deze studie worden geen definitieve gegevens gepresenteerd omtrent aard en omvang van illegale vreemdelingen in Nederland. Wel vindt men onderbouwde schattingen over aantallen illegale vreemdelingen, evenals relevante gegevens over de problematiek van uitzetting en over het vraagstuk van illegaliteit en criminaliteit. Ook worden kwalitatieve analyses gegeven van strategiën van overkomst en verblijf

A Participatory Design Approach to Develop a Web-Based Self-Care Program Supporting Early Rehabilitation among Patients after Total Laryngectomy

To develop a Web-based self-care program for patients after total laryngectomy according to a participatory design approach. Methods: We conducted a needs assessment with laryngectomees (n = 9) and their partners (n = 3) by means of a focus group interview. In 4 focus group sessions, a requirement plan was formulated by a team of health care professionals (n = 10) and translated into a prototype. An e-health application was built including illustrated information on functional changes after total laryngectomy as well as video demonstrations of skills and exercises. Usability of the prototype was tested by end users (n = 4) and expert users (n = 10). Interviews were held to elicit the intention to use and the desired implementation strategy. Results: Six main self-care topics were identified: (1) nutrition, (2) tracheostomy care, (3) voice prosthesis care, (4) speech rehabilitation, (5) smell rehabilitation, and (6) mobility of head, neck, and shoulder muscles. Expert users expressed concerns regarding tailored exercises, indicated a positive intent to implement the intervention in routine care, and expressed a need for guidance when implementing the intervention. End users and expert users appreciated the content completeness and multimedia-based information built into the application. Conclusion: The participatory design is a valuable approach to develop a self-care program to help meet users' needs

A Participatory Design Approach to Develop a Web-Based Self-Care Program Supporting Early Rehabilitation among Patients after Total Laryngectomy

To develop a Web-based self-care program for patients after total laryngectomy according to a participatory design approach. Methods: We conducted a needs assessment with laryngectomees (n = 9) and their partners (n = 3) by means of a focus group interview. In 4 focus group sessions, a requirement plan was formulated by a team of health care professionals (n = 10) and translated into a prototype. An e-health application was built including illustrated information on functional changes after total laryngectomy as well as video demonstrations of skills and exercises. Usability of the prototype was tested by end users (n = 4) and expert users (n = 10). Interviews were held to elicit the intention to use and the desired implementation strategy. Results: Six main self-care topics were identified: (1) nutrition, (2) tracheostomy care, (3) voice prosthesis care, (4) speech rehabilitation, (5) smell rehabilitation, and (6) mobility of head, neck, and shoulder muscles. Expert users expressed concerns regarding tailored exercises, indicated a positive intent to implement the intervention in routine care, and expressed a need for guidance when implementing the intervention. End users and expert users appreciated the content completeness and multimedia-based information built into the application. Conclusion: The participatory design is a valuable approach to develop a self-care program to help meet users' needs