Verborgen zorgbehoeften bij ouderen

Over het algemeen blijven ouderen, ook hoogbejaarden, langer vitaal en onafhankelijk. Ouder worden kan echter ook geleidelijk of plotseling gepaard gaan met kwetsbaarheid. Een multidisciplinair assessment kan dan nodig zijn voor een samenhangend zorgadvies. Het Vivium ABC (Advies en Behandel Centrum) is een regionaal werkend multidisciplinair ambulant ouderenteam dat zich sinds 2003 bezighoudt met de complexe zorgproblematiek van kwetsbare ouderen in de regio Gooi Noord en noordelijke Vechtstreek. In 2009 werd een dossieronderzoek verricht om inzicht te verkrijgen in de verwijsvragen en karakteristieken van alle cliënten die in dat jaar werden aangemeld. 84 consulten werden geanalyseerd. Van de cliënten woonde 32% thuis en 61% in een zorgcentrum. De cliënten van het Vivium ABC zijn overwegend zeer oude mensen: bijna 60% is ouder dan 85 jaar. Zij zijn in meerderheid vrouw en alleenstaand. De consultvraag, die meestal niet eenduidig is, heeft in meerderheid betrekking op diagnostiek naar cognitieve achteruitgang. Uit het multidisciplinaire assessment komen relatief veel niet eerder vastgestelde cognitieve, gedrags- en sociale problemen aan het licht, hetgeen bevestigt dat de problematiek van ouderen complex is. Geconcludeerd wordt dat het op een systematische manier in kaart brengen van de problemen van kwetsbare ouderen de kans vergroot dat zij passende zorg krijgen. Vervolgstudies zijn nodig om de effectiviteit en doelmatigheid van deze interventie te evalueren

Bewijs voor effectiviteit van Comprehensive Geriatric Assessment in de thuissituatie nog mager: een literatuurreview

Achtergrond De meeste ouderen vinden het belangrijk zo lang mogelijk zelfstandig te blijven functioneren. Gerichte opsporing en behandeling van factoren die de functionele zelfstandigheid bedreigen, middels een comprehensive geriatric assessment (CGA), kan het zelfstandig functioneren mogelijk bevorderen. Dit artikel doet verslag van een literatuurstudie naar het effect van comprehensive geriatric assessment in de thuissituatie. Methode In Pubmed (1977–2012) is gezocht naar RCT’s die de effectiviteit van multidisciplinaire, multidimensionele CGA bij ouderen in de thuissituatie onderzocht hebben. Er werden data geëxtraheerd over effectiviteit, kosten en factoren die het effect van het CGA positief of negatief hebben beïnvloed. Resultaten Negen RCT’s werden geïncludeerd. Op één studie na was de kwaliteit matig tot goed. In drie van de zes studies naar functionele status en in twee van de vier studies naar kwaliteit van leven werd een positief effect gevonden. Geen effect werd gevonden op het aantal ziekenhuisopnames en verpleeghuisopnames of op mortaliteit. De meeste studies lieten een stijging zien van de totale gezondheidszorgkosten. Conclusie CGA thuis heeft een beperkt gunstig effect op functionele status en kwaliteit van leven. Er zijn aanwijzingen dat CGA thuis het meeste effect heeft bij relatief goed functionerende ouderen

Haalbaarheid van een poliklinisch geriatrisch Revalidatieprogramma – lessen uit een pilotproject

Doel Beschrijven van de haalbaarheid van een poliklinisch geriatrisch behandelprogramma, als pilotproject ontwikkeld in Vivium Naarderheem. Methoden De uitkomsten werden onderzocht in een pretest-posttest design met één groep. Haalbaarheid werd onderzocht door mondelinge afname van een patiënttevredenheidsvragenlijst en door gestructureerde interviews met behandelaars en management. Het effect werd onderzocht door bij start (T0) en bij ontslag (T1) van het behandelprogramma schriftelijke vragenlijsten af te nemen: bij de patiënten over het participatieniveau en de gezondheidsgerelateerde kwaliteit van leven en bij hun mantelzorgers over de ervaren belasting. Resultaten Er werden 18 patiënten geïncludeerd. Vijftien daarvan revalideerden na een CVA. Behandelaars en managers vonden het programma uitvoerbaar, op voorwaarde dat het vervoer van de patiënten, de roosterplanning en de financiering goed geregeld zijn. Het behandelprogramma werd door de patiënten met een gemiddeld rapportcijfer van 8,1 gewaardeerd. Er zijn geen statistisch significante verschillen gevonden in het participatieniveau van de patiënten en in de zorgbelasting van de mantelzorgers bij de start en het einde van de poliklinische behandeling. De algemene gezondheidsbeleving, gemeten met de RAND-36, was na poliklinische revalidatie achteruit gegaan. Conclusie Uit deze pilotstudie blijkt dat vijftien van de achttien patiënten die gebruik maken van de polikliniek, revalideert vanwege CVA. Poliklinische geriatrische revalidatie is een door de bevraagde patiënten gewaardeerde aanvulling op de klinische revalidatieperiode, en de uitvoering ervan lijkt haalbaar. Een verbetering van de gezondheidstoestand of van het participatieniveau kon niet worden aangetoond

Family caregivers’ perspectives on their interaction and relationship with people living with dementia in a nursing home:A qualitative study

BACKGROUND: Social interactions are important for people living with dementia in a nursing home. However, not much is known about interactions and relationships between residents and family caregivers and related experiences of family caregivers. We aim to advance the knowledge on how family caregivers interact with people living with dementia in a nursing home and how they maintain or redesign a meaningful connection. METHODS: Qualitative research using interviews with family caregivers (n = 31) to explore perspectives on their interaction and relationship with the person living with dementia. Interviews were held during the reopening of nursing homes after the first COVID-19 lockdown in the Netherlands. In this situation, family caregivers became more aware of their interaction and relationship with the resident, which provided a unique opportunity to reflect on this. The interviews explored the interaction and relationship in a broad sense, not specifically for the COVID-19 situation. Thematic analysis was performed to analyze the data. RESULTS: We were able to identify three key themes reflecting the experiences of family caregivers: (1) changes in the interaction and relationship, (2) strategies to promote connection, and (3) appreciation of the interaction and relationship. From the viewpoint of family caregivers, the interaction and relationship are important for both the resident living with dementia and for themselves, and family caregivers have different strategies for establishing a meaningful connection. Nevertheless, some appear to experience difficulties with constructing such a connection with the resident. CONCLUSIONS: Our results provide a basis for supporting family caregivers in perceiving and establishing mutuality and reciprocity so that they can experience togetherness. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02922-x

Bidirectional lipid droplet velocities are controlled by differential binding strengths of HCV Core DII protein

Host cell lipid droplets (LD) are essential in the hepatitis C virus (HCV) life cycle and are targeted by the viral capsid core protein. Core-coated LDs accumulate in the perinuclear region and facilitate viral particle assembly, but it is unclear how mobility of these LDs is directed by core. Herein we used two-photon fluorescence, differential interference contrast imaging, and coherent anti-Stokes Raman scattering microscopies, to reveal novel core-mediated changes to LD dynamics. Expression of core protein’s lipid binding domain II (DII-core) induced slower LD speeds, but did not affect directionality of movement on microtubules. Modulating the LD binding strength of DII-core further impacted LD mobility, revealing the temporal effects of LD-bound DII-core. These results for DII-core coated LDs support a model for core-mediated LD localization that involves core slowing down the rate of movement of LDs until localization at the perinuclear region is accomplished where LD movement ceases. The guided localization of LDs by HCV core protein not only is essential to the viral life cycle but also poses an interesting target for the development of antiviral strategies against HCV

Associations of specific phobia and its subtypes with physical diseases: an adult community study.

Specific phobia is the most prevalent anxiety disorder in the community and is associated with substantial impairment. Comorbidity with physical diseases is assumed and has important implications for etiology, treatment, or prevention of the comorbid conditions. However, due to methodological issues data are limited and subtypes of specific phobia have not been investigated yet. We examined the association of specific phobia and its subtypes with physical diseases in a representative community sample with physician-diagnosed physical diseases and diagnostic criteria of specific phobia. Data of the German Mental Health Survey from 4181 subjects aged 18-65 years were used. Specific phobia was diagnosed using M-CIDI/DIA-X interview; physical diseases were assessed through a self-report questionnaire and a medical interview. Logistic regression analyses adjusted for sex were calculated. Specific phobia was associated with cardiac diseases, gastrointestinal diseases, respiratory diseases, arthritic conditions, migraine, and thyroid diseases (odds ratios between 1.49 and 2.53). Among the subtypes, different patterns of associations with physical diseases were established. The findings were partially replicated in the Swiss PsyCoLaus Study. Our analyses show that subjects with specific phobia have an increased probability for specific physical diseases. From these analyses etiological mechanisms of specific phobia and physical disease can be deduced. As subtypes differed in their patterns of associations with physical diseases, different etiological mechanisms may play a role. The findings are highly relevant for public health in terms of prevention and therapy of the comorbid conditions

Epidemic History and Evolutionary Dynamics of Hepatitis B Virus Infection in Two Remote Communities in Rural Nigeria

BACKGROUND: In Nigeria, hepatitis B virus (HBV) infection has reached hyperendemic levels and its nature and origin have been described as a puzzle. In this study, we investigated the molecular epidemiology and epidemic history of HBV infection in two semi-isolated rural communities in North/Central Nigeria. It was expected that only a few, if any, HBV strains could have been introduced and effectively transmitted among these residents, reflecting limited contacts of these communities with the general population in the country. METHODS AND FINDINGS: Despite remoteness and isolation, approximately 11% of the entire population in these communities was HBV-DNA seropositive. Analyses of the S-gene sequences obtained from 55 HBV-seropositive individuals showed the circulation of 37 distinct HBV variants. These HBV isolates belong predominantly to genotype E (HBV/E) (n=53, 96.4%), with only 2 classified as sub-genotype A3 (HBV/A3). Phylogenetic analysis showed extensive intermixing between HBV/E variants identified in these communities and different countries in Africa. Quasispecies analysis of 22 HBV/E strains using end-point limiting-dilution real-time PCR, sequencing and median joining networks showed extensive intra-host heterogeneity and inter-host variant sharing. To investigate events that resulted in such remarkable HBV/E diversity, HBV full-size genome sequences were obtained from 47 HBV/E infected persons and P gene was subjected to Bayesian coalescent analysis. The time to the most recent common ancestor (tMRCA) for these HBV/E variants was estimated to be year 1952 (95% highest posterior density (95% HPD): 1927-1970). Using additional HBV/E sequences from other African countries, the tMRCA was estimated to be year 1948 (95% HPD: 1924-1966), indicating that HBV/E in these remote communities has a similar time of origin with multiple HBV/E variants broadly circulating in West/Central Africa. Phylogenetic analysis and statistical neutrality tests suggested rapid HBV/E population expansion. Additionally, skyline plot analysis showed an increase in the size of the HBV/E-infected population over the last approximately 30-40 years. CONCLUSIONS: Our data suggest a massive introduction and relatively recent HBV/E expansion in the human population in Africa. Collectively, these data show a significant shift in the HBV/E epidemic dynamics in Africa over the last century

Underlying goals of advance care planning (ACP):a qualitative analysis of the literature

BACKGROUND: Since the introduction of the concept of advance care planning (ACP), many studies have been conducted exploring beneficial effects. These studies show a heterogeneity in clinical endpoints, which reflects diversity of goals connected to ACP. This study aims to get insight in the range of underlying goals that comprise the legitimacy of ACP. METHODS: Systematic literature search in PubMed, EMBASE, PsychInfo, CINAHL and Cochrane Library. Articles on normative aspects of ACP were included, based on title and abstract. Due to the quantity of inclusions, of which many had similar content, purposive sampling was used to select articles for full text document analysis. Analysis stopped once saturation was reached. RESULTS: In total, 6497 unique articles were found of which 183 were included. Saturation was reached after document analysis of 55 articles (30%); this yielded 141 codes concerning goals of ACP and also 70 codes about objections against ACP, which shed light on the underlying goals of ACP as well. We identified five underlying goals: respecting individual patient autonomy, improving quality of care, strengthening relationships, preparing for end-of-life, reducing overtreatment. CONCLUSIONS: Five distinctive underlying goals of ACP were identified, each with corresponding objections that need to be considered. Specifying underlying goals of ACP may direct the debate on definitions, methods and preferred outcomes of ACP. This study was funded by the Netherlands Organisation for Health Research and Development, grant 839120002