Self-efficacy instruments for patients with chronic diseases suffer from methodological limitations - a systematic review

BACKGROUND: Measurement of self-efficacy requires carefully developed and validated instruments. It is currently unclear whether available self-efficacy instruments for chronic diseases fulfill these requirements. Our aim was to systematically identify all existing self-efficacy scales for five major chronic diseases and to assess their development and validation process. METHODS: We conducted a systematic literature search in electronic databases (MEDLINE, PSYCHINFO, and EMBASE) to identify studies describing the development and/or validation process of self-efficacy instruments for the five chronic diseases diabetes, chronic obstructive pulmonary disease (COPD), asthma, arthritis, and heart failure. Two members of the review team independently selected articles meeting inclusion criteria. The self-efficacy instruments were evaluated in terms of their development (aim of instrument, a priori considerations, identification of items, selection of items, development of domains, answer options) and validation (test-retest reliability, internal consistency reliability, validity, responsiveness) process. RESULTS: Of 584 potentially eligible papers we included 25 (13 for diabetes, 5 for asthma, 4 for arthritis, 3 for COPD, 0 for heart failure) which covered 26 different self-efficacy instrument versions. For 8 instruments (30.8%), the authors described the aim before the scales were developed whereas for the other instruments the aim was unclear. In one study (3.8%) a priori considerations were specified. In none of the studies a systematic literature search was carried out to identify items. The item selection process was often not clearly described (38.5%). Test-retest reliability was assessed for 9 instruments (34.6%), validity using a correlational approach for 18 (69.2%), and responsiveness to change for 3 (11.5%) instruments. CONCLUSION: The development and validation process of the majority of the self-efficacy instruments had major limitations. The aim of the instruments was often not specified and for most instruments, not all measurement properties that are important to support the specific aim of the instrument (for example responsiveness for evaluative instruments) were assessed. Researchers who develop and validate self-efficacy instruments should adhere more closely to important methodological concepts for development and validation of patient-reported outcomes and report their methods more transparently. We propose a systematic five step approach for the development and validation of self-efficacy instruments

Cytoplasmic Prep1 Interacts with 4EHP Inhibiting Hoxb4 Translation

embryo development. Interestingly, Prep1 contains a putative binding motif for 4EHP, which may reflect a novel unknown function. development effect. mRNA to the 5′ cap structure. This is the first demonstration that a mammalian homeodomain transcription factor regulates translation, and that this function can be possibly essential for the development of female germ cells and involved in mammalian zygote development

Deciphering the Role of RND Efflux Transporters in Burkholderia cenocepacia

Burkholderia cenocepacia J2315 is representative of a highly problematic group of cystic fibrosis (CF) pathogens. Eradication of B. cenocepacia is very difficult with the antimicrobial therapy being ineffective due to its high resistance to clinically relevant antimicrobial agents and disinfectants. RND (Resistance-Nodulation-Cell Division) efflux pumps are known to be among the mediators of multidrug resistance in Gram-negative bacteria. Since the significance of the 16 RND efflux systems present in B. cenocepacia (named RND-1 to -16) has been only partially determined, the aim of this work was to analyze mutants of B. cenocepacia strain J2315 impaired in RND-4 and RND-9 efflux systems, and assess their role in the efflux of toxic compounds. The transcriptomes of mutants deleted individually in RND-4 and RND-9 (named D4 and D9), and a double-mutant in both efflux pumps (named D4-D9), were compared to that of the wild-type B. cenocepacia using microarray analysis. Microarray data were confirmed by qRT-PCR, phenotypic experiments, and by Phenotype MicroArray analysis. The data revealed that RND-4 made a significant contribution to the antibiotic resistance of B. cenocepacia, whereas RND-9 was only marginally involved in this process. Moreover, the double mutant D4-D9 showed a phenotype and an expression profile similar to D4. The microarray data showed that motility and chemotaxis-related genes appeared to be up-regulated in both D4 and D4–D9 strains. In contrast, these gene sets were down-regulated or expressed at levels similar to J2315 in the D9 mutant. Biofilm production was enhanced in all mutants. Overall, these results indicate that in B. cenocepacia RND pumps play a wider role than just in drug resistance, influencing additional phenotypic traits important for pathogenesis

Learning from the public:citizens describe the need to improve end-of-life care access, provision and recognition across Europe

Background: Despite ageing populations and increasing cancer deaths, many European countries lack national policies regarding palliative and end-of-life care. The aim of our research was to determine public views regarding end-of-life care in the face of serious illness. Methods: Implementation of a pan-European population-based survey with adults in England, Belgium (Flanders), Germany, Italy, the Netherlands, Portugal and Spain. Three stages of analysis were completed on open-ended question data: (i) inductive analysis to determine a category-code framework; (ii) country-level manifest deductive content analysis; and (iii) thematic analysis to identify cross-country prominent themes. Results: Of the 9344 respondents, 1543 (17%) answered the open-ended question. Two prominent themes were revealed: (i) a need for improved quality of end-of-life and palliative care, and access to this care for patients and families and (ii) the recognition of the importance of death and dying, the cessation of treatments to extend life unnecessarily and the need for holistic care to include comfort and support. Conclusions: Within Europe, the public recognizes the importance of death and dying; they are concerned about the prioritization of quantity of life over quality of life; and they call for improved quality of end-of-life and palliative care for patients, especially for elderly patients, and families. To fulfil the urgent need for a policy response and to advance research and care, we suggest four solutions for European palliative and end-of-life care: institute government-led national strategies; protect regional research funding; consider within-and between-country variance; establish standards for training, education and service delivery

Colloidal iron as a nanovector in the environment

Iron (Fe) oxyhydroxide minerals are ubiquitous in soil and are major sinks for humic substances, trace metals and oxyanions that sorb strongly to these minerals. A small fraction of the Fe oxyhydroxides can also occur as colloids in the soil solution and may act as a so-called nanovector that mobilizes, rather than immobilizes, the substances and ions associated with them. This explains the colloidal transport of components such as phosphate (PO4), arsenate (AsO4) and lead (Pb) that are strongly bound to the Fe oxyhydroxides. The colloidal transport of these components in soil remains largely unknown at a large scale, mainly because there is a lack of appropriate Fe colloid sampling and characterization methods.This work was set up to evaluate different Fe colloid characterization methods and identify the relationships between soil properties and Fe colloid properties, i.e. their size, concentration and sorption characteristics. The rationale is that understanding the properties of the colloidal carrier will ultimately lead to a better assessment of the fate of the numerous elements that are associated with it. We first explored the potential of two innovative techniques for colloid characterization, single-particle ICP-MS (sp-ICP-MS) and Flow Field Flow Fractionation (FlFFF) to size environmental Fe colloids. The FlFFF allowed distinguishing between Fe-organic carbon (OC) complexes and larger mineral colloids; it has a wide size detection range between 1-2 nm and 300 nm and has acceptable element recoveries in an environmentally relevant background. The size obtained with FlFFF corresponds with the hydrodynamic diameter of particles in their aggregated state. The relatively high size detection limit in sp-ICP-MS analysis (about 30-50 nm) compromised sizing of environmentally relevant Fe colloids. The FlFFF coupled to UV/VIS and ICP-MS was therefore the method selected to characterize the Fe colloids in this work. Colloid stability is a prerequisite for transport and natural organic matter (NOM) provides both electrostatic and steric stability to Fe oxyhydroxide colloids. An experimental study was set up to specifically test the role of NOM on Fe colloid formation by coprecipitation. The Fe colloids were prepared by oxidation of Fe(II) with variable concentrations of NOM. Stable colloids were formed over the range in dissolved organic carbon (DOC) to Fe ratios representative for surface-and groundwaters. Moreover, a striking effect of NOM on colloid size and composition was observed. The Fe colloids size increased consistently with decreasing DOC/Fe ratio in the test solutions. Over a wide molar DOC/Fe range (1400-10), the Fe colloid size was very small (< 10 nm), further decreasing the DOC/Fe ratio yielded larger colloids of approximately 50 nm until the limit for colloid stability was reached at DOC/Fe < 2. The speciation of the colloids changed from Fe-OC mononuclear complexes at high DOC/Fe, to polynuclear Fe-OC complexes or ferrihydrite embedded in NOM at intermediate DOC/Fe and to larger Fe colloids with low NOM content that ultimately settle. The effect of NOM is explained as inhibition of growth and crystallization, which was supported by the higher organic matter loading in the smallest particles. Interestingly, the surface loading of NOM on the colloids increased more than proportionally with decreasing size, suggesting a conformational change of the NOM, i.e. more extended in small colloids, explained by the high electrostatic and/or steric repulsion. These findings were subsequently tested for natural samples. First, processes that govern Fe colloid size and composition were inferred from pore waters of 97 different topsoils covering a wide range in soil physico-chemical properties. Soil solution Fe concentrations are governed by colloid stability because they are highest at low soil solution Ca and high dissolved organic carbon (DOC) concentrations. The colloid size remarkably varied among soils, organic carbon was identified as a dominant factor explaining the variation. The fraction of Fe forming mononuclear Fe-OC complexes ( 3.5% soil organic carbon, while the larger mineral Fe colloids (50─100 nm) were dominant in soils with low soil organic carbon content. In some samples with low DOC content and low Ca concentration, the elemental ratios in mineral colloids suggested the presence of phyllosilicates. In these pore waters, Fe might be associated with clay minerals and are therefore distributed to the larger size range of clays. Second, Fe colloids were characterized in pore waters from a podzol profile to identify the factors that cause the pronounced vertical Fe mobilization and subsequent immobilization in such soils. The pore water Fe concentration increased from the A to the E (eluvial) horizon and peaked in the E horizon, which is remarkable given the low soil Fe concentration in the E horizon. The pore water Fe concentration was positively related to the DOC concentration within the profile. The colloid characterization analysis revealed that the Fe colloids (<100 nm) not only consisted of Fe-OC complexes, the generally accepted cheluvation theory, but also of mineral Fe colloids, presumably Fe oxyhydroxides coated with organic matter. The smallest Fe-OC complexes dominated in the A horizon while the larger mineral colloids raised most importantly with increasing depth, explaining the rise in total Fe towards the Bh (illuvial) horizon. The adsorption of the negatively charged OM at the top of the Bs horizon is likely the main mechanism of DOC retention in the Bh. Below this depth, the DOC was very low resulting in low pore water Fe concentration. Straining is unlikely a significant mechanism for colloid immobilization as judged from the pore size distribution and the colloidal size. This study demonstrates that natural organic matter plays a key role in the transport of Fe colloids in acid, sandy soils with low Ca. These findings highlight the key role of NOM in Fe colloid transport, but also raised the question on the effect of NOM on the reactivity. With decreasing colloid size, the specific surface area (SSA) available for sorption increases and likely also the colloid mobility. However, adsorbed humic substances might lower the affinity of the colloids for binding oxyanions. The aim was therefore to determine the implication of this organic matter coating on the affinity of the Fe colloids to sorb trace metals and oxyanions. This was first addressed in an experimental study by measuring PO4 adsorption and coprecipitation to Fe colloids with varying size due to varying amounts of NOM. In a second step, that interaction was also verified in an observational study on pore water colloids of different soils, thereby analysing colloid size-dependent fractions of compounds with high affinity to either humic substances (Cu) or to Fe oxyhydroxides (VO4 and AsO4). Both studies indicated that the PO4 loading on the colloids (experimental study) and the fractions of colloidal VO4 and AsO4 (pore water observational study) increased with increasing Fe colloid size. These results contradict the notion that higher colloidal size reduces the SSA and sorption. The results point to a size-dependent competition between NOM and oxyanions on the Fe colloid surfaces. The NOM over oxyanion selectivity is highest in the smaller colloids, which we explained by steric and/or electrostatic interactions resulting from the extended conformation of the adsorbed humic substances in the smallest colloids. The Cu loading on the Fe colloids decreased with size together with the NOM, which suggests Cu binding to the Fe colloids via surface adsorbed NOM. Taken together, recent advances in analytical chemistry allow to study environmental colloids down to the low nanometer range with a size resolution that was not possible to attain before. This thesis has provided deeper insight into Fe colloid size and composition and the environmental conditions that govern them. The importance of DOC on increasing soil solution Fe and decreasing Fe colloid size was highlighted several times. These results add to the growing body of research that indicates that NOM inhibites Fe oxyhydroxide colloid formation by forming Fe-OC complexes and retards Fe oxyhydroxide growth and crystallization. Nevertheless, this is the first study to show the marked effect of NOM on Fe colloid size measured in suspension. In addition, this study is first in quantifying the competition between oxyanions and humic substances in suspended colloids. A conceptual model explaining the paradoxal size dependent oxyanion binding was presented. This new understanding can help to improve predictions on the impact of colloidal Fe as a nanovector in the environment.status: publishe

Determinanten van burn-out en drempels voor latere arbeidsmarktre- integratie : de ervaringen van (ex-)patiënten in kaart

Onderzoek naar burn-out identificeerde reeds een uiteenlopende lijst aan potentiële determinanten en re-integratiedrempels, maar betrok zelden ex-patiënten en percepties (dat wil zeggen, wat men zelf ziet als oorzaken en drempels bij burn-out). Daarenboven heerst in het re-integratieonderzoek een kwalitatieve onderzoekstraditie en schenkt men beperkte aandacht aan demografische kenmerken van onderzoekspopulaties. In deze studie worden bovenstaande tekortkomingen geadresseerd via een kwantitatieve bevraging van 45 gepercipieerde determinanten en drempels bij 1153 Vlaamse (ex-)burn-outpatiënten. Resultaten tonen ten eerste aan dat de frequentst gerapporteerde determinanten en drempels (door minstens 70% van de steekproef) verwijzen naar factoren gerelateerd aan gebrekkig herstel voor én na een burn-outepisode (bijvoorbeeld de eigen neiging om constant hard te willen werken en verminderde productiviteit door resterende symptomen); en ten tweede dat er systematische associaties zijn tussen demografische kenmerken en burn-outervaringen. Zo geven vrouwen, ouderen en mensen zonder tertiair diploma aan meer drempels te zien om te re-integreren naar de arbeidsmarkt

A systematic evaluation of Flow Field Flow Fractionation and single-particle ICP-MS to obtain the size distribution of organo-mineral iron oxyhydroxide colloids

Colloidal iron(III)oxyhydroxides (FeOx)are important reactive adsorbents in nature. This study was set up to determine the size of environmentally relevant FeOx colloids with new methods, i.e. Flow Field Flow Fractionation (FlFFF-UV-ICP-MS)and single-particle ICP-MS/MS (sp-ICP-MS)and to compare these with standard approaches, i.e. dynamic light scattering (DLS), nanoparticle tracking analysis (NTA), microscopy (TEM), membrane filtration, centrifugation and dialysis. Seven synthetic nano- and submicron FeOx with different mineralogy and coating were prepared and two soil solutions were included. The FlFFF was optimized for Fe recovery, yielding 70–90%. The FlFFF determines particle size with high resolution in a 1 mM NH 4 HCO 3 (pH 8.3)background and can detect Fe-NOM complexes 4 HCO 3 )and it has acceptable element recoveries. </p