Creating Opportunities: Gerontological Service Learning in a Community Practice Project

Ten graduate gerontology students volunteered for a service learning project, My Life: Connect with Me, which was developed, supervised and evaluated by a graduate social work intern in a community practice internship. The social work intern trained volunteers in interviewing skills at a continuing care retirement community. Student volunteers’ self-reported confidence in interviewing older adults was measured by a questionnaire created by the social work intern, using Likert scaling and short qualitative responses, as well as journaling. All student volunteers reported increases from pre to posttest, and the social work intern successfully completed all community internship competencies (Council on Social Work Education, 2008). The stakeholders have moved toward a broader implementation of this project

Childhood morbidity in Dutch general practice : epidemiology and management

With the ageing of the population, children's health tends to become a neglected area in health research and health care research. And this is unjustified, considering that the children of today are tomorrow's adults and that their health is originated in childhood. Measurement of child's health over time will identify the emergence of new childhood health problems and morbidity trends. The recognition of such trends may lead to a shift in priorities in child health care. The aims of this thesis are to present an overview of children's morbidity in Dutch general practice and general practitioners' management, and to evaluate changes therein over the past decades. Moreover, determinants of morbidity or changes in general practitioners' management are assessed in order to provide tools for prevention of morbidity or for the improvement of clinical practice. To investigate these issues, data of 0-17 year old children of two successive national surveys in Dutch general practice were used (1987-2001). Both surveys were designed and performed by the Netherlands Institute for Health Service Research (NIVEL). In both surveys, general practitioners registered all contacts with patients during the study period. Among others, they recorded the diagnosis and if a referral or prescription was made, this was linked to the corresponding diagnosis. Characteristics of the practices and study population were obtained by mailed questionnaire, and the response rate was 70-90% dependant on different variables

Vision Impairment and Depression in the Older Adult

The older adult population in the United States is rapidly expanding both because of longer life expectancies as well as the aging of the baby boomers. While vision impairment is a growing concern among older adults, there have been few, mostly small studies, of the impact of vision impairment on this population. The present study uses a national data set, the Second Supplement on Aging (1994 -1996) from the National Health Interview Survey, in a cross-sectional study of 9,447 civilian non-institutionalized persons, aged 70 years and over at the time of their interview. The SOA II has been studied in the context of a social theory of aging that emphasizes interdependence through the life course using a stress process model that has been refined into a disability model. Disability is understood as a social construction outcome rather than as a medical outcome. Vision impairment is the stressor which is mediated by health (falls, functioning and self-health report), financial resources (education, income and having only public health insurance) and social support (marital, living along, having no living children, social activities in number and intensity). Depression is a possible, but not a necessary result of vision impairment. Disability may result when a medical pathology leads to an impairment which results in a functional limitation and finally a social disability. This secondary analysis used a multinomial logistic regression for both the whole sample as well as separately for each gender. For the whole sample the results indicate that a typical profile of a vision-impaired older adult depressed some/all of the time, would be a younger-old White woman (aged 70-74 years old) who has fallen in the past 12 months, has difficult with one or more Activities of Daily Living or with both one or more Activities of Daily Living and Instrumental Activities of Daily Living, has a poor to fair self-heath report, a family income under $20,000, a high school or less education, lives alone, has a living child and lacks social activities in number and intensity. In the gender samples, only the female sample at the some/all of the time depression category is significant. Older vision-impaired adults, especially older women who have more social supports are less likely to be depressed and so disabled. There is a need for social policies that will educate, encourage and support older vision-impaired adults as they seek to compensate for the loss of vision, often late in life

Epidemiology of unintentional injuries in childhood: a population-based survey in general practice

This study aimed to assess the incidence of unintentional injuries presented in general practice, and to identify children at risk from experiencing an unintentional injury. We used the data of all 0-17-year-old children from a representative survey in 96 Dutch general practices in 2001. We computed incidence rates and multilevel multivariate regression analysis in different age strata and identified patient and family characteristics associated with an elevated injury risk. Nine thousand four hundred and eighty-four new injury episodes were identified from 105 353 new health problems presented in general practice, giving an overall incidence rate of 115 per 1000 person years (95% confidence interval [CI] = 113 to 118). Sex and residence in rural areas are strong predictors of injury in all age strata. Also, in children aged 0-4 years, a higher number of siblings is associated with elevated injury risk (> or =3 siblings odds ratio [OR] = 1.57, 95% CI = 1.19 to 2.08) and in the 12-17-year-olds, ethnic background and socioeconomic class are associated with experiencing an injury (non-western children OR = 0.67, 95% CI = 0.54 to 0.81; low socioeconomic class OR = 1.39, 95% CI = 1.22 to 1.58). Unintentional injury is a significant health problem in children in general practice, accounting for 9% of all new health problems in children. In all age groups, boys in rural areas are especially at risk to experience an injury

Quality of Life in Oncological Patients with Oropharyngeal Dysphagia: Validity and Reliability of the Dutch Version of the MD Anderson Dysphagia Inventory and the Deglutition Handicap Index

Quality of life is an important outcome measurement in objectifying the current health status or therapy effects in patients with oropharyngeal dysphagia. In this study, the validity and reliability of the Dutch version of the Deglutition Handicap Index (DHI) and the MD Anderson Dysphagia Inventory (MDADI) have been determined for oncological patients with oropharyngeal dysphagia. At Maastricht University Medical Center, 76 consecutive patients were selected and asked to fill in three questionnaires on quality of life related to oropharyngeal dysphagia (the SWAL-QOL, the MDADI, and the DHI) as well as a simple one-item visual analog Dysphagia Severity Scale. None of the quality-of-life questionnaires showed any floor or ceiling effect. The test-retest reliability of the MDADI and the Dysphagia Severity Scale proved to be good. The test-retest reliability of the DHI could not be determined because of insufficient data, but the intraclass correlation coefficients were rather high. The internal consistency proved to be good. However, confirmatory factor analysis could not distinguish the underlying constructs as defined by the subscales per questionnaire. When assessing criterion validity, both the MDADI and the DHI showed satisfactory associations with the SWAL-QOL (reference or gold standard) after having removed the less relevant subscales of the SWAL-QOL. In conclusion, when assessing the validity and reliability of the Dutch version of the DHI or the MDADI, not all psychometric properties have been adequately met. In general, because of difficulties in the interpretation of study results when using questionnaires lacking sufficient psychometric quality, it is recommended that researchers strive to use questionnaires with the most optimal psychometric properties

Structure and function of PspA and Vipp1 N-terminal peptides: Insights into the membrane stress sensing and mitigation

The phage shock protein (Psp) response maintains integrity of the inner membrane (IM) in response to extracytoplasmic stress conditions and is widely distributed amongst enterobacteria. Its central component PspA, a member of the IM30 peripheral membrane protein family, acts as a major effector of the system through its direct association with the IM. Under non-stress conditions PspA also negatively regulates its own expression via direct interaction with the AAA + ATPase PspF. PspA has a counterpart in cyanobacteria called Vipp1, which is implicated in protection of the thylakoid membranes. PspA's and Vipp1's conserved N-terminal regions contain a putative amphipathic helix a (AHa) required for membrane binding. An adjacent amphipathic helix b (AHb) in PspA is required for imposing negative control upon PspF. Here, purified peptides derived from the putative AH regions of PspA and Vipp1 were used to directly probe their effector and regulatory functions. We observed direct membrane-binding of AHa derived peptides and an accompanying change in secondary structure from unstructured to alpha-helical establishing them as bona fide membrane-sensing AH's. The peptide-binding specificities and their effects on membrane stability depend on membrane anionic lipid content and stored curvature elastic stress, in agreement with full length PspA and Vipp1 protein functionalities. AHb of PspA inhibited the ATPase activity of PspF demonstrating its direct regulatory role. These findings provide new insight into the membrane binding and function of PspA and Vipp1 and establish that synthetic peptides can be used to probe the structure-function of the IM30 protein family

Increasing incidence of skin disorders in children? A comparison between 1987 and 2001

BACKGROUND: The increasing proportion of skin diseases encountered in general practice represents a substantial part of morbidity in children. Only limited information is available about the frequency of specific skin diseases. We aimed to compare incidence rates of skin diseases in children in general practice between 1987 and 2001. METHODS: We used data on all children aged 0–17 years derived from two consecutive surveys performed in Dutch general practice in 1987 and 2001. Both surveys concerned a longitudinal registration of GP consultations over 12 months. Each disease episode was coded according to the International Classification of Primary Care. Incidence rates of separate skin diseases were calculated by dividing all new episodes for each distinct ICPC code by the average study population at risk. Data were stratified for socio-demographic characteristics. RESULTS: The incidence rate of all skin diseases combined in general practice decreased between 1987 and 2001. Among infants the incidence rate increased. Girls presented more skin diseases to the GP. In the southern part of the Netherlands children consulted their GP more often for skin diseases compared to the northern part. Children of non-Western immigrants presented relatively more skin diseases to the GP. In general practice incidence rates of specific skin diseases such as impetigo, dermatophytosis and atopic dermatitis increased in 2001, whereas warts, contact dermatitis and skin injuries decreased. CONCLUSION: The overall incidence rate of all skin diseases combined in general practice decreased whereas the incidence rates of bacterial, mycotic and atopic skin diseases increased