Effecten van verminderde fosfaatgiften op fosfaatfixerende kleigronden

Iedere ondernemer zal zijn eigen strategie hebben om aan de MINAS-eindnormen te voldoen. Van Wijk, deelnemer aan het Koeien & Kansen project, dat als doel heeft het in praktijk ontwikkelen en demonstreren van duurzame melkveehouderij, besloot de fosfaataanvoer te verminderen door terug te gaan in fosfaatkunstmestbemesting (de Koeien & Kansen boeren nemen ook fosfaatkunstmest mee in de MINAS-berekeningen). Het bedrijf Van Wijk is echter gesitueerd op een zeer zware fosfaatfixerende grond. De fosfaattoestand van de bodem is dientengevolge zeer laag. Door middel van een fosfaatbemestingsproef is nagegaan of een verminderde fosfaatbemesting zich zal uiten in een daling van de grasopbrengsten, een verlaagd fosforgehalte in het gras en een lagere fosfaattoestand van de bode

Commentaar:Mondzorg van morgen

Eidn april 2012 bracht de Gezondheidsraad haar advies over mondzorg uit. Het advies schetst een beeld van wat er bereikt is met mondzorg in de afgelopen 30 jaar: een sterke verbetering van de mondgezondheid en terugdringing van cariës. Voor de Nederlandse volksgezondheid is dit uitermate relevant, zowel door reductie van ziektelast als door de invloed van mondgezondheid op andere gezondheidsproblemen. Het advies schetst echter ook een onthutsend beeld van wat nog niet is bereikt: standaardiseratie en gestructureer kwaliteitsbeleid. En dat in een sector waarvan de kosten minstens even hoog zijn als van de totale huisartsenzorg, en waarin stevig geëxperimenteerd wordt met marktwerking. het kan en moet gewoon veel beter

Self-efficacy, affectivity and smoking behavior in adolescence

Background: Research on health-related behaviors confirms the contribution of self-efficacy and affective factors to the initiation and continuation of smoking behavior. The aim was to assess the degree to which affectivity contributes to the association between self-efficacy and smoking behavior in adolescence. Methods: A sample of 501 elementary school students (mean age 14.7 +/- 0.9 years, 48.5% males) from the Slovak and Czech Republics filled out the Self-Efficacy Scale, the Positive and Negative Affect Schedule and answered questions about smoking behavior. Results: Logistic regression showed that social self-efficacy increased the likelihood of smoking behavior but only after adding positive and negative affectivity to the model. Adjustment for age and gender as covariates did not change these findings. Conclusion: Results show the need to prepare programs aimed at enhancing appropriate social self-efficacy and especially improving skills to resist the pressures emerging from peers. Adolescents should also learn to handle their negative emotions differently, instead of through smoking behavior

Parental divorce, adolescents' feelings toward parents and drunkenness in adolescents

The aim of this study was to explore the association between parental divorce and adolescent drunkenness and the contribution of adolescents' feelings toward their parents to this association. Cross-sectional data on 3,694 elementary school students from several cities in Slovakia (mean age 14.3, 49.0% males; response rate 93%) were obtained. Respondents completed questionnaires on how often they had been drunk in the previous 4 weeks, whether their parents were divorced and a measure of their feelings toward their parents. Parental divorce was found to have an effect on adolescent drunkenness in the previous month, as were the high rates of negative and low rates of positive feelings toward both parents. The effect of divorce on drunkenness strongly decreased if adjusted for the affect of the adolescent toward the father, but not the mother. Our findings indicate that to keep the father positively involved after divorce might be a protective factor with regard to a higher probability of adolescent drunkenness in divorced families

Neonatal morbidities and developmental delay in moderately preterm-born children

BACKGROUND AND OBJECTIVE: Children born moderately preterm (32-35(6/7) weeks' gestation) are at increased risk of both neonatal morbidities and developmental delays in early childhood. It is unknown whether neonatal morbidities contribute to the increased risk of developmental delay. The objective of this study was to determine the effect of neonatal morbidities after moderately preterm birth on development at preschool age. METHODS: In a community-based, stratified cohort, parents of 832 moderately preterm children born in 2002 or 2003 completed the Ages and Stage Questionnaire when their child was 43 to 49 months old. Data on Apgar scores, asphyxia, tertiary NICU admission, hospital transfer, circulatory insufficiency, hypoglycemia, septicemia, mechanical ventilation, continuous positive airway pressure, apneas, caffeine treatment, and hyperbilirubinemia were obtained from medical records. We assessed associations of neonatal characteristics with developmental delay, adjusted for gender, small-for-gestational-age status, gestational age, and maternal education. RESULTS: Hypoglycemia and asphyxia were associated with developmental delay; odds ratios (ORs) were 2.42 (95% confidence interval [CI]: 1.23-4.77) and 3.18 (95% CI: 1.01-10.0), respectively. Tertiary NICU admission and hyperbilirubinemia had positive but statistically borderline nonsignificant associations with developmental delay: ORs were 1.74 (95% CI: 0.96-3.15) and 1.52 (95% CI: 0.94-2.46), respectively. No other neonatal morbidities were associated with developmental delay. In multivariate analyses, only hypoglycemia was associated with developmental delay (OR: 2.19; 95% CI: 1.08-4.46). CONCLUSIONS: In moderately preterm-born children, only hypoglycemia increased the risk of developmental delay at preschool age. A concerted effort to prevent hypoglycemia might enhance developmental outcome in this group

Differences between physicians in the likelihood of referral and acceptance of elderly patients for dialysis-influence of age and comorbidity

BACKGROUND: Incidence of dialysis in elderly patients in the Netherlands is low compared to other countries. This study aims to assess the impact of patients' age and comorbidity on the likelihood of referral and acceptance of patients for dialysis and whether this is affected by physician characteristics. METHODS: A vignette study was performed among 209 primary care physicians, 162 non-nephrology specialists and 20 nephrologists working in the north of the Netherlands. Physicians were offered six vignettes concerning case-reports of patients with end-stage renal disease (ESRD) and varying comorbidities or circumstances and asked about the likelihood of referral/acceptance of the patient in the given circumstances. RESULTS: The likelihood of referral within groups of physicians varied widely, especially within the group of primary care physicians and non-nephrology specialists, but was not affected by characteristics of physicians. The likelihood of referral or acceptance of patients for dialysis depended on the patient's age, and type and severity of comorbidity. In general, primary care physicians and non-nephrology specialists were less likely to refer than nephrologists were to accept. Differences within and between groups of physicians were larger for 80- than for 65-year-old patients, and for patients with less severe shortness of breath and cognitive impairments and more severe diabetes and social impairments. Hardly any differences were found for patients with cancer. CONCLUSION: Patients' age and comorbidities affect the likelihood of referral. Differences between groups of physicians suggest that there is insufficient agreement on the extent to which these factors should affect the referral/acceptance of patients for dialysis. These findings underline the need for more research into circumstances under which patients might benefit from dialysis. Guidelines should be developed to improve the referral of elderly and less healthy patients

Jeugdgezondheidszorg: meer preventie voor weinig geld

Het uniforme deel van het Basistakenpakket Jeugdgezondheidszorg (het deel dat aan alle kinderen in Nederland op dezelfde manier wordt aangeboden) bevatte voorheen een combinatie van 18 bewezen effectieve programmaonderdelen, te weten negen vaccinaties, zes screeningsprogramma’s en drie vormen van preventieve advisering. Daarnaast werd een groot aantal programmaonderdelen aangeboden waarvan de werkzaamheid (nog) niet bewezen was. Van deze laatste werden een aantal alsnog onderzocht, om in een later stadium te kunnen besluiten over al dan niet handhaving in het uniforme Basistakenpakket JGZ. Sommige onderdelen lenen zich niet voor evaluatieonderzoek, maar worden door ouders of overheid dermate op prijs gesteld dat ze deel blijven uitmaken van het pakket. Mede dank zij dit gemengde aanbod is het bereik met gemiddeld rond 95% hoog in vergelijking met de ons omringende landen. De afgelopen jaren is het Basistakenpakket JGZ uitgebreid, en is een aantal bestaande onderdelen wetenschappelijk beter onderbouwd. In dit artikel wordt de actuele stand van zaken per juni 2007 weergegeven, voortbouwend op een eerdere analyse uit 2003

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

Accepting or declining dialysis: considerations taken into account by elderly patients with end-stage renal disease

BACKGROUND: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. METHOD: In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis. RESULTS: All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future. CONCLUSION: Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life

Mestsamenstelling in Adviesbasis Bemesting Grasland en Voedergewassen

De samenstelling van mest is afhankelijk van een groot aantal factoren: de diersoort, het gevoerde rantsoen, het stalsysteem, en de hoeveelheid drink- en spoelwater die in de mest komt. Een aantal ontwikkelingen in de veehouderij kan er de oorzaak van zijn dat de gemiddelde mestsamenstelling in de laatste jaren veranderd is. In de rundveehouderij moeten we hierbij denken aan verlaging van de stikstofbemesting en een beperkt gebruik van fosfaatmeststoffen om op die manier te kunnen voldoen aan de gebruiksnormen. Bedrijven die deelnemen aan het berekenen van Bedrijfsspecifieke Excretie (BEX), voeren scherp op de behoeftenormen aan N en P. Hierdoor kan de hoeveelheid van het bedrijf af te voeren mest worden beperkt. Redenen genoeg om de mestcijfers opnieuw onder de loep te nemen