Burgers en gezondheid : Themarapport Volksgezondheid Toekomst Verkenning 2014

Zelfontplooiing van de autonome burger kenmerkt de huidige tijd. Eigen verantwoordelijkheid, autonomie, eigen keuze en eigen regie zijn kernwoorden bij deze ontwikkelingen. Ook als het gaat om gezondheid, preventie en zorg. Het RIVM en het SCP hebben beschreven hoe de burger deze ontwikkelingen ervaart en welke aandachtspunten er voor beleid zijn. Bij de ontwikkelingen gaat het allereerst om de zorg voor de eigen gezondheid: als gezonde burger om gezond te blijven, en als patiënt om zelf de regie te houden over de eigen zorg (zelfmanagement). Mensen kunnen zo kiezen voor vormen van preventie en zorg die goed aansluiten bij hun eigen voorkeuren. Bovendien geeft zelfmanagement patiënten meer controle op de behandeling van de aandoening, en daarmee op de aandoening én op hun leven. Alleen wil niet iedereen zelf die regie voeren. Ook zijn er kwetsbare groepen in de samenleving, zoals ouderen en mensen uit lagere sociaaleconomische milieus, voor wie zelf regie voeren niet lukt, omdat ze daar de vaardigheden niet voor hebben. Deze groepen zullen ondersteuning op maat moeten krijgen. Een tweede ontwikkeling behelst de zorg voor anderen, bijvoorbeeld in de rol van mantelzorger en vrijwilliger. Nederlanders zijn voorstanders van een samenleving waarin mensen voor elkaar zorgen, en doen veel en vaak vrijwilligerswerk. De plicht om te zorgen voor een naaste botst echter met de behoefte aan vrijheid om zelf keuzes te maken. Een verplichting kan daardoor demotiverend werken. De onderzoekers bevelen aan om de komende tijd te monitoren wat de effecten zijn van deze ontwikkelingen op autonomie, eigen regie en gezondheid, maar ook op gezondheidsverschillen, de mate van participatie en de kosten van de zorg. Op die manier kunnen de gevolgen van de veranderingen onderbouwd worden geëvalueerd. Dit onderzoek maakt deel uit van de Volksgezondheid Toekomst Verkenning 2014 (VTV-2014). De VTV is een rapportage die het RIVM elke vier jaar opstelt in opdracht van het ministerie van Volksgezondheid, Welzijn en Sport (VWS)

A continuum model accounting for the effect of the initial and evolving microstructure on the evolution of dynamic recrystallization

Laser assisted forming is a process which is increasingly being adopted by the industry. Application of heat by a laser to austenitic stainless steel (ASS) sheet provides local control over formability and strength of the material. The hot forming behavior of ASS is characterized by significant dynamic recovery and dynamic recrystallization. These two processes lead to a softening stress-strain response and have a significant impact on the microstructure of the material. Most of the research performed on hot forming of ASS focuses on dynamic recrystallization and then specifically on the behavior of the annealed state, consisting of relatively large equiaxed austenite grains. However, in industry it is common to use cold rolled ASS sheet which is a mixture of austenite and martensite. Application of a laser heat treatment to the cold rolled grades of ASS induces a socalled ‘reverse’ transformation of martensite to austenite which, depending on the exact time-temperature combinations, leads to an austenite grain size in the range of nanoto micrometer. It is known from experiments that the effect of initial grain size on dynamic recrystallization is significant, especially on the initial stages of recrystallization. Therefore any continuum model capable of describing hot forming of cold rolled ASS should include the effect of the initial grain size. In this work a physically based continuum model for dynamic recrystallization is presented which accounts for the effect of the initial and evolving grain size on the evolution of dynamic recrystallization. It is shown that the initial grain size can be accounted for by incorporating its effect on the availability of preferred nucleation sites, i.e. grain edges. The new model is compared to experimental results and it is shown that the model correctly predicts accelerated recrystallization with decrease in grain size and that there is a weak dependence of the dynamically recrystallized grain size on the initial grain size. Furthermore predicted recrystallized grain sizes are in good agreement with the experimentally measured values

Hypertrophic Cardiomyopathy β-Cardiac Myosin Mutation (P710R) Leads to Hypercontractility by Disrupting Super Relaxed State

Hypertrophic cardiomyopathy (HCM) is the most common inherited form of heart disease, associated with over 1,000 mutations, many in β-cardiac myosin (MYH7). Molecular studies of myosin with different HCM mutations have revealed a diversity of effects on ATPase and load-sensitive rate of detachment from actin. It has been difficult to predict how such diverse molecular effects combine to influence forces at the cellular level and further influence cellular phenotypes. This study focused on the P710R mutation that dramatically decreased in vitro motility velocity and actin-activated ATPase, in contrast to other MYH7 mutations. Optical trap measurements of single myosin molecules revealed that this mutation reduced the step size of the myosin motor and the load sensitivity of the actin detachment rate. Conversely, this mutation destabilized the super relaxed state in longer, two-headed myosin constructs, freeing more heads to generate force. Micropatterned human induced pluripotent derived stem cell (hiPSC)–cardiomyocytes CRISPR-edited with the P710R mutation produced significantly increased force (measured by traction force microscopy) compared with isogenic control cells. The P710R mutation also caused cardiomyocyte hypertrophy and cytoskeletal remodeling as measured by immunostaining and electron microscopy. Cellular hypertrophy was prevented in the P710R cells by inhibition of ERK or Akt. Finally, we used a computational model that integrated the measured molecular changes to predict the measured traction forces. These results confirm a key role for regulation of the super relaxed state in driving hypercontractility in HCM with the P710R mutation and demonstrate the value of a multiscale approach in revealing key mechanisms of disease

Patient organisations and the reimbursement process for medicines: an exploratory study in eight European countries

<p>Abstract</p> <p>Background</p> <p>Little is known about the role European patient organisations play in the process of deciding on reimbursement for medicines. Therefore we <it>explore </it>the current role of patient organisations in the process of reimbursement for medicines in Western Europe. We focus in particular on collaboration between patient organisations and the pharmaceutical industry in this respect.</p> <p>Methods</p> <p>Sixty-eight patient organisations representing seven medical conditions, from ten Western European countries, were asked to participate in the study. The participating organisations reported their experiences in a web-based questionnaire.</p> <p>Results</p> <p>Twenty-one patient organisations completed the questionnaire (response rate: 31%), of which ten (47.6%) demanded reimbursement for medicines. Organisations demanding reimbursement were larger than those not demanding reimbursement. The main aim of these organisations was to create better accessibility of medicines for patients. Most organisations limited themselves to single actions. Only two engaged in multiple actions. Almost all organisations had general policies on cooperation with the pharmaceutical industry, with autonomy as the key feature. The patient organisations said they were reasonably successful and almost always satisfied with their own role in the reimbursement process.</p> <p>Conclusion</p> <p>Our study has found that the role of European patient organisations in the reimbursement process still seems limited, especially for small patient organisations.</p

Symposium The future of informal care [Symposium De toekomst van de informele zorg]

Due to the reform of long term care in 2015, there is growing concern about whether groups at risk receive the care they need. People in need of care have to rely more on help from their social network. The increased need for informal care requires resilience and organizational skills of families, but also of volunteers, professionals and employers. What does this mean for the provision of informal care in the next decennia? The symposium ‘The future of informal care’, organized on January 26 2017 by the National Institute for Social Research and the Institute for Societal Resilience of the Vrije Universiteit, addressed possible answers to this question. In her inaugural speech Alice de Boer discussed social inequality as possible determinant and outcome of informal care. Some conclusions: Until 2050 the absolute number of 75-plus doubled to about 3 million persons, but the number of informal caregivers will decrease. In addition to the importance of social and economic resources (the ‘have & have-nots’), the ability to arrange care (the ‘can & can-nots’) gains importance. Almost half of the older employers provides informal care just before retirement. Flexibility in working hours and work location facilitates combining work and care, but about half of the employers indicates that partial retirement and working at home are no options. Informal caregivers and professionals often provide care from comparable perspectives and identities. Addressing similarities rather than differences improves their chances for collaboration. The number of adult children providing household care to older parents increased between 2002 and 2014. This suggests an increase in family solidarity, but current reform policies may increase the gender inequality in caregiving families. Spouses and children remain primary caregivers in the future, preferably supported by many different types of caregivers. Not everybody has the capabilities to organize and direct such a large care network. Providing informal care increases the risk for overburden and absence at work or education. Informal caregivers at risk remain, also in the future, women, spouses, migrants, and younger carers

Early intervention for children at risk of visual processing dysfunctions from 1 year of age: a randomized controlled trial protocol

BACKGROUND: An increasing number of children are suffering from brain damage-related visual processing dysfunctions (VPD). There is currently a lack of evidence-based intervention methods that can be used early in development. We developed a visual intervention protocol suitable from 1 year of age. The protocol is structured, comprehensive and individually adaptive, and is paired with quantitative outcome assessments. Our aim is to investigate the effectiveness of this first visual intervention program for young children with (a risk of) VPD. METHODS: This is a single-blind, placebo-controlled trial that is embedded within standard clinical care. The study population consists of 100 children born very or extremely preterm (< 30 weeks) at 1 year of corrected age (CA), of whom 50% are expected to have VPD. First, children undergo a visual screening at 1 year CA. If they are classified as being at risk of VPD, they are referred to standard care, which involves an ophthalmic and visual function assessment and a (newly developed) visual intervention program. This program consists of a general protocol (standardized and similar for all children) and a supplement protocol (adapted to the specific needs of the child). Children are randomly allocated to an intervention group (starting upon inclusion at 1 year CA) or a control group (postponed: starting at 2 years CA). The control group will receive a placebo treatment. The effectiveness of early visual intervention will be examined with follow-up visual and neurocognitive assessments after 1 year (upon completion of the direct intervention) and after 2 years (upon completion of the postponed intervention). DISCUSSION: Through this randomized controlled trial we will establish the effectiveness of a new and earl

Ethnic minorities and prescription medication; concordance between self-reports and medical records

BACKGROUND: Ethnic differences in health care utilisation are frequently reported in research. Little is known about the concordance between different methods of data collection among ethnic minorities. The aim of this study was to examine to which extent ethnic differences between self-reported data and data based on electronic medical records (EMR) from general practitioners (GPs) might be a validity issue or reflect a lower compliance among minority groups. METHODS: A cross-sectional, national representative general practice study, using EMR data from 195 GPs. The study population consisted of Dutch, Turks, Surinamese, Antilleans and Morrocans. Self-reported data were collected through face-to-face interviews and could be linked to the EMR of GPs. The main outcome measures were the level of agreement between annual prescribing rate based on the EMRs of GPs and the self-reported receipt and use of prescriptions during the preceding 14 days. RESULTS: The pattern of ethnic differences in receipt and use of prescription medication depended on whether self-reported data or EMR data were used. Ethnic differences based on self-reports were not consistently reflected in EMR data. The percentage of agreement above chance between EMR data and self-reported receipt was in general relative low. CONCLUSION: Ethnic differences between self-reported data and EMR data might not be fully perceived as a cross-cultural validity issue. At least for Moroccans and Turks, compliance with the prescribed medication by the GP is suggested not to be optimal

The Role of Screenings Methods and Risk Profile Assessments in Prevention and Health Promotion Programmes: An Ethnographic Analysis

In prevention and health promotion interventions, screening methods and risk profile assessments are often used as tools for establishing the interventions’ effectiveness, for the selection and determination of the health status of participants. The role these instruments fulfil in the creation of effectiveness and the effects these instruments have themselves remain unexplored. In this paper, we have analysed the role screening methods and risk profile assessments fulfil as part of prevention and health promotion programmes in the selection, enrolment and participation of participants. Our analysis showed, that screening methods and health risk assessments create effects as they objectify health risks and/or the health status of individuals, i.e., they select the individuals ‘at risk’ and indicate the lifestyle modifications these people are required to make in order to improve their health. Yet, these instruments also reduce the group of participants thereby decreasing the possible effect of interventions, as they provide the legitimisation for people to make choices to whether they enrol or not and what lifestyle changes they incorporate into their lives. In other words, they present a space of interaction, in which agency is distributed across the practice nurses, the participants and the instruments. Decisions were not just made upon the projection of the outcomes of these instruments; decisions that were made by both the patients and practice nurses were the resultant of their opinions on these outcomes that were formed in interaction with the instruments