Geriatrische Interventie: een klinisch-empirisch onderzoek

In 1986 was ik als klinisch geriater werkzaam op een geriatrische afdeling van een psychiatrisch ziekenhuis (GAPZ) en was ik tevens consulent voor het algemeen ziekenhuis Leyenburg. In de daaropvolgende 4 jaren is mij duidelijk geworden wat de voor- en de nadelen zijn van de behandeling op een geriatrische afdeling versus geriatrische consulten en medebehandeling op andere afdelingen. Toen mijn werkveld naar het algemeen ziekenhuis Leyenburg werd verschoven stond ik voor de opdracht om in dit ziekenhuis de klinische geriatrie verder te ontwikkelen. Op dat ogenblik was er in het ziekenhuis een stijgende vraag naar geriatrische consulten. Geriatrische patienten bleken verspreid over alle afdelingen van het ziekenhuis voor te komen. Het werkelijke aantal geriatrische patienten in het ziekenhuis was op basis van de consulten moeilijk in te schatten. Wanneer een afdeling gedurende een jaar veel aandacht kreeg. steeg het aantal consulten zeer sterk. om daarna weer te dalen wanneer de consultatief werkende afdeling geriatrie er minder actief mee bezig was. Er zijn verschillende organisatorische modellen waarmee geriatrie in ziekenhuizen kan worden bedreven

End-of-life care in the Dutch medical curricula

Prevention, Population and Disease management (PrePoD)Geriatrics in primary carePublic Health and primary car

Vitality club: a proof-of-principle of peer coaching for daily physical activity by older adults

Many age-related diseases can be prevented or delayed by daily physical activity. Unfortunately, many older adults do not per- form physical activity at the recommended level. Professional interventions do not reach large numbers of older adults for a long period of time. We studied a peer-coach intervention, in which older adults coach each other, that increased daily physi- cal activity of community dwelling older adults for over 6 years. We studied the format and e ects of this peer coach interven- tion for possible future implementation elsewhere. Through interviews and participatory observation we studied the format of the intervention. We also used a questionnaire (n = 55) and collected 6-min walk test data (n = 261) from 2014 to 2016 to determine the motivations of participants and effects of the intervention on health, well-being and physical capacity. Vitality Club is a self-sustainable group of older adults that gather every weekday to exercise coached by an older adult. Members attend on average 2.5 days per week and retention rate is 77.5% after 6 years. The members perceived improve- ments in several health measures. In line with this, the 6-min walk test results of members of this Vitality Club improved with 21.7 meters per year, compared with the decline of 2–7 meters per year in the general population. This Vitality Club is successful in durably engaging its members in physical activity. The members perceive improvements in health that are in line with improvements in a physical function test. Because of the self-sustainable character of the intervention, peer coaching has the potential to be scaled up at low cost and increase physical activity in the increasing number of older adults.  Prevention, Population and Disease management (PrePoD

Twenty-eight genetic loci associated with ST-T-wave amplitudes of the electrocardiogram

The ST-segment and adjacent T-wave (ST-T wave) amplitudes of the electrocardiogram are quantitative characteristics of cardiac repolarization. Repolarization abnormalities have been linked to ventricular arrhythmias and sudden cardiac death. We performed the first genome-wide association meta-analysis of ST-T-wave amplitudes in up to 37 977 individuals identifying 71 robust genotype-phenotype associations clustered within 28 independent loci. Fifty-four genes were prioritized as candidates underlying the phenotypes, including genes with established roles in the cardiac repolarization phase (SCN5A/SCN10A, KCND3, KCNB1, NOS1AP and HEY2) and others with as yet undefined cardiac function. These associations may provide insights in the spatiotemporal contribution of genetic variation influencing cardiac repolarization and provide novel leads for future functional follow-up

Susceptibility to chronic mucus hypersecretion, a genome wide association study

Background: Chronic mucus hypersecretion (CMH) is associated with an increased frequency of respiratory infections, excess lung function decline, and increased hospitalisation and mortality rates in the general population. It is associated with smoking, but it is unknown why only a minority of smokers develops CMH. A plausible explanation for this phenomenon is a predisposing genetic constitution. Therefore, we performed a genome wide association (GWA) study of CMH in Caucasian populations. Methods: GWA analysis was performed in the NELSON-study using the Illumina 610 array, followed by replication and meta-analysis in 11 additional cohorts. In total 2,704 subjects with, and 7,624 subjects without CMH were included, all current or former heavy smokers (≥20 pack-years). Additional studies were performed to test the functional relevance of the most significant single nucleotide polymorphism (SNP). Results: A strong association with CMH, consistent across all cohorts, was observed with rs6577641 (p = 4.25x10-6, OR = 1.17), located in intron 9 of the special AT-rich sequence-binding protein 1 locus (SATB1) on chromosome 3. The risk allele (G) was associated with higher mRNA expression of SATB1 (4.3x10 -9) in lung tissue. Presence of CMH was associated with increased SATB1 mRNA expression in bronchial biopsies from COPD patients. SATB1 expression was induced during differentiation of primary human bronchial epithelial cells in culture. Conclusions: Our findings, that SNP rs6577641 is associated with CMH in multiple cohorts and is a cis-eQTL for SATB1, together with our additional observation that SATB1 expression increases during epithelial differentiation provide suggestive evidence that SATB1 is a gene that affects CMH

A good beginning: study protocol for a group-randomized trial to investigate the effects of sit-to-stand desks on academic performance and sedentary time in primary education

Action Contro

Treatment of cancer in old age, shortcomings and challenges

The burden of cancer in old age is increasing as a result from both the expanding number of older persons in the population and the high and still increasing cancer incidence in this group. The goal of this article is to outline the shortcomings and challenges of the management of cancer in the elderly. Several factors contribute to the complexity of this management, such as the enormous heterogeneity in this population, increased co-morbidity, reduced functional status, increased frailty and different treatment goals from those in younger patients. Other problems include the lack of data on the efficacy and toxicity of cancer treatment in this age group, the lack of awareness of life-expectancy and the lack of an easy applicable and validated frailty scale. Improvement of the quality of oncological care in this age group could be achieved by initiation of clinical trials specifically directed at the elderly, in which a frailty scale is implemented. The results of these trials may lead to more evidence-based decision making in cancer treatment in the elderly.