Integraal gezondheidsbeleid: theorie en toepassing

Gezondheid wordt beinvloed door veel verschillende factoren. Niet alleen genetische factoren, zorg en leefstijl zijn van invloed op de gezondheidstoestand van individuen, maar ook de fysieke en sociale omgeving speelt een belangrijke rol. Integraal gezondheidsbeleid is erop gericht de gezondheid of determinanten daarvan in samenhang te beinvloeden. Dat betekent in de meest brede zin dat de belangrijkste relevante sectoren binnen en buiten het volksgezondheidsdomein samen werken aan het aspect gezondheid. Integraal gezondheidsbeleid kan ook specifieker zijn, zoals het beinvloeden (facetbeleid) of analyseren (gezondheidseffectschatting) van beleid van sectoren buiten het volksgezondheidsdomein. Het uitvoeren van integraal gezondheidsbeleid blijkt in de praktijk een ingewikkeld proces. Een belangrijke voorwaarde voor het maken en uitvoeren van integraal gezondheidsbeleid is dan ook de intersectorale samenwerking. Echter de betrokkenheid van andere actoren en sectoren is lang niet altijd vanzelfsprekend. Dat komt mede doordat de rol, betekenis en effecten van integraal gezondheidsbeleid nog onvoldoende duidelijk zijn. Om resultaat te boeken met integraal gezondheidsbeleid is het essentieel meer kennis te ontwikkelen en uit te wisselen op het gebied van implementatie en effecten van integraal gezondheidsbeleid. Deze publicatie geeft een overzicht van de verschillende aspecten van integraal gezondheidsbeleid.Abstract not availabl

A surface-patterned chip as a strong source of ultracold atoms for quantum technologies

Laser-cooled atoms are central to modern precision measurements. They are also increasingly important as an enabling technology for experimental cavity quantum electrodynamics, quantum information processing and matter–wave interferometry. Although significant progress has been made in miniaturizing atomic metrological devices, these are limited in accuracy by their use of hot atomic ensembles and buffer gases. Advances have also been made in producing portable apparatus that benefits from the advantages of atoms in the microkelvin regime. However, simplifying atomic cooling and loading using microfabrication technology has proved difficult. In this Letter we address this problem, realizing an atom chip that enables the integration of laser cooling and trapping into a compact apparatus. Our source delivers ten thousand times more atoms than previous magneto-optical traps with microfabricated optics and, for the first time, can reach sub-Doppler temperatures. Moreover, the same chip design offers a simple way to form stable optical lattices. These features, combined with simplicity of fabrication and ease of operation, make these new traps a key advance in the development of cold-atom technology for high-accuracy, portable measurement devices

Cognitive function and drivers of cognitive impairment in a European and a Korean cohort of people living with HIV

Although cognitive impairments are still prevalent in the current antiretroviral therapy era, limited investigations have compared the prevalence of cognitive disorder in people living with HIV (PLWH) and its determinants in different regions and ethnicities. We compared cognitive performance across six domains using comparable batteries in 134 PLWH aged ≥45 years from the COBRA study (Netherlands, UK), and 194 PLWH aged ≥18 years from the NeuroAIDS Project (South Korea). Cognitive scores were standardized and averaged to obtain domain and global T-scores. Associations with global T-scores were evaluated using multivariable regression and the ability of individual tests to detect cognitive impairment (global T-score ≤45) was assessed using the area-under-the-receiver-operating-characteristic curve (AUROC). The median (interquartile range) age of participants was 56 (51, 62) years in COBRA (88% white ethnicity, 93% male) and 45 (37, 52) years in NeuroAIDS (100% Korean ethnicity, 94% male). The rate of cognitive impairment was 18.8% and 18.0%, respectively (p = 0.86). In COBRA, Black-African ethnicity was the factor most strongly associated with cognitive function (11.1 [7.7, 14.5] lower scores vs. white ethnicity, p < 0.01), whereas in NeuroAIDS, age (0.6 [0.1, 1.3] per 10-year, p<0.01) and education (0.7 [0.5, 0.9] per year, p<0.01) were significantly associated with cognitive function with anemia showing only a weak association (−1.2 [−2.6, 0.3], p=0.12). Cognitive domains most associated with cognitive impairment were attention (AUROC = 0.86) and executive function (AUROC = 0.87) in COBRA and processing speed (AUROC = 0.80), motor function (AUROC = 0.78) and language (AUROC = 0.78) in NeuroAIDS. Two cohorts of PLWH from different geographical regions report similar rates of cognitive impairment but different risk factors and cognitive profiles of impairment

Validation of a Novel Multivariate Method of Defining HIV-Associated Cognitive Impairment

Background. The optimum method of defining cognitive impairment in virally suppressed people living with HIV is unknown. We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patientreported outcome measures (PROMs), and neuroimaging markers of brain structure across 3 cohorts.Methods. Differences in the prevalence of cognitive impairment, PROMs, and neuroimaging data from the COBRA, CHARTER, and POPPY cohorts (total n = 908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS), and NMM criteria.Results. The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (eg, 48% for HAND vs 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints generally were weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (P&lt;.05). There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean cortical thickness in both hemispheres (P&lt;.05), as well as smaller brain volumes (P&lt;.01). The associations with measures of white matter microstructure and brain-predicted age generally were weaker.Conclusion. Different methods of defining cognitive impairment identify different people with varying symptomatology and measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer selfreported health status. This may be due to the statistical advantage of using a multivariate approach

V-ATPase-Mediated Granular Acidification Is Regulated by the V-ATPase Accessory Subunit Ac45 in POMC-Producing Cells

The regulation of the V-ATPase, the proton pump mediating intraorganellar acidification, is still elusive. We find that excess of the neuroendocrine V-ATPase accessory subunit Ac45 reduces the intragranular pH and consequently disturbs prohormone convertase activation and prohormone processing. Thus, Ac45 represents the first V-ATPase regulator

High cellular monocyte activation in people living with human immunodeficiency virus on combination antiretroviral therapy and lifestyle-matched controls is associated with greater inflammation in cerebrospinal fluid

Background. Increased monocyte activation and intestinal damage have been shown to be predictive for the increased morbidity and mortality observed in treated people living with human immunodeficiency virus (PLHIV). Methods. A cross-sectional analysis of cellular and soluble markers of monocyte activation, coagulation, intestinal damage, and inflammation in plasma and cerebrospinal fluid (CSF) of PLHIV with suppressed plasma viremia on combination antiretroviral therapy and age and demographically comparable HIV-negative individuals participating in the Comorbidity in Relation to AIDS (COBRA) cohort and, where appropriate, age-matched blood bank donors (BBD). Results. People living with HIV, HIV-negative individuals, and BBD had comparable percentages of classical, intermediate, and nonclassical monocytes. Expression of CD163, CD32, CD64, HLA-DR, CD38, CD40, CD86, CD91, CD11c, and CX3CR1 on monocytes did not differ between PLHIV and HIV-negative individuals, but it differed significantly from BBD. Principal component analysis revealed that 57.5% of PLHIV and 62.5% of HIV-negative individuals had a high monocyte activation profile compared with 2.9% of BBD. Cellular monocyte activation in the COBRA cohort was strongly associated with soluble markers of monocyte activation and inflammation in the CSF. Conclusions. People living with HIV and HIV-negative COBRA participants had high levels of cellular monocyte activation compared with age-matched BBD. High monocyte activation was predictive for inflammation in the CSF

Do people living with HIV experience greater age advancement than their HIV-negative counterparts?

Objectives: Despite successful antiretroviral therapy, people living with HIV (PLWH) may show signs of premature/accentuated aging. We compared established biomarkers of aging in PLWH, appropriately chosen HIV-negative individuals, and blood donors, and explored factors associated with biological age advancement. Design: Cross-sectional analysis of 134 PLWH on suppressive antiretroviral therapy, 79 lifestyle-comparable HIV-negative controls aged 45 years or older from the Co-mor- Bidity in Relation to AIDS (COBRA) cohort, and 35 age-matched blood donors. Methods: Biological age was estimated using a validated algorithm based on 10 biomarkers. Associations between ‘age advancement’ (biological minus chronological age) and HIV status/parameters, lifestyle, cytomegalovirus (CMV), hepatitis B (HBV) and hepatitis C virus (HCV) infections were investigated using linear regression. Results: The average (95% CI) age advancement was greater in both HIV-positive [13.2 (11.6–14.9) years] and HIV-negative [5.5 (3.8–7.2) years] COBRA participants compared with blood donors [7.0 (4.1 to 9.9) years, both P’s<0.001)], but also in HIV-positive compared with HIV-negative participants (P<0.001). Chronic HBV, higher anti-CMV IgG titer and CD8þ T-cell count were each associated with increased age advancement, independently of HIV-status/group. Among HIV-positive participants, age advancement was increased by 3.5 (0.1–6.8) years among those with nadir CD4þ T-cell count less than 200 cells/ml and by 0.1 (0.06–0.2) years for each additional month of exposure to saquinavir

Lacan, subjectivity and the task of mathematics education research

This paper addresses the issue of subjectivity in the context of mathematics education research. It introduces the psychoanalyst and theorist Jacques Lacan whose work on subjectivity combined Freud’s psychoanalytic theory with processes of signification as developed in the work of de Saussure and Peirce. The paper positions Lacan’s subjectivity initially in relation to the work of Piaget and Vygotsky who have been widely cited within mathematics education research, but more extensively it is shown how Lacan’s conception of subjectivity provides a development of Peircian semiotics that has been influential for some recent work in the area. Through this route Lacan’s work enables a conception of subjectivity that combines yet transcends Piaget’s psychology and Peirce’s semiotics and in so doing provides a bridge from mathematics education research to contemporary theories of subjectivity more prevalent in the cultural sciences. It is argued that these broader conceptions of subjectivity enable mathematics education research to support more effective engagement by teachers, teacher educators, researchers and students in the wider social domain

Validation of a novel multivariate method of defining HIV-associated cognitive impairment

Background. The optimum method of defining cognitive impairment in virally suppressed people living with HIV is unknown. We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patient– reported outcome measures (PROMs), and neuroimaging markers of brain structure across 3 cohorts. Methods. Differences in the prevalence of cognitive impairment, PROMs, and neuroimaging data from the COBRA, CHARTER, and POPPY cohorts (total n = 908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS), and NMM criteria. Results. The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (eg, 48% for HAND vs 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints generally were weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (P < .05). There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean cortical thickness in both hemispheres (P < .05), as well as smaller brain volumes (P < .01). The associations with measures of white matter microstructure and brain-predicted age generally were weaker. Conclusion. Different methods of defining cognitive impairment identify different people with varying symptomatology and measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer selfreported health status. This may be due to the statistical advantage of using a multivariate approac

A healthier region : Tips voor using the PHSF 2014

De handreiking 'Een gezondere regio' biedt handvatten om lokaal of regionaal met de informatie uit de VTV-2014 aan de slag te gaan. De handreiking helpt om de afwegingen tussen gezondheidsproblemen, politieke doelen en maatschappelijke waarden op speelse wijze te bespreken, om zo tot (integrale) beleids- en besluitvorming te komen. Bijvoorbeeld om een lokale of regionale volksgezondheidnota te ontwikkelen. Ook andere toepassingen zijn denkbaar. Zo is de informatie uit de VTV bruikbaar om de doelen of visie van een organisatie te formuleren of om aansluiting te zoeken bij nieuwe samenwerkingspartners. Verder kan hij worden gebruikt om in te spelen op lokale ontwikkelingen, zoals de overgang van de verantwoordelijkheid naar de gemeenten voor de jeugdzorg, werk en inkomen, en zorg aan langdurig zieken en ouderen. De handreiking bevat inzichten, werkvormen, (spel)materialen en inspiratie voor GGD'en of andere professionals. De VTV (Volksgezondheid Toekomst Verkenning) brengt elke vier jaar een grote hoeveelheid actuele informatie samen over gezondheid en zorg in Nederland.'A healthier region' is the title of a guidance document with tips for using the information contained in the Public Health Status and Foresight Report 2014 ('PHSF 2014') locally or regionally. The guidance can be useful for weighing up and discussing health problems, political goals and societal values in a light-hearted manner to accomplish integral policy making and decision-making. One example is its use in developing local or regional public health policy documents. Other kinds of use are also conceivable. The information in the PHSF can be used by organisations to formulate their goals or visions or to engage with new collaboration partners. It can also be used to respond to local developments like the transition to municipalities of responsibility for youth care, work and income and care for the long-term sick and the elderly. The guidance includes insights, ways of working, (game) materials and inspiration for Public Health Services and other professionals. Every four years the Public Health Status and Foresight Report, published by the Dutch National Institute for Public Health and the Environment (RIVM), brings together a large body of up-to-date information about health and care in the Netherlands.GGD-GHOR NederlandRIV