A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERAS study)

Background: Although leg ulcers are a burdensome disease most common in those aged 65 years and older, frailty in this population has not yet been well established. Objectives: The aim of this study was to prospectively explore and compare the presence of frailty in elderly patients with chronic leg or foot ulcers by applying different validated frailty screening methods in three healthcare settings and to assess the feasibility of frailty screening. Methods: We compared frailty of leg ulcer patients referred to an academic hospital with a non-academic hospital, leg ulcer patients receiving (primary) homecare, and a dermato-oncology patient population (control group). Frailty and quality of life were assessed using four validated questionnaires: the Groninger Frailty Indicator, Geriatric-8, Mini-Cog and Wound Quality of Life. To analyse data multiple (non)-parametric tests were performed. Results: Fifty of 60 included leg ulcer patients (83%) scored “frail” on at least one frailty questionnaire (GFI, G8 or Mini-Cog). The number of patients scoring “frail” on two or three out of three applied frailty questionnaires were significantly higher in the academic and homecare ulcer population compared with the non-academic ulcer population and control group (p = 0.002). In the academic ulcer population mean Wound Quality of Life scores were 30.2 (SD 17.6), compared with 17.7 (SD 13.1) in the non-academic and 15.0 (SD 10.4) in the homecare ulcer population (p = 0.002). Conclusion: The majority of patients suffering from leg ulcers in this study was frail. The highest frailty prevalence was observed in the academic and homecare ulcer populations. The largest impaired quality of life was reported in the academic ulcer population. In dermatology practice, implementing frailty screening and initiating appropriate (paramedical) supportive care should be considered to improve patient outcomes.</p

Lessons learned from a decade implementing Comprehensive Sexuality Education in resource poor settings: The World Starts With Me

Contains fulltext : 158770.pdf (publisher's version ) (Open Access)Today, more than half of the world population is under the age of 25 years and one in four is under age 18. The urgency of expanding access to Comprehensive Sexuality Education (CSE) notably for children and young people in Africa and Asia is greater than ever before. However, many challenges to the implementation and delivery of CSE in resource poor settings have been identified in the literature. CSE's effectiveness could be strongly improved if these challenges were better met. This paper aims to contribute to those much-needed improvements by sharing lessons learned from a decade of implementation of one particular CSE programme, The World Starts With Me, among various populations in 11 low income countries in Africa and Asia. The aims, content, reach and effectiveness of the programme are described. Next, the challenges for implementation and delivery at student, teacher, school and context level are discussed with reference to the wider knowledge base in this area. Finally, suggestions are provided for ways forward including the increased sensitivity of programmes for normative and practical barriers to sexual health, further advancement towards gender transformativity, a far-reaching expansion of comprehensive forms of teacher training and coaching, and a serious stepping-up of multilevel 'whole school' approaches.16 p

Bodem verontreiniging met PCDDs en PCDFs van kleine (illegale) brandplaatsen van kabels en auto&apos;s

Abstract niet beschikbaarIn this report, results are presented of a study on the occurrence of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) in samples of soil, collected from suspected spots at seven locations in the vicinity of Amsterdam. From these areas it was known that small-scale (illegal) incineration of scrap wire and scrap cars might have resulted in contamination with PCDDs and PCDFs. A total of twenty samples, including five duplicates, was subjected to chemical analysis. Isomer specific analyses were performed at the Laboratory of Environmental and Toxicological Chemistry of the University of Amsterdam. Dioxin levels are expressed in ng 2,3,7,8-TCDD-equivalents per kg of dry material (ng I-TEQ/kg dry weight).DGM/S