Determinants of adverse health outcomes in late-life depression:the role of vitamin D and frailty

Older persons with a depression are at risk for vitamin D deficiency and physical health problems. Karen van den Berg studied the relationship between late-life depression, vitamin D, physical frailty and mortality.Among depressed older persons, vitamin D levels did not predict the course of depression. Lower vitamin D levels were associated with an increased risk to become physically frail or die. Specific depression characteristics did not influence the mortality risk, but physical frailty lead to a higher mortality risk. Two years later, vitamin D levels on average were decreased. This decrease was related to a worsening of physical frailty but not to the course of the depressive disorder. In depressed older persons, vitamin D supplementation might have a beneficial effect on the negative somatic health consequences associated with depression. Thus far, few studies, however, have focused on the effect of vitamin D on negative somatic health consequences besides the effect on depression.In clinical practice, adverse somatic health consequences of depression should be assessed and addressed in the treatment plan, since they negatively affect the prognosis. Since low vitamin D levels are common in depressed older persons, we recommend to actively strive for vitamin D supplementation in these population, even though a direct effect of vitamin D on depression is unlikely and the evidence for a link with adverse health consequences is still limited

Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial

Objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy with standard care in care home residents who have mobility limitations and are dependent in performing activities of daily living

Sympoiesis ‘becoming with and through each other’: Exploring collaborative writing as emergent academics

This paper explores our journey as three female academics as we collaboratively engage in the process of writing for scholarly publication. We read our experience through a Political Ethic of Care, Slow scholarship, and Sympoiesis. Informed by Barad’s (2007) relational ontology of space~time~mattering we explore our process of collaborative writing. We trace our journey as emerging scholars in different environments and through different modalities and material entanglements. The paper contributes to an understanding of how emerging academics find and create opportunities to develop their scholarly practice through collaborative sympoietic relationships. We show how through an engaged and sustained Slow scholarship we were able to claim space and time to enliven our creativity and joy. This empowered us to meaningfully assert ourselves within the context of a neoliberal academic environment and to reimagine how socially just practices of scholarly writing could be realised in the‘belly of the beast’

Flipped out in the blended classroom, the good, the bad and the ugly: When academics become students

This article explores the well-being of three academics from different higher education institutions and disciplines, as they engage in professional academic development (PAD) courses using technology. A collaborative autoethnographic approach is applied to reflect on our professional development experience. The higher education landscape is shifting to a cloud-based ICT infrastructure, opening up multiple educational opportunities in teaching and learning. Lecturers in higher education institutions (HEIs) are required to use a range of new technological tools and applications and engage in new learning methodologies. This is modelled in professional academic development courses, which integrate technology and digital tools into the teaching and learning process. Participant perspectives on PAD within a blended learning environment are examined through the lenses of an ethic of care and authentic learning to uncover social justice pedagogy. Using a diffractive approach in a collaborative autoethnographic study, the possibilities, tensions and contradictions of using technology to enhance pedagogy are explored. Findings point to the importance of an Ethic of Care and authentic learning, in order to enhance a social justice pedagogy in PAD

Adverse health outcomes in vitamin D supplementation trials for depression:A systematic review

BACKGROUND: Vitamin D deficiency is a universal risk factor for adverse health outcomes. Since depression is consistently associated with low vitamin D levels as well as several adverse health outcomes, vitamin D supplementation may be especially relevant for depressed persons. This review examines the potential benefits of vitamin D for (somatic) health outcomes in randomised controlled supplementation trials for depression. METHOD: Systematic literature search to assess whether adverse health outcomes, such as frailty, falls, or cognitive functioning, were included in vitamin D supplementation trials for depression, and whether these outcomes were affected by supplementation. The revised Cochrane tool for assessing risk of bias in randomised trials was used. RESULTS: Thirty-one trials were included. Adverse health outcomes were considered in five studies. Two studies reported some beneficial effect on an adverse health outcome. CONCLUSIONS AND IMPLICATIONS: While depressed persons are at increased risk of vitamin D deficiency, supplementation trials hardly addressed the common negative health consequences of low vitamin D levels as secondary outcome measures. Well-designed trials of the effects of vitamin D supplementation in late-life depression should explore whether adverse health outcomes can be prevented or stabilised, and whether depression benefits from this improvement

Incubating a slow pedagogy in professional academic development: An ethics of care perspective

The current neoliberal impetus in higher education has effects on all aspects of academic life, including professional academic development. These effects include increasing workloads and more casualisation of academic work, particularly teaching and a greater emphasis on quantification of scholarly outputs. The Slow movement provides an alternative way for valuing academic life (Berg and Seeber 2016; Bozalek 2017; Hartman and Darab 2012; Martell 2014; Ulmer 2017), as does the ethics of care, which has been used as a normative framework to evaluate and re-imagine academic development from a different perspective than that of neoliberalism (Bozalek et al. 2014; Tronto 2010). To date, however, there has been little engagement with how Slow pedagogy (Berg and Seeber 2016) might be put into conversation with an ethics of care to re/configure professional academic development. Our paper addresses this gap by diffractively reading the political ethics of care (Tronto 1993; 2013) through the concept of a Slow pedagogy in order to reimagine creative provocations for academic development. Experiences of a group of participants, who attended inter-institutional academic development courses in Cape Town, are drawn upon to illustrate the superpositions of these diffractive readings. The intra-actions in face-to-face and online meetings and artefacts are analysed to see what was helpful for the development and flourishing of the small group of participants using the new insights gained through the diffractive readings. Findings show how a professional development course, informed by elements of care ethics and Slow pedagogy, enhance the sustainability of professional learning communities

A prospective study into change of vitamin D levels, depression and frailty among depressed older persons

Objectives While vitamin D is involved in frailty as well as depression, hardly any study has examined the course of vitamin D levels prospectively. The objective of this study is to examine whether a change of vitamin D in depressed older adults is associated with either depression course, course of frailty, or both. Methods The study population consisted of 232 of 378 older adults (60-93 years) with a DSM-IV defined depressive disorder participating in the Netherlands Study of Depression in Older persons, a prospective clinical cohort study. Baseline and 2-year follow-up data on depressive disorder (DSM-IV diagnosis), symptom severity (inventory of depressive symptoms), frailty phenotype (and its individual components) and vitamin D levels were obtained. Linear mixed models were used to study the association of change in vitamin D levels with depression course, course of frailty, and the combination. Results Vitamin D levels decreased from baseline to follow-up, independent from depression course. An increase in frailty was associated with a significantly sharper decrease of vitamin D levels over time. Post hoc analyses showed that this association with frailty might be driven by an increase of exhaustion over time and counteracted by an increase in walking speed. Conclusions Our findings generate the hypothesis that vitamin D supplementation in late-life depression may improve frailty, which may partly explain inconsistent findings of randomised controlled trials evaluating the effect of vitamin D for depression. We advocate to consider frailty (components) as an outcome in future supplementation trials in late-life depression

Vitamin D deficiency and course of frailty in a depressed older population

Objective: To study the association between vitamin D levels and frailty, its components and course in a depressed sample. Methods: Baseline and two-year follow-up data from the depressed sample of the Netherlands Study of Depression in Older persons (NESDO), a prospective observational cohort study, were analyzed. The 378 participants (aged 60–93) had a diagnosis of depression according to DSM-IV criteria. Frailty was defined according to Fried’s physical phenotype. 25-OH vitamin D measurement was performed by liquid chromatography–tandem mass spectrometry. Linear and logistic regression analyses were performed, adjusted for covariates. Results: Higher vitamin D levels were cross-sectionally associated with lower prevalence of frailty (OR 0.64 [95%-CI 0.45–0.90], p =.010), predicted a lower incidence of frailty among non-frail depressed patients (OR 0.51 [95%-CI 0.26–1.00], p=.050), and, surprisingly, the persistence of frailty among frail depressed patients (OR 2.82 [95%-CI 1.23–6.49], p=.015). Conclusions: In a depressed population, higher vitamin D levels were associated with lower prevalence and incidence of frailty. Future studies should examine whether the favorable effect of low vitamin D levels on the course of frailty can be explained by confounding or whether unknown pathophysiological mechanisms may exert protective effects