Care needs in dementia and digital interactive information provisioning

Jonker, C. [Promotor]Droes, R.M. [Promotor]Scheltens, P. [Copromotor]Meiland, F.J.M. [Copromotor

Validity and reliability of the Dutch version of the Camberwell Assessment of Need for the Elderly in community-dwelling people with dementia

Background: Tailor-made care in dementia requires an individual needs assessment. The Camberwell Assessment of Need for the Elderly (CANE) was developed to assess needs of older people with mental disorders. In this study the validity and reliability of the Dutch version of the CANE were studied among community-dwelling persons with dementia and their informal carers. Method: Interviews were carried out with 236 people with mild to severe dementia and 322 informal carers; 69 informal carers were interviewed twice. Construct and criterion validity and test-retest reliability of the CANE were studied using data for informal carers. Construct validity was also studied for CANE ratings of people with dementia. Results: The construct validity of the CANE was good among people with dementia and informal carers. Criterion validity could be studied for 76.9% of the CANE items, and all significant correlations were convergent. Test-retest reliability of the CANE varied from poor to very good and was best on domains where needs were explicit and problems well defined. Conclusions: Use of the Dutch version of the CANE among community-dwelling people with dementia and their carers is supported by the study results, with the study showing acceptable construct and criterion validity and test-retest reliability of the CANE. © 2008 International Psychogeriatric Association

Leaching of nitrate from agriculture to groundwater: the effect of policies and measures in the Netherlands

Nitrate concentrations in groundwater are correlated with the nitrogen surpluses at the soil surface. In the Netherlands, both nitrogen surpluses of agricultural land and nitrate concentrations in the groundwater of sandy soils are high. At present, nitrate concentrations in the groundwater of sandy soils exceed the 1980 EC Directive on the Quality of Water Intended for Human Consumption by a factor of 1 to 5. This paper discusses the effects of a series of policies and measures launched by the Dutchgovernment from 1986 onwards to decrease nitrogen losses to acceptable levels. Main focus is on the nitrogen and phosphorus accounting system MINAS, which will be implemented from 1998 onwards. The possible effects of the MINAS policy and measures on thenitrate contamination of groundwater have been examined via whole-farm analyses and simulation models, with a main focus on the nitrate leaky sandy soils and dairy farming systems. With MINAS, all farmers have to account for the nitrogen and phosphorus that is entering and leaving the farm. Further, MINAS includes charged and levy-free surpluses. The height of charges and the height of the levy-free surpluses together regulate the actual nitrogen surpluses at the farms. Levy-free nitrogen surpluses willbe lowered step-wise to 100 kg for arable land and 180 kg per ha for grassland in 2008. Following the implementation of the series of policy measures in the late eighties, data statistics indicate that the nitrogen surplus decreased from a mean of 347 kgper ha agricultural land 1985 to a mean of 299 kg per ha in 1995. Following the implementation of MINAS, our model predictions indicate that the nitrogen surplus at farm level will decrease further to a mean of 147 kg per ha in 2008, i.e. a reduction of 58% with reference to 1985. Mean nitrate concentrations at the average lowest groundwater level will decrease by 60%. Ultimately, 12% of the agricultural land (on sandy soils) will still have a nitrate concentration in the groundwater of more than 50 mg per litre. Our results indicate that MINAS is effective; they also indicate that additional measures are needed for agricultural land on dry sandy soils