Changes in health-related quality of life in older patients with acute myocardial infarction or congestive heart failure: a prospective study

OBJECTIVES: To study changes in health-related quality of life (HR-QL) following acute myocardial infarction (AMI) or congestive heart failure (CHF) in older people (greater than or equal to 57 yr).DESIGN: Prospective cohort Study.SETTING: Primary healthcare registers.PARTICIPANTS: Patients were enrolled on the basis of primary healthcare records. Eighty-nine AMI patients (mean age = 69.5) and 119 CHF patients (mean age = 74.5) were included for analysis.MEASUREMENTS: HR-QL was conceptualized and measured by means of physical (activities of daily living (ADL), instrumental activities of daily living (IADL)), psychological (depressive symptoms, anxiety), social, and role functioning. Premorbid data (TO) were available from a 1993 community-based survey. Incident AMI and CHF cases, developed after 1993, were prospectively followed for 12 months. Assessments were performed at 6 weeks (T1) and 6 (T2) and 12 months (T3) after diagnosis.RESULTS: At the premorbid assessment, AMI patients did not significantly differ on HR-QL from a reference group of older people, whereas CHF patients were on average older and had worse HR-QL compared to the reference group. Although CHF had not yet been diagnosed at TO, symptoms were already present and resulted in decreased levels of functioning. At T1, all HR-QL measures showed worse functioning compared with TO, except for depressive symptoms that presented later (at T2). In contrast to the delay in depressive symptoms, a significant increase in anxiety was already seen at T1. The effect of the somatic conditions was the largest on physical functioning. Effects on psychological and social functioning were less pronounced but still significant. Effects were maintained during the 12 months of follow-up.CONCLUSION: The negative consequences on HR-QL in both AMI and CHF patients are not temporary. No recovery of function was seen in AMI patients, and functioning and CHF patients continued to decline in the first year after diagnosis

Religious education in two secular multicultural societies. The Turkish and Dutch case compared

In this paper we present in the first section the historical antecedents of the Turkish and Dutch educational system regarding religion(s) in education. In the second section we will outline the different approaches in religious education in both countries. In the third section the focus is on the relationship between state and church. In the fourth section the issue is how in both countries curricula and textbooks for religious education are constructed, checked and approved. Finally, we will summarize the most remarkable points of comparison between the Dutch and the Turkish case regarding religion(s) in education. © 2011 Published by Elsevier Ltd

A criterion for condensation in kinetically constrained one-dimensional transport models

We study condensation in one-dimensional transport models with a kinetic constraint. The kinetic constraint results in clustering of immobile vehicles; these clusters can grow to macroscopic condensates, indicating the onset of dynamic phase separation between free flowing and arrested traffic. We investigate analytically the conditions under which this occurs, and derive a necessary and sufficient criterion for phase separation. This criterion is applied to the well-known Nagel-Schreckenberg model of traffic flow to analytically investigate the existence of dynamic condensates. We find that true condensates occur only when acceleration out of jammed traffic happens in a single time step, in the limit of strong overbraking. Our predictions are further verified with simulation results on the growth of arrested clusters. These results provide analytic understanding of dynamic arrest and dynamic phase separation in one-dimensional traffic and transport models

The role of cognitive abilities in laparoscopic simulator training

Learning minimally invasive surgery (MIS) differs substantially from learning open surgery and trainees differ in their ability to learn MIS. Previous studies mainly focused on the role of visuo-spatial ability (VSA) on the learning curve for MIS. In the current study, the relationship between spatial memory, perceptual speed, and general reasoning ability, in addition to VSA, and performance on a MIS simulator is examined. Fifty-three laparoscopic novices were tested for cognitive aptitude. Laparoscopic performance was assessed with the LapSim simulator (Surgical Science Ltd., Gothenburg, Sweden). Participants trained multiple sessions on the simulator until proficiency was reached. Participants showed significant improvement on the time to complete the task and efficiency of movement. Performance was related to different cognitive abilities, depending on the performance measure and type of cognitive ability. No relationship between cognitive aptitude and duration of training or steepness of the learning curve was found. Cognitive aptitude mediates certain aspects of performance during training on a laparoscopic simulator. Based on the current study, we conclude that cognitive aptitude tests cannot be used for resident selection but are potentially useful for developing individualized training programs. More research will be performed to examine how cognitive aptitude testing can be used to design training programs

外国雜誌論題

markdownabstractMusculoskeletal disorders (MSDs) are universally prevalent among all age and gender groups and across all socio-demographic strata of society. Besides causing pain and decreased functional capacity, MSDs have a substantial influence on work capacity and quality of life. Altogether, they inflict an enormous financial burden on society through direct medical costs as well as indirect costs due to loss of productivity and social security benefits. The yearly burden of disease in the Netherlands for the two most important groups of MSDs, low back pain (LBP) and neck and upper extremity complaints, is over € 5.500 million. The majority of MSDs fall into the category of nonspecific disorders. Often these nonspecific disorders are related to overload, deconditioning or workrelated overexertion. Although much research has been performed, especially with regard to LBP, knowledge about the long-term pain patterns or predictors over the life course is limited. For many possible prognostic indicators, especially regarding the psychosocial domain, consistent evidence is lacking. Early identification of patients more likely to develop persistent symptoms could help to guide decisions regarding medical management. However, optimal management strategies, including attention for psychological and workrelated factors, are still unclear. In this thesis several studies are brought together about the course, prognosis and management of LBP and neck and upper extremity complaints. Together, these studies provide insight into the possibilities to identify subgroups of patients through the assessment of non-medical criteria, especially within the category of nonspecific complaints. These subgroups might profit from a different approach in treatment or guidance

A plea for inclusive worldview education in all schools

Taking personhood education (‘Bildung’) of students as the aim of schools, the author argues that worldview education should form an integral part of this education in all schools. It is shown that such a conceptualisation of worldview education is adequately combinable with citizenship education. In worldview-citizenship education the emphasis is first of all on students’ appropriation and (continuous) development of their own worldview. A second important aim of this modus of education is that students should learn to live together in the context of the school as an embryonic society which represents different worldviews. With this two−fold aim the individual or personal and the social or communal side of the pedagogical coin are kept together. In the final part a concrete example of an inclusive practice of worldview citizenship education is described in a partnership of a Christian, a state, and an Islamic elementary school in the area of Amsterdam South−East