Relationship between drug burden and physical and cognitive functions in a sample of nursing home patients with dementia.

PURPOSE: The Drug Burden Index (DBI) is a tool to quantify the anticholinergic and sedative load of drugs. Establishing functional correlates of the DBI could optimize drug prescribing in patients with dementia. In this cross-sectional study, we determined the relationship between DBI and cognitive and physical functions in a sample of patients with dementia. METHODS: Using performance-based tests, we measured physical and cognitive functions in 140 nursing home patients aged over 70 with all-cause dementia. We also determined anticholinergic DBI (AChDBI) and sedative DBI (SDBI) separately and in combination as total drug burden (TDB). RESULTS: Nearly one half of patients (48%) used at least one DBI-contributing drug. In 33% of the patients, drug burden was moderate (0 < TDB < 1) whereas in 15%, drug burden was high (TDB ≥ 1). Multivariate models yielded no associations between TDB, AChDBI, and SDBI, and physical or cognitive function (all p > 0.05). CONCLUSIONS: A lack of association between drug burden and physical or cognitive function in this sample of patients with dementia could imply that drug prescribing is more optimal for patients with dementia compared with healthy older populations. However, such an interpretation of the data warrants scrutiny as several dementia-related factors may confound the results of the study.

The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomised controlled trial.

OBJECTIVE: This study aimed to compare the effects of music therapy with general recreational day activities in reducing agitation in people with dementia, residing in nursing home facilities. METHODS: In a randomised controlled design, residents with dementia (n = 94) were allocated to either music therapy or recreational activities. Both music therapy and general activities were offered twice weekly for 4 months. Changes in agitation were measured with a modified Cohen-Mansfield Agitation Inventory (CMAI) at four intervals on each intervention day. A mixed model analysis was used to evaluate the effectiveness of music therapy, compared with general activities, on CMAI scores at 4 h after the intervention, controlled for CMAI scores at 1 h before the session and session number. RESULTS: Data were analysed for 77 residents (43 randomised to music therapy and 34 to general activities). In both groups, the intervention resulted in a decrease in agitated behaviours from 1 h before to 4 h after each session. This decrease was somewhat greater in the music therapy group than in the general activities group, but this difference was statistically not significant (F = 2.885, p = 0.090) and disappeared completely after adjustment for Global Deterioration Scale stage (F = 1.500; p = 0.222). CONCLUSIONS: Both music therapy and recreational activities lead to a short-term decrease in agitation, but there was no additional beneficial effect of music therapy over general activities. More research is required to provide insight in the effects of music therapy in reducing agitation in demented older people.

The corona pandemic and participatory governance: Responding to the vulnerabilities of secondary school students in Europe.

Adolescents in secondary schools have limited susceptibility to the SARS-COV-2 virus, but paradoxically are considered to be carrying the highest psychosocial burden during this pandemic. The aim of our European multi-country qualitative research was to investigate the COVID-19 crisis response in secondary schools and the role of national, regional, and local stakeholders in contributing to a participatory governance approach. We carried out 11 months of qualitative fieldwork, which included 90 respondents from the Netherlands, Ireland, and Finland for in-depth interviews and/or group discussions. Participant observation was conducted in four secondary schools to explore the interplay of day-to-day formal and informal practices of crisis governance. Our findings contribute to a better understanding of what efforts were made to facilitate participatory governance and where a bottom-up approach would have served useful in successfully implementing the COVID-19 mitigation strategies. Moreover, we show how these mitigation strategies have led to unintended consequences, such as students' difficulties with isolation and associated mental health problems, and the struggles of socialization when returning to a physical school environment. Our findings highlight the importance of the school environment in the socio-emotional developments of adolescents. We introduce the TAPIC-R model to analyze good governance, advancing the existing TAPIC model with an emphasis on the role of resilience in shaping participatory governance. We argue this is urgently needed during crises to strengthen engagement of the community, including vulnerable groups and achieve positive outcomes within and across policy structures and action domains.

Selection of Sphingomonadaceae at the base of Laccaria proxima and Russula exalbicans fruiting bodies.

The dense hyphal network directly underneath the fruiting bodies of ectomycorrhizal fungi might exert strong influences on the bacterial community of soil. Such fruiting bodies might serve as hot spots for bacterial activity, for instance by providing nutrients and colonization sites in soil. Here, we assessed the putative selection of specific members of the Sphingomonadaceae family at the bases of the fruiting bodies of the ectomycorrhizal fungi Laccaria proxima and Russula exalbicans in comparison to the adjacent bulk soil. To do so, we used a previously designed Sphingomonadaceae-specific PCR-denaturing gradient gel electrophoresis (DGGE) system and complemented this with analyses of sequences from a Sphingomonadaceae-specific clone library. The analyses showed clear selective effects of the fruiting bodies of both fungi on the Sphingomonadaceae community structures. The effect was especially prevalent with R. exalbicans. Strikingly, similar fungi sampled approximately 100 m apart showed similar DGGE patterns, while corresponding bulk soil-derived patterns differed from each other. However, the mycospheres of L. proxima and R. exalbicans still revealed divergent community structures, indicating that different fungi select for different members of the Sphingomonadaceae family. Excision of specific bands from the DGGE patterns, as well as analyses of the clone libraries generated from both habitats, revealed fruiting body-specific Sphingomonadaceae types. It further showed that major groups from the mycospheres of R. exalbicans and L. proxima did not cluster with known bacteria from the database, indicating new groups within the family of Sphingomonadaceae present in these environments.

Prevalence of dementia in a rural Netherlands population and the influence of DSM-III-R and CAMDEX criteria for the prevalence of mild and more severe forms.

To obtain estimates of the prevalence of mild and moderate/severe dementia among people age 65 and over, applying criteria for severity of both DSM-III-R and CAMDEX, a two-stage community-based study was conducted in a rural area of the Netherlands. In the first stage, 2191 subjects (out of the target population of 2655) participated in an interview which included the Mini-Mental State Examination (MMSE). Based on MMSE score, a non-proportional random sample (n=496) was drawn for the second stage. A total of 421 subjects responded and were subsequently examined using the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). In determining the severity of dementia, criteria of both DSM-III-R and CAMDEX were applied. Overall prevalence for both classification systems was 6.5%. There was a large discrepancy between the two classification systems with regard to the criteria for rating severity. The prevalence of moderate/severe dementia using DSM-III-R criteria was twice as high as the prevalence using CAMDEX criteria. These findings reflect the differences between DSM-III-R and CAMDEX in descriptions of dementia severity. Rating according to CAMDEX predicts institutionalization in specialized nursing homes somewhat better than staging according to DSM-III-R. Both content analysis and institutionalization data suggest that the CAMDEX operationalization of rating severity seems preferable.

Characteristics of non-responders and the impact of non-response on prevalence estimates of dementia.

BACKGROUND: Differential distributions of sociodemographic characteristics and cognitive impairment in responders and non-responders may result in a biased prevalence estimate of dementia based on responders only. METHODS: Responders (n = 2191) to a cross-sectional, two-stage community study were compared with regard to sociodemographic characteristics and cognition with three subgroups of non-responders: (A) subjects who refused to participate (n = 369), (B) subjects who were too ill or who had died prior to the screening (n = 72) and (C) subjects who had moved out of the study region or were not traceable (n = 23). Prevalence estimates specific for age and housing situation in responders and physicians' ratings of cognitive impairment were used to estimate the prevalence of dementia among non-responders. RESULTS: Group A differed from responders in age and housing situation, group B in age, housing and cognition, and group C only in age. Separate prevalence estimates of dementia based on age, housing and cognition yielded figures for group A between 4.9% and 7.2%, for group B between 13.1% and 19.1%, and for group C between 2.6% and 4.2%. Joined with the prevalence rate among responders (6.5%) the best possible point estimate of the prevalence of dementia in the target population lies between 6.4% and 6.9%, i.e. within the 95% confidence interval (CI) of the prevalence among responders (5.4-7.5%). CONCLUSIONS: Although in this study non-response had no important influence on the overall prevalence, the findings among the distinct non-response subgroups point to the importance of describing non-response sociodemographically as well as in terms of the study objective. The authors recommend that non-responders are categorized into distinct groups based on the reason for non-response.

A 19F NMR study of fluorobenzoate biodegradation by Sphingomonas sp. HB-1.

While several microorganisms readily degrade 2- and 4-fluorobenzoates, only a very small number appear to catabolise the 3-fluoro isomer, owing to the accumulation of toxic intermediates. Here we describe the isolation of a bacterium capable of using 3-fluorobenzoate as a sole source of carbon and energy, and the experiments conducted to define the steps involved in the biodegradation of this compound. The organism was identified as a strain belonging to the genus Sphingomonas by sequence analysis of its 16S rRNA gene. To date no other organism from this genus is known to degrade this compound. Using fluorine nuclear magnetic resonance spectroscopy (19F NMR) to analyse the culture supernatant it was possible to observe the disappearance of 3-fluorobenzoate and the appearance of fluoride ion and four other fluorinated compounds. These were identified as 3-fluorocatechol, 2-fluoromuconic acid and 3- and 5-fluoro-1,2-dihydro-1,2-dihydroxybenzoates. Thus, the likely catabolic pathway involves dioxygenation of 3-fluorobenzoate yielding fluorocatechol and subsequent intra-diol cleavage to yield fluoromuconic acid. The organism can also use 2- and 4-fluorobenzoates as growth substrates.

Cancer pain control by infusion techniques in the home situation in the Northern Netherlands: an innovative project on the use of medical technology in the home situation.

Since 1982, 229 terminally ill cancer pain patients were treated by the administration of epidural opioids. An adequate level of aid was provided by the coordinated efforts of the patients' general practitioner, the district nurse, and the anesthesiologist. Based on 9 yr of experience with this model, a project on quality improvement and organization of cancer pain control by infusion techniques in the home situation was proposed. The purpose of the study is to create a nationwide organization for cancer pain control for terminal patients on a home-care basis. Specially trained ambulatory field teams will be set up to collect and process the information necessary to make protocols and instructions.

Fairy tales as a trance experience: possible therapeutic uses.

The psychological literature contains little documentation of the therapeutic use of fairy tales. We suggest that fairy tales are uniquely suitable for hypnotherapy and for helping clients reframe existential issues. We propose that the structure of fairy tales allows the meaning of the story to be applied personally and that they also stimulate unconscious search. We examine the way in which hypnosis is achieved when fairy tales are read to children, as well as possible therapeutic uses of this learning set in therapy with both children and adults. We conclude by suggesting that fairy tales need to be given serious consideration as an alternative therapeutic trance procedure.

[The dementia syndrome in the clinical practice of 15 family physicians. A pilot study of the prevalence in the Zwolle area]. / Het dementiesyndroom in de praktijk van 15 huisartsen. Een oriënterend prevalentie-onderzoek in de regio Zwolle.

A pilot investigation among 15 general practitioners in the region of Zwolle has been carried out in order to obtain an indication as to the prevalence of the dementia syndrome among noninstitutionalized elderly people. According to the general practitioner--on the basis of the Clinical Dementia Rating--4.4% of the population of people of 65 years and older display the symptoms of dementia, a percentage that is low compared with foreign studies. There is a striking difference in the prevalence rate between urban (2.8%) and rural (5.7%) populations. The most obvious explanation for this difference is that in rural areas there is more informal care and a larger degree of tolerance of demented elderly people, which helps prevent institutionalization. This assumption is supported by an identical difference in the admission rate to nursing homes. As a person becomes older, the chance that he/she will suffer from the dementia syndrome increases, although the increase is not a steady one. Despite the well-recognized necessity for thorough medical examination of demented elderly people, it is only carried out to a small degree. The authors argue in favour of more extensive research into the prevalence rate of the dementia syndrome, which will promote policy making with regard to medical practice and the planning of care facilities.

Epidural pain treatment in the northern Netherlands. Organizational and treatment aspects.

During the past six years opiates administered in the vicinity of the medulla spinalis (intrathecally or extradurally) were shown to be successful tools in the treatment of both acute and chronic pain (1, 6). Continuous installation and long-term treatment have become possible by insertion of a permanent catheter into the epidural space. In cases where conventional analgesic therapy has remained ineffective or given rise to serious side-effects this method of analgesia should be preferred to control protracted painful conditions, most typically in cancer patients. This article presents the results of a number of cases of long-term treatment with extradural opiates and mainly focuses on outpatient treatment and the organization this requires.

[The health status and health care use of elderly living in sheltered residences. A comparison with independently living elderly]. / Gezondheidstoestand en zorggebruik van bewoners van service-ouderenwoningen. Een vergelijking met zelfstandig wonenden.

A sheltered residence for older persons is a living arrangement in between independent living and a residential institution. There is little knowledge about the health of elderly living in these residences. We studied the physical, functional and psychosocial health of 401 persons living in a sheltered residence for elderly in Zwolle through a standardised interview. We compared the health of these elderly to the health of independently living elderly in the same region studied in the Longitudinal Aging Study Amsterdam and adjusted for sex, age and married state. We found an impaired functional health and more chronic illnesses among elderly living in a sheltered residence. In addition, more medication was used (OR = 2.4). The studied elderly felt more often depressed (OR = 1.9) or lonely (OR = 1.7). Their mental state was more frequently impaired (OR = 1.7), they visited health professionals more often and received more help for personal care (OR = 2.0) and housekeeping (OR = 1.6). We conclude that people living in sheltered residences form a distinct group of elderly, characterised by impaired physical, functional and psychosocial health. Planners of future care must be aware of this vulnerable group.

Effects of adrenaline, an alpha 2-adrenoceptor agonist, the volume of injection, and the global pain state of the animal on the activity of epidural sufentanil.

A study was made of the effects of different volumes of injection product, adrenaline, the alpha 2-adrenoceptor-agonist medetomidine and Mycobacterium butyricum on epidural sufentanil in the rat. Increasing the volume of epidural sufentanil, and similarly decreasing the concentration of the injection product, resulted in a potentiation of the analgesic properties of epidural sufentanil without affecting the effects of the drug on the pinna and cornea reflexes and on muscle tonus. An analogue effect was observed if rats were tested for epidural analgesia during a chronic pain phase after inoculation with Mycobacterium butyricum. Adding adrenaline to epidural sufentanil also resulted in an increased analgesia but there was also a minor potentiation of all other behavioural parameters measured. The alpha 2-adrenoceptor-agonist medetomidine, clearly potentiated all behavioural effects induced by epidural sufentanil. As a consequence, there was no gain in specificity for epidural analgesia. Medetomidine, however, clearly reversed the normally observed skeletal muscle rigidity into a muscle hypotonia. Globally, these results thus indicate that manipulations of the volume of injection, the additional treatment with other drugs and the pain state of the animal can alter the activity of epidural sufentanil. Therefore, it might be concluded that the differences in the duration of analgesia observed with epidural sufentanil between human and animal studies can be partially explained in terms of differences between the experimental conditions.

[Prevalence and severity of the dementia syndrome in homes for the aged and nursing homes. A study in elderly from a rural area near Zwolle]. / Prevalentie en ernst van het dementiesyndroom in bejaardenoorden en verpleeghuizen. Een onderzoek bij ouderen afkomstig van het platteland rondom Zwolle.

In the Netherlands both nursing homes and homes for the aged serve as a residence for demented elderly. Although these institutions differ considerably regarding financing and care facilities, specific functions of each institute concerning demented elderly have not been clearly defined. In order to know to what extent residential facilities serve demented elderly, the prevalence and severity of dementia among residents aged 65 and over was studied as part of a prevalence study among elderly people in a rural area of the Netherlands. The target population existed of all persons aged 65 and over who were registered in eight general practices. Patients who had to leave the practice on account of ill-health and were admitted to nursing homes were included in the study. In a two stage study the MMSE was applied as a screening instrument. Based on MMSE-score a non-proportional stratified random sample was drawn for the second, diagnostic stage, which existed of the CAMDEX. Prevalence estimates for DSM-III-R-dementia were 21% among residents of homes for the aged, 48% among residents of somatic wards of nursing homes and 100% among those admitted to psychogeriatric wards of nursing homes. Severity of dementia was highest among residents of psychogeriatric wards of nursing homes and lowest among those living in homes for the aged. Prevalence of dementia among residents of homes for the aged can be fully attributed to the age-distribution. The high frequency of dementia among residents of somatic nursing home wards can be explained in several ways: First, admission can be necessary due to a combination of dementia and somatic illness.(ABSTRACT TRUNCATED AT 250 WORDS)

[Usefulness of the 'Mini-Mental State Test'for the diagnosis of dementia; study of criterion validity in a Dutch rural population]. / Bruikbaarheid van de 'Mini-mental state examination' voor het vaststellen van dementie; onderzoek naar de criteriumvaliditeit in een Nederlandse plattelandspopulatie.

OBJECTIVE: To establish the criterion validity of the MMSE for dementia in a community-based population. DESIGN: Descriptive. SETTING: Eight rural general practices and eight adherent institutions for long-term care near Zwolle, the Netherlands. METHODS: In the first (screening) stage, the MMSE was applied, in the second (diagnostic) stage the 'Cambridge examination for mental disorders of the elderly' (CAMDEX) was used. After exclusion of subjects with clinically relevant impairment of hearing and (or) vision, analyses were based on 2151 screened subjects. Based on a non-proportional, stratified randomized sampling procedure using the MMSE score as the stratification variable, 390 of the screened subjects were examined with the CAMDEX. Seventy-seven cases of DSM-III-R dementia were identified. Based on 390 paired observations the relationship between MMSE score and DSM-III-R dementia was modelled by logistic regression. After extrapolation of this relationship to the total screened population, sensitivity and specificity figures were calculated at several cut-offs of the MMSE, and Receiver Operating Characteristic (ROC) curves were constructed for the total population as well as for four subpopulations. (men, women, < 80, > or = 80 years). RESULTS: At the cut-off of 23/24, sensitivity was 0.76 and specificity 0.91 in the total population. However, the criterion validity of the MMSE varied substantially between the four sex-age combinations. Criterion validity was especially poor for women in the younger age range. CONCLUSION: The MMSE has only limited value in clinical practice. Use of uniform cut-offs has to be rejected.

Students Perception of Ability Scale: comparison of scores for gifted, average, and learning disabled students.

On the Student's Perception of Ability Scale, comparison of scores for gifted, average, and learning disabled students differentiated the groups, thereby providing some construct validity as well as confirming the ceiling is high enough for use.

Performance of students with learning disabilities on validity indexes of the Perception of Ability Scale for Students.

The present study examined the performance of 78 students with learning disabilities and 71 normally achieving students in regular Form 1 (Grade 6) classes on three validity indexes of the Perception of Ability Scale for Students, a measure of academic self-concept. The three indexes assess consistency of responding, negative or positive response biases, and misrepresentation of self-perceptions in terms of unrealistic perceptions of perfection in school. Analysis showed that learning disabled students obtained significantly lower Full Scale scores than the normal students, but no significant differences appeared on the three validity indexes. Users of the test can be confident that learning disabled students respond to items in as valid a manner as other students. Having specific learning problems in school should not interfere with response patterns on this scale.