Psychosocial health of cochlear implant users compared to that of adults with and without hearing aids: Results of a nationwide cohort study.

OBJECTIVES: This study aimed to examine the psychosocial health status of adult cochlear implant (CI) users, compared to that of hearing aid (HA) users, hearing-impaired adults without hearing aids and normally hearing adults. DESIGN: Cross-sectional observational study, using both self-reported survey data and a speech-in-noise test. SETTING: Data as collected within the Netherlands Longitudinal Study on Hearing (NL-SH) between September 2011 and June 2016 were used. PARTICIPANTS: Data from 1254 Dutch adults (aged 23-74), selected in a convenience sample design, were included for analyses. MEAN OUTCOME MEASURES: Psychosocial health measures included emotional and social loneliness, anxiety, depression, distress and somatisation. Psychosocial health, hearing status, use of hearing technology and covariates were measured by self-report; hearing ability was assessed through an online digit triplet speech-in-noise test. RESULTS: After adjusting for the degree of hearing impairment, HA users (N = 418) and hearing-impaired adults (N = 247) had significantly worse scores on emotional loneliness than CI users (N = 37). HA users had significantly higher anxiety scores than CI users in some analyses. Non-significant differences were found between normally hearing (N = 552) and CI users for all psychosocial outcomes. CONCLUSIONS: Psychosocial health of CI users is not worse than that of hearing-impaired adults with or without hearing aids. CI users' level of emotional loneliness is even lower than that of their hearing-impaired peers using hearing aids. A possible explanation is that CI patients receive more professional and family support, and guidance along their patient journey than adults who are fitted with hearing aids.

Patient navigation and activation interventions for elderly patients with cancer: A systematic review.

Patient navigation (PN) and patient activation (PA) interventions are widely used to help patients with cancer to manage the disease and the care trajectory. However, the usability and impact of these interventions on older patients and their well-being are unclear. This study aims to show which PN and PA interventions are being used and what impact they have. After systematically searching the literature, we assessed the quality of the publications we found. The publications had to involve at least a subgroup of older people with minimally one abnormal oncologic test result each, and they had to focus on PN or PA interventions. Six PA publications examined the interventions exclusively for elderly patients. Each of the 11 PN and PA publications contained at least one comment about the impact on older patients. The types of impact varied substantially, but there was scant attention to the quality of life. The type of intervention, the outcome measures and the quality of publications also varied considerably. Generally, age is not an important factor in PN and PA studies. To facilitate adjustment of navigation and activation interventions to the individual patient, more rigorous research into the impact of PN and PA interventions on older patients is necessary.

Person-centred care and job satisfaction of caregivers in nursing homes: a systematic review of the impact of different forms of person-centred care on various dimensions of job satisfaction.

OBJECTIVE: The positive effects of person-centred care on older clients have been demonstrated. However, relatively little is known about the effect that giving person-centred care has on caregivers. This literature review examines the job satisfaction of caregivers who deliver person-centred care in nursing homes. DESIGN: The research questions are: Do the various forms of person-centred care affect job satisfaction differently? Which particular dimensions of job satisfaction have been evaluated in studies on person-centred care, and does their sensitivity to person-centred care differ? Using the search engines Pubmed, Cinahl, Psychinfo and Embase up to August 2010, 46 efficacy studies were found, seven of which satisfied our criteria. RESULTS: Emotion-oriented care, snoezelen, and small-scale care most often show positive effects on job satisfaction. Person-centred care has been shown to have positive effects on general job satisfaction, job demands at psychogeriatric wards, emotional exhaustion and personal accomplishment. CONCLUSIONS: Taking into account the fair-to-moderate quality of the studies included, it is concluded that there are limited indications that person-centred care has a positive effect on a number of dimensions of caregivers' job satisfaction. Further study is required to expand and to support these tentative conclusions.

Black tea reduces diarrhoea prevalence but decreases growth performance in enterotoxigenic Escherichia coli-infected post-weaning piglets.

Enterotoxigenic Escherichia coli (ETEC) is a main cause of diarrhoea in humans and piglets. In vitro, black tea extract (BTE) has anti-pathogenic properties. Anti-diarrhoeal properties of BTE were assessed in a pig model of gastrointestinal infection. At weaning (day 0), piglets (n = 96) were randomly assigned to a diet containing 0% (control), 0.4% or 0.8% (wt/wt) BTE during 27 days. Piglets were orally infected with 6.4 × 10(6) cfu of ETEC on day 6. Faecal consistency, feed intake and body weight were measured. In a sub-study (n = 30 piglets), the effect of BTE palatability on feed intake was assessed. Additionally, the effect of BTE on ETEC growth in the presence or absence of iron was studied in vitro. The 0.8% BTE diet reduced diarrhoea prevalence by 20% but also decreased feed intake by 16% and feed efficiency by 12% over the total period. The 0.4% BTE diet decreased feed efficiency and weight gain from day 13 onwards. The palatability study demonstrated that piglets preferred the control to the BTE diets. In vitro, BTE delayed ETEC exponential growth, which was reversed by iron addition. Although BTE had anti-diarrhoeal properties, this effect was accompanied by impaired performance. The absence of a correlation between diarrhoea prevalence and feed intake suggests that reduced diarrhoea directly results from BTE rather than from reduced feed intake caused by BTE astringency.

[Cognitive behavioural therapy for schizophrenia]. / Cognitieve gedragstherapie bij schizofrenie.

UNLABELLED: BACKGROUND The publication of the Dutch multidisciplinary guidelines Schizophrenia and the launching of the Breakthrough project on schizophrenia led by the Trimbos Institute in 2006 aroused considerable interest in the Netherlands for the implementation of cognitive behavioural therapy for patients with schizophrenia. One of the reasons was that pharmacotherapy has its limitations in the treatment of schizophrenia; an antipsychotic drug does not lead to an adequate decrease in psychotic symptoms in all patients; cognitive behavioural therapy is then added as a form of psychotherapy. The effectiveness of cognitive behavioural therapy has been described in meta-analyses. AIM: To ascertain the efficacy of cognitive behavioural therapy for the treatment of schizophrenia and to give advice on how this therapy can be implemented. METHOD: We reviewed relevant articles and meta-analyses via PubMed and Ovid using the search terms: 'cognitive behavioural therapy', 'continuity/psychosis', 'implementation', 'metaanalysis', 'nurse therapist', 'psychosis' , 'schizophrenia'. results Many randomised controlled trials show the effectiveness of cognitive behavioural therapy in the treatment of schizophrenia. At the moment, the encouraging results of scientific research are not being adequately transferred to clinical practice. However, the performance of special interventions by trained nurses is making implementation feasible. CONCLUSION: Cognitive behavioural therapy is an effective treatment for schizophrenia. It is advisable that this type of therapy be made available to patients, in accordance with their specific needs.

Bim, Bad and Bmf: intrinsically unstructured BH3-only proteins that undergo a localized conformational change upon binding to prosurvival Bcl-2 targets.

All BH3-only proteins, key initiators of programmed cell death, interact tightly with multiple binding partners and have sequences of low complexity, properties that are the hallmark of intrinsically unstructured proteins (IUPs). We show, using spectroscopic methods, that the BH3-only proteins Bim, Bad and Bmf are unstructured in the absence of binding partners. Detailed sequence analyses are consistent with this observation and suggest that most BH3-only proteins are unstructured. When Bim binds and inactivates prosurvival proteins, most residues remain disordered, only the BH3 element becomes structured, and the short alpha-helical molecular recognition element can be considered to behave as a 'bead on a string'. Coupled folding and binding is typical of many IUPs that have important signaling roles, such as BH3-only proteins, as the inherent structural plasticity favors interaction with multiple targets. This understanding offers promise for the development of BH3 mimetics, as multiple modes of binding are tolerated.

This is an older men's world: A qualitative study of men's experiences with prostate cancer.

PURPOSE: Prostate cancer is highly prevalent and invasive among older men. Not knowing their experiences hampers care and support to men with prostate cancer and prostate cancer survivors. This study aims to provide insight into older men's experiences with prostate cancer in order to improve personalised care. METHODS: A qualitative research design through semi-structured interviews with 22 older men with prostate cancer was conducted in two areas of the Netherlands in 2015. Patients were selected through systematic non-probabilistic sampling. The transcripts were analysed with conventional content analysis and affinity diagramming. RESULTS: Four themes emerged from the data: impact of prostate cancer, dealing with prostate cancer and treatment, involvement of and with others, and experiences with professional care and the care trajectory. The way patients dealt with prostate cancer and their experiences with the care they received varied. Overall, hospital care was rated positively, and communication was a crucial determinant of the patient's satisfaction or dissatisfaction. Some patients lacked information about their health status, which may have influenced decision-making processes. Some were reluctant to talk about their disease with other people and sometimes hesitated to ask for help. CONCLUSION: Despite many positive care experiences, some patients felt that the communication, information provision and decision-making were inadequate. Vulnerable patients with severe complications or limited social support may need additional psychosocial care. Lowering the threshold for patients to ask for help and the availability of a professional with expert knowledge about prostate cancer and ageing may decrease unnecessary hardship and increase personal strengths.

[Postmeningitis deafness in young children: action warranted before obliteration of the cochlea]. / Doofheid na bacteriële meningitis bij jonge kinderen: ingrijpen vóór de cochlea is geoblitereerd.

Meningitis may cause inflammation of the cochlea, which may result in deafness and also in rapid obliteration ofthe cochlea with fibrous tissue or even ossification, conditions that obstruct the placement ofa cochlear implant. In the first of two cases of postmeningitis deafness, in a boy aged 6 months and a girl aged 1 year and 9 months, ignorance about the time of audiological follow-up threatened the options for restoration of hearing. In the other case, a long diagnostic programme and an unsuccessful attempt at cochlear implantation caused a long delay in optimal restoration of hearing. Both cases illustrate the difficulties in connection with postmeningitis deafness in relation to the option of a cochlear implant operation. To increase the chances of a successful implantation, the time span between meningitis and audiological and radiological follow-up must be short. Auditory brain stem responses (ABR) and MRI are the keystones of the work-up.

[Combined vision and hearing impairment: in an estimated 30,000-35,000 people aged 55 years or over in The Netherlands]. / Gecombineerde visus- en gehoorbeperking: naar schatting bij 30,000-35,000 55-plussers in Nederland.

OBJECTIVE: To determine the number of older people with acquired dual sensory impairment (DSI) in The Netherlands. DESIGN: Combination of studies in the general population and in relevant subpopulations. METHOD: Eight databases derived from recent studies on older persons with vision and hearing data on Dutch subjects aged 55 years or over were selected for further analysis. The measurement methods included self-reports, clinical measurements and observations. The prevalences of DSI were calculated for the general population, the non-institutionalised population, and subgroups such as older people in nursing homes and homes for the elderly. The calculated prevalences were extrapolated to the overall Dutch population. RESULTS: For the non-institutionalised population of 55 years and older, the prevalences of acquired DSI in two different data sets were 0.4% (95% CI: 0.2-0.6) and 0.6% (95% CI: 0.3-0.8), respectively. Among the inhabitants of homes for the elderly these percentages were 5.4% (95% CI: 0.9-9.9) and 5.5% (95% CI: 3.8-7.2), and in nursing homes they were 12.7% (95% CI: 9.7-15.7) and 16.7% (95% CI: 14.6-18.8). Acquired DSI was most common in persons 85 years of age and older. It was estimated that the number of people aged 55 years and over with acquired DSI in The Netherlands is 30,000 to 35,000. CONCLUSION: DSI is particularly a problem of the oldest old. An integrated approach to the visual and hearing problems of these subjects is essential.

[Searching for rest in one's soul: the experience of mental health complaints in older Moroccan immigrants]. / Op zoek naar rust in de ziel Rahat el baal. De beleving van problemen met de geestelijke gezondheid van Marokkaanse ouderen.

The number of Moroccan elderly in the Netherlands is growing. Although many have mental health problems, the mental health services have difficulties in reaching them. This study reports on the experience of mental health problems of elderly Moroccan migrants, their search for help and their view on the role of the mental health services. Twenty-two Moroccan elderly (11 men, 11 women) aged 55-75 were interviewed with a semi-structured questionnaire. From the interviews and observations it appeared that these elderly experience their health as bad. When asked, they deny mental health problems. Stress and dejection are not experienced as relating to mental health but as part of life associated with ageing, living in a foreign country, having physical, social and financial problems. The elderly feel that God sets them these tasks to overcome by themselves. Achieving rest in one's soul is central in this process. There is a taboo on serious mental health problems and people are ashamed of them. Only people who neglect religious prescriptions can to be affected by mental health problems. The elderly Moroccans hardly consult mental health services for these problems because then it would become clear that they cannot overcome their problems by themselves. Furthermore, the mental health services are unknown. Therefore, those services have to pay attention to the specific experience of mental complaints of elderly Moroccans. By offering psycho-education the mental health services may come within reach of those elderly.

Op zoek naar rust in de ziel Rahat el baal : De beleving van problemen met de geestelijke gezondheid van Marokkaanse ouderen.

Searching for rest in one's soul: the experience of mental health complaints in older Moroccan immigrants The number of Moroccan elderly in the Netherlands is growing. Although many have mental health problems, the mental health services have difficulties in reaching them. This study reports on the experience of mental health problems of elderly Moroccan migrants, their search for help and their view on the role of the mental health services. Twenty-two Moroccan elderly (11 men, 11 women) aged 55-75 were interviewed with a semi-structured questionnaire. From the interviews and observations it appeared that these elderly experience their health as bad. When asked, they deny mental health problems. Stress and dejection are not experienced as relating to mental health but as part of life associated with ageing, living in a foreign country, having physical, social and financial problems. The elderly feel that God sets them these tasks to overcome by themselves. Achieving rest in one's soul is central in this process. There is a taboo on serious mental health problems and people are ashamed of them. Only people who neglect religious prescriptions can to be affected by mental health problems. The elderly Moroccans hardly consult mental health services for these problems because then it would become clear that they cannot overcome their problems by themselves. Furthermore, the mental health services are unknown. Therefore, those services have to pay attention to the specific experience of mental complaints of elderly Moroccans. By offering psycho-education the mental health services may come within reach of those elderly.

Low education is a genuine risk factor for accelerated memory decline and dementia.

A relatively high prevalence and incidence of dementia have been found in population strata with low levels of education in comparison to population strata with high levels of education. However, doubt remains whether this may be an artifact of education bias in the screening tests used. To investigate this matter, we analyzed results of two Dutch population surveys in which unbiased measures of memory decline were used. In the Longitudinal Aging Study Amsterdam (n = 1774) the percentage of words retained in a verbal learning test was found to be disproportionately low in the oldest age cohort (80-85 years) with less than 11 years of education. The Amsterdam Study of the Elderly (n = 4051) found a "dose-response" relationship between education and dementia prevalence. Cross-sectional and longitudinal results showed that, in less educated people, memory decline is faster and sets in at an earlier age. These findings indicate that the relationship between dementia and education is not just an artifact of case detection methods.

Comparison of three polymerase chain reaction methods for routine detection of bovine herpesvirus 1 DNA in fresh bull semen.

Five bulls were inoculated intrapreputially with Bovineherpes virus 1 (BHV 1), in order to compare the relative sensitivity of three polymerase chain reaction (PCR) assays for routine diagnosis of fresh bovine semen for the presence of BHV 1 Semen was collected twice a week up to 107 days post-infection (dpi). To reactivate latent virus, the bulls were treated with dexamethasone from 44 until 48 dpi. All samples were examined before and after cryopreservation treatment using a standard virus isolation (VI) method and three PCR assays: PCR A, PCR B and PCR C. PCR A and PCR C used an internal control plasmid DNA template and PCR B used the split sample method in order to control for false negative results. Of the 149 fresh semen samples that were tested, PCR A detected 45 positive, PCR B detected 39 positive and PCR C detected 66 positive, while virus was isolated from 22 samples. Of the 149 samples treated by cryopreservation, the virus was isolated from 13 samples and PCR C was positive in 21 samples. The results demonstrate that all three PCR assays are more sensitive than virus isolation, particularly during the later phases of infection.

Paroxetine for pruritus in advanced cancer.

Pruritus associated with malignancy may be one of the most bothersome symptoms in advanced cancer. Its control is still difficult to achieve and is a challenge to palliative medicine specialists. We describe five patients suffering from pruritus of different etiologies who responded rapidly to administration of paroxetine, a serotonin reuptake inhibitor, in a dose-dependent manner. Two patients experienced transient but severe nausea and vomiting. We suggest that paroxetine's antipruritic effect may be explained by rapid downregulation of the 5-HTs receptors, which may have an important role in the generation of pruritus and pain.

Wavelength-dependent effects of benzoporphyrin derivative monoacid ring A in vivo and in vitro.

Benzoporphyrin derivative monoacid ring A (BPD-MA) is a chlorin-like photosensitizer currently in clinical trials for cancer and psoriasis. It has maximal absorption peaks at both 630 and 690 nm and can be activated at both these wavelengths. In vitro phototoxicity tests using the P815 murine mastocytoma cell lines conducted over wavelengths of light between 678 and 700 nm emitted by an argon-ion pumped dye laser showed that equivalent cell kill could be achieved between 682 and 690 nm. Tests on in vivo phototoxicity of normal skin of DBA/2 mice injected with 2 mg/kg of BPD-MA and exposed to light at 125 J/cm2, between 620 and 700 nm, demonstrated peaks of normal skin damage occurring at 630-640 nm and 680-690 nm. In tests carried out with light between 620 and 700 nm, at 10 nm increments, it was seen that light delivered at 680-690 nm caused slightly more damage to normal skin than light delivered at 630-640 nm. When lower doses of light between 675 and 705 nm were tested using smaller increments, it was determined that equivalent skin damage occurred over a range of 680-695 nm. Antitumor efficacy in tumor-bearing DBA/2 mice was tested between 683 and 695 nm. It was found that equivalent antitumor efficacy, determined by assessing tumor-free status at 20 days posttreatment, occurred at wavelengths between 685 and 693 nm.(ABSTRACT TRUNCATED AT 250 WORDS)

Personality: a moderator of the relation between cognitive functioning and depression in adults aged 55-85?

Previous studies found modest associations between cognitive functioning and depressive symptoms in community samples of older adults. Low levels of cognitive functioning are associated with depressive symptoms. The present study investigates whether personality (locus of control and neuroticism) moderates this relation, and whether gender-differences in moderating effects can be established. The study is based on data of the baseline sample of 3107 participants of the Longitudinal Aging Study Amsterdam (LASA), which was age (55-85 years) and sex-stratified. Multiple regression analyses are used to detect moderating effects. The findings show modest effects, indicating that personality is a moderator of the relation between cognitive functioning and depressive symptoms, particularly in women. In women, a relatively strong internal locus of control is protective of becoming depressed when experiencing impairment in general cognitive functioning (MMSE), and impairment in fluid intelligence and information processing speed. In men, a low level of neuroticism is protective of becoming depressed when experiencing memory impairment. If these findings are replicated and extended in future studies, pertinent interventions such as cognitive therapy or memory training may be designed to alleviate depressive symptoms.

Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands.

BACKGROUND: Western societies host increasing number of elderly labour migrants from Turkey and Morocco. The article studied the prevalence of clinically significant depressive symptoms among elderly Turkish and Moroccan migrants compared with native Dutch elderly and if differences in prevalence rates were explained by known risk factors for depression and/or ethnic, migration-related factors. METHODS: 330 Turkish, 299 Moroccan, and 304 Dutch elderly (55-74 years) were interviewed (cross-sectionally) using the Center for Epidemiologic Depression Scale (CES-D). Potential risk factors included sex, income level, marital status, ethnic origin, chronic physical illnesses, limitations in daily functioning, migration and acculturation questions. RESULTS: The prevalence of self-reported depressive symptoms (CES-D>or=16) was very high in elderly migrants, 33.6% for Moroccan and 61.5% for Turkish elderly. The prevalence of depressive symptoms in the native Dutch sample was similar to earlier studies in the Netherlands and abroad: 14.5%. Among migrants education and income level was very low and they had a high number of physical limitations and chronic medical illnesses. This only explained part of the ethnic differences found. In all three samples, depressive symptoms were associated with sex, chronic physical illness and physical limitations. In multivariate analysis, ethnic origin was uniquely associated with the presence of clinically significant depressive symptoms. Only a small number of remigration and acculturation items were associated with depressive symptoms in bivariate analysis. CONCLUSIONS: The prevalence of clinically significant depressive symptoms among elderly migrants from Turkey and Morocco in the Netherlands is very high. Ethnicity was a strong independent risk factor.

Cognitive and emotional predictors of disablement in older adults.

This study focused on the association between aspects of emotional and cognitive functioning and two stages of the disablement process model, functional limitations, and instrumental activities of daily living (IADL) disability. The age- and sex-stratified sample aged 55 to 89 years consisted of 100 inhabitants of a small Dutch town who scored 24 or higher on the Mini Mental State Examination (MMSE). Controlling for background factors (health problems, age, education, and gender), depressive symptoms and fluid intelligence were independently associated with functional limitations. Of the cognitive functions, only everyday memory was independently associated with IADL disability. Emotional functioning was not independently associated with IADL disability. These findings expand on the disablement process model and demonstrate the importance of emotional functioning, fluid intelligence, and everyday memory for the disablement process.

Changes in hypnotic usage in residential homes for the elderly: a longitudinal study.

The use of hypnotic drugs in 25 local authority homes for the elderly was recorded on a 1-day point prevalence study following a 6-mth monitoring programme involving all new admissions. From a total population of 1114 residents 390 (35%) were taking hypnotics on the night of the survey, showing a slight increase from similar surveys carried out in 1980 and 1981. The proportion of residents receiving hypnotics within each home varied from 0.0 to 61.8%. Correlation with levels of usage in the previous surveys was low, suggesting that pattern of hypnotic usage may change considerably over time within individual homes. Of the 156 residents who were admitted as permanent residents during the 6-mth period preceding the survey, 56 (35.9%) had been taking hypnotics on admission. Both the results of the drug monitoring programme and the survey show an association between hypnotic usage and source of admission: residents admitted from hospital being more likely to be taking sleeping tablets. A considerable change was found in the type of hypnotic currently prescribed with an increased preference being shown for short half-life hypnotics. A higher proportion of residents also were prescribed lower doses of hypnotics than previously, suggesting an increased awareness of the risks associated with hypnotic use in the elderly.