ABSTRACT
The consequences of the COVID-19 pandemic for the health and wellbeing of the Dutch population exceed the normal regional research-approach. That is why the 'network GOR-COVID-19' - comprised of GGD GHOR Nederland (representing the municipal health services), RIVM, Nivel and ARQ National Psychotrauma Centre - has taken the initiative for a national research program to monitor the health impact of the corona crisis over time. In this article we describe the background and design of a comprehensive longitudinal health monitor that combines and harmonizes multiple data sources in order to provide perspectives for practice and policy, on both a local and national level.
ABSTRACT
BACKGROUND: Functional limitations are a major cause for needing care and institutionalization among older adults. Exposure to air pollution has been suggested to be associated with increased functional limitations in older people. OBJECTIVE: Our objective was to assess the association between air pollution and physical functioning in Dutch older adults. METHODS: We analyzed data on performance-based (walking speed, ability to rise from a chair, putting on and taking off a cardigan, balance test) and self-reported physical functioning for 1,762 participants of the Longitudinal Aging Study Amsterdam, who participated in measurement cycles performed in 2005/2006, 2008/2009, and 2011/2012. Annual average outdoor air pollution concentrations [nitrogen dioxide (NO2), nitrogen oxides (NOx), particulate matter with diameters ≤2.5µm (PM2.5), ≤10µm (PM10), and 2.5-10µm (PMcoarse), and PM2.5 absorbance] at the home address at the start of the first measurement cycle were estimated using land-use regression models. Analyses were performed using mixed models with random participant intercepts adjusting for potential confounders. RESULTS: Exposure to most air pollutants was associated with reduced performance-based physical functioning; for example, an interquartile range increase in NO2 exposure was associated with a 0.22 (95% confidence interval: 0.03, 0.42) lower performance test score in fully adjusted models, equivalent to the difference in performance score between participants who differed by 9 mo in age. Exposure to air pollution was generally not statistically significantly associated with self-reported functional limitations, and not associated with a faster decline in performance-based physical functioning over the study period. CONCLUSION: This study suggests that exposure to air pollution may adversely affect physical performance of older adults in the Netherlands. https://doi.org/10.1289/EHP2239.
Subject(s)
Air Pollutants/adverse effects , Air Pollution/adverse effects , Environmental Exposure/adverse effects , Particulate Matter/adverse effects , Activities of Daily Living , Aged , Aged, 80 and over , Air Pollutants/analysis , Air Pollution/analysis , Cohort Studies , Environmental Monitoring/methods , Female , Humans , Longitudinal Studies , Male , Netherlands , Nitrogen Dioxide/analysis , Nitrogen Oxides/analysis , Particulate Matter/analysis , Prospective StudiesABSTRACT
The different choices doctors, nurses, and patients make regarding wound dressing materials are generally based on personal preferences, because strong evidence and guidelines on local wound care for open wounds are lacking. We studied which attributes of a wound dressing doctors, nurses, and patients consider the most important. A conjoint analysis questionnaire comprising paper-based descriptions with six attributes, and questions regarding the willingness-to-pay for these attributes were sent out to surgical patients, (assistant)-surgeons and nurses. Preferences for wound dressing attributes were similar for doctors (n=50), nurses (n=150), and patients (n=74). Pain during dressing changes, duration of hospitalization, and wound healing time were ranked highest. Doctors would spend more money on a shorter hospitalization, nurses on pain reduction, and patients on quicker wound healing. Patients were willing to pay a relatively small monthly amount out of pocket for a dressing that would result in a quicker and less-painful wound healing. Doctors, nurses, and patients prefer similar attributes of wound dressing materials, but differ in their willingness-to-pay. To achieve a more consistent local wound care, clinical decision-making should be in accordance with these preferences. These should also be the focus for manufacturers and researchers to obtain more evidence on which materials best match these attributes.
