Each of us has a story that comes alive as we wake up in the morning, develops throughout the day, and holds layers of meaning as we lay our heads down at night – it might be called a narrative of our identity. When loss occurs, our story fragments into unfamiliar pieces, and who we identify as becomes scattered – sometimes even shattered. We must work to reconstruct meaning in our lives and to rebuild our identity. As leading author on this editorial, with an article of my own in this issue, I confronted this when my father died. I felt his story slipping away, becoming blurred, forgotten, and for some, erased – and the same held true for me. The chaos of my shattered identity exacerbated the deep pain of losing him and I experienced complicated grief. I had to reshape my narrative to remember the authentic parts of me and rebuild a new self in a fatherless world. This journey is in part what motivated me to become a symposium co-editor for the journal. All four of us editors of this special issue have experienced “living with loss” following the premature loss of either our father or spouse, and I wanted to see what lived experience and knowledge we could bring to the readers about loss in the fields of both guidance and counselling.
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Background: This study investigated the trajectories of decline in individual instrumental activities of daily living (IADL) with aging and the effect of hearing loss, vision loss, or dual sensory loss on these trajectories in community-living frail older persons. Method: This longitudinal population-based study was conducted in 9,319 community-living frail Dutch persons aged 60 years and older. Self-reported hearing loss, vision loss, or dual sensory loss and nine IADL were assessed in 15 studies of the Dutch National Care for the Elderly Program (The Older Persons and Informal Caregivers Survey Minimum Dataset). Probabilities of limitations in IADL, odds ratios (per 5 years) for binary, and rate ratios (per 5 years) for score outcomes were calculated using mixed logistic and negative binomial models with age as the underlying timescale, stratified by sensory loss, and corrected for confounders. Results: At baseline, the number of IADL limitations was higher in dual sensory loss (2.00 [interquartile range 1.00–4.00]) and vision loss (2.00 [interquartile range 1.00–4.00]) compared to no sensory loss (1.00 [interquartile range 0.00–2.00]) or hearing loss (1.00 [interquartile range 0.00–3.00]). Trajectories of individual IADL showed an increase in limitations in all IADL with age. Household tasks, traveling, shopping, preparing a meal, and walking showed the most rapid decline. Handling finances, traveling, and walking followed a different pattern of decline based on sensory loss status. Conclusions: The age effect on limitations in IADL appears to be similar across all types of sensory loss, with the exception of handling finances, traveling, and walking. At baseline, persons with self-reported sensory loss had higher levels of self-reported functional limitations. Trajectories depict a decline in IADL competence with age.
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Assessment of the seismic vulnerability of the building stock in the earthquake-prone Marmara region of Turkey is of growing importance since such information is needed for reliable estimation of the losses that possible future earthquakes are likely to induce. The outcome of such loss assessment exercises can be used in planning of urban/regional-scale earthquake protection strategies; this is a priority in Turkey, particularly following the destructive earthquakes of 1999. Considering the size of the building inventory, Istanbul and its surrounding area is a case for which it is not easy to determine the structural properties and characteristics of the building stock. In this paper, geometrical, functional and material properties of the building stock in the northern Marmara Region, particularly around Istanbul, have been investigated and evaluated for use in loss estimation models and other types of statistic- or probability-based studies. In order to do that, the existing reinforced concrete (RC) stock has been classified as 'compliant' or 'non-compliant' buildings, dual (frame-wall) or frame structures and emergent or embedded-beam systems. In addition to the statistical parameters such as mean values, standard deviations, etc., probability density functions and their goodness-of-fit have also been investigated for all types of parameters. Functionalities such as purpose of use and floor area properties have been defined. Concrete properties of existing and recently constructed buildings and also characteristics of 220 and 420 MPa types of steel have been documented. Finally, the financial effects of retrofitting operations and damage repair have been investigated. © 2007 Elsevier Ltd. All rights reserved.
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An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5-7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5-7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (>20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5-7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P < .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.
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Tumor necrosis factor alpha (TNF-α) and its key role in modulating immune responses has been widely recognized as a therapeutic target for inflammatory and neurodegenerative diseases. Even though inhibition of TNF-α is beneficial for the treatment of certain inflammatory diseases, total neutralization of TNF-α largely failed in the treatment of neurodegenerative diseases. TNF-α exerts distinct functions depending on interaction with its two TNF receptors, whereby TNF receptor 1 (TNFR1) is associated with neuroinflammation and apoptosis and TNF receptor 2 (TNFR2) with neuroprotection and immune regulation. Here, we investigated the effect of administering the TNFR1-specific antagonist Atrosimab, as strategy to block TNFR1 signaling while maintaining TNFR2 signaling unaltered, in an acute mouse model for neurodegeneration. In this model, a NMDA-induced lesion that mimics various hallmarks of neurodegenerative diseases, such as memory loss and cell death, was created in the nucleus basalis magnocellularis and Atrosimab or control protein was administered centrally. We showed that Atrosimab attenuated cognitive impairments and reduced neuroinflammation and neuronal cell death. Our results demonstrate that Atrosimab is effective in ameliorating disease symptoms in an acute neurodegenerative mouse model. Altogether, our study indicates that Atrosimab may be a promising candidate for the development of a therapeutic strategy for the treatment of neurodegenerative diseases.Keywords: Neuroimmunology ; Neurological disorders ; Pharmaceutics ; Tumour-necrosis factors
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DBELA is a Displacement-Based Earthquake Loss Assessment methodology for urban areas which relates the displacement capacity of the building stock to the displacement demand from earthquake scenarios. The building stock is modeled as a random population of building classes with varying geometrical and material properties. The period of vibration of each building in the random population is calculated using a simplified equation based on the height of the building and building type, whilst the displacement capacity at different limit states is predicted using simple equations which are a function of the randomly simulated geometrical and material properties. The displacement capacity of each building is then compared to the displacement demand obtained, from an over-damped displacement spectrum, using its period of vibration; the proportion of buildings which exceed each damage state can thus be estimated. DBELA has been calibrated to the Turkish building stock following the collection of a large database of structural characteristics of buildings from the northern Marmara region. The probabilistic distributions for each of the structural characteristics (e.g. story height, steel properties etc.) have been defined using the aforementioned database. The methodology has then been applied to predict preliminary damage distributions and social losses for the Istanbul Metropolitan Municipality for a Mw 7.5 scenario earthquake.
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BACKGROUND: Intentional weight loss in obese older adults is a risk factor for muscle loss and sarcopenia.OBJECTIVE: The objective was to examine the effect of a high whey protein-, leucine-, and vitamin D-enriched supplement on muscle mass preservation during intentional weight loss in obese older adults.DESIGN: We included 80 obese older adults in a double-blind randomized controlled trial. During a 13-wk weight loss program, all subjects followed a hypocaloric diet (-600 kcal/d) and performed resistance training 3×/wk. Subjects were randomly allocated to a high whey protein-, leucine-, and vitamin D-enriched supplement including a mix of other macro- and micronutrients (150 kcal, 21 g protein; 10×/wk, intervention group) or an isocaloric control. The primary outcome was change in appendicular muscle mass. The secondary outcomes were body composition, handgrip strength, and physical performance. Data were analyzed by using ANCOVA and mixed linear models with sex and baseline value as covariates.RESULTS: At baseline, mean ± SD age was 63 ± 5.6 y, and body mass index (in kg/m(2)) was 33 ± 4.4. During the trial, protein intake was 1.11 ± 0.28 g · kg body weight(-1) · d(-1) in the intervention group compared with 0.85 ± 0.24 g · kg body weight(-1) · d(-1) in the control group (P < 0.001). Both intervention and control groups decreased in body weight (-3.4 ± 3.6 kg and -2.8 ± 2.8 kg; both P < 0.001) and fat mass (-3.2 ± 3.1 kg and -2.5 ± 2.4 kg; both P < 0.001), with no differences between groups. The 13-wk change in appendicular muscle mass, however, was different in the intervention and control groups [+0.4 ± 1.2 kg and -0.5 ± 2.1 kg, respectively; β = 0.95 kg (95% CI: 0.09, 1.81); P = 0.03]. Muscle strength and function improved over time without significant differences between groups.CONCLUSION: A high whey protein-, leucine-, and vitamin D-enriched supplement compared with isocaloric control preserves appendicular muscle mass in obese older adults during a hypocaloric diet and resistance exercise program and might therefore reduce the risk of sarcopenia. This trial was registered at the Dutch Trial Register (http://www.trialregister.nl) as NTR2751.
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Abstract Background: Cardiovascular disease is the leading cause of the estimated 11–25 years reduced life expectancy for persons with serious mental illness (SMI). This excess cardiovascular mortality is primarily attributable to obesity, diabetes, hypertension, and dyslipidaemia. Obesity is associated with a sedentary lifestyle, limited physical activity and an unhealthy diet. Lifestyle interventions for persons with SMI seem promising in reducing weight and cardiovascular risk. The aim of this study is to evaluate the effectiveness and cost-effectiveness of a lifestyle intervention among persons with SMI in an outpatient treatment setting. Methods: The Serious Mental Illness Lifestyle Evaluation (SMILE) study is a cluster-randomized controlled trial including an economic evaluation in approximately 18 Flexible Assertive Community Treatment (FACT) teams in the Netherlands. The intervention aims at a healthy diet and increased physical activity. Randomisation takes place at the level of participating FACT-teams. We aim to include 260 outpatients with SMI and a body mass index of 27 or higher who will either receive the lifestyle intervention or usual care. The intervention will last 12 months and consists of weekly 2-h group meetings delivered over the first 6 months. The next 6 months will include monthly group meetings, supplemented with regular individual contacts. Primary outcome is weight loss. Secondary outcomes are metabolic parameters (waist circumference, lipids, blood pressure, glucose), quality of life and health related self-efficacy. Costs will be measured from a societal perspective and include costs of the lifestyle program, health care utilization, medication and lost productivity. Measurements will be performed at baseline and 3, 6 and 12 months. Discussion: The SMILE intervention for persons with SMI will provide important information on the effectiveness, cost-effectiveness, feasibility and delivery of a group-based lifestyle intervention in a Dutch outpatient treatment setting. Trial registration: Dutch Trial Registration NL6660, registration date: 16 November 2017.
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Abstract: Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged 75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. ‘Difficulty in walking’ and ‘unexplained weight loss’ appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.
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Biodiversity preservation is often viewed in utilitarian terms that render non-human species as ecosystem services or natural resources. The economic capture approach may be inadequate in addressing biodiversity loss because extinction of some species could conceivably come to pass without jeopardizing the survival of the humans. People might be materially sustained by a technological biora made to yield services and products required for human life. The failure to address biodiversity loss calls for an exploration of alternative paradigms. It is proposed that the failure to address biodiversity loss stems from the fact that ecocentric value holders are politically marginalized and underrepresented in the most powerful strata of society. While anthropocentric concerns with environment and private expressions of biophilia are acceptable in the wider society, the more pronounced publicly expressed deep ecology position is discouraged. “Radical environmentalists” are among the least understood of all contemporary opposition movements, not only in tactical terms, but also ethically. The article argues in favor of the inclusion of deep ecology perspective as an alternative to the current anthropocentric paradigm. https://doi.org/10.1080/1943815X.2012.742914 https://www.linkedin.com/in/helenkopnina/
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