Not much is known about the favourable indoor air conditions in long term care facilities (ltcf’s), where older adults suffering from dementia live. Due to the decrease in cognition function, it is hard to evaluate comfort and health in this group. Nevertheless, infectious diseases are a persistent problem. Based on literature an assessment method has been developed to analyse ltcf’s to determine if differences in building characteristics and HVAC systems influence the spread of airborne infectious diseases. The developed method is applied in seven long term care facilities in the Netherlands. From this research it can be concluded that this method has potential to evaluate and compare ltcf’s and develop design guidelines for these buildings. However, some adjustments to the methodology are necessary to achieve this objective. Therefore the relation between the indoor environment and infection risk is not yet analysed, but a consistent procedure to analyse this link is provided.
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Background: Urban slums are characterised by unique challenging living conditions, which increase their inhabitants’ vulnerability to specific health conditions. The identification and prioritization of the key health issues occurring in these settings is essential for the development of programmes that aim to enhance the health of local slum communities effectively. As such, the present study sought to identify and prioritise the key health issues occurring in urban slums, with a focus on the perceptions of health professionals and community workers, in the rapidly growing city of Bangalore, India. Methods: The study followed a two-phased mixed methods design. During Phase I of the study, a total of 60 health conditions belonging to four major categories: - 1) non-communicable diseases; 2) infectious diseases; 3) maternal and women’s reproductive health; and 4) child health - were identified through a systematic literature review and semi-structured interviews conducted with health professionals and other relevant stakeholders with experience working with urban slum communities in Bangalore. In Phase II, the health issues were prioritised based on four criteria through a consensus workshop conducted in Bangalore. Results: The top health issues prioritized during the workshop were: diabetes and hypertension (non-communicable diseases category), dengue fever (infectious diseases category), malnutrition and anaemia (child health, and maternal and women’s reproductive health categories). Diarrhoea was also selected as a top priority in children. These health issues were in line with national and international reports that listed them as top causes of mortality and major contributors to the burden of diseases in India. Conclusions: The results of this study will be used to inform the development of technologies and the design of interventions to improve the health outcomes of local communities. Identification of priority health issues in the slums of other regions of India, and in other low and lower middle-income countries, is recommended.
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Not much is known about the favourable indoor air quality in long term care facilities (LTCFs), where older adults suffering from dementia live. Older adults, especially those who suffer from dementia, are more sensible to the indoor environment. However, no special requirements for the indoor air in long term care facilities exist. Due to the decrease in cognition function, it is hard to evaluate comfort and health in this group. Nevertheless, infectious diseases are a persistent problem. Based on literature an assessment methodology has been developed to analyse LTCFs to determine if differences in building characteristics and Heating, Ventilation and Air Conditioning (HVAC) systems influence the spread of airborne infectious diseases. The developed methodology is applied in seven long term care facilities in the Netherlands. After that, the methodology has been evaluated and its feasibility and applicability are discussed. From this study, it can be concluded that this method has potential to evaluate, compare LTCFs, and develop design guidelines for these buildings. However, some adjustments to the methodology are necessary to achieve this objective. Therefore, the relation between the indoor environment and infection risk is not yet analysed, but a consistent procedure to analyse this link is provided.
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Wat is er op dit moment (medio augustus 2020) in de wetenschappelijke literatuur bekend over (de effecten van maatregelen tegen) de verspreiding van het coronavirus en wat is de betekenis daarvan voor organisatoren van evenementen?
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From Narcis.nl :" Patients with substance use disorder (SUD) are frequently suffering from co-occurring somatic disorders, increasing the risk of mortality. Somatic health care utilization (sHCU) often remains unknown to the physician during SUD treatment. This paper analyses sHCU and associated costs among patients in SUD treatment compared to matched, non-substance dependent controls. METHODS: Health care utilization data on 4972 SUD patients were matched to 19,846 controls by gender, birth year and ethnic origin. Subcategories of patients were formed based on SUD and on co-morbid psychiatric disorder. Data on sHCU during the year prior to the last treatment contact (the 'index date') for both patients and their matched controls were extracted from a health insurance database. RESULTS: Patients had a higher sHCU (with increased associated costs) than controls, especially when alcohol dependence was involved. In particular, sHCU for cardiovascular, respiratory, infectious diseases, injuries and accidents was increased among patients. However, the use of preventive medication, such as lipid-lowering drugs, is lower among SUD patients. Co-morbidity of psychiatric disorders led to further increase of sHCU, whereas patients with comorbid non-affective psychotic disorder (NAPD) showed lower sHCU and costs. CONCLUSION: Patients with SUD overall have a high sHCU, associated with high costs. There are indications that SUD patients have less access to preventive medication. Patients with comorbid NAPD are at risk of possible underutilization of somatic health care. Furthermore, we conclude that these larger administrative databases allow for comparisons between various diagnostic categories."
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Praktische aanbevelingen op basis van bevindingen uit systematisch literatuuronderzoek bij de Covid-19 en vergelijkbare virusuitbraken en interviews met experts en ervaringsdeskundigen.
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Background:In hospitalized patients with COVID-19, the dosing and timing of corticosteroids vary widely. Low-dose dexamethasone therapy reduces mortality in patients requiring respiratory support, but it remains unclear how to treat patients when this therapy fails. In critically ill patients, high-dose corticosteroids are often administered as salvage late in the disease course, whereas earlier administration may be more beneficial in preventing disease progression. Previous research has revealed that increased levels of various biomarkers are associated with mortality, and whole blood transcriptome sequencing has the ability to identify host factors predisposing to critical illness in patients with COVID-19.Objective:Our goal is to determine the most optimal dosing and timing of corticosteroid therapy and to provide a basis for personalized corticosteroid treatment regimens to reduce morbidity and mortality in hospitalized patients with COVID-19.Methods:This is a retrospective, observational, multicenter study that includes adult patients who were hospitalized due to COVID-19 in the Netherlands. We will use the differences in therapeutic strategies between hospitals (per protocol high-dose corticosteroids or not) over time to determine whether high-dose corticosteroids have an effect on the following outcome measures: mechanical ventilation or high-flow nasal cannula therapy, in-hospital mortality, and 28-day survival. We will also explore biomarker profiles in serum and bronchoalveolar lavage fluid and use whole blood transcriptome analysis to determine factors that influence the relationship between high-dose corticosteroids and outcome. Existing databases that contain routinely collected electronic data during ward and intensive care admissions, as well as existing biobanks, will be used. We will apply longitudinal modeling appropriate for each data structure to answer the research questions at hand.Results:As of April 2023, data have been collected for a total of 1500 patients, with data collection anticipated to be completed by December 2023. We expect the first results to be available in early 2024.Conclusions:This study protocol presents a strategy to investigate the effect of high-dose corticosteroids throughout the entire clinical course of hospitalized patients with COVID-19, from hospital admission to the ward or intensive care unit until hospital discharge. Moreover, our exploration of biomarker and gene expression profiles for targeted corticosteroid therapy represents a first step towards personalized COVID-19 corticosteroid treatment.Trial Registration:ClinicalTrials.gov NCT05403359; https://clinicaltrials.gov/ct2/show/NCT05403359International Registered Report Identifier (IRRID):DERR1-10.2196/48183
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IntroductionThe Dutch Medical Doctor-Global Health (MD-GH) prepares to work in low-resource settings (LRS) by completing a hybrid postgraduate training program of 2 years and 9 months, with clinical and public health exposure in the Netherlands and a Global Health residency in LRS. The objectives of the program include acquiring clinical skills to work as a physician in a setting with different (often more severe) pathology and limited resources. In public health teaching, emphasis is given, among other, to adapting to a culturally different environment. After graduation, MD-GH work in a wide variety of countries and settings for variable time. As part of a curriculum review, this study examines MD-GHs' perception of the quality of the training program and provides recommendations for improvement.MethodsA qualitative study was performed. Thematic analysis was applied to semi-structured interviews with 23 MD-GH who graduated between 2017 and 2021.ResultsMD-GHs predominantly worked as clinicians; several were (also) involved in management or capacity building. The clinical training program adequately addressed general skills, but did not sufficiently prepare for locally encountered, often severe, pathology. During the training, adequate supervision with clear learning goals was found pivotal to a positive learning experience. Gaps included clinical training in Internal Medicine (particularly infectious diseases and non-communicable diseases) and Paediatrics. Public Health teaching as well as cultural awareness should be intensified and introduced earlier in the program. The Global Health residency was considered important, but tasks and learning outcomes varied. Teaching, supervision, and capacity building were considered increasingly important key elements of working in LRS. Consensus favoured the current duration of the training program without extension.DiscussionWhile the generalist nature of the MD-GH training was appreciated, the program would benefit from additional clinical training in infectious diseases, non-communicable diseases, and Paediatrics. Moving forward, emphasis should be placed on structured mentorship, enhanced public health teaching, and standardized residency programs with clearly delineated objectives to better equip MD-GH professionals for their multifaceted roles in LRS. Moreover, future revisions of the training program should incorporate the perspectives of host institutes in LRS and tailor the training needs.
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Objectives: Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.Design: Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.Results: Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.Conclusions: Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.
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Wat zijn belangrijke succesfactoren om onderzoek, onderwijs en ondernemen bij elkaar te brengen, zó dat 'het klikt'. De uitdaging voor de toekomst van bedrijven in de smart factoryligt bij data science: het omzetten van ruwe (sensor) data naar (zinnige) informatie en kennis, waarmee producten en diensten verbeterd kunnen worden. Tevens programma van het symposium t.g.l. inauguratie 3 december 2015
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