Search

Background: Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban. Methods: With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15–50 ml/min, weight ≤60 kg, and/or use of strong p‑glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC). Results: Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe. BeNe patients were younger than OEC patients (mean age: 72.3 vs 73.9 years), and had lower CHA2DS2-VASc (mean: 2.8 vs 3.2) and HAS-BLED scores (mean: 2.4 vs 2.6). Patients from BeNe less often had hypertension (61.6% vs 80.4%), and/or diabetes mellitus (17.3% vs 23.1%) than patients from OEC. Moreover, relatively fewer patients in BeNe were prescribed the reduced dose of 30 mg edoxaban (14.8%) than in OEC (25.4%). Overall, edoxaban was dosed according to label in 83.1% of patients. Yet, 30 mg edoxaban was prescribed in the absence of any dose reduction criteria in 36.9% of 30 mg users (5.5% of all patients) in BeNe compared with 35.5% (9.0% of all patients) in OEC. Conclusion: There were several notable differences between BeNe and OEC regarding clinical characteristics and dosing practices in patients prescribed edoxaban, which are relevant for the local implementation of dose evaluation and optimisation. Trial registration: NCT02944019; Date of registration 24 October 2016 [ABSTRACT FROM AUTHOR]

Efficient mobility is an essential driving force for the development of cross-border (CB) regions. The different settings and visions of neighbouring CB entities may lead to unsatisfactory transport connections across the border. This case study of a CB connection focuses on this issue and highlights, by means of a comparative analysis, how the differences in six perspectives (the economic context; urban and regional planning in Belgium and the Netherlands; the structure of the rail network; barriers in the exploitation of the railway; the current travel demand by rail; and the governance, public planning and policy context) lead to an unsatisfactory rail connection between Liège (Belgium) and Maastricht (the Netherlands). Based on the results of the analysis, we suggest reinforcing cross-mobility connections through several tools such as (i) the development of a common governance, not only at the institutional level but also at the counter level of institutional level, by including economic and social stakeholders; (ii) the development of joint technical projects in relation to the infrastructure, communication systems and the rolling stock; and (iii) the strengthening of flows between the two sides of the border, especially the home-work flows. [ABSTRACT FROM AUTHOR]

Incorporating natural spaces within urban areas has been shown to have multiple benefits. However, despite greening and adaptation strategies at different levels of government, progress remains slow with a lack of easy to use and comprehensive tools identified as key to overcoming this. This paper presents a co-designed tool with academic and local authority partners to demonstrate the ecosystem service benefits of small-scale urban green infrastructure projects. Through the tool, users can readily assess the impact of green infrastructure investments on the delivery of a selection of ecosystem services in the early stages of a project. Furthermore, the tool provides a standardised assessment of cultural ecosystem services' contributions, as well as offering a method to score spatial designs on the impact on habitat for biodiversity. Use of the tool is demonstrated using a pilot study in Kapelle, the Netherlands. The results set out an overview of the impacts of the spatial design on estimated ecosystem service delivery. They also show the tool's potential to add value in early project stages and as a planning and design tool, helping to maximise the benefits that can be achieved through green infrastructure design. Complementing these arguments with ball-park estimations on green infrastructure costs, the Nature Smart Cities Business Model aims to offer public sector officers the means to create a business case for green infrastructure measures, facilitating the translation from strategies to actual plans, thus benefitting green infrastructure implementation in the public realm. [ABSTRACT FROM AUTHOR]

Introduction: In the Netherlands several additional facilities and working methods are created to strengthen the effectiveness and capacity of the regular daily health care during large incidents and disasters. One system is called GGB (Large-scale medical assistance). The daily healthcare is organized in 25 safety-regions, which are far too small to handle big incidents. GGB provides in organizing assistance between regions, increasing the effectiveness of ambulance care, the deployment of other emergency services and volunteers, and coordination of this all. GGB is developed to deal with an incident with 250 injuries. This method was investigated to determine value. Method: Based on a standard questionnaire, key persons of ambulance care, trauma care, Red Cross and Offices of Public Health and Safety per safety region were asked about their experiences with GGB. (125 forms) Subsequently, the regional outcomes for each discipline were evaluated in a national conferences (four conferences). To conclude, an interdisciplinary national meeting was held to bring the results together. The authors developed the questionnaires, supervised the research process, and presented the results to the authorities. Results: Results indicated that the working methods for scaled-up care is useful and should be continued. The extra financial costs outweigh the gained strength. The cooperation between professionals and volunteers also receives a lot of support. Proposals have been made for further improvements, in particular concerning cooperation between organizations. Bottlenecks have also been identified in the collaboration between health care, fire services and community care. Conclusion: In the perception of the care providers there is added value and cost-effectiveness. This is important for the support of the system. As a next step, the authors want to focus on measuring the actual effectiveness. For that, we want to be able to compare systems in several countries. The presentation ends with a call to do so. [ABSTRACT FROM AUTHOR]

Previous generations of researchers have suggested that seigniorial towns in the Burgundian-Habsburg Netherlands were exempted from investing in gifts to nobles and princely officers who could influence the regional and central decision process to the benefit of the town. Clearly, seignioral lords felt a natural duty to protect the needs of their towns. However, this assumption has not been tested yet. In this article we assess the network of power brokers that the town of Diest constructed and the position its highborn lords had in that network during the first half of the sixteenth century. We argue that conflicting interests and rivaling clients forced the town of Diest to invest in a privileged relationship with its lord. In addition, the town magistrates maintained relations with alternative power brokers. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the implementation of integrated emotion-oriented care (IEOC) in psychogeriatric nursing home wards. Staff from 16 wards were trained to work with a standardized care plan before the experimental period. It was concluded that the implementation of IEOC was effective.

Background: ageing is frequently accompanied by a higher incidence of infections and an increase in disability in activities of daily living (ADL).Objective: this study examines whether clinical infections [urinary tract infections (UTI) and lower respiratory tract infections (LRTI)] predict an increase in ADL disability, stratified for the presence of ADL disability at baseline (age 86 years).Design: the Leiden 85-plus Study. A population-based prospective follow-up study.Setting: general population.Participants: a total of 154 men and 319 women aged 86 years.Methods: information on clinical infections was obtained from the medical records. ADL disability was determined at baseline and annually thereafter during 4 years of follow-up, using the 9 ADL items of the Groningen Activity Restriction Scale.Results: in 86-year-old participants with ADL disability, there were no differences in ADL increase between participants with and without an infection (−0.32 points extra per year; P = 0.230). However, participants without ADL disability at age 86 years (n = 194; 41%) had an accelerated increase in ADL disability of 1.07 point extra per year (P < 0.001). For UTIs, this was 1.25 points per year (P < 0.001) and for LRTIs 0.70 points per year (P = 0.041). In this group, an infection between age 85 and 86 years was associated with a higher risk to develop ADL disability from age 86 onwards [HR: 1.63 (95% CI: 1.04–2.55)].Conclusions: among the oldest-old in the general population, clinically diagnosed infections are predictive for the development of ADL disability in persons without ADL disability. No such association was found for persons with ADL disability. [ABSTRACT FROM PUBLISHER]

Clinical practice developed to promote psychosexual well-being in DSD is under scrutiny. Although techniques for genital surgery have much improved lately, long-term studies on psychosexual functioning and cosmetic outcome on which to base treatment and counseling are scarce. We studied 91 women with a DSD. Feminizing surgery was performed in 64% of the women; in 60% of them, resurgery in puberty was needed after a single-stage procedure. Both patients and gynecologists were satisfied with the cosmetic appearance of the genitalia. However, forty percent of these females experienced sexuality-related distress and 66% was at risk for developing a sexual dysfunction, whether they had surgery or not. Recognizing the difficulty of accurate assessment, our data indicate that feminizing surgery does not seem to improve nor hamper psychosexual outcome, especially in patients with severe virilization. [ABSTRACT FROM AUTHOR]

Objectives To describe the epidemiological, virological, and institutional characteristics of influenza-like illness ( ILI) in nursing homes ( NHs). Design Continuous clinical surveillance of ILI and virological surveillance of ILI and other acute respiratory infections ( ARIs) during four influenza seasons. Setting National sentinel NH surveillance network. Participants National sentinel residents. Measurements Weekly registration of ILI cases (influenza seasons 2008/09-2009/10), influenza virus detection (influenza seasons 2006/07-2009/10), and collection of institutional characteristics of NHs at start of participation. Results During the 2008/09 influenza season, ILI incidence started to rise in Week 49 of 2008, peaked in Week 3 of 2009 (158 cases per 10,000 resident weeks), and flattened out by Week 16 of 2009 (mean ILI incidence during epidemic: 73 cases per 10,000 resident weeks). During the 2009/10 influenza pandemic, there was no epidemic peak. Influenza virus type and subtype varied throughout virological surveillance but was limited to influenza A(H3N2) and B viruses. Higher staff vaccination coverage (>15%) was associated with lower ILI-incidence in the 2008/09 influenza season in a univariate negative binomial regression analysis (incidence rate ratio = 0.3, 95% confidence interval = 0.1-0.8)). Conclusion Neither seasonal nor pandemic influenza A(H1N1) viruses were detected in the network, despite widespread community transmission of seasonal and influenza A(H1N1) virus. ILI incidence trends corresponded to virological trends. Sentinel surveillance of ILI combining clinical and virological data in NHs increases understanding of transmission risks in this specific vulnerable population. [ABSTRACT FROM AUTHOR]

Presents a study which investigated the cause of unplanned weight loss among Dutch nursing-home patients with dementia, while examining the relationship between difficulties in self-feeding and weight loss. How the study was structured; Methods employed to conduct the study; Comparison of weight loss and food choice among demented and non-demented patients; What findings indicated.

Investigates the influence of chronic disease, drug treatment and functional disability on the immune response to influenza vaccine in the elderly in the Netherlands. Association of advanced age with declined protection; Differences in subjects' state of health; Correlation between the Katz score and all of the vaccine strains investigated.

• In 2020, students' beliefs regarding chronic pain were more biopsychosocial. • In 2020, students' guideline adherence was higher except for work, it remained low. • 4th year students have stronger biopsychosocial beliefs than 2nd year students. • Students' beliefs regarding chronic pain differed significantly between institutions. • Actions are needed to improve students' attitudes and beliefs regarding chronic pain. In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work. To assess the differences in physical therapy students' attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020. In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity, and work. In 2013, 927 second-year and 695 fourth-year students; in 2020, 695 second-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations. Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low. [ABSTRACT FROM AUTHOR]