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Item does not contain fulltext, AIM: To quantify lymphovascular invasion (LVI) and to assess the prognostic value in patients with pT1b esophageal adenocarcinoma. METHODS: In this nationwide, retrospective cohort study, patients were included if they were treated with surgery or endoscopic resection for pT1b esophageal adenocarcinoma. Primary endpoint was the presence of metastases, lymph node metastases, or distant metastases, in surgical resection specimens or during follow-up. A prediction model to identify risk factors for metastases was developed and internally validated. RESULTS: 248 patients were included. LVI was distributed as follows: no LVI (n = 196; 79.0%), 1 LVI focus (n = 16; 6.5%), 2-3 LVI foci (n = 21; 8.5%) and ≥4 LVI foci (n = 15; 6.0%). Seventy-eight patients had metastases. The risk of metastases was increased for tumors with 2-3 LVI foci [subdistribution hazard ratio (SHR) 3.39, 95% confidence interval (CI) 2.10-5.47] and ≥4 LVI foci (SHR 3.81, 95% CI 2.37-6.10). The prediction model demonstrated a good discriminative ability (c-statistic 0.81). CONCLUSION: The risk of metastases is higher when more LVI foci are present. Quantification of LVI could be useful for a more precise risk estimation of metastases. This model needs to be externally validated before implementation into clinical practice.

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Item does not contain fulltext, Many barriers to the provision of general practice (GP) care for people with intellectual disabilities (ID) relate to problems in exchanging health information. Deficits in the exchange of health information may have an adverse impact on healthcare access and health outcomes in individuals with ID. The aim of this paper is to report how health information exchange (HIE) in GP care for people with ID is being described in the ID healthcare literature. Thematic analysis of 19 included articles resulted in six major themes: (1) communication skills; (2) organisational factors; (3) record keeping and sharing; (4) health literacy and self-advocacy; (5) carers and health professionals' knowledge; and (6) third parties. The results indicate that HIE takes place in a chain of events happening before, during, and after a medical consultation, depending on specific contextual care factors. The included papers lack a broad focus on the entire HIE process, and causes and effects of gaps in health information are described only marginally or on a very general level. However, a study of the HIE process in its entirety is imperative in order to identify weak links and gaps in information pathways. The themes presented here provide a starting point for an in-depth study on the HIE process in GP care for individuals with ID that may facilitate future research on health interventions in this setting.

Item does not contain fulltext, People with intellectual disabilities (ID) experience substantial health inequities compared, with the general population. Many secondary conditions and lifestyle related health problems could be, prevented with adequate health promotion. The aim of this structured review is to provide insight into, the main characteristics of published health promotion intervention studies for people with ID and, in, doing so, to identify best practice and knowledge gaps. Relevant studies were identified through a, structured literature search of multiple electronic databases (PubMed, CINHAS, Scopus, PsychINFO), the search strategy covered health promotion and intellectual disabilities for available papers, published between February 2002 and 2012. In total, 25 studies were included and analyzed. Overall, studies were diverse and explored a variety of health issues. Papers included a variety of participants (in relation to level of disability) and intervention approaches. With regard to quality, many studies, failed to report how they recruited their participants, and there were substantial challenges identified, by authors in relation to recruitment, implementation of interventions, and the selection of outcome, measures used as well as the usability of measures themselves. Our findings suggest that this field, experiences methodological weaknesses and inconsistencies that make it difficult to compare and, contrast results. Theoretically driven studies that take into account the views and expectations of, participants themselves are needed, as is research that investigates the reliability and validity of, outcome measures for the ID population. Collaboration with mainstream health promotion research is, critical.

Item does not contain fulltext, In the general elderly population, multifactorial screening of fall risks has been shown to be effective. Although persons with intellectual disabilities (ID) fall more often, there appears to be no targeted screening for them. The aim of this study was to develop, implement, and evaluate a falls clinic for persons with ID. Based on guidelines, literature, and expert meetings, a falls clinic for persons with ID was developed. In total, 26 persons with ID and a fall history participated in the study. Process evaluation was conducted with evaluation forms and focus groups. Fifty interventions (0-8 per person) were prescribed. The (para)medical experts, clients, and caregivers described the falls clinic as useful. Advice for improvement included minor changes to clinic content. Logistics were the largest challenge for the falls clinic, for example organizing meetings, completing questionnaires prior to meetings, and ensuring that a personal caregiver accompanied the person with ID. Furthermore, the need for a screening tool to determine whether a person would benefit from the falls clinic was reported. In conclusion, the falls clinic for persons with ID was considered feasible and useful. Some minor content changes are necessary and there is a need for a screening tool. However, logistics concerning the falls clinic need improvement. More attention and time for multifactorial and multidisciplinary treatment of persons with ID is necessary. Implementation on a larger scale would also make it possible to investigate the effectiveness of the falls clinic with regard to the prevention of falls in this population.

Item does not contain fulltext, Elderly persons with intellectual disabilities (ID) are at increased risk for falls and fall-related injuries. Although there has been extensive research on risk factors for falling in the general elderly population, research on this topic in persons with ID is rather sparse. This is the first study to prospective investigate risk factors for falling among elderly persons with mild to moderate ID. Seventy-eight ambulatory persons with mild to moderate ID (mean age 62.8+/-7.6 years; 44 (56%) men; 34 (44%) mild ID) participated in this study. This longitudinal cohort study involved extensive baseline assessments, followed by a one-year follow-up on fall incidents. Falls occurred in 46% of the participants and the fall rate was 1.00 falls per person per year. The most important risk factors for falling in elderly persons with mild to moderate ID were (mild) severity of ID, (high) physical activity, (good) visuo-motor capacity, (good) attentional focus and (high) hyperactivity-impulsiveness, which together explained 56% of the fall risk. This pattern of risk factors identified suggests a complex interplay of personal and environmental factors in the aetiology of falls in elderly persons with ID. We recommend further research on the development of multifactorial screening procedures and individually tailored interventions to prevent falling in persons with ID.

Presentatie over onderzoek naar de toepassing van enzymen voor de verbetering van het ontwateren van gerecycled papier.

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