The impact of self-perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients: results of a cross-sectional study.

Objective: To examine the impact of perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients.

Design: Cross-sectional survey.

Setting: Department of Neurology, University Medical Center Groningen, the Netherlands.

[Education within the Dutch National Care for the Elderly Programme].

The Netherlands Organisation of Health Research and Development started in 2008 the Dutch National Care for the Elderly Programme (in Dutch abbreviated as NPO) with the aim to improve the quality of life for the frail older people through better quality of care (health, social, community) which is tailored to the needs and wants of older people. The delivery of good care is related with competent professional behaviour which is inextricably linked to the education of professionals. This article presents an overview of 32 educational programmes developed within the NPO.

Essential competencies for the education of nursing assistants and care helpers in elderly care.

Background: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of professionals required to meet this demand. However, a recent study showed that the curricula in vocational education for nursing assistants and care helpers remains inadequate to prepare them for the social and healthcare needs of the elderly.

Objective: To determine the essential competencies for the initial education of nursing assistants and care helpers in elderly care.

Interprofessional education in primary care for the elderly: a pilot study.

Background: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of nurses and physicians required to meet this demand.At present, the main focus of health care in the Netherlands lies on illness and treatment. However, (frail) elderly need care and support that takes their daily functioning and well-being into consideration as well.

Prevalence of chronic health conditions in children with intellectual disability: a systematic literature review.

A systematic review of the prevalence rates of chronic health conditions in populations of children with intellectual disability was provided. We identified 2,994 relevant studies by searching Medline, Cinahl, and PsycINFO databases from 1996 to 2008. We included the 31 studies that had sufficient methodological quality.

Limited concordance between teachers, parents and healthcare professionals on the presence of chronic diseases in ID-adolescents.

Evidence on teachers' knowledge about somatic and mental chronic diseases among ID-adolescent compared to the knowledge parents and healthcare professionals have, is limited. The aim of this study is: (1) to assess the knowledge of teachers on the presence of chronic diseases in ID-adolescents; (2) to compare teachers with parents and healthcare professionals and parents with healthcare professionals regarding the knowledge on the presence of chronic diseases in ID-adolescents. We obtained data on 1044 ID-adolescents attending secondary schools, fully covering one region of the Netherlands.

Prevalence of chronic diseases in adolescents with intellectual disability.

Valid community-based data on the prevalence of chronic diseases in adolescents (12-18 years) with intellectual disability (ID-adolescents) are scarce. The aim of this study was to assess the prevalence rates and the nature of chronic diseases in a population of ID-adolescents and to compare them with the rates among adolescents in the general population. Therefore, we obtained data on 1083 ID-adolescents attending secondary schools, day care centers or living in residential centers fully covering one region of The Netherlands.

Emotional and behavioural problems in adolescents with intellectual disability with and without chronic diseases.

Background: Adolescents with intellectual disability (ID) (ID-adolescents) and adolescents with chronic diseases are both more likely to have emotional and behavioural problems. The aim of this study was to assess the association between chronic diseases in ID-adolescents and emotional and behavioural problems in a large school-based sample.

Methods: We obtained data on 1044 ID-adolescents, aged 12-18 years, attending secondary schools in the Netherlands.

Pervasive developmental disorder behavior in adolescents with intellectual disability and co-occurring somatic chronic diseases.

Evidence on the association between somatic chronic diseases in ID-adolescents and the full range of pervasive developmental disorder behavior (PDD behavior) is scarce. The aim of the present study is to assess the association between somatic chronic diseases in ID-adolescents and mild PDD behavior. We obtained data on 1044 ID-adolescents, aged 12-18, attending secondary schools in the Netherlands.

Effects of case management for frail older people or those with chronic illness: a systematic review.

Background: Financial constraints and quality requirements demand that interventions selected are most effective. A previous systematic review of the effectiveness of the patient advocacy case management model was not found.

Objective: The objective of this study was to evaluate the effects of patient advocacy case management on service use and healthcare costs for impaired older people or adults with a chronic somatic disease living in the community.

The quality of caring relationships.

In health care, relationships between patients or disabled persons and professionals are at least co-constitutive for the quality of care. Many patients complain about the contacts and communication with caregivers and other professionals. From a care-ethical perspective a good patient-professional relationship requires a process of negotiation and shared understanding about mutual normative expectations.

What is it to be a daughter? Identities under pressure in dementia care.

This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person's well-being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members.

Results of a multidisciplinary program for patients with fibromyalgia implemented in the primary care.

Purpose: Fibromyalgia is a syndrome of unknown origin with a high prevalence. Multimodal approaches seem to be the treatment of choice in fibromyalgia. A multidisciplinary program was developed and implemented for patients with fibromyalgia in the primary care setting.

Care as a mutual endeavour: experiences of a multiple sclerosis patient and her healthcare professionals.

In Dutch healthcare policy patients are seen as informed, autonomous experts and active decision makers with control over their illness and care. Healthcare professionals are expected to operate as providers of information. The purpose of this article is to argue that the consumerist approach of the patient-professional relationship is not a productive way to envision the patient-professional relationship.

Two women with multiple sclerosis and their caregivers: conflicting normative expectations.

It is not uncommon that nurses are unable to meet the normative expectations of chronically ill patients. The purpose of this article is to describe and illustrate Walker's expressive-collaborative view of morality to interpret the normative expectations of two women with multiple sclerosis. Both women present themselves as autonomous persons who make their own choices, but who also have to rely on others for many aspects of their lives, for example, to find a new balance between work and social contacts or to find work.

Reducing discrepancies between MS patients' needs and use of healthcare services by applying a transmural care model.

The Dutch healthcare system is effective for patients with acute, uncomplicated health problems but ineffective for patients with complex, chronic health problems such as multiple sclerosis (MS). To tackle these deficits, special working parties and the Dutch Ministry of Health concluded that healthcare professionals from primary and hospital settings should, by mutual agreement, cooperation, and shared responsibility, better coordinate their care and tailor care to meet patients' individual needs. In the Netherlands this approach is called transmural care.

Cerebrovascular response to acute metabolic acidosis in humans.

Objectives: Evaluation of the cerebrovascular response (delta CBV/delta PaCO2) during baseline metabolic conditions and acute metabolic acidosis.

Methods: 15 healthy subjects, 5 m, 10 f, 56 +/- 10 yrs were investigated. For acidification, NH4Cl was given orally.

A modeling investigation to the possible role of myoglobin in human muscle in near infrared spectroscopy (NIRS) measurements.

Near Infrared Spectroscopy (NIRS) analyzes infrared light having traveled through tissue, for its oxygenation status. The main chromophore analyzed is hemoglobin (Hb), but in muscle tissue also myoglobin (Mb) is present. Since NIRS cannot discern between these two species experimentally, we did model calculation studies using general data for human muscle.

Pinacidil-induced opening, like glibenclamide-induced closure of cardiac KATP channels, protects cardiac function against ischemia in isolated, working, erythrocyte perfused rat hearts.

Glibenclamide-induced closure of ATP-dependent potassium (KATP) channels decreases coronary blood flow during normoxic and post-ischemic conditions. We have found that post-ischemic cardiac function is improved after glibenclamide treatment. Our theory was that this is a result of higher intracellular calcium concentrations due to reduction in ischemia-mediated hyperpolarization of the myocardial cell membrane.

Oxygen diffusion coefficient and oxygen permeability of metmyoglobin solutions determined in a diffusion chamber using a non-steady state method.

Non-steady state measurements of oxygen diffusion through various model layers can be performed using a diffusion chamber that was described earlier [1, 2]. A closer analysis of these measurements showed that they not only yield the oxygen diffusion coefficient (DO2) of the diffusion layer, but also the oxygen permeability (PO2). In this study DO2 and PO2 have been determined in solutions of metmyoglobin (metMb) with concentrations varying between 5 and 40 g/dL at 25 degrees C.

Cerebral (31)P magnetic resonance spectroscopy and systemic acid-base balance during hypoxia in fetal sheep.

The purpose of this study was to investigate cerebral energy metabolism and acid-base homeostasis during impaired oxygen supply in fetal sheep. Systemic acid-base balance was correlated with the sequence in changes of cerebral phosphorus metabolite ratios and intracellular pH. Phosphorus magnetic resonance spectra were obtained from the brain of six fetal sheep simultaneously with repeated measurements of fetal arterial oxygen saturation and acid-base balance.

The role of myocardial KATP-channel blockade in the protective effects of glibenclamide against ischaemia in the rat heart.

Glibenclamide preserves postischaemic myocardial function in the isolated, erythrocyte perfused, working rat heart model. This study addresses the possible involvement of KATP channels in this beneficial action of glibenclamide. We hypothesized that if glibenclamide improved postischaemic cardiac function by blocking of KATP channels, opening of these KATP channels should result in the opposite, namely detrimental effects on postischaemic heart function.

1H-NMR spectroscopy of cerebrospinal fluid of fetal sheep during hypoxia-induced acidemia and recovery.

The purpose of the study was to investigate the sequence of processes occurring during and after hypoxia-induced acidemia. We used proton nuclear magnetic resonance spectroscopy, which provides an overview of metabolites in cerebrospinal fluid (CSF), reflecting neuronal metabolism and damage. The pathophysiological condition of acute fetal asphyxia was mimicked by reducing maternal uterine blood flow in 14 unanesthetized pregnant ewes.

Physiological insulin concentrations protect against ischemia-induced loss of cardiac function in rats.

This study determined whether insulin at pre- (fasting) and post-prandial concentrations increases coronary blood flow and improves cardiac function after acute ischemia during a situation of myocardial stunning. The experiments were performed using an isolated, erythrocyte perfused, working rat heart model. To the perfusate we added erythrocytes and 1.

Metformin improves cardiac functional recovery after ischemia in rats.

The biguanide, metformin, is widely used for the treatment of type 2 diabetes mellitus. In the recently published United Kingdom Prospective Diabetes Study (UKPDS), it was shown that the use of metformin was associated with a reduction of macrovascular complications compared to other blood glucose-lowering strategies. The present study was aimed at determining whether metformin has direct beneficial effects on the heart.