The corona pandemic and participatory governance: Responding to the vulnerabilities of secondary school students in Europe.

Adolescents in secondary schools have limited susceptibility to the SARS-COV-2 virus, but paradoxically are considered to be carrying the highest psychosocial burden during this pandemic. The aim of our European multi-country qualitative research was to investigate the COVID-19 crisis response in secondary schools and the role of national, regional, and local stakeholders in contributing to a participatory governance approach. We carried out 11 months of qualitative fieldwork, which included 90 respondents from the Netherlands, Ireland, and Finland for in-depth interviews and/or group discussions. Participant observation was conducted in four secondary schools to explore the interplay of day-to-day formal and informal practices of crisis governance. Our findings contribute to a better understanding of what efforts were made to facilitate participatory governance and where a bottom-up approach would have served useful in successfully implementing the COVID-19 mitigation strategies. Moreover, we show how these mitigation strategies have led to unintended consequences, such as students' difficulties with isolation and associated mental health problems, and the struggles of socialization when returning to a physical school environment. Our findings highlight the importance of the school environment in the socio-emotional developments of adolescents. We introduce the TAPIC-R model to analyze good governance, advancing the existing TAPIC model with an emphasis on the role of resilience in shaping participatory governance. We argue this is urgently needed during crises to strengthen engagement of the community, including vulnerable groups and achieve positive outcomes within and across policy structures and action domains.

Relationship between drug burden and physical and cognitive functions in a sample of nursing home patients with dementia.

PURPOSE: The Drug Burden Index (DBI) is a tool to quantify the anticholinergic and sedative load of drugs. Establishing functional correlates of the DBI could optimize drug prescribing in patients with dementia. In this cross-sectional study, we determined the relationship between DBI and cognitive and physical functions in a sample of patients with dementia. METHODS: Using performance-based tests, we measured physical and cognitive functions in 140 nursing home patients aged over 70 with all-cause dementia. We also determined anticholinergic DBI (AChDBI) and sedative DBI (SDBI) separately and in combination as total drug burden (TDB). RESULTS: Nearly one half of patients (48%) used at least one DBI-contributing drug. In 33% of the patients, drug burden was moderate (0 < TDB < 1) whereas in 15%, drug burden was high (TDB ≥ 1). Multivariate models yielded no associations between TDB, AChDBI, and SDBI, and physical or cognitive function (all p > 0.05). CONCLUSIONS: A lack of association between drug burden and physical or cognitive function in this sample of patients with dementia could imply that drug prescribing is more optimal for patients with dementia compared with healthy older populations. However, such an interpretation of the data warrants scrutiny as several dementia-related factors may confound the results of the study.

The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomised controlled trial.

OBJECTIVE: This study aimed to compare the effects of music therapy with general recreational day activities in reducing agitation in people with dementia, residing in nursing home facilities. METHODS: In a randomised controlled design, residents with dementia (n = 94) were allocated to either music therapy or recreational activities. Both music therapy and general activities were offered twice weekly for 4 months. Changes in agitation were measured with a modified Cohen-Mansfield Agitation Inventory (CMAI) at four intervals on each intervention day. A mixed model analysis was used to evaluate the effectiveness of music therapy, compared with general activities, on CMAI scores at 4 h after the intervention, controlled for CMAI scores at 1 h before the session and session number. RESULTS: Data were analysed for 77 residents (43 randomised to music therapy and 34 to general activities). In both groups, the intervention resulted in a decrease in agitated behaviours from 1 h before to 4 h after each session. This decrease was somewhat greater in the music therapy group than in the general activities group, but this difference was statistically not significant (F = 2.885, p = 0.090) and disappeared completely after adjustment for Global Deterioration Scale stage (F = 1.500; p = 0.222). CONCLUSIONS: Both music therapy and recreational activities lead to a short-term decrease in agitation, but there was no additional beneficial effect of music therapy over general activities. More research is required to provide insight in the effects of music therapy in reducing agitation in demented older people.

Dutch psychogeriatric day-care centers: a qualitative study of the needs and wishes of carers.

BACKGROUND: In the past day-care facilities for people with dementia were developed with little input from the users. As these facilities play an increasingly important role in the lives of the growing number of community-living persons with dementia and their caregivers, it now seems obvious to incorporate users' perspectives when establishing or optimizing day care. This study addresses the needs and wishes of informal caregivers when providing skilled psychogeriatric day-care in the Netherlands. METHOD: This is a qualitative, exploratory study, based on interviews with family caregivers and professional focus groups as the primary data source. RESULTS: Using data from the interviews, the needs and wishes of carers were classed into three general domains: (1) approach to care - relating to shared and tailored care and confidence in professionals as well as the facility as important themes; (2) professional expertise - relating to the carers' need for education and information regarding dementia, available resources, as well as cooperation between professionals; and (3) the day program - concerning the content and structure of the day care. CONCLUSIONS: The interviews with the caregivers suggest that the relationship with day-care personnel is an important aspect of psychogeriatric day-care. Caregivers have high expectations regarding the expertise of professionals, but seem to be unaware of available resources and services. Professionals should play a more active role in providing education, advice and support. Above all, the attendees must have a positive experience of the day-care facilities and its activities.

Selection of Sphingomonadaceae at the base of Laccaria proxima and Russula exalbicans fruiting bodies.

The dense hyphal network directly underneath the fruiting bodies of ectomycorrhizal fungi might exert strong influences on the bacterial community of soil. Such fruiting bodies might serve as hot spots for bacterial activity, for instance by providing nutrients and colonization sites in soil. Here, we assessed the putative selection of specific members of the Sphingomonadaceae family at the bases of the fruiting bodies of the ectomycorrhizal fungi Laccaria proxima and Russula exalbicans in comparison to the adjacent bulk soil. To do so, we used a previously designed Sphingomonadaceae-specific PCR-denaturing gradient gel electrophoresis (DGGE) system and complemented this with analyses of sequences from a Sphingomonadaceae-specific clone library. The analyses showed clear selective effects of the fruiting bodies of both fungi on the Sphingomonadaceae community structures. The effect was especially prevalent with R. exalbicans. Strikingly, similar fungi sampled approximately 100 m apart showed similar DGGE patterns, while corresponding bulk soil-derived patterns differed from each other. However, the mycospheres of L. proxima and R. exalbicans still revealed divergent community structures, indicating that different fungi select for different members of the Sphingomonadaceae family. Excision of specific bands from the DGGE patterns, as well as analyses of the clone libraries generated from both habitats, revealed fruiting body-specific Sphingomonadaceae types. It further showed that major groups from the mycospheres of R. exalbicans and L. proxima did not cluster with known bacteria from the database, indicating new groups within the family of Sphingomonadaceae present in these environments.

A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting.

BACKGROUND: Little is known about the extent of drug-related problems of polypharmacy patients in Dutch nursing homes. OBJECTIVES: We investigated the feasibility of teams of hospital pharmacists and nursing home physicians carrying out medication reviews. We aimed to identify the number and nature of drug-related problems of nursing home patients receiving more than nine drugs (polypharmacy). METHODS: The study was carried out in five Dutch nursing homes (n = 742 beds) between October 2005 and May 2006. Ninety-one polypharmacy patients, (average age 80 years) were included. A medication review was carried out by teams consisting of one hospital pharmacist and the patient's nursing home physician with a follow-up meeting of the same team 6 weeks later. RESULTS: A total of 323 drug-related problems were identified (mean of 3.5 problems per patient). Sixty-two per cent of problems, in 87% of patients, were classified as 'unclear or not confirmed indication or need for review' of the prescribed drug. By the time of the follow-up, a mean of 1.7 (n = 159) problems per patient had been solved and the number of drugs per patient had decreased significantly from 13.5 to 12.7 (P < 0.0001). CONCLUSIONS: The majority of patients had at least one drug prescribed for which the indication was unknown. The intervention was accompanied by a significant decrease in the number of drugs per patient, but half of the drug-related problems remained unsolved.

A 19F NMR study of fluorobenzoate biodegradation by Sphingomonas sp. HB-1.

While several microorganisms readily degrade 2- and 4-fluorobenzoates, only a very small number appear to catabolise the 3-fluoro isomer, owing to the accumulation of toxic intermediates. Here we describe the isolation of a bacterium capable of using 3-fluorobenzoate as a sole source of carbon and energy, and the experiments conducted to define the steps involved in the biodegradation of this compound. The organism was identified as a strain belonging to the genus Sphingomonas by sequence analysis of its 16S rRNA gene. To date no other organism from this genus is known to degrade this compound. Using fluorine nuclear magnetic resonance spectroscopy (19F NMR) to analyse the culture supernatant it was possible to observe the disappearance of 3-fluorobenzoate and the appearance of fluoride ion and four other fluorinated compounds. These were identified as 3-fluorocatechol, 2-fluoromuconic acid and 3- and 5-fluoro-1,2-dihydro-1,2-dihydroxybenzoates. Thus, the likely catabolic pathway involves dioxygenation of 3-fluorobenzoate yielding fluorocatechol and subsequent intra-diol cleavage to yield fluoromuconic acid. The organism can also use 2- and 4-fluorobenzoates as growth substrates.

[The health status and health care use of elderly living in sheltered residences. A comparison with independently living elderly]. / Gezondheidstoestand en zorggebruik van bewoners van service-ouderenwoningen. Een vergelijking met zelfstandig wonenden.

A sheltered residence for older persons is a living arrangement in between independent living and a residential institution. There is little knowledge about the health of elderly living in these residences. We studied the physical, functional and psychosocial health of 401 persons living in a sheltered residence for elderly in Zwolle through a standardised interview. We compared the health of these elderly to the health of independently living elderly in the same region studied in the Longitudinal Aging Study Amsterdam and adjusted for sex, age and married state. We found an impaired functional health and more chronic illnesses among elderly living in a sheltered residence. In addition, more medication was used (OR = 2.4). The studied elderly felt more often depressed (OR = 1.9) or lonely (OR = 1.7). Their mental state was more frequently impaired (OR = 1.7), they visited health professionals more often and received more help for personal care (OR = 2.0) and housekeeping (OR = 1.6). We conclude that people living in sheltered residences form a distinct group of elderly, characterised by impaired physical, functional and psychosocial health. Planners of future care must be aware of this vulnerable group.

A novel class of secreted hydrophobic proteins is involved in aerial hyphae formation in Streptomyces coelicolor by forming amyloid-like fibrils.

Streptomycetes exhibit a complex morphological differentiation. After a submerged mycelium has been formed, filaments grow into the air to septate into spores. A class of eight hydrophobic secreted proteins, ChpA-H, was shown to be instrumental in the development of Streptomyces coelicolor. Mature forms of ChpD-H are up to 63 amino acids in length, and those of ChpA-C are larger (+/-225 amino acids). ChpA-C contain two domains similar to ChpD-H, as well as a cell-wall sorting signal. The chp genes were expressed in submerged mycelium (chpE and chpH) as well as in aerial hyphae (chpA-H). Formation of aerial hyphae was strongly affected in a strain in which six chp genes were deleted (DeltachpABCDEH). A mixture of ChpD-H purified from cell walls of aerial hyphae complemented the DeltachpABCDEH strain extracellularly, and it accelerated development in the wild-type strain. The protein mixture was highly surface active, and it self-assembled into amyloid-like fibrils at the water-air interface. The fibrils resembled those of a surface layer of aerial hyphae. We thus conclude that the amyloid-like fibrils of ChpD-H lower the water surface tension to allow aerial growth and cover aerial structures, rendering them hydrophobic. ChpA-C possibly bind ChpD-H to the cell wall.

Survival in a population-based cohort of dementia patients: predictors and causes of mortality.

OBJECTIVES: To examine predictors of survival time and causes of mortality in a population-based cohort of demented subjects. DESIGN: Longitudinal naturalistic follow-up study. SETTING: A rural area in The Netherlands. PARTICIPANTS: The study population consisted of 102 demented subjects derived from a population-based, two-stage prevalence study of dementia among subjects aged 65 and over. MEASUREMENTS AND ANALYSIS: Survival analysis was performed using the Realized Probability of Dying as a measure of survival time. Adjustment for duration and severity at study entry was employed in all analyses. RESULTS: A substantial excess mortality was present among demented subjects as compared with their non-demented birth cohort. Disorders related to dementia, such as cachexia, dehydration and pneumonia, were major causes of death. Variables related to severity of functional impairment, aphasia and a shorter duration at study entry predicted a shorter survival in the study population.

Prevalence of dementia in a rural Netherlands population and the influence of DSM-III-R and CAMDEX criteria for the prevalence of mild and more severe forms.

To obtain estimates of the prevalence of mild and moderate/severe dementia among people age 65 and over, applying criteria for severity of both DSM-III-R and CAMDEX, a two-stage community-based study was conducted in a rural area of the Netherlands. In the first stage, 2191 subjects (out of the target population of 2655) participated in an interview which included the Mini-Mental State Examination (MMSE). Based on MMSE score, a non-proportional random sample (n=496) was drawn for the second stage. A total of 421 subjects responded and were subsequently examined using the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). In determining the severity of dementia, criteria of both DSM-III-R and CAMDEX were applied. Overall prevalence for both classification systems was 6.5%. There was a large discrepancy between the two classification systems with regard to the criteria for rating severity. The prevalence of moderate/severe dementia using DSM-III-R criteria was twice as high as the prevalence using CAMDEX criteria. These findings reflect the differences between DSM-III-R and CAMDEX in descriptions of dementia severity. Rating according to CAMDEX predicts institutionalization in specialized nursing homes somewhat better than staging according to DSM-III-R. Both content analysis and institutionalization data suggest that the CAMDEX operationalization of rating severity seems preferable.

Characteristics of non-responders and the impact of non-response on prevalence estimates of dementia.

BACKGROUND: Differential distributions of sociodemographic characteristics and cognitive impairment in responders and non-responders may result in a biased prevalence estimate of dementia based on responders only. METHODS: Responders (n = 2191) to a cross-sectional, two-stage community study were compared with regard to sociodemographic characteristics and cognition with three subgroups of non-responders: (A) subjects who refused to participate (n = 369), (B) subjects who were too ill or who had died prior to the screening (n = 72) and (C) subjects who had moved out of the study region or were not traceable (n = 23). Prevalence estimates specific for age and housing situation in responders and physicians' ratings of cognitive impairment were used to estimate the prevalence of dementia among non-responders. RESULTS: Group A differed from responders in age and housing situation, group B in age, housing and cognition, and group C only in age. Separate prevalence estimates of dementia based on age, housing and cognition yielded figures for group A between 4.9% and 7.2%, for group B between 13.1% and 19.1%, and for group C between 2.6% and 4.2%. Joined with the prevalence rate among responders (6.5%) the best possible point estimate of the prevalence of dementia in the target population lies between 6.4% and 6.9%, i.e. within the 95% confidence interval (CI) of the prevalence among responders (5.4-7.5%). CONCLUSIONS: Although in this study non-response had no important influence on the overall prevalence, the findings among the distinct non-response subgroups point to the importance of describing non-response sociodemographically as well as in terms of the study objective. The authors recommend that non-responders are categorized into distinct groups based on the reason for non-response.

[Usefulness of the 'Mini-Mental State Test'for the diagnosis of dementia; study of criterion validity in a Dutch rural population]. / Bruikbaarheid van de 'Mini-mental state examination' voor het vaststellen van dementie; onderzoek naar de criteriumvaliditeit in een Nederlandse plattelandspopulatie.

OBJECTIVE: To establish the criterion validity of the MMSE for dementia in a community-based population. DESIGN: Descriptive. SETTING: Eight rural general practices and eight adherent institutions for long-term care near Zwolle, the Netherlands. METHODS: In the first (screening) stage, the MMSE was applied, in the second (diagnostic) stage the 'Cambridge examination for mental disorders of the elderly' (CAMDEX) was used. After exclusion of subjects with clinically relevant impairment of hearing and (or) vision, analyses were based on 2151 screened subjects. Based on a non-proportional, stratified randomized sampling procedure using the MMSE score as the stratification variable, 390 of the screened subjects were examined with the CAMDEX. Seventy-seven cases of DSM-III-R dementia were identified. Based on 390 paired observations the relationship between MMSE score and DSM-III-R dementia was modelled by logistic regression. After extrapolation of this relationship to the total screened population, sensitivity and specificity figures were calculated at several cut-offs of the MMSE, and Receiver Operating Characteristic (ROC) curves were constructed for the total population as well as for four subpopulations. (men, women, < 80, > or = 80 years). RESULTS: At the cut-off of 23/24, sensitivity was 0.76 and specificity 0.91 in the total population. However, the criterion validity of the MMSE varied substantially between the four sex-age combinations. Criterion validity was especially poor for women in the younger age range. CONCLUSION: The MMSE has only limited value in clinical practice. Use of uniform cut-offs has to be rejected.

Care services for dementia patients: predictors for service utilization.

AIM: The objective of this study was to examine service utilization figures among a representative sample of demented patients and to determine whether sociodemographic and health-related variables are associated with care utilization. METHOD: The study population was derived from a population-based, two-stage cross-sectional study in The Netherlands and consisted of 102 demented subjects. Four levels of care intensity were used: level 1, no use of professional care; level 2, use of one or more types of professional care by community-dwelling subjects; level 3, residential living in homes for the aged; level 4, long-term care in specialized nursing homes. Sociodemographic variables and variables related to mental and physical health, functional dependency and severity of dementia were studied as determinants of levels of care. RESULTS: Eighty-two per cent of the study subjects used one or more types of formal care and 55% were institutionalized. Multivariate analysis yielded age, severity of dementia, somatic disorders, dependency in terms of ADL and martial status as predictors of higher levels of care. Sets of predictors differed across different care levels. CONCLUSIONS: The findings point to the importance of the social network and the relevance of general medical treatment and an active approach towards decreasing the impact of ADL dependency in demented subjects.

Differences in prevalence of dementia based on community survey and general practitioner recognition.

A study was conducted, which simultaneously used GPs and epidemiological assessment procedures (MMSE, CAMDEX), to identify individuals with DSM-III-R dementia in the same population. In addition, a 1-year follow-up assessment was conducted in patients with a CAMDEX-diagnosis of dementia. In the non-institutionalized group, which was assessed both by the GP and with the epidemiological test battery, the prevalence of dementia according to the GP was 2.2%, whereas the prevalence based on the epidemiological approach amounted to 5.2%. In general CAMDEX-diagnoses of dementia were confirmed at 1-year follow-up, and thus the discrepancy between the two prevalence estimates must be attributed to the low sensitivity of the GPs. Sensitivity of the GP was related to help-seeking behaviour, with low sensitivity in patients with a low contact rate. It was also related to the use of less specific diagnostic labels by the GP (cognitive impairment), and to poor recognition of cognitive impairment in patients who visited their GP.

[Prevalence and severity of the dementia syndrome in homes for the aged and nursing homes. A study in elderly from a rural area near Zwolle]. / Prevalentie en ernst van het dementiesyndroom in bejaardenoorden en verpleeghuizen. Een onderzoek bij ouderen afkomstig van het platteland rondom Zwolle.

In the Netherlands both nursing homes and homes for the aged serve as a residence for demented elderly. Although these institutions differ considerably regarding financing and care facilities, specific functions of each institute concerning demented elderly have not been clearly defined. In order to know to what extent residential facilities serve demented elderly, the prevalence and severity of dementia among residents aged 65 and over was studied as part of a prevalence study among elderly people in a rural area of the Netherlands. The target population existed of all persons aged 65 and over who were registered in eight general practices. Patients who had to leave the practice on account of ill-health and were admitted to nursing homes were included in the study. In a two stage study the MMSE was applied as a screening instrument. Based on MMSE-score a non-proportional stratified random sample was drawn for the second, diagnostic stage, which existed of the CAMDEX. Prevalence estimates for DSM-III-R-dementia were 21% among residents of homes for the aged, 48% among residents of somatic wards of nursing homes and 100% among those admitted to psychogeriatric wards of nursing homes. Severity of dementia was highest among residents of psychogeriatric wards of nursing homes and lowest among those living in homes for the aged. Prevalence of dementia among residents of homes for the aged can be fully attributed to the age-distribution. The high frequency of dementia among residents of somatic nursing home wards can be explained in several ways: First, admission can be necessary due to a combination of dementia and somatic illness.(ABSTRACT TRUNCATED AT 250 WORDS)

Performance of students with learning disabilities on validity indexes of the Perception of Ability Scale for Students.

The present study examined the performance of 78 students with learning disabilities and 71 normally achieving students in regular Form 1 (Grade 6) classes on three validity indexes of the Perception of Ability Scale for Students, a measure of academic self-concept. The three indexes assess consistency of responding, negative or positive response biases, and misrepresentation of self-perceptions in terms of unrealistic perceptions of perfection in school. Analysis showed that learning disabled students obtained significantly lower Full Scale scores than the normal students, but no significant differences appeared on the three validity indexes. Users of the test can be confident that learning disabled students respond to items in as valid a manner as other students. Having specific learning problems in school should not interfere with response patterns on this scale.