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Context makes a difference: a qualitative study exploring how to implement a multifactorial falls prevention intervention in the community
No full textBackgroundFalls are a major problem in community-dwelling older people. Multifactorial falls prevention interventions are recommended as intervention. However, poor implementation impacts successful outcomes of multifactorial falls prevention interventions. The context is critical to understand variation in implementation and clinical outcomes. This study aims to analyze and describe determinants at all levels of the context that influence the implementation of a multifactorial falls prevention intervention in the community in Flanders (Belgium).MethodsThis study consists of semi-structured interviews with 6 key persons, 3 focus group interviews with healthcare professionals (n = 16), 1 focus group with local policy makers (n = 6) and 4 semi-structured interviews and 1 focus group (n = 3) with older people. The Integrated Checklist of Determinants of Practice (TICD checklist) was used to develop the interview guide and to make sure that there was enough understanding of the contextual determinants at the different domains. The interviews and focus groups were verbatim transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). To clarify themes, data were coded in NVivo 12 (TM).ResultsWe identified 4 key themes related to successful implementation of a multifactorial falls prevention intervention in the community setting: (1) stakeholder involvement and participation, (2) Fostering awareness, beliefs, knowledge, and skills for falls prevention, (3) working proactively and (4) communication, collaboration, coordination and financing care. This study identified 33 determinants of the TICD checklist and all 7 domains were represented.ConclusionsUnderstanding the existing structures, norms, policies and contextual factors allows us to proactively tailor the implementation strategies and a multifactorial falls prevention intervention to the community context.The Flemish Government, Department of Welfare, Public Health & Family funded this study. The funding agency had no role in the design of the study, writing the manuscript and the collection, analysis, or interpretation of data
Blood Brain Barrier transmigration triggers inflammasome activation in Th lymphocytes during neuroinflammation
No full textIchthyo(parasito)logical research for parasite conservation, One Health, and education
No full textAquatic ecosystems are crucial for nature’s positive contributions to people and biodiversity, but they are heavily impacted by human activities. Fish are the most diverse vertebrates, and dominate most waterbodies. The health of aquatic ecosystems and its fauna underlies a plethora of services they provide, thus it represents a societally urgent challenge requiring a One Health approach.
We assess how global change alters host-parasite systems in African aquatic ecosystems. In protected Ramsar sites in the Congo Basin, we monitor how the community of macroinvertebrates, fishes, and their respective parasites changes along a gradient of anthropogenic impacts. In Senegal, we compare protected and unprotected mangroves to estimate how fishing influences their health-related ecosystem (dis)services and the pathogenic landscape, particularly through potential changes in vector predation. Finally, in the Lake Victoria region we reconstruct how bio-invasions and eutrophication rearranged fish-parasite networks in decades, retrieving parasitological information from host historical collections.
The science of ecosystem monitoring can only truly underpin sustainable development of ecosystem services in a One Health context when not confined to the research environment. Therefore, we endeavor to extend our work into capacity development, decision-making and higher education. We support the recently-founded Parasite Specialist Group within the Species Survival Commission of the International Union for Conservation of Nature, aiming for assessment of conservation status of parasites, parasite conservation plans (excluding species of medical or veterinary concern) and awareness about ecological roles of parasites. To innovate collection-based education in zoology in general and parasitology in particular, we apply state-of-the-art scanning and digitization techniques to extend our collaborations in the Global South. We expand the use of parasites as indicators of ecosystem health while working with local research partners and communities on specific approaches
Post-operative incidence of lymphedema after RARP with or without extended pelvic lymph node dissection in a cohort study
No full textObjectives: Lymphedema of the lower limbs and pubic area is a potential complication following extended pelvic lymph node dissection (ePLND) during robot-assisted radical prostatectomy (RARP). The incidence of lymphedema after ePLND has not been systematically reported in the literature. This study aimed to determine the incidence of lymphedema, describe its clinical characteristics and identify specific risk factors in patients undergoing RARP with or without ePLND. Methods: A retrospective cohort study was conducted at a tertiary referral centre between April 2016 and July 2020. Structured electronic case report forms (eCRFs) integrated into the electronic health record system were used to document intraoperative, perioperative and postoperative data. The primary endpoint was the incidence of lymphedema. Secondary endpoints included risk factors for and localization of the postoperative lymphedema. Results: A total of 500 patients who underwent RARP were included, with 301 patients undergoing ePLND and 199 patients without any form of PLND. Median follow-up period was 18 (range 3-49) months. Seventy-eight out of 301 (26%) of patients who underwent ePLND developed lymphedema, compared to only 2 out of 199 (1%) patients without ePLND. In most patients (49/301, 16%), lymphedema was mild (grade 1), whereas 29 patients (10%) developed grade 2 lymphedema. Twenty-six patients (9%) received decongestive lymphatic therapy. The most frequent site of lymphedema occurrence were the lower (54%) and the upper legs (40%). The number of nodes removed during RARP was identified as a risk factor for post-operative lymphedema (OR 1.04; p < 0.05). Conclusions: In this cohort study, approximately one in four patients undergoing RARP with ePLND developed lower limb and/or midline oedema, whereas one in ten patients started decongestive lymphatic therapy for symptomatic lymphedema. These findings provide valuable information for patient counselling about the potential benefits and risks of ePLND.Fonds Wetenschappelijk Onderzoek, Grant/Award Number: 1804625
Healthy lifestyle and the risk of endometrial cancer
No full textBackground: The incidence and mortality rate of endometrial cancer (EC) is increasing worldwide. Modifiable lifestyle factors associated with an increased or decreased risk of cancer typically cluster. Therefore, this study aimed to investigate the association between a healthy lifestyle, measured with a Healthy Lifestyle Index (HLI), based on diet, smoking, alcohol consumption, physical activity and Body Mass Index (BMI), and the risk of EC. Methods: A case-cohort analysis was conducted using data from the prospective Netherlands Cohort Study on Diet and Cancer (n = 62,573). At baseline in 1986, participants (aged 55-69) completed a questionnaire on potential cancer determinants. Data on aforementioned risk factors were used to calculate an HLI-score, ranging 0-20, with higher scores reflecting a healthier lifestyle. Cox regression analyses were used to estimate hazard ratios (HR's) and 95 % confidence intervals (CI's) for the association between HLI-score and EC risk in 414 cases and 1593 subcohort women, after 20.3 years of follow-up. After stratification by smoking status, Cox regression was applied using an HLI-score without smoking. Results: The HR for the total HLI score was 0.86 (95 %CI 0.78-0.94) per 1 standard deviation (SD) increment. The HR for the HLI score without smoking component was 0.75 (95 %CI 0.67-0.83) for non-smokers (never smoked or former smoker >10 years ago) and 0.85 (95 %CI 0.70-1.02) for recent smokers (current or former smoker <10 years ago), all per 1 SD increment. Sensitivity analyses excluding each HLI component show that BMI and physical activity are the main drivers of the inverse association between HLI-score and EC. Conclusion: A healthier lifestyle, measured with an HLI based on diet, alcohol consumption, physical activity, BMI and smoking is associated with a reduced EC risk. The association is stronger for non-smokers.We thank the participants of the Netherlands Cohort Study, and the Netherlands Cancer Registry and Dutch Pathology Registry PALGA for providing data, and we thank the staff of the Netherlands Cohort Study for their valuable contributions
New species of groundwater Candonidae (Crustacea, Ostracoda) from Benin: towards their use as bioindicators of water quality
No full textAquatic ecosystems are currently being subjected to major transformations as a result of anthropogenic actions and the effects of climate change, with a significant impact on public health by increasing the prevalence of water-borne diseases in Africa. Monitoring of groundwater quality is therefore becoming crucial to ensure clean drinking water supplies and preserving local ecosystems. Ostracods are small and bivalved aquatic crustaceans and due to their sensitivity to environmental variations, they are considered to be reliable bioindicators, although an accurate understanding of their ecology and distribution is required. Between 2015 and 2022, ostracods were sampled from more than 200 wells distributed over four catchment areas in Benin to explore the potential of ostracods as bioindicators. Sixty species of ostracods were identified and divided into two distinct ecological groups: 36 new to science stygobitic species from the family Candonidae, marking an endemic evolutionary radiation, and 24 non-stygobitic species, mainly from the family Cyprididae. Five new species of Candonidae were described, belonging to a new genus and subfamily, characterised by distinctive features such as a sevensegmented antennule, a specific caudal ramus, and other features of carapace and hemipenis morphology. Presence of ostracods was studied as a function of predictor variables, including water quality variables and other characteristics of the wells. The results showed that factors such as electrical conductivity, pH, temperature, bicarbonate concentration and NO2- levels significantly influenced the structure of ostracod communities. Stygobitic species compared to non-stygobites were found to be particularly sensitive to high nitrite levels, highlighting their vulnerability to anthropogenic disturbance. Thus, we conclude that the new stygobitic ostracod species, show promising potential to serve as reliable bioindicators for groundwater quality in tropical West Africa.
Keywords: Freshwater Ostracoda, Africa, water quality, ecology, bioindicator
Comparative Evaluation of Consumer Wearable Devices for Atrial Fibrillation Detection: Validation Study
No full textBackground: Consumer-oriented wearable devices (CWDs) such as smartphones and smartwatches have gained prominence for their ability to detect atrial fibrillation (AF) through proprietary algorithms using electrocardiography or photoplethysmography (PPG)-based digital recordings. Despite numerous individual validation studies, a direct comparison of interdevice performance is lacking. Objective: This study aimed to evaluate and compare the ability of CWDs to distinguish between sinus rhythm and AF. Methods: Patients exhibiting sinus rhythm or AF were enrolled through a cardiology outpatient clinic. The participants were instructed to perform heart rhythm measurements using a handheld 6-lead electrocardiogram (ECG) device (KardiaMobile 6L), a smartwatch-derived single-lead ECG (Apple Watch), and two PPG-based smartphone apps (FibriCheck and Preventicus) in a random sequence, with simultaneous 12-lead reference ECG as the gold standard. Results: A total of 122 participants were included in the study: median age 69 (IQR 61-77) years, 63.9% (n=78) men, 25% (n=30) with AF, 9.8% (n=12) without prior smartphone experience, and 73% (n=89) without experience in using a smartwatch. The sensitivity to detect AF was 100% for all devices. The specificity to detect sinus rhythm was 96.4% (95% CI 89.5%-98.8%) for KardiaMobile 6L, 97.8% (95% CI 91.6%-99.5%) for Apple Watch, 98.9% (95% CI 92.5%-99.8%) for FibriCheck, and 97.8% (95% CI 91.5%-99.4%) for Preventicus (P=.50). Insufficient quality measurements were observed in 10.7% (95% CI 6.3%-17.5%) of cases for both KardiaMobile 6L and Apple Watch, 7.4% (95% CI 3.9%-13.6%) for FibriCheck, and 14.8% (95% CI 9.5%-22.2%) for Preventicus (P=.21). Participants preferred Apple Watch over the other devices to monitor their heart rhythm. Conclusions: In this study population, the discrimination between sinus rhythm and AF using CWDs based on ECG or PPG was highly accurate, with no significant variations in performance across the examined devices. Trial Registration: ClinicalTrials.gov NCT06023290; https://clinicaltrials.gov/study/NCT06023290FW is supported as a predoctoral student by the Bijzonder Onderzoeksfonds of Hasselt University (BOF20DOC17). HG is supported as a predoctoral strategic basic research fellow by the Fund for Scientific Research Flanders (FWO 1S83221N). This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. The consumer-oriented wearable devices were provided by Qompium NV. The authors would like to thank Daimy Roebroek for her contribution to this work