Helianthe Kort

Level of daily physical activity in individuals with COPD compared with healthy controls

BackgroundPersons with Chronic Obstructive Pulmonary Disease (COPD), performing some level of regular physical activity, have a lower risk of both COPD-related hospital admissions and mortality. COPD patients of all stages seem to benefit from exercise training programs, thereby improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue. Physical inactivity, which becomes more severe with increasing age, is a point of concern in healthy older adults. COPD might worsen this scenario, but it is unclear to what degree. This literature review aims to present the extent of the impact of COPD on objectively-measured daily physical activity (DPA). The focus is on the extent of the impact that COPD has on duration, intensity, and counts of DPA, as well as whether the severity of the disease has an additional influence on DPA.ResultsA literature review was performed in the databases PubMed [MEDLINE], Picarta, PEDRO, ISI Web of Knowledge and Google scholar. After screening, 11 studies were identified as being relevant for comparison between COPD patients and healthy controls with respect to duration, intensity, and counts of DPA. Four more studies were found to be relevant to address the subject of the influence the severity of the disease may have on DPA. The average percentage of DPA of COPD patients vs. healthy control subjects for duration was 57%, for intensity 75%, and for activity counts 56%. Correlations of DPA and severity of the disease were low and/or not significant.ConclusionsFrom the results of this review, it appears that patients with COPD have a significantly reduced duration, intensity, and counts of DPA when compared to healthy control subjects. The intensity of DPA seems to be less affected by COPD than duration and counts. Judging from the results, it seems that severity of COPD is not strongly correlated with level of DPA. Future research should focus in more detail on the relation between COPD and duration, intensity, and counts of DPA, as well as the effect of disease severity on DPA, so that these relations become more understandable.

Clinical evaluation of a double-blind dust-mite avoidance trial with mite-allergic rhinitic patients.

Inheritance and allergen exposure are key factors in the development and the course of atopic allergy, expressed as conjunctivitis, rhinitis, asthma or dermatitis. This study concerns the clinical significance of mite and mite‐allergen avoidance measures based on intensive cleaning with acaricide (solidified benzylbenzoate) added (10 dwellings), and without biocidal activity (10 other homes) as a control in a double‐blind trial with matched pairs. Twenty subjects with persisting rhinitic complaints were selected. They lived in 20 different dwellings and were ail sensitized to pyroglyphid mites; 12 of them were also sensitized to stored product miles (Acari). Daily symptoms and medication score, guanine and dust exposure, total and mite‐specific IgE in serum, eosinophilia in the blood and in the nasal smear, intracutaneous tests with house dust mite and storage mite extracts were compared in both pairs and groups. Acarological data, physiochemical aspects and exposure assessment are discussed in detail elsewhere. Symptom scores dropped significantly, as did the total IgE and exposure to dust and mite products in the acaricidal cleaner treatment group. After 1 year, the daily symptoms median was 47% (P= 0.025), total IgE was 38% (P=0.0049), and exposure to dust and mite products (guanine exposure) was 53% (P= 0.0449) better or lower than in the controls. Intensive cleaning, without acaricidal treatment performed twice a year, resulted in clinical improvement in four out of 10 subjects, of whom none became free of complaints. In the Acarosan treatment group (cleaning+ benzylbenzoate) eight out of 10 subjcets improved, in three cases subjective symptoms disappeared. The conclusion is that mite avoidance in homes can be carried out successfully with a special acaricidal cleaning formulation Acarosan.

Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation

Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation. A randomised controlled trial was performed in 32 physiotherapy practices in the Netherlands. COPD patients were randomised into intervention or usual care groups. The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists. Measurements were performed at 0, 3, 6 and 12 months. Physical activity, functional exercise capacity, lung function, health-related quality of life and body mass index were assessed. 157 patients started the study and 121 completed it. There were no significant positive effects of the intervention on physical activity (at 0 months: intervention 5824±3418 steps per weekday, usual care 5717±2870 steps per weekday; at 12 months: intervention 4819±2526 steps per weekday, usual care 4950±2634 steps per weekday; p=0.811) or on the secondary end-points. There was a significant decrease over time in physical activity (p<0.001), lung function (p<0.001) and mastery (p=0.017), but not in functional exercise capacity (p=0.585). Although functional exercise capacity did not deteriorate, our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation. mHealth intervention does not improve or maintain physical activity in COPD patients after pulmonary rehabilitation http://ow.ly/SS2T301BA85

Competencies required for nursing telehealth activities: A Delphi-study

BACKGROUND Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. METHOD In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. RESULTS Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. DISCUSSION/CONCLUSION Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.

Systematic review on the interaction between office light conditions and occupational health: Elucidating gaps and methodological issues:

Purpose The International Commission on Illumination (CIE) recommends researchers to investigate a wide variety of behavioural and health outcomes. However, researchers often investigate only a part of occupational health (OH) in relation to light. A literature study (2002–2017) regarding the relationship between office lighting conditions and OH was performed to identify gaps and methodological issues. Method The OH outcomes investigated in this paper were grouped according to the International Classification of Diseases and analysed per category: physical and physiological health, mental health, eye health, sleep parameters and visual comfort. Results Findings from the literature study (20 eligible papers) showed that all OH aspects were mostly but not exclusively measured subjectively. Furthermore, most studies investigated only a fraction of office lighting parameters and OH aspects. Conclusions It seems that Correlated Colour Temperature (CCT) and illuminance mainly correlate with OH. However, this may also be explained by gaps and methodological issues in studies described in eligible papers. Based on the literature study, an overview was composed elucidating gaps and methodological issues of office lighting and OH studies. It can be used to design and target the purpose of light and health research.

Zelfmanagement bij chronische ziekten

SamenvattingTrappenburg J, Jonkman N, Jaarsma T, Van Os-Medendorp H, Kort H, De Wit N, Hoes A, Schuurmans M. Zelfmanagement bij chronische ziekten. Huisarts Wet 2014;57(3):120–4. Zelfmanagement is trendy: algemeen is het een erkend onderdeel van de behandeling van chronische aandoeningen en de verwachtingen zijn torenhoog. Toch stuit brede invoering van zelfmanagementprogramma’s op beletsels. Er is veel wetenschappelijk onderzoek gedaan, maar er is nog geen eenduidig bewijs voor de effectiviteit van zelfmanagementprogramma’s, onder andere door grote verschillen in terminologie. Er zijn zeker indicaties dat zelfmanagement potentie heeft, maar lang niet alle patiënten reageren op de interventies. De variatie tussen programma’s en patiëntenpopulaties is enorm en daardoor is moeilijk te bepalen wat nu precies werkt en bij wie. De begripsverwarring, ook bij zorgverleners, beleidmakers en publiek, herbergt het risico dat ‘zelfmanagement’ een nietszeggend containerbegrip wordt.Deze beschouwing verduidelijkt de terminologie en evalueert de bewijskracht voor de effectiviteit van zelfmanagementprogramma’s. Overduidelijk is dat niet alle patiënten profiteren van de huidige one-size-fits-all-benadering. Er is dus behoefte aan zorg-opmaat, afgestemd op de individuele patiënt. Dat vergt nader onderzoek naar de succesfactoren: welk type interventie, met welke inhoud, in welke vorm en in welke intensiteit is het kansrijkst bij welk type patiënt? Het onderzoeksconsortium Tailored Self-management & Ehealth (TASTE) probeert deze factoren systematisch te ontrafelen en op maat gesneden interventies te ontwikkelen. Vooralsnog doen eerstelijnszorgverleners er goed aan, de geschiktheid van een zelfmanagementinterventie voor iedere patiënt goed af te wegen.AbstractTrappenburg JCA, Jonkman N, Jaarsma T, Van Os-Medendorp H, Kort H, De Wit NJ, Hoes AW, Schuurmans M. Self-management and chronic disease. Huisarts Wet 2014;57(3):120–4. Self-management is trendy: it is a recognized component of the treatment of chronic disorders and expectations are high. Even so, there are barriers to the introduction of self-managements programmes. Despite considerable research, there is still no hard evidence of the efficacy of self-management programmes, in part because of differences in terminology. There are indications that self-management has potential, but not all patients respond to these interventions. Differences between programmes and patient populations make it difficult to establish which programme works for which patient group. Terminological confusion, also among care providers, policy makers, and the public, harbours the risks that ‘self-management’ may become a meaningless concept.This article clarifies terminology and evaluates the strength of evidence for the efficacy of self-management programmes. It is clear that not all patients benefit from the ‘one size fits all’ approach and that there is a need for tailored care, based on the individual patient. This requires further investigation of determinants of success; which type of intervention, and with what content, form, and intensity, has the great est likelihood of success in specific patient groups. The research consortium Tailored Self-management & Ehealth (TASTE) is trying to unravel these factors and to develop tailored interventions. For the moment, primary care practitioners would do well to evaluate the suitability of self-management programmes for individual patients.

Understanding Older People’s Readiness for Receiving Telehealth: Mixed-Method Study

Background The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people’s intention to use technology. Objective The objective of this study was to understand community-dwelling older people’s readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators. Methods A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people’s intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people’s actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2). Results In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people’s perception of videoconferencing. Older people’s (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people’s capacities and incapacities in using digital technology: (1) “self-efficacy and digital literacy,” (2) “obstacles to using technology,” (3) “prior experience and frequency of use,” (4) “sources of support and facilitating conditions,” and (5) “performance expectancy.” These 5 themes recurred in all 15 observations. Conclusions Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people’s intention to use videoconferencing. Self-efficacy appeared to play a role in both older people’s intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people’s effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people’s capacities to make use of digital technology.

A structural approach for the redesign of a small-scale care facility as a guideline for decision-makers

ABSTRACT Long-term care facilities in the Netherlands try to implement new design approaches to enrich their environments and to cope with the changes and innovations in the Dutch healthcare sector. An enriched environment supports both quality of life of people with frail health and the well-being of the healthcare professionals who take care of them. Despite the increased attention devoted to built environments in relation to health, a gap in knowledge remains how to implement new design approaches. The aim of this study is to present a structural approach for a decision-making process to help to create enriched small-scale care facilities for older people with a frail health condition. A case study was conducted to understand how the structural approach contributes to implementing design features of an enriched environment. The structural approach identifies the key factors (such as shared language, collective understanding and involvement of stakeholders) that should be considered when developing such facilities and describes the critical steps for decision-makers for such environment. This case study provides a rich source of information from actual experiences for a better understanding of steering mechanisms for decision-making by the management of small-scale care facilities.

Personal Lighting Conditions to Obtain More Evidence in Light Effect Studies

Research demonstrated a large variety regarding effects of light (e.g. health, performance, or comfort effects). Since human health is related to each individual separately, the lighting conditions around these individuals should be analysed individually as well. This paper provides, based on a literature study, an overview identifying the currently used methodologies for measuring lighting conditions in light effect studies. 22 eligible articles were analysed and this resulted in two overview tables regarding the light measurement methodologies. In 70% of the papers, no measurement details were reported. In addition, light measurements were often averaged over time (in 84% of the papers) or location level (in 32% of the papers) whereas it is recommended to use continuous personal lighting conditions when light effects are being investigated. Conclusions drawn in light effect studies based on personal lighting conditions may be more trusting and valuable to be used as input for an effect-driven lighting control system.

Local Lighting Control in Open-Plan Offices: The Influence of Office Lay-Out

Highly granular lighting control involves switching on and off luminaires based on individual occupancy. The resulting high frequency of lighting changes can distract the office workers and negatively impact their work performance. In a cubicle office, this might be less of an issue than in an office without partitions, as users do not have an overview over the space here. We tested this control strategy in both office types and compared the results to determine the influence of office lay-out on the amount and acceptability of distractions that it poses. Our results indicated the opposite: occupants in the cubicle office were more often distracted and rated the distractions as less acceptable than in the bullpen office. As the job function types varied and the bullpen was consequently more dynamic, it seems that the type of work environment is of larger influence on users’ satisfaction with local lighting control. However, more research is required to confirm this finding.