Hilde Tobi

Use of Antipsychotic Drugs Among Dutch Youths Between 1997 and 2005

OBJECTIVE The authors examined prevalence, incidence, and duration of antipsychotic drug use in the northern and eastern regions of the Netherlands between 1997 and 2005 among youths in regard to age, gender, and class of drug. METHODS Prescription drug dispensing data were collected from community pharmacies in the northern Netherlands (www.iadb.nl). Prevalence, incidence, and duration of use were studied among roughly 100,000 youths ranging in age from infancy to age 19 years, calculated by age group (zero to four years, five to nine years, ten to 14 years, and 15 to 19 years), for boys and girls, and for first- and second-generation antipsychotics. Duration of use was compared between youths who started antipsychotic treatment in 1998-1999 and those who started in 2001-2002. RESULTS From 1997 to 2005, prevalence increased from 3.0 to 6.8 per thousand. Prevalence was highest among ten-year-olds to 14-year-olds (11 per thousand), especially among boys (17 per thousand). The increased prevalence was mainly attributable to an increased use of second-generation antipsychotics and to a longer duration of use. Median duration of use doubled from .8 year in 1998-1999 to 1.6 years in 2001-2002. CONCLUSIONS Second-generation antipsychotic drugs were increasingly prescribed, and for longer periods of time, to younger children, probably because of new indications. This practice increases the exposure of a young population to (partly unknown) risks.

Current issues around the pharmacotherapy of ADHD in children and adults

Background New drugs and new formulations enter the growing market for ADHD medication. The growing awareness of possible persistence of ADHD impairment beyond childhood and adolescence resulting in increased pharmacotherapy of ADHD in adults, is also a good reason for making an inventory of the what is generally known about pharmacotherapy in ADHD. Aim To discuss current issues in the possible pharmacotherapy treatment of ADHD in children, adolescents and adults with respect to the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used. Methods A search of the literature with an emphasis on the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used in pharmacotherapy. Results According to the guidelines, the treatment of ADHD in children consists of psychosocial interventions in combination with pharmacotherapy when needed. Stimulants are the first-choice drugs in the pharmacological treatment of ADHD in children despite a number of well known and frequently reported side effects like sleep disorders and loss of appetite. With regard to the treatment of adults, stimulant treatment was recommended as the first-choice pharmacotherapy in the single guideline available. Both in children and adults, there appears to be an additional though limited role for the nonadrenergic drug atomoxetine. The increase of ADHD medication use, in children, adolescents and in adults, can not only be interpreted as a sign of overdiagnosis of ADHD. Despite the frequent use of stimulants, there is still a lack of clarity on the effects of long-term use on growth and nutritional status of children. Cardiovascular effects of both stimulants and atomoxetine are rare but can be severe. The literature suggests that atomoxetine may be associated with suicidal ideation in children. Conclusion Although pharmacotherapy is increasing common in the treatment of ADHD in both children and adults, there are still a lot of questions about side effects and how best to counter them. This suggests an important role for close monitoring of children and adults treated with stimulants or atomoxetine.

Socio-economic differences in prescription and OTC drug use in Dutch adolescents

Objective: To detect whether there were socio‐economic differences in the overall use of prescription and OTC drugs among adolescents. Methods: This study was a secondary analysis of questionnaire data collected to investigate socio‐economic differences in health risk behaviour and decision‐making. Results: About 20% of the 741 girls and 10% of the 736 boys reported using at least one prescription drug in the past 14 days, oral contraceptives excluded. For OTC drugs these percentages were 45% and 24%, respectively. No statistically significant socio‐economic differences in prescription drug use could be detected. A higher socio‐economic status was associated with an increased OTC drug use, especially in boys. The odds of girls who reported medication was about twice that for boys, after adjusting for perceived health and socio‐economic status.Conclusion: There were socio‐economic differences with regard to OTC drug use. No socio‐economic differences in prescription medication use could be found. There were gender differences with respect to medication use in adolescence, regardless of perceived health and socio‐economic status.

When Natural met Social: A Review of Collaboration between the Natural and Social Sciences

Abstract This paper investigates the opportunities for further collaboration between the natural and social sciences. From 81 systematically identified and reviewed papers published in scientific journals, it became clear that complex situations that depend on human behaviour as well as natural processes require natural–social science collaboration. The creation of a community of collaborative natural–social science research, that learns from and can contribute to best practice across the sciences, is advocated to support natural– social science collaboration. Across disciplines, it became clear that such a community should deal with (1) difference between paradigms in the current sciences; (2) creation of skills and competences of the involved scientists; (3) scarcity of institutions sympathetic to collaborative research; and (4) the internal organization of collaborative projects.

Psychometric properties of the OLQ-13 scale to measure Sense of Coherence in a community-dwelling older population

BackgroundWith the ongoing demographic shift, the quality of life and health promotion among older individuals are becoming increasingly important. Recent research suggests that Sense of Coherence positively affects quality of life. Hence, a valid and reliable measurement of Sense of Coherence is pivotal. The 13-item Orientation to Life Questionnaire (OLQ-13) can be used to measure Sense of Coherence. The purpose of the present study is to assess the psychometric properties, validity, and reliability, of the OLQ-13 in community-dwelling individuals, aged 65 and older.MethodsThe OLQ-13 scale was administered as part of a healthy aging project for non-institutionalized people aged 65 years and older. Internal consistency and reliability were assessed by means of inter-item and test-halves correlations and Cronbachs alpha. Construct validity was explored using cluster analysis and exploratory factor analysis (n = 703) and tested using confirmatory factor analysis on a separate subset of individuals (n = 658). Item face validity was investigated by means of 12 semi-structured interviews.ResultsThe reliability and the validity of the OLQ-13 in this population of non-institutionalized individuals aged 65 years and older was ambiguous, at least partly due to the poor performance of two items (b and d), which was confirmed by results from the qualitative part of this study. The psychometric properties of the proposed OLQ-11, obtained by deleting the two items, were better. In particular, the interpretation of exploratory factor solution improved. Whereas the underlying theoretical constructs could not be linked to the exploratory analyses of OLQ-13, this was to some extent possible in OLQ-11. The superior validity of OLQ-11 over OLQ-13 was supported by the better model fit in the confirmatory factor analysis.ConclusionsThe present mixed-method study suggests the proposed OLQ-11 as a more suitable instrument for measuring Sense of Coherence than the OLQ-13 in a population of ageing individuals. This study confirms that the validity and reliability of OLQ-13 may differ substantially in different populations.

Inquiry-Based Science Education Competencies of Primary School Teachers: A Literature Study and Critical Review of the American National Science Education Standards.

Inquiry-based science education is an important innovation. Researchers and teachers consider it to be stimulating for pupils’ application of research skills, construction of meaning and acquiring scientific knowledge. However, there is ambiguity as to what competencies are required to teach inquiry-based science. Our purpose is to develop a profile of professional competence, required for effective inquiry-based science teaching in primary schools in the Netherlands. This article reviews literature and compares the outcomes to the American National Science Education Standards (NSES). In so doing, it seeks to answer the following research questions: What elements of competencies required by primary school teachers who teach inquiry-based science are mentioned, discussed and researched in recent literature? To what extent are the American NSES (introduced 15 years ago) consistent with elements of competencies found in recent literature? A comprehensive literature review was conducted using Educational Resources Information Centre and Google Scholar databases. Fifty-seven peer-reviewed scientific journal articles from 2004 to 2011 were found using keyword combinations. Analysis of these articles resulted in the identification and classification of 22 elements of competencies. This outcome was compared to the American NSES, revealing gaps in the standards with respect to a lack of focus on how teachers view science teaching and themselves as teachers. We also found that elements of competencies are connected and poor mastery of one may affect a teachers mastery of another. Therefore, we propose that standards for the Netherlands should be presented in a non-linear, holistic, competence-based model.

Complex pharmaceutical care intervention in pulmonary care Part B. Patient opinion and process survey

AbstractObjective: The IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigates and describes the results of complex pharmaceutical care interventions provided to selected pulmonary patients to improve their drug use. This paper describes the patients’ opinions about the care provided and the results of the intervention. Method: Questionnaires investigating patients’ opinions about provided pharmaceutical care were sent to 185 patients participating in the IPMP study after the intervention by their pharmacists had been finished. One year after the start of the intervention, patients were invited to a final consultation by their pharmacists to evaluate their drug use and their symptoms (n = 138). At this point in time pharmacists investigated the knowledge of the patients about the medication and their inhaler technique again. Main outcome measure: The influence of the intervention on patients’ symptoms. Change in drug-related problems, knowledge and skills concerning pulmonary medication after intervention. Satisfaction of the patients with the provided pharmaceutical care. Results: In total 141 out of 185 patients completed the questionnaire. Patients were satisfied with the intervention by their pharmacists and considered it important. The majority (67%) reported that they had learned more about their medication or the inhaler technique, resulting in significantly improved coping behaviour with their pulmonary medication compared with patients who valued the intervention as a nice conversation with their pharmacist only. Patients with improved ability to cope reported statistically significantly fewer symptoms compared with patients reporting no change in behaviour (chi-square test, P < 0.05). In the final consultation of 138 patients, pharmacists observed increased knowledge and skills and decreased drug-related problems. The patients concerned were pleased with the change in treatment and were more satisfied with their current medication as compared with their earlier reports. Conclusion: Patients can be influenced effectively by the tailored intervention of pharmacists resulting in improved ability to cope with pulmonary medication and in fewer reported adverse effects and symptoms. Patients attributed these results to the intervention of the pharmacists.

Science Theatre at School: Providing a context to learn about socio‐scientific issues

Science theatre is recognised as a method for teaching socio‐scientific issues (SSI), but is largely under‐researched. The essence of science theatre at school is to shape a contextualisation for science and technology and its relationships to individuals and society at large, with the aim to trigger the imagination, raise questions and stimulate debate among the audience to increase their understanding of the SSI at stake. To further the theoretical basis of science theatre at school, we investigated students’ experiences in coherence with the views from experts about the play’s possibilities and limitations, in the context of a performance about food science and technology. The play dramatised dilemmas that were related to science as a knowledge‐producing process, and through its consumer products. Our study indicated that the societal context for staging science and technology, through consumers’ dilemmas to eat healthy, raised interest among the students to a larger extent than the subject of science and technology per se. According to both students and experts, the level of scientific complexity and the use of caricature to portray scientists may have hampered the possibilities to reach the audience. An alternative to contextualisation on an individualised level is to make scientific controversy and its relationship to various social interests, the heart of the matter. The discussion after the play was considered crucial and appreciated, although the students were critical about the nature of the theses. Exploring the moral positions involved in dilemmas could provide an alternative perspective of understanding to the audience.

Exploring the Validity and Robustness of a Competency Self-Report Instrument for Vocational and Higher Competence-Based Education

Research on the effectiveness of competence-based education (CB-education) across educational contexts and levels requires a new evaluation measurement. This study explores the face validity, construct validity, and robustness of a competency self-report instrument that is aligned with contemporary competence theory and with current educational practice based on CB-qualification frameworks. A pilot study showed face validity of the competency constructs and indicators according to students from various levels in tertiary education. The results of the principal components analyses and parallel analyses, using data from 351 secondary vocational education and academic students, show more construct validity and robustness for competency constructs that are concrete and easy to relate to specific situations (e.g., “applying expertise”) compared with the abstract competencies (e.g., “deciding and initiating”). This article sets out implications for designing and administrating uniform competency self-reports across educational levels and discusses suggestions for subsequent research.

Comparing day care at green care farms and at regular day care facilities with regard to their effects on functional performance of community-dwelling older people with dementia

Day care at green care farms (GCFs) is a new care modality for community-dwelling older people with dementia. In view of the more physical and normal daily life activities available at GCFs than at RDCFs, we investigated whether functional decline differed between subjects from both day care settings. In this observational cohort study, primary caregivers of 47 subjects from GCFs and 41 subjects from RDCFs rated the subjects’ functional performance three times during one year. They also provided information on the subjects’ diseases and medication use. Generally, no significant change over time in functional performance, the number of diseases and the number of medications was observed, and no differences in these rates of change were found between subjects from both day care settings. This study suggests that GCFs are not more effective in maintaining functional performance or slowing down its decline in community-dwelling older people with dementia than RDCFs.