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Consideration of older adults' quality of life (QoL) is becoming increasingly important in the evaluation, quality improvement and allocation of health and social care services. While numerous definitions and theories of QoL have been proposed, an overall synthesis of the perspective of older adults themselves is lacking. Qualitative studies were identified in PubMed, Ebsco/Psycinfo and Ebsco/CINAHL, through a search on 28 November 2018. Articles needed to meet all of the following criteria: (i) focus on perceptions of QoL, (ii) older adults living at home as main participants, (iii) use of qualitative methodology, (iv) conducted in a Western country and (v) published in English (vi) not focused on specific patient groups. A thematic synthesis was conducted of the selected studies, using the complete 'findings/results' sections from the papers. We included 48 qualitative studies representing the views of more than 3,400 older adults living at home in 11 Western countries. The QoL aspects identified in the synthesis were categorized into nine QoL domains: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighbourhood, and financial security. The results showed that although different domains can be distinguished, these are also strongly connected. QoL can be expressed in a number of domains and related subthemes that are important for older adults living at home. The findings further support that the concept of QoL should be seen as a dynamic web of intertwined domains.

The economic losses due to porcine reproductive and respiratory syndrome virus (PRRSv) outbreaks are reported in the literature to be substantially high, but recent figures are not available. The aim of this study was to quantify the economic effects of epidemic PRRSv outbreaks in Dutch sow herds. Nine sow herds were selected based on a confirmed PRRSv outbreak within those populations. The economic impact during the first 18 weeks after the outbreak was estimated by comparing the overall costs between pre- and postoutbreak periods, using different factors (production data, medication, diagnostics, labour, etc.). An outbreak of PRRSv resulted in a reduced number of sold pigs per sow of 1.7. The economic loss varied between €59 and €379 for one sow per 18-week period outbreak. The mean loss per sow per outbreak was €126. The costs after the outbreak varied significantly from €3 to 160 per sow, due to the different methods used by farmers to tackle PRRSv outbreaks. The calculated costs in this study correlate with the costs of the initial outbreak in The Netherlands of 98 per sow.

Background In pig husbandry, most piglets receive an intramuscular injection with iron around three days of age for the prevention of hypochromic, microcytic anaemia. In recent years an increased interest is noted for needle-free injections, because of efficiency and safety for man and animal. This study aims to support the evidence on efficacy to extent the registration of a commercial iron supplement with a needle-free administration application. To this aim the study has two objectives: 1) to determine the effect of needle-free injection of the iron supplement on the mean blood Haemoglobin level at weaning, as primary outcome, and mean Haematocrit and mean Body weight of pigs at weaning as secondary outcome compared to no treatment, as main determinant of iron deficiency anaemia in piglets at time of weaning; 2) to compare the effects of needle-free administration of the iron supplement with regular injection by needle, with regard to the course over time of Haemoglobin, Haematocrit, piglet growth and the differentiated haematological and serum iron parameters. Methods A double blind randomized controlled trial was conducted with 72 piglets, 8 piglets per litter from 9 litters. At three days of age pigs were selected, based on body weight, and random allocated to three study groups: a) control non-treated group (2 pigs per litter, 18 in total), b) a group with regular iron injection by needle injection (3 pigs per litter, 27 in total), c) a group that received iron by needle-free injection (3 pigs per litter, 27 in total). At four points in time (day 3, 14, 26 and 40) piglets were weighed and bled to analyse the dynamics of red blood counts and haematological parameters as well as serum iron parameters. The primary outcome parameter was the Haemoglobin (Hb) level on day 26. Of secondary importance were Haematocrit (Ht) and body weight (BW) at weaning and parameters with tertiary importance were the course of Hb, Ht and differentiated red blood cell parameters, serum iron, iron binding capacity and iron saturation. In the statistical analyses, linear mixed effect regression modelling was used to account for repeated measures within litters and pigs. Results The analyses showed that needle-free administration was as efficacious to prevent iron deficiency anaemia at day 26 as administration using regular needle injection, compared to the control group. The mean level of Hb and Ht of pigs in the needle and needle-free group did not differ significantly. No side effects were observed. Conclusion It is concluded that needle-free iron administration of the tested product is as efficacious as regular administration by needle injection.

The objective of the current study was to investigate whether plasma citrulline or intestinal fatty acid-binding protein (I-FABP) concentrations might be used as longitudinal markers for small intestinal function in piglets after weaning. Plasma citrulline and I-FABP concentrations were measured longitudinally in weaned and unweaned piglets, and related to intestinal absorption values (i.e., plasma mannitol and 3-xylose concentrations in a sugar absorption test). Within each litter (n = 10), 2 piglets with a close-to-litter-average BW were selected. At 20.8 +/- 0.4 d of age, the selected piglets per litter were either weaned conventionally (CW) or remained with the sow (UNW). One day before, and 0.5, 2, 4, and 7 d after weaning of the CW piglets, the selected piglets of both groups were subjected to a sugar absorption test. After a 2-h fast, piglets were administered an oral dose of 2 mL/kg of sugar solution, containing 50 mg/kg of mannitol and 100 mg/kg of 3-xylose. One hour after administration, a blood sample was collected from a jugular vein for determination of plasma I-FABP, citrulline, mannitol, and 3-xylose concentrations. Plasma I-FABP concentration showed great variation within treatments, and no difference was observed in plasma I-FABP concentrations between the CW and UNW treatments (P = 0.63). The absorption of 3-xylose was not different between treatments (P = 0.83). Mannitol absorption, however, was less in the weaned CW piglets compared with the UNW piglets (P = 0.003), with the nadir on d 4 postweaning. Weaning also reduced plasma citrulline concentrations in the CW treatment compared with the UNW treatment (P < 0.001). On d 4 and 7 postweaning, plasma citrulline concentrations of CW piglets were less (P < 0.001 and P = 0.0013) than preweaning values. Furthermore, in the CW treatment, plasma citrulline concentrations correlated with plasma mannitol concentrations at d 4 postweaning (r = 0.89, P = 0.008) and overall (r = 0.76, P = 0.001). Based on these results, plasma citrulline concentration seems to be a possible marker for monitoring intestinal function in pigs after weaning.

Purpose To assess the social cognitive constructs of the Health Action Process Approach (HAPA) of parents of high caries risk children to be treated under intravenous sedation (IVS) or with behavioural guidance techniques (BGT), and to assess the changes in these constructs for each treatment group after treatment. Design In this cohort study, 160 children aged 3–10 years were allocated by their paediatric dentist to either IVS (77.4%) or BGT. Their parents filled out a HAPA questionnaire, before (T1, n  = 160), immediately (T2, n  = 108) and three months (T3, n  = 71) after their children's dental rehabilitation. Results Before treatment, all parents had high scores on all social cognitive constructs. There were no differences in mean HAPA scores between the treatment groups ( p  > 0.05). After treatment, mean scores changed in both groups. In the BGT group, action self-efficacy changed from 3.64 (T1) to 3.36(T2) ( p  = 0.027) and to 3.13 (T3) ( p  = 0.021) and coping self-efficacy changed from 3.63 (T1) to 3.23 (T2) ( p  = 0.015). In the IVS group, action planning changed from 3.25 (T1) to 3.05(T3) ( p  = 0.036) and action control changed from 2.58 (T1) to 2.82 (T2) ( p  = 0.012) and to 2.87 (T3) ( p  = 0.006). Conclusions High scores on social cognitive constructs of parents of children referred to a paediatric dentist showed that they seem to be motivated to brush their children’s teeth, irrespective of the treatment group. Small changes were observed in the HAPA constructs, however, these are not considered clinically relevant.

Introduction Previous studies showed that 5-year-old Dutch-Moroccan children had significantly higher dmft scores compared to Dutch children of the same age, even after correction for socio-economic status. The mechanisms underlying this difference are little understood. Aim To explore cultural factors involved in poorer oral health of Dutch-Moroccan children by identifying knowledge, attitudes and behaviour of their mothers concerning their children’s oral health. Methods In 2012 mothers of Dutch-Moroccan preschool children in two cities in the Netherlands were interviewed in two focus groups (n = 16) or individual semi-structured interviews (n = 13). Semi structured interviews were also c onducted with three oral health professionals, working with Dutch-Moroccan children, and one physician from an under-five-clinic. All interviews were voice recorded, transcribed and inductively coded. MAXQDA software was used for data analysis. Results All mothers mentioned pain complaints, swelling and black front teeth as oral health problems in their children. Although mothers were aware that brushing teeth and reducing sugary snacks are effective preventative strategies, they did not sufficiently implement these measures. This was due to lack of brushing skills, insufficient awareness of the daily sugar intake of their children and their childrearing concerning these measures. Most mothers indicated they felt empowered in making dental care decisions. Conclusions This research revealed the presence of knowledge on preventive strategies regarding their children’s oral health in Dutch-Moroccan mothers, but an inadequate implementation of these measures in their daily lives. Additional qualitative research is needed to gain deeper insight for broader exposure of values, knowledge and culture.

Purpose The purpose of this study was to gain insight into how low back pain (LBP) patients conceptualize the construct of expectations regarding treatment. Methods This study was nested within a mixed-method randomized clinical trial comparing three primary care interventions for LBP. A total of 77 participants with LBP lasting longer than 6 weeks were included; semi-structured interviews were conducted querying patients about their expectations for treatment. Also factors influencing their expectations were explored. Interviews were administered following enrollment into the study, but prior to study treatment. Two researchers independently conducted a content analysis using NVIVO 9 software. Results LBP patients’ expectations could be categorized in two main domains: outcome and process expectations, each with subdomains. Patients expressed expectations in all subdomains both as values (what they hoped) and probabilities (what they thought was likely). In multiple subdomains, there were differences in the nature (positive vs. negative) and frequency of value and probability expectations. Participants reported that multiple factors influenced their expectations of which past experience with treatment appeared to be of major influence on probability expectations. Conclusion and recommendations This study showed that LBP patients’ expectations for treatment are multifaceted. Current measurement instruments do not cover all domains and subdomains of expectations. Therefore, we recommend the development of new or improved measures that make a distinction between value and probability expectations and assess process and/or outcome expectations covering multiple subdomains. Some of the influencing factors found in this study may be useful targets for altering patients’ treatment expectations and improving health outcomes.

In contemporary urban policy making, the term \\“active frontages” of buildings is often used. However, a precise spatial definition in order to measure it is missing. As various studies have shown, the spatial configuration of a city’s street and road net affects people’s natural movement patterns and the distribution of shops and retail and the geographic and temporal distribution of crime and anti-social behaviour. However, the spatial relationships in these studies are mainly calculated on a macro spatial level. Little research is done so far on the urban micro scale level when it comes to the spatial relationship between buildings and streets. The few conducted studies make it clear that a building’s degree of exposure to neighbours plays a role on where burglaries take place. When revealing present design practice, the demand for privacy in combination with a demand for high quality dwellings in urban central areas seems to neglect the spatial possibilities for social interaction with their vicinity on an urban micro scale level. Up until now, spatial tools for measuring the topological relationship between private and public space were missing. In a research project on space and crime, it became inevitable to pay attention to the interdependence between the macro as well as the micro scale spatial conditions. For this purpose, spatial analyses methods were developed and tested in the Dutch towns Alkmaar and Gouda. The application of these analyses tools shows clearly that micro scale spatial relationships have impact on street life and crime distribution in urban areas.

The purpose of this study was to evaluate the impact of the emergence of animal related methicillin resistant Staphylococcus aureus ST398 in an area with a high density of pig farms. A retrospective analysis was performed of all MRSA isolates in the laboratory database from 2002 till 2008 including typing results and clinical data from infection control archives and patient charts. The implementation of the screening of people in contact with pigs and veal calves for MRSA led to an increase in the average number of newly identified carriers from 16 per year between July 2002 and July 2006 to 148 between July 2006 and December 2008. This is a 925% increase of which 82% (108/132) was due to ST398. The majority (74%) came from targeted screening but 7% was due to unexpected findings. A wide range of infections with ST398 occurred in patients with and without contact with livestock varying from post-operative wound infections to sepsis and post-trauma osteomyelitis with an overrepresentation of spa type t567 among the clinical isolates. ST398 isolates were more often multi-resistant than isolates of other spa-types. The emergence of MRSA ST398 led to an increase in both MRSA carriers and MRSA infections.