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Biomedical subjects

H J Cools

Publications and source records attributed to H J Cools.

At least 19 recordsLinked to original sources
PubMed2006

Impact of changes in the target P450 CYP51 enzyme associated with altered triazole-sensitivity in fungal pathogens of cereal crops.

Control of diseases caused by fungi in both medicine and agriculture is heavily dependent on the use of triazoles. As a consequence, resistance to triazoles is a threat to both human health and the sustainability of agricultural production systems. In human pathogens, particularly Candida albicans, mutations encoding alterations in the target cytochrome P450 sterol 14alpha-demethylase (CYP51; where CYP is cytochrome P450) enzyme are the primary determinants of triazole resistance. In fungal pathogens of cereals, CYP51A1 modifications, some at positions known to contribute to a resistant phenotype in human pathogens, have also been identified in isolates with altered triazole-sensitivity. However, unlike medicine where resistance to triazoles is a major clinical problem, failures of triazoles to control crop diseases in the field are rare with mean population sensitivities generally remaining low, perhaps due to differences in the selection pressures imposed on human and cereal pathogen populations. Nonetheless, the biological potential for resistance exists, and the question remains as to whether widespread triazole resistance can develop in an important cereal pathogen.

Cytochrome P-450 Enzyme System↗
PubMed2001

Randomized controlled trial of seroresponses to double dose and booster influenza vaccination in frail elderly subjects.

Responses to influenza vaccination are poor in frail elderly subjects who suffer the greatest morbidity and mortality due to infection. Therefore, a randomized clinical trial was performed to determine the effect of a double dose and booster vaccination on antibody responses after influenza vaccination. A total of 815 patients (median age 83 years, median disability score 8, median disease categories 2 and median number of medications 4) residing in 14 nursing homes in the Netherlands were vaccinated during the influenza season 1997-98. The first vaccine dose (15 or 30 microg) was given on Day 0 followed by a booster dose (placebo or 15 microg) on Day 84. Blood samples were taken before and 25 days after vaccination. There were four treatment groups: (i) 15 microg and placebo, (ii) 15 microg and 15 microg booster, (iii) 30 microg and placebo and (iv) 30 microg and 15 microg booster. Geometric mean antibody titers of those receiving the double vaccine dose was 15% (95% CI, 6% to 24%, P = 0.001) higher as compared to the standard 15 microg dose. A booster dose, given 84 days after the first vaccination, yielded postvaccination titters that were 14% (95% CI, 9% to 19%, P = 0.001) higher as compared to placebo. Subgroup analysis did not reveal patient groups that had a proportionally greater benefit from adapted vaccination strategies. It is concluded that higher antibody responses can be achieved in frail elderly people by a double vaccine dose or a booster vaccination.

Aged↗
PubMed2001

Measuring disability in nursing home residents: validity and reliability of a newly developed instrument.

A 24-item multidimensional nurse-administered Nursing Home Disabilities Instrument (NHDI) was developed to measure disabilities in nursing home residents. We present the psychometric features and value of this instrument, with the following domains assessed: Mobility, Activities of Daily Living (ADLs), Alertness, Resistance to Nursing Assistance, Incontinence, Cognition, and PERCEPTION: Test-retest and interrater reliability was assessed using the Spearman correlation coefficient. Internal consistency was examined by Cronbach's alpha. Criterion validity tests were performed by comparing the scales with scales of the Elderly Residents Rating Scale (BOP). Test-retest reliability correlation coefficients ranged from 0.63 to 0.94. Interrater reliability was high for the scales Cognition, Mobility, ADL, and Incontinence (0.79 to 0.93), moderate for Resistance (0.51), and low for Perception (0.33). Cronbach's alpha of the scales was high, ranging from 0.78 (Alertness) to 0.93 (Mobility); only Perception showed a low alpha: 0.54. Criterion validity was high for Cognition, ADL, and Mobility (0.75 to 0.78), and moderate for Alertness (0.59). The NHDI appears to be a valid and efficient multidimensional instrument for measuring disabilities in nursing home residents. These findings imply that the NHDI is a useful instrument for nursing homes to achieve a reliable assessment of cognitively impaired elders.

Activities of Daily Living↗
PubMed2001

Hip fracture in elderly patients: outcomes for function, quality of life, and type of residence.

A prospective study was done to investigate functional outcome, quality of life, and type of residence after hip fracture in patients 65 years of age and older. One hundred two patients admitted consecutively to a university and a general hospital were followed up as long as 4 months after admission. The mean age of the participants was 83 years; 58% of patients came from their own home, and 42 % of patients came from institutions. Nearly 70% of patients had two or more diagnoses other than the hip fracture. Cumulative mortality was 20% at 4 months after fracture. Of surviving patients, 57% were back in their original situation for accommodation, 43% reached the same level of walking ability, and 17% achieved the same level of activities of daily living as before fracture. Patients experienced on average three complications, 26% of which were severe. Quality of life improved in the followup period of 4 months; however, the quality of life at 4 months was worse than the quality of life reported in a reference population. Average costs amounted to euro (Euro) 15.338 (which at the time was nearly equivalent to the US dollar) per patient, with nearly 50% of the costs attributable to hospital costs and 30% attributable to nursing home costs. The results of this study show a poor outcome after hip fracture in elderly patients.

Activities of Daily Living↗
PubMed2000

Reduced IFN-gamma production in elderly people following in vitro stimulation with influenza vaccine and endotoxin.

Cytokine interferon gamma (IFN-gamma) is pivotal in the defence against viruses and intracellular pathogens and an age-related decreased IFN-gamma production may explain the increased infectious disease morbidity and mortality in the elderly. Therefore, we performed a series of clinical experiments evaluating the influence of age and health status on IFN-gamma production following in vitro stimulation with influenza vaccine or endotoxin. Both healthy and frail elderly people produced significantly lower amounts of IFN-gamma following ex vivo stimulation with influenza vaccine or endotoxin. We conclude that ageing is accompanied by a decreased capacity to produce IFN-gamma. This may explain the increased incidence and case-fatality caused by viruses and intracellular pathogens in the elderly.

Adult↗
PubMed1998

[Infections and aging].

Elderly people are exposed to infectious risks in ways different from younger people. These risks relate to environment, transmission routes and vectors, microbial colonisation of body surfaces and quality of host defence. Admission to a nursing home or a hospital may easily lead to colonisation with (resistant) potentially pathogenic micro-organisms, while pre-existing morbidity, medication and functional disability impair the quality of host defence, to a greater degree than the process of aging. In general, infections have a great impact on the elderly patient. Not only are infections in the elderly often serious, but they often have a deleterious effect on comorbidity and functional ability. Infections in elderly people with serious comorbidity face the physician with the dilemma how far to go with diagnostic procedures and therapy.

Aged↗
PubMed1998

The relationship between difficulties in feeding oneself and loss of weight in nursing-home patients with dementia.

OBJECTIVE: to investigate the cause of unintentional weight loss in demented nursing-home patients. DESIGN: body weight was measured at 3-month intervals and related to the primary diagnosis, problems in feeding oneself and other factors influencing food intake. SETTING: a Dutch nursing home. SUBJECTS: 250 resident patients and 264 new and consecutively admitted patients above the age of 65. RESULTS: for both demented and non-demented nursing-home patients, a strong relationship exists between weight loss and choosing food, bringing it to the mouth and chewing: the greater these difficulties, the lower the body weight. This relationship was more evident in existing residents than in newly admitted patients. Body weight was not well correlated with the diagnosis of dementia but was correlated with poor appetite and immobility. CONCLUSION: disabilities resulting from dementia can lead to an inadequate intake of food and thus to weight loss in nursing-home residents.

Activities of Daily Living↗
PubMed1998

[The dentist in the circle of care of dependent elderly].

By preventing avoidable causes of death, man usually dies at advanced age after a prolonged period of increasing dependency often in homes for the elderly and in nursing homes. This dependency means problems in self care, walking, cognition, communication and in oral health. Geriatric dentistry can be incorporated in a model arranging care (the care circle) in which the dentist operates independently, or organised in teams with other caregivers or central directed by a nursing home doctor (so-called multidisciplinary dentistry). Multidisciplinary dentistry means that the dentist is a member of a multidisciplinary team, contributing to the reduction of individual problems with eating, drinking and oral health. The dentist involves the team in the indications of dental treatment. He operates within the rules of recent Dutch legislation. These laws are based on self-determination of the patient, institutional quality-assurance and individual skills-guarantees of the care provider.

Aged↗
PubMed1997

[Increased chance of dying among nursing home patients with lower body weight].

OBJECTIVE: To investigate a possible relationship between changes in weight and mortality among nursing home patients of 65 years and older, after adjustment for age, sex and main diagnosis. DESIGN: Descriptive longitudinal study. SETTING: Dutch nursing home in Delft, the Netherlands. METHODS: For three years after admission the body weight of patients newly admitted from April 1st 1987 to April 1st 1989 was measured every three months under the same conditions. It was recorded if a patient died or was discharged in this three-year period. The effects of body weight at admission, sex, age and diagnostic category (psychogeriatric, neurological, orthopaedic, oncological, other) on mortality were analysed using the univariate Cox regression analysis. The effect of the time-dependent covariate body weight on mortality in the nursing home was analysed with a combined logistic regression analysis per 3-month interval. RESULTS: The mean weight of the females increased from 59.7 kg (n = 194) at the time of admission to 63.7 kg (n = 57) three years later and that of the males from 64.7 kg (n = 70) to 70.3 (n = 11) due to the low body weight of those who died. During the first 3 months after admission mortality was high (14%) and only diagnosis related. In subsequent 3-month periods there was a significant association between mortality and weight, weight change, age and sex: the risk of mortality was higher for those with a lower body weight, weight loss, higher age and male sex. CONCLUSION: Nursing home patients with a low body weight or loss of weight after the first 3 months after admission, have an increased risk of death.

Aged↗
PubMed1997

[Use of drugs for CNSLD (asthma and COPD) in Dutch residential homes and nursing homes].

Of the 1019 residents of eight dutch homes for the elderly and 699 patients of five nursing homes, respectively 6.0 and 8.1% were administered drugs for chronic non-specific lung disease (CNSLD), which is a term covering asthma as well as copd. The treatment consisted of, usually inhaled, beta-agonists and/or anti-cholinergics in 82%, inhaled as well as oral corticosteroids in 60%, and xanthine-derivates and N-acetylcysteïne, both of which were taken orally, in 28 and 21% of the patients respectively. It was found that almost half (47%) of the patients using inhaled drugs, which 90% of them did either with or without help, made at least three mistakes during inhalation. Considering that CSNLD is probably underdiagnosed, especially when it occurs as a cause of co-morbidity and will have an unfavourable influence on the general state of health by reducing lung function, the suboptimal application of inhaled drugs should be a cause of concern for those who treat elderly patients with asthma and or copd.

Administration, Inhalation↗
PubMed1996

Subcutaneous morphine infusion by syringe driver for terminally ill patients.

The study aimed to find whether subcutaneous morphine administration by syringe driver for terminally ill patients in a Dutch nursing home led to higher morphine doses and earlier death than routine morphine administration. The data comprised the files of all patients dying over a 2 year period in a 355-bed nursing home in Delft in the Netherlands. Thirty-eight per cent of the patients had been given morphine, 29% by continuous subcutaneous syringe driver. In comparing the patients given morphine with and without a syringe driver no differences emerged in mean age, sex, length of admission, type of ward, diagnosis, duration of morphine administration and mean dose. The data indicate that subcutaneous morphine administration by syringe driver decreases dose frequency problems and improves the control of pain and other symptoms in the last week before death. There was no evidence that administration of morphine in this way shortens survival.

Cause of Death↗
PubMed1994

[12-year infection policy in a nursing homes].

OBJECTIVE: To evaluate the management of infections in a nursing home. DESIGN: A descriptive study of yearly reviews of 1981-1992. LOCATION: Nursing home De Bieslandhof, Delft. PATIENTS AND METHOD: Of all the patients admitted during a year in the nursing home, the prescribed antimicrobial therapy differentiated by localisation of infection was registered. Whenever prescription of antimicrobial therapy was considered, the use of an indwelling catheter was limited and urine was collected for culturing. RESULTS: From 1981-1984 the number of patients with an indwelling catheter decreased to 50% as did the number of patients who needed recurrent antimicrobial therapy. From 1985 on, the patients receiving a simple or repeated antimicrobial therapy courses were 20% and 7%, respectively, of the total population. Per 1000 patient days 0.9 urinary and 1.1 airway infections were treated; other infections played a minor part. Non-catheterised nursing home patients or non-catheterised patients just admitted from the hospital had more urinary E. coli infections than patients who had been catheterised. The choice of antimicrobial therapy did not change during the study period except for the replacement of sulfamethizole by pipemidic acid in 1989. CONCLUSION: Nursing home doctors can collectively manage and control infections in a nursing home by using a restrictive policy on antimicrobial therapy and on the use of indwelling catheters. Infections not treated with antimicrobial agents are not included in this policy.

Aged↗