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  • 1
    Electronic Resource
    Electronic Resource
    Serum lipids in early pregnancy and risk of pre-eclampsia (1996)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 103 (1996), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine whether first and late second trimester serum total and high density lipoprotein cholesterol are associated with blood pressure, uterine artery pulsatility index and pregnancy outcome.Design A prospective cohort study. Data were analysed using multiple linear and logistic regression analysis.Participants Three hundred and ninety-three pregnant women requesting chorionic villus sampling because of advanced maternal age (36 years and older).Main outcome measures Serum total cholesterol and high density lipoprotein cholesterol were measured by an automated enzymatic method. Uterine artery flow velocity waveforms were recorded using continuous Doppler ultrasound. Pregnancy outcome was assessed by questionnaire.Results First trimester serum total cholesterol was significantly associated with the risk of pre-eclampsia, with the adjusted relative risk exceeding 5 for women with serum total cholesterol levels above 6.0 mmol/l when compared with women with a cholesterol level below 5.0 mmol/l. First trimester serum total cholesterol also showed a significant relationship with diastolic blood pressure (coefficient of linear regression = 0.02 (mmol/l)/mmHg, 95% CI = 0.01 to 0.03), and the change in both diastolic and systolic blood pressure from the first to the late second trimester was associated with linear changes in serum total cholesterol and high density lipoprotein cholesterol.Conclusions These data suggest a relation between serum lipids in early pregnancy and the development of pre-eclampsia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1996.tb09661.x
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  • 2
    Electronic Resource
    Electronic Resource
    Diagnostic Performance of Various QTc Interval Formulas in a Large Family with Long QT Syndrome Type 3: Bazett's Formula Not So Bad After All … (2003)
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Annals of noninvasive electrocardiology 8 (2003), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Recently, we identified a novel mutation of SCN5A (1795insD) in a large family with LQTS3. The aim of this study was to assess whether the various proposed corrections of the QT interval to heart rate help to improve the identification of carriers of the mutant gene. Methods: The study group consisted of 101 adult family members: 57 carriers and 44 noncarriers (mean age 44.6 ± 14.6 and 40.3 ± 12.8 years, respectively). In all individuals a 12-lead ECG, exercise ECG, and 24-hour Holter ECG were obtained. Results: Correction for heart rate significantly improved the diagnostic performance of the QT interval. Diagnostic performance of the Bazett formula was similar to that of the newer formulas (Fridericia, Hodges, Framingham, and a logarithmic formula). At a cut-off value of 440 ms, the Bazett corrected QT interval was associated with a sensitivity and specificity of 90% and 91%, respectively. Using the 24-hour Holter ECG, a prolonged QTc at heart rates less than 60 beats/min was almost pathognomonic for genetic mutation (sensitivity and specificity both 99%), whereas the QTc calculated at the lowest heart rate using Bazett's formula provided full discrimination. Conclusion: In the present family, the resting ECG gave a good indication about the presence or absence of genetic mutation but a 24-hour Holter recording was mandatory to ascertain the diagnosis. In the diagnosis of this form of LQTS3, Bazett's formula was at least as good as other proposed corrections of the QT interval to heart rate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1542-474X.2003.08402.x
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  • 3
    Electronic Resource
    Electronic Resource
    Acute and chronic effects of dinner with alcoholic beverages on nitric oxide metabolites in healthy men (2003)
    Oxford, UK : Blackwell Science Pty
    Clinical and experimental pharmacology and physiology 30 (2003), S. 0 
    Details
    ISSN: 1440-1681
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: 1. The present study investigated the acute and chronic effect of dinner with alcoholic beverages on serum nitric oxide (NO) metabolites, namely nitrate and nitrite (NOx), in 11 healthy, non-smoking middle-aged men.2. In a randomized, diet-controlled, cross-over trial, subjects consumed dinner with four glasses of red wine, beer, spirits (Dutch gin) or sparkling mineral water (control) for 3 weeks. At the end of each 3 week period, serum NOx concentrations were measured just before and 1, 5 and 13 h after dinner.3. Serum NOx concentrations were approximately 50% higher 1 and 5 h after dinner with any beverage compared with just before dinner (P = 0.0001). At 1 h after dinner, the serum NOx concentration was approximately 11% lower after dinner with alcoholic beverages compared with concentrations observed after dinner with water (P = 0.01). The fasted serum NOx concentration (13 h after dinner) was similar to the preprandial concentration and there were no differences in serum NOx concentrations between the alcoholic beverages.4. Food intake acutely and transiently increased serum NOx concentrations, an effect that was slightly attenuated if combined with alcoholic beverages. Chronic moderate alcohol consumption had no effect on serum NOx concentration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1440-1681.2003.03863.x
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  • 4
    Electronic Resource
    Electronic Resource
    Predicting pressure ulcers: cases missed using a new clinical prediction rule (2005)
    Oxford, UK : Blackwell Science Ltd
    Journal of advanced nursing 49 (2005), S. 0 
    Details
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim.  The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule and comparing them with patients who were correctly classified as ‘not at risk’.Background.  Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified.Methods.  Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission.Results.  Patients who developed pressure ulcers experienced more problems with ‘friction and shear’ and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions.Conclusion.  We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule from patients who were correctly classified as ‘not at risk’. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2648.2004.03259.x
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  • 5
    Electronic Resource
    Electronic Resource
    Changes in Quality-of-Life After Pacemaker Implantation: Responsiveness of the Aquarel Questionnaire (2001)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 24 (2001), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: STOFMEEL, M.A.M., et al.: Changes in Quality-of-Life After Pacemaker Implantation: Responsiveness of the Aquarel Questionnaire. Before being introduced for widespread use, health status instruments should be evaluated for reliability, validity, and responsiveness to relevant clinical changes. In a previous study the validity and reliability of Aquarel, a disease-specific quality-of-life (QOL) questionnaire for pacemaker patients, were tested and found satisfactory. The purpose of this study was to assess the sensitivity to change in health of Aquarel. A cohort of 51 patients was assessed at baseline and at 4–6 weeks after pacemaker implantation. We compared the sensitivity to change over time on the Aquarel scores to the scores on the SF-36 using various techniques (t-test value, effect size, standard error of measurement). Using the 1-standard error of measurement (SEM) criterion for clinically relevant change, Aquarel seemed to provide better classification of patients compared to the SF-36 alone. This study supports the value of Aquarel as a disease-specific measure of QOL in pacemaker patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.00288.x
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  • 6
    Electronic Resource
    Electronic Resource
    Quality-of-Life of Pacemaker Patients: A Reappraisal of Current Instruments (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Current clinical practice permits the use of single chamber ventricular or dual chamber pacemakers. However, it is not known which type of pacemaker results in superior clinical and patient outcomes. This is of growing importance because of the higher costs and increased risk of technical failures of dual chamber pacemakers. Patient outcomes can be assessed with quality of life questionnaires, but it is unclear which questionnaires are valid for use in pacemaker patients. This article reappraises studies on quality of life instruments for pacemaker patients. We searched MEDLINE (1985–1998) for studies assessing quality-of-life in general and in pacemaker patients. The SF-36 appeared to be the best among generic questionnaires because of its psychometric characteristics and experience of use. Concerning disease specific instruments, the Karolinska quality of life questionnaire has desirable content validity but lacks more rigorous psychometric validation, which constitutes a serious limitation. Previous studies suggested that implantation of atrioventricular pacemakers improves quality-of-life compared to ventricular pacemakers, but since no well-designed and validated questionnaire exists, these results should be interpreted with caution. The best outcome measure to evaluate quality-of-life in pacemaker patients would be a combination of a generic health profile with established reliability and validity supplemented with a cardiovascular assessment adjusted to suit pacemaker patients. By doing so, individual scores can be compared within a disease cohort and to same-aged, nondiseased persons, as well as other diseased populations. The development and validation of such an instrument is currently needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00879.x
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  • 7
    Electronic Resource
    Electronic Resource
    Lack of association between five polymorphisms in the human glucocorticoid receptor gene and glucocorticoid resistance (1997)
    Springer
    Human genetics 〈Berlin〉 99 (1997), S. 663-668 
    Details
    ISSN: 1432-1203
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Glucocorticoid resistance due to mutations in the gene for the glucocorticoid receptor has been suggested to be more common than is thought at present, owing to the relative mildness of its symptoms and the difficulty of its diagnosis. To investigate the prevalence of mutations in the glucocorticoid receptor gene responsible for relative insensitivity to glucocorticoids, we carried out polymerase chain reaction/single-strand conformation analysis of the glucocorticoid receptor gene in a group of 20, otherwise healthy, persons with a reduced response in a dexamethasone suppression test and in 20 controls. We did not find mutations or polymorphisms associated with a reduced sensitivity to glucocorticoids. However, we identified five novel polymorphisms in the gene for the human glucocorticoid receptor, which may be useful in analyzing whether loss of (part of) the glucocorticoid receptor gene plays a role in glucocorticoid-resistant malignancies. Although relative resistance to glucocorticoids seems to be rather frequent in otherwise healthy persons, it is not usually associated with mutations or polymorphisms in the glucocorticoid receptor gene.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004390050425
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  • 8
    Electronic Resource
    Electronic Resource
    The Dutch Vascular Factors in Dementia Study: rationale and design (1997)
    Springer
    Journal of neurology 245 (1997), S. 32-39 
    Details
    ISSN: 1432-1459
    Keywords: Key words Cardiovascular ; disease ; Dementia ; Haemostasis ; Atherosclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Dementia is a rapidly increasing health problem in the industrialized countries. With the ageing of the population the number of demented persons increases both in relative and absolute terms. Obviously, there is a need for prevention and intervention strategies. We describe the methods and baseline findings of a large study aimed at identifying potentially modifiable vascular, thrombogenic, and metabolic determinants of dementia. The study population consists of subjects 55 years of age or older. Since the vascular wall of the cerebral vessels is different from that of the coronary or peripheral vessels, we formed three subgroups in which vascular risk factors for dementia are studied. Subjects with stroke were distinguished from subjects with coronary or peripheral artery disease, and from subjects without stroke or coronary or peripheral artery disease. To obtain a large enough number of subjects with stroke, cases and controls from a stroke registry were combined with cases and controls of a population-based study from the same region. For the diagnosis of dementia the DSM-III-R criteria were used. Extensive information on cardiovascular risk factors was collected, including indicators of atherosclerosis. Blood and urine were sampled to study platelet function and thrombogenic and metabolic factors. The study population consists of 7,466 subjects, of whom 300 were recruited from a hospital-based stroke registry. Coronary or peripheral artery disease was present in 956 subjects and stroke in 617. Dementia was present in 434 (5.8%) of all subjects. The prevalence of dementia was 3.0, 24.0, and 4.4% in subjects with a history of coronary or peripheral artery disease, a history of stroke, and subjects without a history of coronary or peripheral artery disease or stroke, respectively. The study will allow us to investigate the role of vascular factors in dementia, irrespective of its cause.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050171
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  • 9
    Electronic Resource
    Electronic Resource
    Methodological aspects of physical activity assessment in epidemiological studies (1998)
    Springer
    European journal of epidemiology 14 (1998), S. 63-70 
    Details
    ISSN: 1573-7284
    Keywords: Physical activity measurement ; Questionnaire ; Reproducibility ; Validity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A range of epidemiological studies conducted over the past decades has produced strong support for the view that lack of physical activity is associated with increased risks of several chronic diseases, such as cardiovascular disease, diabetes mellitus, cancer, etc. Much is still unknown about the type and degree of activity that is required to influence the risk of specific diseases. Furthermore, physical activity can act as a confounder in relationships between other exposure variables (e.g. diet) and disease. Thus, the measurement of physical activity in epidemiological studies is of great importance. The questionnaire is the most frequently used method in epidemiological research. Before using a questionnaire on a large scale, validity and reproducibility should be assessed in a representative population. Some practical and methodological aspects of physical activity validation studies are described, together with the possible implications of the results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007427831179
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  • 10
    Electronic Resource
    Electronic Resource
    Classification of heart failure in population based research: An assessment of six heart failure scores (1997)
    Springer
    European journal of epidemiology 13 (1997), S. 491-502 
    Details
    ISSN: 1573-7284
    Keywords: Classification ; Epidemiology ; Heart failure ; Predictive value ; Sensitivity ; Specificity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Several scores based on symptoms and signs have been developed to assess the presence of heart failure. The goal of this study was to compare six heart failure scores in non-hospitalised subjects and to determine their usefulness in population based research. The scores were applied to 54 participants of a population based study. All underwent a complete medical examination, including chest X-ray, electrocardiography and Doppler echocardiography. Using all information available, a cardiologist, unaware of the results of the scores, clinically classified participants as having no, possible or definite heart failure. Sensitivity, specificity, predictive values and receiver operating characteristics were calculated, using the cardiologist's assessment as a gold standard. The cardiologist judged definite or possible heart failure to be present in 17 persons. All scores had a high sensitivity for the detection of definite heart failure, whereas the study of men born in 1913 and Walma's score had the highest sensitivity for the combination of possible and definite heart failure. Gheorgiade's and the Boston score had the highest positive predictive values. In conclusion, five of the six scores we studied are broadly similar in the detection of heart failure. The men born in 1913 score relies heavily on the assessment of dyspnea, resulting in a relatively large number of false positives. Although the scores are useful in detecting manifest heart failure, objective measurements of cardiac function appear necessary to reduce the false positive rate and accurately detect early stages of heart failure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007383914444
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