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  • 1
    Electronic Resource
    Electronic Resource
    Compliance of asthmatic families with a primary prevention programme of asthma and effectiveness of measures to reduce inhalant allergens – a randomized trial (2004)
    Oxford, UK : Blackwell Science Ltd
    Clinical & experimental allergy 34 (2004), S. 0 
    Details
    ISSN: 1365-2222
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background Compliance to and the effect of pre- and post-natal exposure reduction measures to prevent asthma in high-risk children from asthmatic families were studied.Method Families were randomized to a special care group (n=222) and a control group (n=221). Educational advice on measures to reduce their newborn's exposure to allergens and smoke was provided to the special care group during three visits (two pre-natal and one post-natal). The control group (n=221) received usual care.Result After the intervention, the special care group differed significantly (P〈0.01) from the usual care group in: use of anti-mite encasings (parental: 88% vs. 14%; baby: 98% vs. 10%); keeping pets outside (51% vs. 19%); combined breast- and hypoallergenic formula feeding (55% vs. 22%); first solids postponement until after the sixth month (71% vs. 28%); maternal post-natal smoking (52% vs. 28%). Little or no compliance was found for other sanitary measures (cleaning habits, providing a smooth floor covering, ventilation/airing, pet removal), exclusive breastfeeding, pre-natal smoking and partner smoking. In spite of pre-existent low allergen levels in both groups, there was a significant reduction of mite, cat, and dog allergens on the mattresses and mite and cat allergens in the living room in the special care group and were significantly lower compared with the usual care group after 1 year.Conclusion High compliance was found for the use of anti-mite encasings; substantial compliance for using hypoallergenic formula, solid food postponement, keeping pets outside and reported post-natal maternal smoking. There was no compliance for sanitary measures and the reduction of maternal pre-natal passive smoking. Mite and pet allergens on mattresses were strongly reduced by anti-mite encasings.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2222.2004.01991.x
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  • 2
    Electronic Resource
    Electronic Resource
    Prenatal exposure to mite and pet allergens and total serum IgE at birth in high-risk children (2005)
    Oxford, UK : Munksgaard International Publishers
    Pediatric allergy and immunology 16 (2005), S. 0 
    Details
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To examine the relationship between prenatal exposure to mite, cat and dog allergens and total serum IgE at birth in newborns at high risk of asthma. In the homes of 221 newborns with at least one first-degree relative with asthma, concentrations (ng/g dust) of allergens of house dust mite (mite), cat and dog were measured at the fourth to sixth month of pregnancy in dust samples from the maternal mattress and living room. At day 3–5 after birth, total IgE was measured in capillary heel blood. A total number of 174 blood samples were available (11 mothers refused newborn's blood sampling, and in 36 cases the blood sample was too small for analysis). In 24% of the newborns, total IgE was elevated (cut-off value 0.5 IU/ml). A significant dose response relationship was found between increasing mite allergen levels [divided in quartiles ng/g dust (qrt)] and the percentage of elevated IgE: first qrt (0–85 ng/g) 13%; second qrt (86–381) 19%; third qrt (382–2371) 26%; fourth qrt (≥2372) 42%, respectively, p = 0.01. This relationship remained significant after adjusting for passive smoking, maternal and paternal mite allergy, socio-demographic factors, birth characteristics and (breast) feeding practice in the first week of life. In high-risk newborns, prenatal exposure to mite allergens, but not to cat and dog allergens from dust of the living room and of the maternal mattress was associated with total serum IgE at birth.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1399-3038.2005.00243.x
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  • 3
    Electronic Resource
    Electronic Resource
    Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome (2004)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 19 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Both high-fibre dietary advice and the prescription of fibre as a bulking agent are very common in primary and secondary care management of irritable bowel syndrome. Irritable bowel syndrome patients with constipation may have delayed intestinal transit. Therefore, fibres that accelerate intestinal transit may be beneficial in these patients. The uncertain benefits reported in several clinical studies, however, have led us to reappraise the value of fibre in irritable bowel syndrome management.Aim : To quantify the effect of different types of fibre on global and symptom relief from irritable bowel syndrome.Methods : Using a structured literature search in MEDLINE (1966–2002), we selected randomized controlled trials involving irritable bowel syndrome patients treated with fibre. Analyses were performed for the total group and for trials using soluble and insoluble fibre separately.Results : Seventeen studies were included in the analysis. None investigated primary care irritable bowel syndrome patients. Fibre, in general, was effective in the relief of global irritable bowel syndrome symptoms [relative risk, 1.33; 95% confidence interval (CI), 1.19–1.50]. Irritable bowel syndrome patients with constipation may receive benefit from fibre treatment (relative risk, 1.56; 95% CI, 1.21–2.02), but there was no evidence that fibre was effective in the relief of abdominal pain in irritable bowel syndrome. Soluble and insoluble fibre, separately, had different effects on global irritable bowel syndrome symptoms. Soluble fibre (psyllium, ispaghula, calcium polycarbophil) showed significant improvement (relative risk, 1.55; 95% CI, 1.35–1.78), whereas insoluble fibre (corn, wheat bran), in some cases, worsened the clinical outcome, but there was no significant difference compared with placebo (relative risk, 0.89; 95% CI, 0.72–1.11).Conclusions : The benefits of fibre in the treatment of irritable bowel syndrome are marginal for global irritable bowel syndrome symptom improvement and irritable bowel syndrome-related constipation. Soluble and insoluble fibres have different effects on global irritable bowel syndrome symptoms. Indeed, in some cases, insoluble fibres may worsen the clinical outcome. Future clinical studies evaluating the effect and tolerability of fibre therapy are needed in primary care.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.0269-2813.2004.01862.x
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  • 4
    Electronic Resource
    Electronic Resource
    Somatization in frequent attenders of general practice (1996)
    Springer
    Social psychiatry and psychiatric epidemiology 31 (1996), S. 29-37 
    Details
    ISSN: 1433-9285
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The DSM-III-(R) definition of somatization disorder is too restrictive for use in general practice. A more comprehensive definition, the “somatic symptom index” (SSI) has shown good validity in open populations. However, a definition has to differentiate validlywithin a population of frequent attenders to be a useful diagnostic instrument in general practice. We studied a threshold of five complaints (nearly identical to the SSI) in 80 Dutch general practice patients. Patients were selected on age (20–44 years), history of back, neck or abdominal complaints, and on frequency of consultation—at least 12 consultations in the previous 3 years, corrected for consultations with compelling somatic reason for encounter. Prevalence of somatization in this group was 45%. Women had a 2 times higher risk of somatization. A relation with age was not found. Somatization was related to depressive complaints (relative risk 2.5) and probably also to anxiety. Somatizing patients consulted their general practitioner more often and had more health problems (especially psychic problems) than non-somatizers. These results support the validity of this definition. The distinction between our definition of somatization and somatization defined as a symptom of psychiatric (e.g. depressive or anxiety) disorder is emphasized.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00789119
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  • 5
    Electronic Resource
    Electronic Resource
    Diagnostic value of history and physical examination in patients suspected of sciatica due to disc herniation: a systematic review (1999)
    Springer
    Journal of neurology 246 (1999), S. 899-906 
    Details
    ISSN: 1432-1459
    Keywords: Key words Clinical diagnosis ; Disc displacement ; Nerve root ; involvement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We conducted a systematic review of the literature from 1965–1994 to assess the value of history and physical examination in the diagnosis of sciatica due to disc herniation; we also included population characteristics and features of the study design affecting diagnostic value. Studies on the diagnostic value of history and physical examination in the diagnosis of sciatica due to disc herniation are subject to important biases, and information on numerous signs and symptoms is scarce or absent. Our search revealed 37 studies meeting the selection criteria; these were systematically and independently read by three readers to determine diagnostic test properties using a standard scoring list to determine the methodological quality of the diagnostic information. A meta-analysis was performed when study results allowed statistical pooling. Few studies investigated the value of the history. Pain distribution seemed to be the only useful history item. Of the physical examination signs the straight leg raising test was the only sign consistently reported to be sensitive for sciatica due to disc herniation. However, the sensitivity values varied greatly, the pooled sensitivity and specificity values being 0.85 and 0.52, respectively. The crossed straight leg raising test was the only sign shown to be specific; the pooled sensitivity and specificity values were 0.30 and 0.84, respectively. There was considerable disagreement on the specificity of the other neurological signs (paresis, sensory loss, reflex loss). Several types of bias and other methodological drawbacks were encountered in the studies limiting the validity of the study results. As a result of these drawbacks it is probable that test sensitivity was overestimated and test specificity underestimated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050480
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  • 6
    Electronic Resource
    Electronic Resource
    Somatisation in primary care: clinical judgement and standardised measurement compared (2000)
    Springer
    Social psychiatry and psychiatric epidemiology 35 (2000), S. 276-282 
    Details
    ISSN: 1433-9285
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Background: In daily practice general practitioners (GPs) generally rely on their clinical judgement in assessing whether patients somatise distress. Nevertheless, conclusions derived from research on somatisation in primary care are largely based on standardised measurements of somatisation. We investigated the relation between GPs' clinical judgement of somatisation and a somatisation research instrument (DSM-III-R), and examined how both operationalisations of somatisation related to other important variables. Methods: In nine general practices, 407 frequently attending patients answered a questionnaire on somatisation symptoms, while the GPs gave their judgement on somatisation and communication for each patient. Other variables were extracted from the registered health status of the patients. Results: We found a weak association (correlation: 0.27) between the GPs' judgement and the research instrument; however, relations with other variables showed that both operationalisations were very similar constructs. The research instrument incorporated more psychological problems (depression and anxiety), while the GPs' judgement of somatisation was more influenced by attendance rate and by aspects of communication with the patient. Conclusion: For research addressing somatisation in primary care as a practical clinical problem, the operationalisation of somatisation should include the clinical judgement of the practitioner as well, thereby widening the focus from co-morbid mental disturbances to communication aspects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001270050239
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  • 7
    Electronic Resource
    Electronic Resource
    The Prevalence of Low Bone Mineral Density in Dutch Perimenopausal Women: The Eindhoven Perimenopausal Osteoporosis Study (1998)
    Springer
    Osteoporosis international 8 (1998), S. 404-409 
    Details
    ISSN: 1433-2965
    Keywords: Key words:Bone mineral density – Estrogens – Hysterectomy – Menopause – Osteopenia – Osteoporosis –
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: The aim of this study was to estimate the prevalence of osteopenia and osteoporosis in perimenopausal women, and to assess determinants of low bone mineral density (BMD). All women born between 1941 and 1947 (aged between 46 and 54 years) living in the city of Eindhoven were invited to participate in the study; 5896 white Dutch women, representing 73% of the total number of Dutch women in this age group, were studied. Of these, 24% were using estrogen preparations and 19% had undergone hysterectomy, with or without oophorectomy. All women were interviewed and bone mineral density (BMD) of the lumbar spine was measured by dual-energy X-ray absorptiometry (DXA). Osteopenia and osteoporosis were defined according to the criteria proposed by a WHO working group. In the population studied the prevalence of osteopenia and osteoporosis was 27.3% and 4.1%, respectively. With progression from premenopause to menopause, the prevalence of osteoporosis increased from 0.4% to 12.7%, and that of osteopenia from 14.5% to 42.8%. An increased risk for low BMD (osteopenia and osteoporosis) was associated with age, menopausal status and smoking, while alcohol consumption, high body mass index (BMI) and use of estrogens had a protective effect. This study of a large population-based cohort of perimenopausal women revealed a high prevalence of low bone mass and, therefore, a higher risk for osteoporotic fractures. The data further suggest that, when issues on the long-term efficacy and safety of preventive treatments are resolved, it may be possible to identify women at higher risk who are most likely to benefit from screening strategies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001980050083
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  • 8
    Electronic Resource
    Electronic Resource
    Plasma viscosity and erythrocyte sedimentation rate in inflammatory and non-inflammatory rheumatic disorders (1992)
    Springer
    Clinical rheumatology 11 (1992), S. 66-71 
    Details
    ISSN: 1434-9949
    Keywords: Plasma Viscosity ; Erythrocyte Sedimentation Rate ; Rheumatoid Arthritis ; Ankylosing Spondylitis ; Discriminating Ability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Plasma viscosity (PV) and erythrocyte sedimentation rate (ESR) are considered to reflect the complex of acute phase reactants in inflammations. Both tests were studied with regard to their ability to discriminate between inflammatory and non-inflammatory rheumatic diseases. PV and ESR were measured using the Coulter Viscometer II and the Westergren method, respectively. ESR was found to be a better parameter for rheumatoid arthritis and ankylosing spondylitis than PV, independent of the chosen reference values, age, gender and the hemoglobin level. ESR may still be regarded as an acceptable parameter for monitoring inflammatory rheumatic diseases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02207087
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  • 9
    Electronic Resource
    Electronic Resource
    Symptoms and selection bias: The influence of selection towards specialist care on the relationship between symptoms and diagnoses (1989)
    Springer
    Theoretical medicine and bioethics 10 (1989), S. 67-81 
    Details
    ISSN: 1573-1200
    Keywords: anemia ; confounding by indication ; diagnostics ; epidemiology ; fatigue ; general practice ; Hb-determination ; medical decision-making ; selection bias ; symptoms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Philosophy
    Notes: Abstract Observations with respect to the relationship between symptoms and diseases can seriously be biased by selection phenomena. This selection may occur from the general population, via consultation behavior, diagnostic and therapeutic activities of the general practitioner, and by referral. Relationships may be suggested and reproduced even if they do not exist in unselected populations, as a product of diagnostic routines. Correction for selection bias can only be achieved by choosing proper comparison groups. While this can be done in a general practice setting, this is almost impossible after referral, as is demonstrated in this paper. Surprisingly, the most unbiased estimation of the relationship between symptoms and diseases after referral can be made from patient groups that are referred for reason unrelated to the disease under study. Definitive answers for the general practitioner can only be provided by prospective studies from a primary care setting. In the meantime, however, biased relationships can be maintained by teaching knowledge derived from a specialist experience.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00625761
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