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C van Weel

Publications and source records attributed to C van Weel.

At least 127 records · Page 7Linked to original sources
PubMed1995

Cardiovascular morbidity and mortality in type 2 diabetic patients: a 22-year historical cohort study in Dutch general practice.

A historical cohort study was performed to assess cardiovascular morbidity and mortality in Type 2 (non-insulin-dependent) diabetic patients. The data were collected from 1967 to 1989 in four Dutch general practices performing the Continuous Morbidity Registration Nijmegen. Each newly diagnosed Type 2 diabetic patient fulfilling the WHO criteria (n = 265) was matched to a control patient for practice, sex, age, and social class. Inclusion started in 1967, the first year of the still ongoing, Continuous Morbidity Registration Nijmegen. On average, a follow-up of 6.8 years (range 1 month-22 years) was realized. Compared to the non-diabetic control patients, the Type 2 diabetic patients showed higher cardiovascular morbidity (risk ratio 1.76, 95% CI 1.34-2.30) and a higher mortality rate (risk ratio 1.54, 95% CI 1.07-2.23). Mortality after 10 years was 36% vs 20% (p < 0.01), the median survival time 16 years vs 19 years. The cumulative survival rates were significantly different (p < 0.01) between patients and controls in the age group 65-74 years. The higher mortality in Type 2 diabetic patients was completely due to an excess of cardiovascular death (risk ratio 2.05, 95% CI 1.24-3.37).

Aged↗
PubMed1995

Screening for microalbuminuria in type 2 diabetic patients: the evaluation of a dipstick test in general practice.

To evaluate the Micral test, a semiquantitative dipstick test, in a general practice setting, 317 Type 2 diabetic patients completed a screening for microalbuminuria by means of the Micral test as well as immuno-nephelometry with the Disc 120 immuno-nephelometer (Hyland, Nivelles, Belgium). Data were collected in 10 general practices performing the Nijmegen Monitoring Project. At a regular check-up each Type 2 diabetic patient was asked to collect first morning urine samples on three consecutive days. The sensitivity of the Micral test was 67%, the specificity 93%. Between the practices the sensitivity ranged from 58% to 81%, the specificity from 87% to 95%. Microalbuminuria, defined as a mean urine albumin concentration > or = 20 mg I-1 by nephelometry on three consecutive days, was found in 66 patients (21%). The first Micral test correctly picked out these patients with microalbuminuria in 70% of the cases and in 90% those patients without microalbuminuria. The diagnostic performance of the Micral test was further proved by a Receiver Operating Characteristic (ROC) curve. The Area Under the Curve (AUC) of the Micral test was 0.84 (95% CI 0.78-0.90). Micral test results of 0 and 10 should be regarded as negative.

Albuminuria↗
PubMed1995

The influence of an inhaled steroid on quality of life in patients with asthma or COPD.

Relatively little is known about the influence of inhaled corticosteroids on general well-being (quality of life) in patients with asthma or COPD. In a 4-year prospective controlled study, we examined the influence of beclomethasone dipropionate (BDP), 400 micrograms, two times daily, on quality of life in 56 patients with asthma or COPD in comparison with the effects of BDP on symptoms and lung function. During the first 2 years, patients received only bronchodilator therapy with salbutamol or ipratropium bromide. During the third and fourth years, additional treatment with BDP was given. Fifty-six patients (28 with asthma, 28 with COPD) with an annual decline in the forced expiratory volume in 1 s (FEV1) of at least 80 mL/yr in combination with at least two exacerbations per year during bronchodilator therapy alone participated. Quality of life was assessed at the start and after 2 and 4 years by means of the Inventory of Subjective Health (ISH) and the Nottingham Health Profile (NHP). Although BDP significantly improved the course of lung function (FEV1)(p < 0.0001), it did not improve the ISH score or the six dimensions of the NHP neither in asthma nor in COPD. Beclomethasone dipropionate temporarily decreased respiratory symptoms during months 4 to 6 of BDP treatment in patients with asthma (p < 0.01) and during months 7 to 12 in patients with COPD (p < 0.05). A weak correlation was found both cross-sectionally and longitudinally between (change in) symptoms and quality of life on the one hand, and the (change in) FEV1 on the other. It was concluded that BDP did not improve the general well-being of patients with asthma or COPD as measured by these generic health instruments. However, BDP significantly improved the course of lung function and temporarily decreased the severity of symptoms. It seems probable that changes in quality of life would have been better detected by use of a disease-specific health instrument. Such an instrument was not available at the start of the study. Another possible explanation for these observations is that patients soon get used to different levels of lung function and learn to live with their disease. It is advised that disease-specific health instruments are used in future intervention studies and that quality of life is measured frequently during the early phase of the intervention, eg, once every month.

Administration, Inhalation↗
PubMed1995

Continuous and on demand use of bronchodilators in patients with non-steroid dependent asthma and chronic bronchitis: four-year follow-up randomized controlled study.

BACKGROUND: A previous two-year study of continuous and on demand bronchodilator therapy in patients with moderate asthma and chronic bronchitis showed a deterioration in lung function in those on continuous therapy. AIM: A two-year follow-up study was undertaken of patients who had been shown in the previous study to have non-steroid dependent (mild) asthma and chronic bronchitis, in order to investigate the effect of continuous and on-demand treatment with bronchodilator therapy. METHOD: Patients for the study were drawn from 29 general practices in the catchment area of the University of Nijmegen, the Netherlands. A total of 83 patients (27 with asthma and 56 with chronic bronchitis) were selected from a group of 160 patients who had completed the previous two-year bronchodilator trial. During these first two years the selected subjects had been shown to be non-steroid dependent (no rapid decline in lung function and a low number of exacerbations of their condition per year), and they were followed up for another two years of treatment with bronchodilator therapy. At the start of the four-year study, patients were randomly assigned to one of two parallel treatment groups: continuous treatment (dry powder inhalations of either salbutamol 1600 micrograms or ipratropium bromide 160 micrograms daily) or treatment on demand (only during exacerbations or periods of dyspnoea). Outcome parameters were the annual decline in lung function, changes in peak flow rate, bronchial hyper-responsiveness, exacerbation rate, respiratory symptoms and reported health. RESULTS: After correction for possibly confounding variables and for regression to the mean, the decline in lung function was 49 ml year in patients taking bronchodilators continuously and 51 ml year in patients using bronchodilators on demand, irrespective of the drug use. Continuously treated patients, whether suffering from asthma or chronic bronchitis, did not differ from patients treated on demand with respect to mean morning peak flow rate, diurnal (and week to week) variation of the peak flow rate, bronchial hyper-responsiveness, exacerbation rate and reported health. There was no difference between the long-term effects of salbutamol and ipratropium. CONCLUSION: Continuous use of bronchodilators over four years in patients with non-steroid dependent asthma or chronic bronchitis does not increase the decline in lung function which had been observed previously in patients with moderate asthma or chronic bronchitis during two years of continuous treatment with bronchodilators.

Albuterol↗
PubMed1995

Asthma and chronic bronchitis. Can family physicians predict rates of progression?

OBJECTIVE: To investigate whether the progression rate of asthma or chronic bronchitis can be predicted from a cross-sectional assessment of features that can be measured by family physicians. DESIGN: Secondary analysis of data from a 2-year randomized, controlled bronchodilator intervention study in family practice. SETTING: Twenty-nine general practices in the eastern part of The Netherlands. PATIENTS: One hundred sixty patients (101 with chronic bronchitis, 59 with asthma) from the 29 general practices. INTERVENTIONS: Predictors were related to the annual decline in lung function (the forced expiratory volume in one second) by means of multiple analysis of variance, controlling for age, sex, smoking habits, initial FEV1 level, bronchial hyperresponsiveness, reversibility of obstruction, and medication during the study. MAIN OUTCOME MEASURES: Predictors of the annual decline in lung function (FEV1), which is believed to be the most important measure for progression. RESULTS: Only three variables predicted the decline in lung function: having a barrel-shaped chest, experiencing wheezing, and an unusual diurnal peak-flow rate index. Wheezing was the best predictor of the annual decline in lung function. In chronic bronchitis, the decline in FEV1 of wheezing patients was 133 mL/y compared with 62 mL/y for non-wheezing patients (P < 0.05). In asthma with more severe symptoms, wheezing patients had a tendency to decline 156 mL/y compared with 57 mL/y among non-wheezing patients (P = 0.08). CONCLUSIONS: It is nearly impossible to predict the progression rate of asthma or chronic bronchitis from symptoms, physical signs of the chest, and the PEFR. Therefore, patients with a rapid progression rate can probably be detected only by monitoring progression of the disease through repeated lung function testing.

Asthma↗
PubMed1994

Teamwork.

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Adaptation, Psychological↗
PubMed1994

Asthma control.

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Albuterol↗
PubMed1994

[Beneficial effect of exercise therapy in urinary incontinence in family practice depends largely on therapy compliance and motivation].

OBJECTIVE: Determining the factors which influence the success of training therapy in women suffering from urinary incontinence. DESIGN: Descriptive. SETTING: Thirteen general practices in Nijmegen and environs, the Netherlands. METHOD: A total of 110 women between 20 and 65 years old, suffering from urinary incontinence were examined by their general practitioners. Age, personality, parity, psychological features and type, duration, severity, beginning of the disease, as well as the presence of cystocele or prolapse were recorded. Women were asked about their own experiences regarding factors that influenced success. The treatment consisted of training of pelvic muscles in stress incontinence and bladder training in urge incontinence. Outcomes and compliance were measured 3 and 12 months after start of treatment by means of a so-called incontinence diary. RESULTS: After 3 months the mean frequency of urine loss per week diminished from 21 to 8, and after 12 months to 6 times. Compliance was the most important contribution to success. Patients were more motivated to practise when the subjective burden of the urine loss was more severe. Other features did not influence success.

Adult↗
PubMed1994

[Indicators for progression of dementia in nursing home patients].

OBJECTIVE: To investigate the relationship of progression of dementia with patients' characteristics, comorbidity and psychotropic drug use in nursing home patients. SETTING: Psychogeriatric nursing home 'Joachim en Anna', Nijmegen, the Netherlands. DESIGN: Retrospective analysis of medical charts. PATIENTS AND METHODS: In 645 patients, admitted between 1980 and 1989, progression of dementia was expressed by means of a functional status questionnaire developed in the nursing home. Severity of dementia at entry was expressed by a rating scale for elderly patients. Comorbid conditions were classified according to the ICHPPC-2-defined. Psychotropic drug use was expressed as the ratio between days of usage and days of the observation period. Statistical analysis was done by analysis of (co)variance and regression analysis. RESULTS: In univariate as well as in multivariate analysis progression of dementia was related to time spent in the nursing home, severity of dementia at entry and comorbidity and to a lesser degree psychotropic drug use. Patients who stayed for a short time and had a high frequency of concomitant diseases and psychotropic drug use had a faster progression of dementia. Gender, age at entry and type of dementia were of no significance. The factors mentioned, however, accounted for only 20% of the variance. CONCLUSION: Progression of dementia is a complex process which can only partly be explained by the factors mentioned. Nursing home physicians nevertheless should consider these factors when predicting progression.

Activities of Daily Living↗
PubMed1994

[Mortality in patients with dementia following admission to a nursing home; a 10-year analysis].

OBJECTIVE: To identify factors that have an effect on mortality after admission of nursing home patients with dementia and to investigate changes in mortality and patients' characteristics throughout ten years of patient admittance. SETTING: Psychogeriatric nursing home 'Joachim en Anna', Nijmegen, the Netherlands. DESIGN: Retrospective analysis of medical charts. PATIENTS AND METHODS: In 890 patients, admitted between 1980 and 1989, the diagnosis of dementia was determined by means of the DSM-III-R criteria and the ischaemia scale of Hachinski. Comorbid conditions were classified by the ICHPPC-2-defined. Severity of dementia was expressed by a rating scale for elderly patients. Survival analysis was done by using product-limit estimates and Cox proportional hazards model. RESULTS: The overall 2-year survival rate after admission was 43%, 30% for men and 49% for women. The results of proportional hazards modelling indicated that gender, age at admission, type of dementia, rate of dependency and some comorbid conditions had a statistically significant influence on mortality. Between 1980 and 1989 there were no significant changes in mortality nor in patients' characteristics. CONCLUSION: Mortality after admission to this psychogeriatric nursing home is determined by multiple factors. Based on these factors the prognosis with respect to survival can be estimated.

Activities of Daily Living↗
PubMed1994

[Changes in drug use during a stay in a psychogeriatric nursing home].

OBJECTIVE: To describe the changes in drug intake during institutionalization in a Dutch psychogeriatric nursing home. SETTING: Psychogeriatric nursing home Joachim en Anna in Nijmegen, the Netherlands. DESIGN: Retrospective analysis of medical charts. PATIENTS AND METHODS: In 390 patients drug intake (sixteen drug groups) at admission, after six weeks, at half yearly intervals and on the day of death was recorded in a longitudinal fashion, as were side effects. Increase or decrease in drug intake was tested by means of linear regression analysis. RESULTS: After an initial decrease there was a gradual increase in mean drug intake during institutionalization. Laxatives and to a lesser degree drugs for the respiratory tract and heart were mostly responsible for this increase. In the other groups no change or even decrease was noted. The degree of dependency and the type of dementia had an influence on these changes. At the day of death analgesics, morphinomimetics and bronchodilators were the most frequent drugs. Neuroleptics caused most of the side effects observed. CONCLUSION: Prescription of laxatives is mostly responsible for the increase in mean drug intake in this Dutch psychogeriatric nursing home.

Aged↗
PubMed1994

[Dysmorphic erythrocytes in urinary sediment in differentiating urological from nephrological causes of hematuria].

OBJECTIVE: To determine the significance of dysmorphic erythrocytes in the urinary sediment for discrimination between urological and nephrological causes of haematuria. DESIGN: Evaluation of diagnostic test. SETTING: Departments of Nephrology and Pathology, University Hospital Nijmegen. METHOD: Of 107 patients with haematuria in whom renal parenchymal or urological disease was diagnosed, the percentage of dysmorphic erythrocytes was estimated in the unstained urinary sediment with normal light microscopy. By using a Receiver Operating Characteristic curve the cutoff point that provided the highest diagnostic value of the erythrocyte morphology was determined. In addition, the inter-observer variation was estimated in a separate series of 26 urinary sediments. RESULTS: At a cutoff value of 40% dysmorphic erythrocytes the sensitivity for urological pathology was 100% and the specificity 66.7%. When presence of erythrocyte, haemoglobin or fatty casts was also considered as a criterion for a nephrological diagnosis, the specificity for urological pathology rose to 88.1%. The inter-observer variation showed a correlation coefficient of 0.90 (kappa: 0.77). CONCLUSION: Evaluation of the erythrocyte morphology in the urinary sediment is a reliable aid in determining the strategy to be followed in patients with haematuria. It is important, however, that strict criteria for establishing erythrocyte dysmorphism are applied.

Adolescent↗
PubMed1994

Can the Dartmouth COOP/WONCA charts be used to assess the functional status of Chinese patients?

This is the first study on the use of the Dartmouth functional health assessment charts COOP/WONCA in the assessment of the functional status of Chinese patients. The Chinese are the world's largest ethnic group and make up more than one-fifth of the world's population. We have developed a Chinese translation of the Dartmouth COOP/WONCA charts that satisfies the two minimal and one intermediate criteria on translation of scales and instruments set by the European Research Group in Health Outcome (ERGHO). We tested the charts on 84 Chinese patients with previous strokes when they attended follow-up at the General Practice Unit of the University of Hong Kong from 1 August to 30 November 1992. We found that the Dartmouth COOP/WONCA charts in Chinese were easy to administer and were well accepted by our patients. All but one patient understood all the charts. There was good face validity in the results obtained by the charts. The consulting doctors found that the information detected by the charts was moderately useful in 64% of the patients and was very useful in 5% of the patients. Our translation can be applied to other Chinese in Hong Kong as well as other countries, because there is only one written Chinese language. It is hoped that our pilot study will stimulate further research to establish the reliability, validity and clinical application of the COOP/WONCA charts in Chinese.

Activities of Daily Living↗
PubMed1994

Asthma in adolescents and young adults: screening outcome versus diagnosis in general practice.

The objectives of this study were to investigate underdiagnosis of asthma in adolescents and young adults in general practice and to examine the influence of patient characteristics. The results of screening on asthma (questionnaire, spirometry) were compared with the diagnosis made in general practice. Screening results served as the reference standard. Four general practices forming the Continuous Morbidity Registration, Nijmegen were used. Five-hundred and fifty-one subjects aged 10-23, registered since their birth till the year of the study (1989) on the practice lists of these practices were involved in the study. The data collected included: (i) all episodes of respiratory morbidity in their life presented in general practice; (ii) socioeconomic level and family history of asthma; and (iii) current respiratory status, allergy to inhalant allergens and smoking behaviour (questionnaire, spirometry, histamine-challenge test and Phadiatop-test). The screening identified asthma in 19% of the study subjects, of whom 56% not had been recognized in general practice. Of the asthmatics recognized in general practice, significantly more were boys, had presented acute bronchitis in the last 5 years preceding this study and had a family history of asthma than those not recognized. Of the latter, 30% had not presented any respiratory disease in the last 5 years to their general practitioner (GP). This study suggests underdiagnosis of asthma in adolescents and young adults. Asthmatics are more likely to be recognized by their GPs in case of male sex, previous diagnosis of acute bronchitis and a family history of asthma. Reluctance of some patients to consult their doctor and low perception of symptoms may play a role in underdiagnosis.

Adolescent↗
PubMed1994

Implementing guidelines in general practice. Evaluation of process and outcome of care in chronic diseases.

In a prospective longitudinal study over 21 months the performance of general practitioners and the disease status of their patients was measured during the formulation and implementation of guidelines on follow-up care. Data on 15 general practitioners and on 613 patients with hypertension, 95 with diabetes mellitus, 66 with chronic ischemic heart disease, 115 with chronic respiratory disease, and 17 with osteoarthritis were used for analysis. Performance measures were defined and for each disease a disease status indicator was used. The possibly modifying effect of compliance of the general practitioner, and of patient compliance with the guidelines was taken into account. The general practitioners formulated consensus guidelines on follow-up care and implemented these guidelines in their practices. The implementation was supported by peer review. The performance of general practitioners tended to conform more with the guidelines during the study period, especially with regards to actions that should be performed routinely. There were no major changes in the disease status indicators. Compliant hypertensive patients had a normotensive status more frequently than non-compliant patients. Diabetic patients were more likely to be normoglycaemic when they received care according to guidelines. None of the differences were statistically significant over time.

Adult↗
PubMed1994

Feasibility of comparing risk profiles for cervical cancer between participants and nonparticipants in a screening programme.

OBJECTIVE: Feasibility of comparing risk profiles by questionnaire of participants and nonparticipants in a cervical screening programme: does asking information on sexual behaviour by means of a questionnaire lead to high non-response? is the non-response selective (related to participation in the screening) and if so how can we limit this? DESIGN: A postal survey on risk factors for cervical cancer, including sexual behaviour, in a group of participants and nonparticipants. SETTING: Two villages, Wijchen and Beuningen, situated near Nijmegen in The Netherlands. SUBJECTS: 139 participants and 99 nonparticipants in the national screening programme in 1989 or 1990. RESULTS: Overall, the response to the questionnaire was high: 83%. Collecting the questionnaire by asking the women to return it by mail in a stamped addressed envelope and one reminder by phone showed a response rate of 79%. This response was selective: 93% of the participants in the screening responded and 61% of the nonparticipants. Collecting them personally showed an extremely high response of 96% which was not selective. Only 3 respondents did not answer the questions about sexual behaviour. MAIN CONCLUSION: Obtaining information on sexual behaviour by questionnaire is feasible. Selective response can be limited by an extremely high response rate, which can be achieved by collecting the questionnaires personally.

Adult↗