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Biomedical subjects

J Dekker

Publications and source records attributed to J Dekker.

At least 37 records · Page 2Linked to original sources
PubMed2004

Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature.

OBJECTIVE: To identify all available shoulder disability questionnaires designed to measure physical functioning and to evaluate evidence for the clinimetric quality of these instruments. METHODS: Systematic literature searches were performed to identify self administered shoulder disability questionnaires. A checklist was developed to evaluate and compare the clinimetric quality of the instruments. RESULTS: Two reviewers identified and evaluated 16 questionnaires by our checklist. Most studies were found for the Disability of the Arm, Shoulder, and Hand scale (DASH), the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons Standardised Shoulder Assessment Form (ASES). None of the questionnaires demonstrated satisfactory results for all properties. Most questionnaires claim to measure several domains (for example, pain, physical, emotional, and social functioning), yet dimensionality was studied in only three instruments. The internal consistency was calculated for seven questionnaires and only one received an adequate rating. Twelve questionnaires received positive ratings for construct validity, although depending on the population studied, four of these questionnaires received poor ratings too. Seven questionnaires were shown to have adequate test-retest reliability (ICC >0.70), but five questionnaires were tested inadequately. In most clinimetric studies only small sample sizes (n<43) were used. Nearly all publications lacked information on the interpretation of scores. CONCLUSION: The DASH, SPADI, and ASES have been studied most extensively, and yet even published validation studies of these instruments have limitations in study design, sample sizes, or evidence for dimensionality. Overall, the DASH received the best ratings for its clinimetric properties.

Disability Evaluation↗
PubMed2004

Internal consistency and validity of a new physical workload questionnaire.

AIMS: To examine the dimensionality, internal consistency, and construct validity of a new physical workload questionnaire in employees with musculoskeletal complaints. METHODS: Factor analysis was applied to the responses in three study populations with musculoskeletal disorders (n = 406, 300, and 557) on 26 items related to physical workload. The internal consistency of the resulting subscales was examined. It was hypothesised that physical workload would vary among different occupational groups. The occupations of all subjects were classified into four groups on the basis of expected workload (heavy physical load; long lasting postures and repetitive movements; both; no physical load). Construct validity of the subscales created was tested by comparing the subscale scores among these occupational groups. RESULTS: The pattern of the factor loadings of items was almost identical for the three study populations. Two interpretable factors were found: items related to heavy physical workload loaded highly on the first factor, and items related to static postures or repetitive work loaded highly on the second factor. The first constructed subscale "heavy physical work" had a Cronbach's alpha of 0.92 to 0.93 and the second subscale "long lasting postures and repetitive movements", of 0.86 to 0.87. Six of eight hypotheses regarding the construct validity of the subscales were confirmed. CONCLUSIONS: The results support the internal structure, internal consistency, and validity of the new physical workload questionnaire. Testing this questionnaire in non-symptomatic employees and comparing its performance with objective assessments of physical workload are important next steps in the validation process.

Adult↗
PubMed2004

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

OBJECTIVE: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke. METHODS: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics and measures of outcome, a best-research synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score). RESULTS: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs). Methodological quality of all RCTs had a median of 5 points on the 10-point PEDro scale (range 2-8 points). Based on high-quality RCTs strong evidence was found in favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% Cl 0.03-0.23) for effects of high intensity of exercise training to 0.92 (95% Cl 0.54-1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% Cl 0.07-0.91), treadmill training with or without body weight support, respectively 0.70 (95% Cl 0.29-1.10) and 1.09 (95% Cl 0.56-1.61), aerobics (SES 0.39; 95% Cl 0.05-0.74), external auditory rhythms during gait (SES 0.91; 95% Cl 0.40-1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% Cl 0.76-2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches; exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive devices; and physical therapy interventions for reducing hemiplegic shoulder pain and hand oedema. CONCLUSIONS: This review showed small to large effect sizes for task-oriented exercise training, in particular when applied intensively and early after stroke onset. In almost all high-quality RCTs, effects were mainly restricted to tasks directly trained in the exercise programme.

Biofeedback, Psychology↗
PubMed2003

Factors contributing to possession and use of walking aids among persons with rheumatoid arthritis and osteoarthritis.

OBJECTIVE: To investigate the possession and use of walking aids among patients with rheumatoid arthritis (RA) or osteoarthritis (OA), and to identify factors contributing to possession and actual use of these aids. METHODS: A random sample of 640 patients with RA or OA was derived from a database of 6,500 registered patients. A total of 410 (64%) patients (223 RA, 187 OA) completed a questionnaire on possession and use of walking aids. Demographics, disease-related characteristics, and information about possession and use were assessed. Logistic regression analyses were used to determine which factors are associated with the possession and use of walking aids. RESULTS: Forty-nine percent of the RA patients and 44% of the OA patients owned a walking aid. Canes, forearm crutches, walkers, and orthopedic footwear were most frequently possessed. In the RA group, age, education, frequency of pain, and disability were associated with possessing a walking aid. In the OA group, age and disability were associated with possession. Approximately 30% of the owners did not use their walking aid. Factors associated with the actual use of an aid included higher age, a high intensity of pain, more disability, decrease in morning stiffness by the aid, and a positive evaluation of the aid. CONCLUSION: Almost half of patients with RA or OA possess a walking aid. Disability, pain, and age-related impairments seem to determine the need for a walking aid. Nonuse is associated with less need, negative outcome, and negative evaluation of the walking aid.

Arthritis, Rheumatoid↗
PubMed2003

The possession of technical aids among persons with a somatic chronic disease.

PURPOSE: Previous research has highlighted disability as a determinant of the need for technical aids; surprisingly, disease as a potential determinant has been ignored. The goal of the present study was to determine whether the possession of technical aids is dependent on the type of chronic disease, illness duration, co-morbidity, disability, age, and several other factors. METHODS: The study was performed in a representative sample of persons with a somatic chronic disease (n=2262). Type of chronic disease, time post-diagnosis and co-morbidity were assessed by the patient's general practitioner. Disability was assessed with the Sickness Impact Profile. The possession of technical aids and other characteristics were assessed by questionnaire. RESULTS: Type of chronic disease (osteoarthritis, rheumatoid arthritis, diabetes and COPD), disability, age and gender were significantly and independently associated with the possession of technical aids. CONCLUSIONS: Apart from disability, disease-, age-, and gender-related characteristics determine the possession of technical aids. A detailed assessment of these characteristics is required in order to ensure that technical aids meet personal needs.

Activities of Daily Living↗
PubMed2003

Occupational therapy for multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) patients are referred to occupational therapy with complaints about fatigue, limb weakness, alteration of upper extremity fine motor coordination, loss of sensation and spasticity that causes limitations in performance of activities of daily living and social participation. The primary purpose of occupational therapy is to enable individuals to participate in self-care, work and leisure activities that they want or need to perform. OBJECTIVES: To determine whether occupational therapy interventions in MS patients improve outcome on functional ability, social participation and/or health related quality of life. SEARCH STRATEGY: Relevant full length articles were identified by electronical searches in Medline, Cinahl, Embase, Amed, Scisearch and The Cochrane MS Group Trials Register. The reference list of identified studies and reviews were examined for additional references. Date of last search: December 2002. SELECTION CRITERIA: Controlled (randomized and non-randomized) and other than controlled studies addressing occupational therapy for MS patients were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The methodological quality of the included trials was independently assessed by two reviewers. Disagreements were resolved by discussion. A list proposed by Van Tulder et al. (Van Tulder 1997) was used to assess the methodological quality. For outcome measures, standardized mean differences were calculated. The results were analysed using a best-evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures. MAIN RESULTS: Only one randomized clinical trial was identified. Two other included studies were a controlled clinical trial and a study with a pre-post test design. The studies included 271 patients in total. Two studies evaluated an energy-conservation course for groups of patients and one study evaluated a counselling intervention. The results of the energy conservation studies could be biased because of the designs used, the poor methodological quality and the small number of included patients. The high quality RCT on counselling reported non-significant results. REVIEWER'S CONCLUSIONS: On basis of this review no conclusions can be stated whether occupational therapy improves outcome in MS patients. The lack of (randomized controlled) efficacy studies in most intervention categories of OT shows an urgent need for future research in occupational therapy for multiple sclerosis. Initially, a survey of occupational therapy practice for MS patients including the characteristics and needs of these patients is necessary to develop a research agenda for efficacy studies.

Humans↗
PubMed2003

Urbanisation as a risk indicator for psychiatric admission.

OBJECTIVE: This study examines the independent effect of urbanisation on the risk for admission irrespective of age, sex and marital status. METHOD: Logit analysis was performed on a dataset containing all first admissions to Dutch general psychiatric hospitals and psychiatric teaching clinics in 1991. RESULTS: Unmarried people and people living in urbanised municipalities have an increased risk of admission in all diagnostic groups analysed. People over 45 have an increased risk of admission for affective psychosis and organic psychosis. Women have an increased risk of affective psychosis. CONCLUSION: A high level of urbanisation increases the risk of admission in the diagnosis groups studied. However, being unmarried is a higher risk factor.

Female↗
PubMed2003

Gastric-type mucin and TFF-peptide expression in Barrett's oesophagus is disturbed during increased expression of MUC2.

AIMS: Barrett's oesophagus constitutes metaplastic epithelium, often diagnosed by mucin histochemistry. We determined the mucins and trefoil factor family (TFF)-peptides that were expressed in Barrett's oesophagus, in order to study changes in protein expression in early stages of Barrett's oesophagus development. METHODS AND RESULTS: Biopsy specimens of 71 Barrett's oesophagus patients were collected, and sections were stained for secretory mucins by histochemistry. Immunohistochemistry was performed for secretory mucins (MUC2, MUC5AC, MUC5B, MUC6), TFFs (TFF1, TFF2, TFF3), and proliferation (Ki67). Protein expression in the tissue was measured semiquantitatively. MUC5AC and TFF1 showed high levels and strong colocalization in the surface epithelium, whereas MUC6, MUC5B and TFF3 were found in the deeper glandular structures. TFF2 was found in both surface and glandular epithelium. The co-ordinate expression patterns of these six markers were similar to gastric antrum epithelium. MUC2 expression was ubiquitously associated with goblet cells within intestinal metaplasia, occurring in 68% of patients, and was correlated with increasing proliferation in the epithelium. CONCLUSIONS: Virtually all cells in Barrett's oesophagus epithelium displayed a secretory phenotype, demonstrating a co-ordinate gastric-type MUC and TFF expression. When MUC2 expression was more pronounced, the expression patterns of the other MUCs and the TFFs were increasingly disturbed. MUC2 expression may constitute a marker for early change in the phenotype of Barrett's oesophagus as a precancerous lesion.

Adult↗
PubMed2002

Avoidance of activity and disability in patients with osteoarthritis of the knee: the mediating role of muscle strength.

OBJECTIVE: Avoidance of activity is hypothesized to lead to muscle weakness and consequently, to physical disability. This study was undertaken to validate the avoidance model by providing evidence for the mediating role of muscle weakness in the relationship between avoidance of activity and physical disability in patients with osteoarthritis (OA) of the knee. METHODS: Data on avoidance of activity, observed physical disability, and muscle strength of the knee in 107 patients with knee OA were analyzed. A series of regression analyses was performed to establish the mediating role of muscle weakness. First, the effect of avoidance of activity on the level of disability was assessed. Next, the relationship between avoidance of activity and muscle strength was established. Finally, the mediating role of muscle strength could be established if the effect of avoidance of activity on disability decreased when muscle strength was taken into account. RESULTS: Initially, avoidance of activity accounted for 21.5% of variance in disability. Avoidance of activity also accounted for 3.9% of variance in muscle strength. After muscle strength was taken into account, the variance in disability accounted for by avoidance of activity was reduced from 21.5% to 15.7%. Thus, the criteria for establishing the mediating role of muscle strength were met. CONCLUSION: The results of this study provide evidence for the mediating role of muscle weakness in the relationship between avoidance of activity and disability in patients with knee OA.

Aged↗
PubMed2002

Assertive community treatment in Amsterdam.

In Amsterdam in the Netherlands, in 1993, an intensive case management project was initiated. This article describes this well-known Dutch project as it was tested in a randomised clinical trial using regular outpatient and inpatient care as the control conditions. All the patients in this project are very ill and most of them suffer from schizophrenia. The new form of care has the same effect on everyday problems as regular care. The basis of this data is too narrow for the drawing of conclusions about the risk of suicide. Longer follow-up would be advisable in order to improve our understanding of this problem. There has been no drop in compulsory admissions. On the other hand, there has been a spectacular decrease in the number of bed days (a reduction of 66% in the second year of the ACT programme).

Analysis of Variance↗
PubMed2002

What is the risk of mortality for people who are screen positive in a diabetes screening programme but who do not have diabetes on biochemical testing? Diabetes screening programmes from a public health perspective.

OBJECTIVES: To assess mortality risk in people classified by the Cambridge risk score (CRS), a previously validated simple screening tool for undiagnosed type 2 diabetes that uses only information routinely available in primary care. SETTING: Random sample of the general population between 50 and 75 years of age in Hoorn, The Netherlands METHODS: The results of the CRS were compared with the gold standard for diabetes, the oral glucose tolerance test (OGTT) results classified according to the World Health Organisation (WHO) 1999 diagnostic criteria. Cox's proportional hazards regression was used to assess the risk of mortality of screen positive and screen negative people. RESULTS: 154 people out of the total population of 2297 had previously undiagnosed diabetes and 113 (73%) of these would have been detected with the CRS (true positive). However, the CRS identified a much larger group (n=1037) who were positive for the score, but who did not have diabetes on biochemical testing (false positive). Unadjusted risk of mortality was highest in the true positive group (3.40 95% confidence interval (95% CI, 2.15 to 5.38)), intermediate in false positive people (2.62 (2.00 to 3.43)), and lowest in false negative people (1.50 (0.55 to 4.09)) with the true negative group as reference. Adjustment for age and sex resulted in similar risk estimates for all three groups, but mortality risk was significantly increased only in false positive and true positive groups compared with the true negative group. CONCLUSIONS: People who have a positive risk score are at high risk of mortality whether or not subsequent testing shows them to have diabetes. Direct public health interventions in this high risk population may be appropriate.

Aged↗
PubMed2002

Investigation of the anti-HIV properties of oxihumate.

A unique process has been developed to convert bituminous coal by controlled wet oxidation followed by base treatment to a water-soluble humate called oxihumate. Oxihumate inhibited HIV-1 infection of MT-2 cells with an IC(50) of 12.5 microg/ml. Treatment of free and cell-attached HIV with oxihumate irreversibly reduced infectivity, while the susceptibility of target cells to the virus was not impaired by treatment prior to infection. The infectivity of the HIV particles was inhibited by interference with CD4 binding and the V3 loop-mediated step of virus entry. No viral resistance to oxihumate developed over a 12-week period in vitro. Oxihumate therefore holds promise for the treatment of HIV-infected patients.

Anti-HIV Agents↗
PubMed2001

Hyperosmotic stress activates the insulin receptor in CHO cells.

Stress factors, such as osmotic stress and genotoxic agents, activate stress kinases, whereas growth factors preferentially stimulate the structurally homologous mitogen-activated protein kinases, ERK1/2. Hyperosmolarity also has insulin-mimicking action as reflected by ERK1/2 activation and by the stimulation of glucose uptake in adipocytes. We examined to what extent hyperosmolarity activates components of the insulin receptor (IR) signalling pathway. CHO cells expressing the human IR were treated with 500 mM NaCl or 700 mM sorbitol and the activation of insulin signalling intermediates was studied. Hyperosmolarity induced tyrosine phosphorylation of the IR beta-subunit, and the adaptor proteins p52-Shc, p66-Shc, and IRS1. Furthermore, the stress kinases JNK and p38 were activated. When CHO cells were transfected with a kinase-dead IR (K1030R) mutant, hyperosmolarity did not induce tyrosine phosphorylation of the IR, indicating that hyperosmolarity induced IR autophosphorylation directly, rather than inducing phosphorylation by an exogenous tyrosine kinase. A partially purified and detergent-solubilized IR was not phosphorylated in response to hyperosmolarity, suggesting that hyperosmolarity activates the receptor only when present in the plasma membrane. In cells stably expressing the kinase-dead IR, IRS1 and Shc Tyr phosphorylation was abrogated, indicating that the hyperosmolarity signalling was dependent on an active IR tyrosine kinase. In contrast, the stress kinases p38 and JNK were normally activated by hyperosmolarity in the IR-K1030R mutant. We conclude that, at least in CHO cells, hyperosmolarity signals partially through IR autophosphorylation and subsequent activation of the IR downstream targets. This may be responsible for some of the insulin-mimicking effects of hyperosmolarity. The activation of stress kinases by hyperosmolarity occurs independent of the IR.

Adaptor Proteins, Signal Transducing↗
PubMed2001

Seven new mutations in the nicotinamide adenine dinucleotide reduced-cytochrome b(5) reductase gene leading to methemoglobinemia type I.

Cytochrome b(5) reductase (b5R) deficiency manifests itself in 2 distinct ways. In methemoglobinemia type I, the patients only suffer from cyanosis, whereas in type II, the patients suffer in addition from severe mental retardation and neurologic impairment. Biochemical data indicate that this may be due to a difference in mutations, causing enzyme instability in type I and complete enzyme deficiency or enzyme inactivation in type II. We have investigated 7 families with methemoglobulinemia type I and found 7 novel mutations in the b5R gene. Six of these mutations predicted amino acid substitutions at sites not involved in reduced nicotinamide adenine dinucleotide (NADH) or flavin adenine dinucleotide (FAD) binding, as deduced from a 3-dimensional model of human b5R. This model was constructed from comparison with the known 3-dimensional structure of pig b5R. The seventh mutation was a splice site mutation leading to skipping of exon 5 in messenger RNA, present in heterozygous form in a patient together with a missense mutation on the other allele. Eight other amino acid substitutions, previously described to cause methemoglobinemia type I, were also situated in nonessential regions of the enzyme. In contrast, 2 other substitutions, known to cause the type II form of the disease, were found to directly affect the consensus FAD-binding site or indirectly influence NADH binding. Thus, these data support the idea that enzyme inactivation is a cause of the type II disease, whereas enzyme instability may lead to the type I form.

Adult↗
PubMed2001

Responsiveness of observational and self-report methods for assessing disability in mobility in patients with osteoarthritis.

OBJECTIVE: To establish the responsiveness of observational and self-report methods for the assessment of disability in mobility in patients with osteoarthritis (OA). METHODS: Data from 186 patients with hip OA or knee OA were used. Data from 1 observational method and 4 self-report methods for the assessment of disability in mobility were collected at week 0 and again 12 weeks later. Using correlations and factor analysis, the relationships among changes in these 5 methods were established. RESULTS: Intercorrelations between change scores of the self-report methods ranged from 0.12 to 0.34. Correlations between the observational method and the self-report methods ranged from 0.14 to 0.26. In the factor analysis, both the self-report methods and the observational method loaded on the same factor. CONCLUSION: In a longitudinal design, no evidence for differential responsiveness of observational and self-report methods was obtained. Because of the advantages of questionnaires (they are easier to use, less time-consuming, and less of a burden to subjects), this implies that the use of self-report methods is to be preferred over observational methods.

Disability Evaluation↗
PubMed2001

Combining psychotherapy and antidepressants in the treatment of depression.

OBJECTIVE: To compare the efficacy of antidepressants with that of antidepressants plus psychotherapy ("combined therapy") in the treatment of depression. METHODS: 6 month randomised clinical trial of antidepressants (N=84) and combined therapy (N=83) in ambulatory patients with Major Depression and a 17-item HDRS baseline score of at least 14 points. The antidepressant protocol provides for three successive steps in case of intolerance or inefficacy: fluoxetine, amitriptyline and moclobemide. The combined therapy condition consists, in addition to pharmacotherapy, of 16 sessions of Short Psychodynamic Supportive Psychotherapy. Efficacy is assessed using the 17-item HDRS, the CGI of Severity and of Improvement, the depression subscale of the SCL-90, and the Quality of Life Depression Scale. The data analysis is conducted on three samples: the intention-to-treat sample, the per protocol sample and the observed cases sample. RESULTS: After randomisation, 32% of the patients refused the proposed pharmacotherapy while 13% refused the proposed combined therapy. In 24 weeks, 40% of the patients who started with the pharmacotherapy stopped medication; 22% of those receiving the combined therapy did so. The difference in success rates is statistically significant, favouring combined therapy, in 23%, 31% and 62% of the patients after 8, 16 and 24 weeks of treatment, respectively. At week 24, the mean success rate is 40.7% in the pharmacotherapy group and 59.2% in the combined therapy group. CONCLUSION: Patients found combined treatment significantly more acceptable, they were significantly less likely to drop out of combined therapy and, ultimately, significantly more likely to recover. Combined therapy is preferable to pharmacotherapy in the treatment of ambulatory patients with major depression.

Adolescent↗