Biomedical subjects

A Dijkstra

Publications and source records attributed to A Dijkstra.

At least 19 recordsLinked to original sources

PubMed2005

Lung function decline in asthma: association with inhaled corticosteroids, smoking and sex.

BACKGROUND: Inhaled corticosteroids (ICS) provide short term benefits in asthma but the long term effects are still unknown. METHODS: 281 patients diagnosed with moderate to severe asthma in 1963-75 were re-examined in 1991-9. Information was collected on forced expiratory volume in 1 second (FEV(1)), bronchial hyperresponsiveness, atopy, smoking, use and dosage of oral and ICS. Patients were included in the analyses if they had at least three FEV(1) measurements during two consecutive years after the age of 30 and used ICS during follow up. RESULTS: Analyses were performed on 122 patients. During a median follow up period of 23 years, 71 men and 51 women had on average 37 and 40 individual FEV(1) measurements, respectively. Linear mixed effect models showed that men had a mean annual decline in FEV(1) of 20.6 ml/year less after ICS initiation than before (p = 0.011), and in women the decline in FEV(1) was 3.2 ml/year less (p = 0.73). In individuals with <5 pack years of smoking the decline in FEV(1) was 36.8 ml/year less after ICS institution in men (p = 0.0097) and 0.8 ml/year less in women (p = 0.94), the difference between the sexes being significant (p = 0.045). These effects were not observed in those with > or =5 pack years smoking. A higher daily dose of ICS was associated with a smaller decline in FEV(1) in men (p = 0.006), an effect not observed in women. CONCLUSION: Treatment with ICS in adult patients with moderate to severe asthma was associated with a reduction in the decline in FEV(1) over a 23 year follow up period in men who had smoked <5 pack years. This effect was dose dependent and was not present in women or in men with > or =5 pack years of smoking at follow up. The lack of effect of ICS on the decline in FEV(1) in women needs further study.

Administration, Inhalation↗

PubMed2005

Cognitive changes in cardiovascular patients following a tailored behavioral smoking cessation intervention.

BACKGROUND: Action aimed at changing smoking behavior to prevent cardiovascular patients from further impairing their health is advisable. Cognitive behavioral interventions can be effective in this regard since they attempt to influence cognitive determinants that presumably lead to smoking cessation. The Minimal Intervention Strategy for Cardiology patients (C-MIS) is such an intervention, tailored to the patients' readiness to change. Our aim is to investigate whether the C-MIS is successful in changing patients' cognitions such as attitudes, social influence, self-efficacy and intention to quit during a 1-year period. METHODS: Smoking outpatients (N = 315) with cardiovascular disease were included. They were randomized and received either Nicotine Replacement Therapy (NRT) or NRT + C-MIS. At baseline (T1), sociodemographic and clinical characteristics were measured. Cognitions and quitting behavior were assessed at baseline and at four follow-up measurements. RESULTS: Comparing treatments, the C-MIS did not affect pros of quitting, pros of smoking and social influence. We did find small effects of the C-MIS on intention to quit and self-efficacy, although only for higher-educated patients. CONCLUSION: The C-MIS appears successful in affecting intention to quit and self-efficacy abilities, but only for patients with higher education levels. Initial positive changes in cognitions may also emerge in a medical intervention, such as the provision of NRT.

Adult↗

PubMed2004

Polymorphisms of the ADAM33 gene are associated with accelerated lung function decline in asthma.

BACKGROUND: Asthma is a genetically complex disease characterized by respiratory symptoms, intermittent airway obstruction and airway hyper-responsiveness due to airway inflammation and remodelling. The ADAM33 gene is associated with asthma and airway hyper-responsiveness and is postulated as a gene for airway remodelling. OBJECTIVE: To investigate whether polymorphisms of the ADAM33 gene are associated with accelerated lung function decline in patients with asthma. METHODS: In a cohort of 200 asthma patients followed over 20 years, eight single nucleotide polymorphisms of the ADAM33 gene were analysed to estimate their effect on annual FEV(1) decline. RESULTS: The rare allele of the S_2 polymorphism was significantly associated with excess decline in FEV(1) (P<0.05). CONCLUSION: These findings suggest that a variant in ADAM33 is not only important in the development of asthma but also in disease progression, possibly related to enhanced airway remodelling.

ADAM Proteins↗

PubMed2003

[Care dependency in nursing homes--a psychometric study].

The Dutch Care Dependency Scale, an instrument for the assessment of a patient's care dependency, has been translated into German. The purpose of this study was to examine the reliability and validity of the German version of the scale. The 15-item scale has been developed for the use in nursing homes. Data were collected from 81 people living in nursing homes in Berlin, Germany. The sample was measured three times. Cronbach's alpha was 0.94. Interrater and intrarater reliability revealed moderate to substantial Kappa statistics. As the results of this study were satisfying, positive recommendations regarding the suitability of the German version of the Care Dependency Scale for use in nursing homes could be made. However, further psychometric testing of the scale is recommended.

Aged↗

PubMed2003

Worry about health in smoking behaviour change.

Many smokers and ex-smokers worry about their health. Given that worry keeps attention focused on the threat, it was expected that worrying about health in smokers would motivate them to quit and in ex-smokers may prevent relapse. Furthermore, worry was expected to influence the process of smoking cessation in interaction with self-efficacy, which is a measure of control over smoking, and with disengagement beliefs, which distorts the threatening meaning of potential motivating information. In the present study 380 smokers and 324 ex-smokers were recruited to join a prospective study with a follow-up of eight months. At T1, smoking/quitting behavior, worry and the other psychological constructs were assessed. At T2 quitting activity in smokers and relapse in ex-smokers were assessed. As expected, smokers who worried about the health effects of smoking reported higher quitting activity at T2. The three-way interactions between worry, self-efficacy and disengagement beliefs in the prospective prediction of quitting activity and relapse were significant: Among smokers with high self-efficacy combined with strong disengagement beliefs, worry led to more quitting activity. Among ex-smokers with low self-efficacy combined with strong disengagement beliefs, worry led to more relapse. The present results suggest new ways of approaching the stimulation of quitting and the prevention of relapse.

Adolescent↗

PubMed2003

[The 'Soarchmjitter'. The use of a Frisian lingual measurement instrument in care of the elderly].

In this article a research has been described funded by the province Fryslân. The aim of this research project is bipartite. First, to determine the reliability and the validity of the instrument and, secondly, to inquire the involved residents living in old people's homes after the valuation of the use of the Frisian language in the care. The research is conducted among 73 residents living in nine old people's homes in the province Fryslân. On two moments in time residents of the old people's homes are asked to fill in a questionnaire with regard to their own care (in)dependency and once with regard to the use of the Frisian language in the care. Reliability analysis shows with regard to internal consistency high Cronbach's alpha values. Test-retest reliability (Cohen's kappa and Spearman Correlation) reveals fair to moderate values. Factor analysis (principal components analysis) results in a one-factor solution. According to the residents, the 'Soarchmjitter' gives a good picture of their care dependency and its questions and answers join their needs. It can be concluded that the 'Soarchmjitter' is a useful instrument to communicate in the own spoken language of the resident and to come in this way to an agreement with nurses about their care demands.

Aged↗

PubMed2001

Readiness to adopt the self-management approach to cope with chronic pain in fibromyalgic patients.

The effectiveness of cognitive-behavior therapy aimed at helping patients with the acquisition of self-management skills to cope with pain, is thought to depend partly on the patients' willingness to adopt a self-management approach. Some patients may not believe that self-management will be helpful while others have decided to adopt it and others already apply the self-management skills in their daily lives. The present study explored the concept of 'Readiness to change' in a population of Dutch fibromyalgic patients. A self-report questionnaire was completed by 321 patients. Factor analysis revealed three scales, each assessing the characteristic of one stage of readiness to change, the Precontemplation, Contemplation and Action scale. Firstly, the reliabilities of these scales were 0.61, 0.86 and 0.61, respectively, and only the latter two scales correlated significantly (r=0.14). Secondly, the scales were validated using subscales from the Multidimensional Pain Inventory, beliefs on the credibility of the self-management approach and subscales from the Illness Perception Questionnaire. These subscales explained 5, 22 and 8% of the variance of the scores on the Precontemplation, Contemplation and the Action scales, respectively. Thirdly, on the basis of the three scale scores, over 80% of the fibromialgia patients could be classified into one of five potentially psychological relevant subgroups: Precontemplation, Contemplation, Preparation, Action and Relapse. The data suggest that improvements in operationalizations of the Precontemplation and Action dimensions of readiness to change are needed and that the theoretical foundation of readiness to change needs further development.

Adaptation, Psychological↗

PubMed2001

[The care dependency scale, an assessment instrument].

The Care Dependency Scale, an instrument for the assessment of patients'care dependency, has been translated into German. The scale was tested on (inter-) rater reliability and criterion and construct validity in a hospital population on geriatric, surgical and paediatric wards. As the results of this study were very satisfying, positive recommendations regarding the suitability of the scale for use in the German nursing care situation could be made. However further psychometric testing of the scale is important, for instance in other populations. A final conclusion is that the scale may be used in care settings in German-speaking countries.

Dependency, Psychological↗

PubMed2001

Do self-help interventions in health education lead to cognitive changes, and do cognitive changes lead to behavioural change?

OBJECTIVES: The present study examined the extent to which self-help interventions change specific cognitions and the extent to which changes in such cognitions are related to behavioural changes. DESIGN: A randomized field experiment with follow-ups after 2 weeks and 3 months. METHOD: Smokers (N = 1546) were randomly assigned to one of four conditions offering smoking cessation self-help materials containing (1) outcome information, (2) self-efficacy enhancing information, (3) both sorts of information, or (4) no information. RESULTS: First, with regard to behavioural effects, only self-help interventions that included self-efficacy enhancing information were more effective than no information. Second, with regard to the cognitive changes, the data showed that outcome information led to increase in expected positive outcomes but also to increases in self-efficacy expectations. Further, self-efficacy-enhancing information led to increases in self-efficacy. Third, different cognitive changes between T1 and T2 were related to different types of quitting activity at T3 in different groups of smokers. CONCLUSIONS: Some types of information lead to specific cognitive changes, while other types have more generalized cognitive effects. Further, cognitive changes produced by a self-help intervention predict future quitting activity.

Clinical Trial↗

PubMed2000

An international psychometric testing of the care dependency scale.

In an international study, psychometric properties of the Care Dependency Scale (CDS) were examined by analysing data gathered in Dutch, Canadian, Italian and Norwegian nursing homes. For that purpose, from these countries a convenience sample was developed consisting of 525 patients with dementia. The English, Italian and Norwegian research instruments were translations of the original Dutch CDS. Psychometric evaluations of the CDS were carried out for each country separately as well as for the four countries combined. High alpha coefficients between 0.94 and 0.97 were calculated. Subsequent test-retest and inter-rater reliability revealed moderate to substantial Kappa values. Factor analysis resulted in a one-factor solution. The scalability of the CDS was demonstrated by means of Mokken scale analysis. One of the main outcomes of the cross-cultural comparison was that the findings in the four countries show more similarities than differences, so that the scale can be used appropriately in nursing home practice.

Adult↗

PubMed2000

Subtypes of precontemplating smokers defined by different long-term plans to change their smoking behavior.

Many smokers are not motivated to quit smoking. In the Stages of Change model these smokers are called precontemplators. When developing interventions designed to motivate these smokers to quit, it is of importance to know whether this group is homogeneous or not. In the present study, different groups of precontemplators were distinguished according to their long-term quitting smoking plan: 861 precontemplators were asked to indicate the one plan that best fitted their own plans with regard to their smoking behavior: (1) planning to never quit and not planning to cut down (n = 194), (2) planning to never quit but planning to cut down (n = 186), (3) planning to quit somewhere in the future but not within the next 5 years (n = 290), (4) planning to quit within the next 5 years (n = 136) and (5) planning to quit within the next year but not within the next 6 months (n = 54). These groups of smokers were compared on several variables cross-sectionally and longitudinally. The results indicate that the psychological factors that will have to be targeted in smoking cessation interventions in efforts to motivate smokers to quit could be assessed reliably in precontemplators. Furthermore, precontemplators with different quitting plans differed on several cognitive variables and the quitting plans at pre-test were predictive of quitting activity after 7 months. Precontemplators who received self-help smoking cessation materials made forward changes in quitting plans and these changes seemed to follow a certain order. Forward changes in plans were differentially related to positive outcome expectations, to self-efficacy expectations depending on the quitting plan and not to changes in negative outcomes. The present study is one step in mapping the psychology of low motivation to change behavior.

Adolescent↗

PubMed2000

[Care dependency of nursing home patients with dementia: assessment from European perspective].

In an international, study psychometric properties of the Care Dependency Scale (in Dutch shortened as: ZAS) were examined by analysing data gathered in nursing homes in Germany, Finland, Italy, The Netherlands, Norway and Wales (UK). For that purpose, from these countries a convenience sample was developed consisting of 832 patients with dementia. The English, Finnish, German, Italian and Norwegian research instruments were translations of the original Dutch ZAS. Psychometric evaluations of the ZAS were carried out for each country separately as well as for the countries combined. High alpha coefficients between 0.93 and 0.97 were calculated. Subsequent interrater and test-retest reliability revealed moderate to substantial kappa values. Factor analysis resulted in a one-factor solution. One of the main outcomes of the cross-cultural comparison was that the findings in the six countries show more similarities than differences, so that the scale can be used appropriately in nursing home practice and for international comparison of care dependency.

Aged↗

PubMed2000

A reliability and utility study of the care dependency scale.

The purpose of this study was to examine the reliability and utility of the Care Dependency Scale (CDS). This 15-item scale has been developed recently for assessing the care dependency of demented or mentally handicapped inpatients. Data for this study were collected from 153 demented and 139 mentally handicapped inpatients. The sample was measured three times. Internal consistency was determined using Cronbach's alpha and ranged from 0.95 to 0.97. Interrater reliability revealed moderate to substantial weighted Kappa statistics between 0.51 and 0.83. Test-retest reliability analysis resulted in substantial weighted Kappas between 0.66 and 0.89. Utility tests also revealed satisfactory results. The findings support the reliability and utility of the CDS.

Dependency, Psychological↗

PubMed1999

Targeting smokers with low readiness to change with tailored and nontailored self-help materials.

BACKGROUND: Few smoking cessation self-help materials are available for smokers who are not planning to quit. However, computer-tailored interventions can be designed specifically for these smokers. METHODS: In a large randomized field trial (N = 843), two different tailored smoking cessation self-help interventions (multiple tailoring and single tailoring) and one standardized smoking cessation self-help guide were compared with a no-information control group and with each other. The contents of the tailored interventions were adapted to individuals' self-reported stage of change, outcome expectations, self-efficacy levels, and smoking behavior. RESULTS: The primary outcome measure was forward stage transition. The standardized self-help guide had no effect. Among smokers who were not planning to quit within the next 5 years the multiple-tailored intervention was more effective than the single-tailored intervention. This pattern was supported by the cognitive changes caused by the interventions. Among smokers who were planning to quit within the next 5 years but not within the next 6 months, none of the self-help materials had any effect. CONCLUSION: The present results show that the self-help material currently available in the Netherlands, the standardized self-help guide, was not effective among smokers with low readiness to change. However, computer-generated tailored interventions seem a promising means of communicating information on smoking and smoking cessation to these smokers.

Adult↗

PubMed1999

Predictors of care dependency in Alzheimer's disease after a two-year period.

This paper presents the results from a panel study in the Netherlands of 68 female in-patients with Alzheimer's disease. The main focus of this study was to investigate longitudinal changes and differences in care dependency. Descriptive statistics indicated an increase in almost all 15 features of dependency in a two-year period. A stepwise regression procedure revealed that the loss of social relationships, the loss of the ability to communicate, and the degree of care dependency at entry to the study were the strongest predictors of the follow-up ratings. The pattern of findings reveals that the Care Dependency Scale is sensitive to care dependency increase after a two-year period, and that the scale has utility in establishing longitudinal patterns of care dependency.

Activities of Daily Living↗

PubMed1999

The development of computer-generated tailored interventions.

Tailoring information to individual characteristics of a person is a promising line of development of self-help interventions. This article presents a three-phase methodology for developing computer-generated tailored interventions. The first phase of the development concerns the formulation of intervention objectives on the basis of analyses of the cognitive determinants of behavior. The second phase concerns the core of the development of a tailored intervention. For each objective, a so-called tailoring matrix is developed which specifies the individual characteristics to which the message will be adapted to. The tailoring matrices are the basis of the tailored messages and the tailoring questionnaire which will assess the individual characteristics. In the third phase, all the separately written messages must be integrated to one coherent intervention text and the lay-out is designed. This methodology may result in largely different tailored interventions depending on the theoretical framework used, the adaptation of the messages and the inclusion of feedback.

Cognition↗

PubMed1999

Construct validity of the Nursing Care Dependency Scale.

This paper describes the results of a study determining construct validity aspects of the Nursing Care Dependency (NCD) Scale. This 15-item instrument has been developed recently for the assessment of the care dependency of dementia or learning-disabled inpatients. Data was collected for 450 dementia and 203 learning-disabled patients using the NCD instrument. Factor analysis of the NCD instrument resulted in one Factor. With Mokken scale analysis an H-coefficient of 0.75 was found, which implied a strong hierarchical scale. Cronbach's alpha coefficients (0.97) were high enough to use the NCD instrument in clinical practice, at both group and individual levels.

Activities of Daily Living↗

PubMed1998

A criterion-related validity study of the Nursing-Care Dependency (NCD) scale.

The purpose of this study was to examine some aspects of the criterion-related validity of the Nursing-Care Dependency (NCD) scale. This 15-item counting scale has recently been developed for assessing the care dependency of demented or mentally handicapped in-patients. Its criterion-related validity was investigated by studying the relationship between the Nursing-Care Dependency scale, the Rating Scale for Elderly Patients (RSEP), the Behavior Observation Scale for Intramural Psychogeriatrics (BOSIP) and the Scale for Social Functioning (SSF). Data were collected from 322 demented and 105 mentally handicapped patients using the mentioned instruments. High correlations were found between NCD and RSEP, and NCD and SSF. There was a low relationship between the NCD sumscore and BOSIP subscales-scores. The NCD was able to purposefully distinguish diagnostic groups of demented patients when an external criterion was used.

Activities of Daily Living↗