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Biomedical subjects

A M van Hemert

Publications and source records attributed to A M van Hemert.

At least 19 recordsLinked to original sources
PubMed2000

Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study.

offerosclerosis and osteoporosis are major causes of morbidity and mortality in postmenopausal women and have been suggested to be associated. No study has examined whether progression of atherosclerotic calcification is associated with bone loss. In the present study, we examined progression of aortic calcification, diagnosed by radiographic detection of calcified deposits in the abdominal aorta, in relation to metacarpal bone loss, as assessed by metacarpal radiogrammetry, during menopause. Initially premenopausal women (n=236), aged 45 to 57 years at baseline, were followed for 9 years. We additionally assessed the cross-sectional association between the extent of aortic calcification and metacarpal bone mass and density in 720 postmenopausal women. Twenty-five percent of women going through menopause showed progression of aortic calcification. The average loss of metacarpal bone mass among women with progression of aortic calcification was 3.2 mm(2), and their loss of metacarpal bone density was 7.2 mm(2) %, whereas in women without progression of aortic calcification, these losses were 2.0 mm(2) and 5.6 mm(2) %, respectively, adjusted for age and years of follow-up (P<0.05). Additional adjustment for age at menopause, body mass index, blood pressure, smoking, diabetes mellitus, and use of hormone replacement therapy, thiazide, and loop diuretics did not influence these results. In postmenopausal women, a graded inverse cross-sectional association between the extent of aortic calcification and metacarpal bone mass and density was found. In conclusion, our results indicate that progression of atherosclerotic calcification is associated with increased bone loss in women during menopause.

Aortic Diseases↗
PubMed1996

[Criteria for somatization studied in an outpatient clinic for general internal medicine].

OBJECTIVE: To compare the evolution of bodily symptoms and the frequency of medical consultation using three different operational definitions of 'somatization'. DESIGN: Descriptive follow-up study. SETTING: General Internal Medicine Outpatient Clinic of Leiden University Hospital, the Netherlands. METHOD: Information about physical and psychic symptoms and about the somatic-medical diagnosis was collected in a group of 158 newly referred patients. The concept of 'somatization' was operationalized in three ways: a) seeking medical consultation for somatically unexplained symptoms; b) seeking medical consultation for somatically unexplained symptoms combined with an anxiety disorder or a depressive disorder according to the 'present state examination'; c) seeking medical consultation for somatically unexplained symptoms combined with a somatization disorder or hypochondria according to the Diagnostic and statistical manual of mental disorders (DSM) III R criteria. After a follow-up period of 1.2 years, information was collected from the entire study group about the evolution of the physical symptoms and the frequency of medical consultation. RESULTS: Patients with somatically unexplained symptoms combined with a somatization disorder or hypochondria were characterized in the follow-up by numerous physical symptoms and a high frequency of medical consultation. Compared with the other patients with unexplained symptoms, they visited the general practitioner during the follow-up period 2.5 times as often, saw specialists twice as often and were admitted to a 'somatic' hospital, 6 times as often. CONCLUSION: Using criteria of low restrictiveness for somatization, a large group of patients were identified with a relatively normal (average) illness behaviour. Using more restrictive criteria led to identification of a smaller group with more extreme illness behaviour.

Adult↗
PubMed1996

A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients.

The aim of this study was to assess the reliability and validity of the Whitely Index (WI), the Illness Attitude Scales (IAS), and the Somatosensory Amplification Scale (SAS). The study population consisted of 130 general medical outpatients, 113 general practice patients, and 204 subjects from the general population. The factorial structure of the IAS appeared to consist of two subscales, namely Health Anxiety and Illness Behaviour. The internal consistency and stability of the three questionnaires were satisfactory, and their scores were highly intercorrelated. Scores on the WI and Health Anxiety subscale of the IAS declined significantly from general medical outpatients, through general practice patients to subjects from the general population. This might imply that medical care utilisation is related to hypochondriasis. A prospective study is needed to determine whether health anxiety contributes to the decision to seek medical care or the consultation of a general practitioner or consultant gives rise to worry about possible illness.

Adult↗
PubMed1995

Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial.

OBJECTIVE: To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care. DESIGN: Randomised controlled trial with follow up assessments six and 12 months after the baseline evaluation. SETTING: General medical outpatient clinic in a university hospital. SUBJECTS: An intervention group of 39 patients and a control group of 40 patients. INTERVENTIONS: The intervention group received between six and 16 sessions of cognitive behavioural therapy. Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aimed at breaking the vicious cycles of the symptoms and their consequences. The control group received optimised medical care. MAIN OUTCOME MEASURES: The degree of change, frequency and intensity of the presenting symptoms, psychological distress, functional impairment, hypochondriacal beliefs and attitudes, and (at 12 months of follow up) number of visits to the general practitioner. RESULTS: At six months of follow up the intervention group reported a higher recovery rate (odds ratio 0.40; 95% confidence interval 0.16 to 1.00), a lower mean intensity of the physical symptoms (difference -1.2; -2.0 to -0.3), and less impairment of sleep (odds ratio 0.38; 0.15 to 0.94) than the controls. After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms (0.32; 0.13 to 0.77), limitations in social (0.35; 0.14 to 0.85) and leisure (0.36; 0.14 to 0.93) activities, and illness behaviour (difference -2.5; -4.6 to -0.5). At 12 months of follow up the differences between the groups were largely maintained. CONCLUSION: Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms.

Adolescent↗
PubMed1995

Psychosexual functioning of partners of men with presumed non-organic erectile dysfunction: cause or consequence of the disorder?

In the treatment of couples where the male partners have erectile dysfunction (ED) it often becomes apparent that characteristics of the female partners and of the relationship in general have contributed to the problem. However, this has received little research attention. We investigated female partners of men with ED where no organic cause could be found (n = 34) and partners of men with organically based ED (n = 71) to compare their views on their relationships, sexual function, sexual attitudes, and psychological adjustment. Relationship problems and the psychosexual dysfunctions of vaginismus and dyspareunia were more common in the partners of men with nonorganic ED; they also reported higher levels of sexual interest. Female sexual dysfunctions in the nonorganic ED group had usually preceded the onset of the erectile difficulties. While belief in male sexual myths was substantial in both groups of patients, neither the presence of traditional views on sexuality nor psychological complaints distinguished partners of men experiencing nonorganic ED from those with organic ED. Relationship problems, female psychosexual dysfunction, and the possible effect of relatively high levels of female sexual interest may contribute to the onset, exacerbation, and maintenance of ED. These should be addressed during assessment and treatment of couples in which the male partners have erectile difficulties.

Adult↗
PubMed1995

The acceptability of psychological treatment in patients with medically unexplained physical symptoms.

Patients with unexplained physical symptoms are considered to benefit from psychological treatment, but are believed to be reluctant to accept a referral to a psychiatrist or psychologist. As a part of a treatment study, we had the opportunity to examine to what extent somatising patients are willing to accept psychological treatment and how patients who are willing to accept it differ from those who are not. The study was introduced to the patient by the attending physician, and the treatment took place in the general medical outpatient clinic itself. Of 229 patients who had presented with unexplained physical symptoms to a general hospital medical outpatient clinic, 172 (75%) were interviewed at about three months after their initial visit to the clinic. Fourty-five (26%) patients appeared to have either improved or recovered from their presenting symptoms, and 26 (15%) were already receiving psychiatric or psychological treatment. Of 98 patients eligible for treatment, 79 (81%) were willing to participate. Compared with the patients who agreed to take part, the nonparticipants reported lower levels of physical symptoms and less functional impairment. In conclusion, most of the patients who might have benefitted from additional psychological help were willing to accept it. Somatising patients who rejected psychological treatment were those with the least serious problems.

Adolescent↗
PubMed1995

Detecting psychiatric disorders in medical practice using the General Health Questionnaire. Why do cut-off scores vary?

In this study we assessed the accuracy of the General Health Questionnaire in detecting psychiatric disorders in general medical out-patients. A total of 290 newly referred patients were interviewed with the Present State Examination. Prior to the interview, 112 patients completed the full GHQ-60, 100 completed the GHQ-30 and 78 completed the GHQ-12. Data from the first group were used to study the full GHQ-60, together with the GHQ-30 and and GHQ-12, when disembedded from the full questionnaire. In a comparison between the disembedded and the separate versions of the GHQ-30 and GHQ-12 we observed considerable variation in the cut-off scores where a certain sensitivity and specificity was attained. In ROC-analysis, the versions were not materially different in their discriminatory capacity (area under the curve). The use of different criteria to define a 'case' demonstrated that case severity was another source of increasing cut-off scores. Our data demonstrate that the use of disembedded or separate versions of the questionnaire, together with variation in the case criteria can be a major explanation for variation in cut-off scores that was observed in previous studies.

Adolescent↗
PubMed1995

Recurrent priapism as a side effect of zuclopenthixol decanoate.

Priapism has been described as a rare side effect of certain phenothiazine antipsychotics with high alpha1-adrenergic blocking potential. We describe a patient who in the course of clinical treatment with the thioxanthene antipsychotic zuclopenthixol (Clopixol) decanoate had several episodes of priapism. Although the alpha-blocking potential of zuclopenthixol is only moderate, it seems that in sufficient dose, or in combination with other antipsychotics, this drug is capable of inducing priapism.

Adult↗
PubMed1994

J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis.

The J-shaped relation between diastolic blood pressure and mortality from coronary heart disease continues to provoke controversy. We examined the association between diastolic blood pressure and progression of aortic atherosclerosis in a population-based cohort of 855 women, aged 45-64 years at baseline. The women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to reflect intimal atherosclerosis. After 9 years of follow-up, slight progression of atherosclerosis was noted in 19% of women and substantial progression in 16%. The age-adjusted relative risk of substantial atherosclerotic progression in women with a decrease in diastolic pressure of 10 mm Hg or more was 2.5 (95% CI 1.3-5.6), compared with the reference group of women who had a smaller decrease or no change. The excess risk in this group was confined to women whose increase in pulse pressure was above the median (3.9 [1.5-9.9] vs 1.1 [0.3-4.2] in women with an increase in pulse pressure below the median). The relative risks for women with rises in diastolic pressure of 1-9 mm Hg and 10 mm Hg or more were 2.2 (1.1-4.3) and 3.5 (1.6-8.0), respectively. These findings suggest that a decline in diastolic blood pressure indicates vessel wall stiffening associated with atherosclerotic progression. They support the hypothesis that in low-risk subjects progression of atherosclerosis may be accompanied by a decrease in diastolic blood pressure rather than the opposing idea that low diastolic blood pressure precipitates the occurrence of atherosclerotic events.

Age Factors↗
PubMed1994

Excess mortality in general hospital patients with delirium: a 5-year follow-up of 519 patients seen in psychiatric consultation.

Mortality was determined in 519 patients with delirium who were seen in psychiatric consultation in two general hospitals. Among 419 patients with simple delirium (DSM-III: 293.00) in-hospital mortality was 26%. As compared to average hospital patients the age adjusted in-hospital excess mortality ratio varied from 6.2 for patients with malignancies to 2.1 for patients with motor system disease. After hospital discharge the 5-yr cumulative mortality was 51%. As compared to the general population excess mortality was noted in most, but not in all diagnostic subgroups. The age and sex adjusted excess mortality ratio varied from 14.1 for malignancies to 1.3 for motor system disease. The figures underline a general notion that delirium may be an indicator of disorders of grave prognosis, but mortality appears to depend more on the medical condition than on the presence of delirium.

Adolescent↗
PubMed1993

Discrimination between psychogenic and organic erectile dysfunction.

The aim of this study was to develop a screening test based on the Leiden Impotence Questionnaire (LIQ) in order to assist in the difficult process of differentiating between psychogenic and organic erectile dysfunction (ED). The main sample consisted of 176 patients with ED, which was classified according to the results of the urological and psychiatric assessment as either organic, in 109 (62%) patients, or psychogenic, in 67 (38%) patients. A logistic regression model including six general items from the LIQ correctly identified psychogenic ED in 62% of the cases, and organic ED in 86%, with an overall correct classification rate of 76%. Adding information regarding sexual intercourse and the relationship in patients who had a partner and were having sexual intercourse the correct classification rates were: psychogenic 77%, organic 94%, and overall 87%. Discrimination between psychogenic and organic ED is improved when more information concerning sexual activity can be assessed.

Diagnosis, Differential↗
PubMed1993

Key symptoms in the detection of affective disorders in medical patients.

Psychiatric disorder in medical patients often goes undetected. In this study we have attempted to identify a minimum set of key symptoms from an extensive research interview [Present State Examination (PSE)] that might assist in the identification of psychiatric disorders among general medical patients. Stepwise logistic regression analysis was used to identify PSE-items that contributed most to the PSE-CATEGO classification of psychiatric disorders in 192 Dutch medical out-patients. A risk score based on two core symptoms (panic and depressed mood) and five supplementary symptoms classified patients with a sensitivity of 0.94 and a specificity of 0.91. In a separate U.K. sample of medical in-patients, consisting of 37 PSE cases and age and sex matched controls, the risk score yielded a sensitivity and specificity of 0.89 and 0.97 respectively. The results suggest that a few questions concerning psychiatric symptoms may facilitate the identification of the majority of patients with anxiety and depressive disorders in medical populations.

Adaptation, Psychological↗
PubMed1993

Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic.

In many patients clinical care in general medical settings is complicated by the presence of psychiatric disorders in addition to the presenting physical symptoms. In the present study the prevalence and type of psychiatric disorders was assessed in relation to the medical diagnostic findings in a general internal medicine out-patient clinic. The Present State Examination, a standardized psychiatric interview, was used to detect psychiatric disorders in 191 newly referred patients. Psychiatric disorders were found to be particularly prevalent among patients with medically ill-explained or unexplained symptoms. The prevalence of psychiatric disorders was 15% for patients with a medical explanation for their presenting symptom, 45% for patients with ill-explained and 38% for those with unexplained symptoms. Approximately 40% of the patients with psychiatric disorders met DSM-III-R criteria for somatization disorder or hypochondriasis, suggesting that these disorders contributed in particular to general medical out-patient referrals.

Adolescent↗
PubMed1993

The importance of thyroid microsomal antibodies in the development of elevated serum TSH in middle-aged women: associations with serum lipids.

OBJECTIVE: We assessed the relative risk of both serum TSH and antithyroid antibody concentrations with regard to progression of thyroid failure and studied the lipid profiles of individuals with elevated TSH levels. DESIGN, PATIENTS AND MEASUREMENTS: In a randomly selected group of 427 women aged 40-60 (mean 55) years volunteering in an epidemiological survey in Zoetermeer, TSH and thyroid microsomal antibodies (TMA) were determined. Ten years after the initial survey only TSH was measured and the lipid profiles of the individuals with elevated serum TSH levels were studied and compared with a reference group. RESULTS: During follow-up, four of 427 women were treated with thyroxine. Seventeen of 423 women initially had elevated serum concentrations of TSH (> 4.2 mU/l), 11 of whom were TMA positive. In the group of 406 women with initially a normal TSH, nine out of 37 (24%) TMA-positive women developed elevated serum levels of TSH over 10 years. In contrast only 10 of 369 (3%) TMA-negative women had elevated serum TSH levels 10 years after the initial survey (P < 0.001). Altogether, at the end of the observation period, 40% of TMA-positive subjects had elevated serum TSH concentrations, compared to 3% in the TMA-negative group (P < 0.01). TSH levels in the upper part of the normal range also appeared to have a predictive value: if those both with TSH levels between 2.0 and 4.2 and with a positive TMA status were contrasted with those without antibodies and low TSH, the crude relative risk was 71.5 (31.0-164.3), whereas the crude relative risk of presence versus absence of TMA was only 36.3 (18.8-70.3). Women with elevated TSH levels did not show changes in serum concentrations of total cholesterol (7.4 +/- 1.1 mmol/l), apo-A, (4.7 +/- 1.0 mmol/l) and apo-B (3.1 +/- 0.7 mmol/l) lipoproteins, compared with control individuals (7.2 +/- 1.3, 4.7 +/- 0.8 and 3.0 +/- 0.7 mmol/l, respectively). CONCLUSIONS: The determination of serum TMA in middle-aged women can identify an important group of women at risk of developing an elevated serum TSH. TMA measurement is of potential use in the prevention of cardiovascular disease. An elevated serum TSH, however, in our study-group does not seem to be accompanied by an abnormal lipid profile, as reported by others.

Adult↗
PubMed1993

Cigarette smoking and the development and progression of aortic atherosclerosis. A 9-year population-based follow-up study in women.

BACKGROUND: Cigarette smoking has been recognized as an important risk factor for cardiovascular disease in men and women. Whether the increased risk results from an atherogenic effect of smoking is still debated. We examined the relation between cigarette smoking and atherosclerotic changes in the abdominal aorta. METHODS AND RESULTS: The association between cigarette smoking and atherosclerotic changes in the abdominal aorta was examined in a population-based cohort of 758 women, initially aged 45 to 64 years. All women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to represent intimal atherosclerosis. After 9 years of follow-up, atherosclerotic changes, indicating development or progression of plaques, could be demonstrated in 37% of women. A direct association was found between atherosclerotic change and number of cigarettes smoked per day. Compared with women who had never smoked, the relative risks of those who smoked 1 to 9, 10 to 19, and 20 or more cigarettes per day were 1.4 (95% confidence interval, 1.0 to 2.0), 2.0 (1.6 to 2.5), and 2.3 (1.8 to 3.0), respectively, after adjustment for age and other cardiovascular risk factors. Associations of atherosclerotic change with inhaling habit and duration of smoking were borderline significant after number of cigarettes smoked per day was taken into account. Among former smokers, the risk decreased with increasing duration of stopping but a significant excess risk was still observed after 5 to 10 years since quitting (relative risk, 1.6; 95% confidence interval, 1.1 to 2.2). CONCLUSIONS: These follow-up data support the evidence for an effect of cigarette smoking on atherosclerosis. The findings suggest that the rate of atherosclerotic change may be reduced by cessation of smoking, but a residual effect appears to be present for at least 10 years.

Aorta, Abdominal↗
PubMed1992

[Non-urgent patients in a non-traumatology Emergency Service; general aspects and screening for psychiatric disorders].

The Emergency Department is used by a rather large number of patients with a non-urgent condition. It is unknown whether the request for medical assistance for non-urgent conditions is partly due to the presence of a mental disorder. We conducted a cross-sectional study of 711 patients of a non-traumatic Emergency Department. The prevalence and determinants of non-urgent conditions and of mental disorders of non-urgent patients were studied. Of all patients, 31% had a non-urgent condition. Self-referrals and young adults more often had a non-urgent condition. However, in our study only 17% of all patients were self-referred. The prevalence of a score greater than or equal to 5 on the general health questionnaire (GHQ), an indication of the presence of a mental disorder, in the non-urgent patients was 59%. Non-acute symptoms, life events, the use of psychotropic drugs and alcoholism were determinants for a high GHQ score, but their specificity was low. It is advised to include questions concerning mental disorders in the medical interview of non-urgent patients.

Academic Medical Centers↗