Biomedical subjects

Arnold D M Kester

Publications and source records attributed to Arnold D M Kester.

At least 19 recordsLinked to original sources

PubMed2006

Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study.

BACKGROUND: Many risk factors for fractures have been documented, including low bone-mineral density (BMD) and a history of fractures. However, little is known about the short-term absolute risk (AR) of fractures and the timing of clinical fractures. Therefore, we assessed the risk and timing of incident clinical fractures, expressed as 5-year AR, in postmenopausal women. METHODS: In total, 10 general practice centres participated in this population-based prospective study. Five years after a baseline assessment, which included clinical risk factor evaluation and BMD measurement, 759 postmenopausal women aged between 50 and 80 years, were re-examined, including undergoing an evaluation of clinical fractures after menopause. Risk factors for incident fractures at baseline that were significant in univariate analyses were included in a multivariate Cox survival regression analysis. The significant determinants were used to construct algorithms. RESULTS: In the total group, 12.5% (95% confidence interval (CI) 10.1-14.9) of the women experienced a new clinical fracture. A previous clinical fracture after menopause and a low BMD (T-score <-1.0) were retained as significant predictors with significant interaction. Women with a recent previous fracture (during the past 5 years) had an AR of 50.1% (95% CI 42.0-58.1) versus 21.2% (95% CI 20.7-21.6) if the previous fracture had occurred earlier. In women without a fracture history, the AR was 13.8% (95% CI 10.9-16.6) if BMD was low and 7.0% (95% CI 5.5-8.5) if BMD was normal. CONCLUSION: In postmenopausal women, clinical fractures cluster in time. One in two women with a recent clinical fracture had a new clinical fracture within 5 years, regardless of BMD. The 5-year AR for a first clinical fracture was much lower and depended on BMD.

Aged↗

PubMed2006

Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua.

BACKGROUND: Little is known about how sexual and reproductive (SRH) health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP) method for such evaluation. METHODS: 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher) and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after). Also the influence of doctors' characteristics was tested using non-parametric statistical methods. RESULTS: Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01). Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02). Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. CONCLUSION: This study illustrates provider-related obstacles adolescents often face when requesting contraception. The care provided during the voucher program improved for some important outcomes. The improvements were more pronounced among providers with the weakest initial performance. Shared decision-making and condom promotion were improvements that sustained after the program ended. The SP method is suitable and relatively easy to apply in monitoring clinics' performance, yielding important and relevant information. Objective assessment of change through the SP method is much more complex and expensive.

Adolescent↗

PubMed2006

The motivational determinants of breast-feeding: predictors for the continuation of breast-feeding.

OBJECTIVE: The aim of this study was to evaluate the motivational determinants of the continuation of breast-feeding until 3 months postpartum. METHODS: A prospective cohort study using the Integrated Change Model in 341 women in 5 child health care centers. RESULTS: At birth, 73% of the mothers started with breast-feeding and 39% of them continued at least 3 months postpartum. Mothers who continued for 3 months differed in almost all the motivational determinants from mothers who discontinued. In the multiple logistic regression analysis, social support for formula feeding from significant others and situational self-efficacy for breast-feeding made a significant independent contribution to the continuation of breast-feeding. Among the predisposing determinants, the strongest positive predictor of continuation was the intention to return to work at 1 month postpartum. CONCLUSION: The Integrated Change Model is valid to explain and predict the continuation of breast-feeding. Hence, the results may be used to tailor future interventions aimed at promoting breast-feeding. In the discussion, we use the results to target interventions.

Adult↗

PubMed2006

Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229].

BACKGROUND: The treatment of non-specific chronic low back pain is often based on three different models regarding the development and maintenance of pain and especially functional limitations: the deconditioning model, the cognitive behavioral model and the biopsychosocial model. There is evidence that rehabilitation of patients with chronic low back pain is more effective than no treatment, but information is lacking about the differential effectiveness of different kinds of rehabilitation. A direct comparison of a physical, a cognitive-behavioral treatment and a combination of both has never been carried out so far. METHODS: The effectiveness of active physical, cognitive-behavioral and combined treatment for chronic non-specific low back pain compared with a waiting list control group was determined by performing a randomized controlled trial in three rehabilitation centers. Two hundred and twenty three patients were randomized, using concealed block randomization to one of the following treatments, which they attended three times a week for 10 weeks: Active Physical Treatment (APT), Cognitive-Behavioral Treatment (CBT), Combined Treatment of APT and CBT (CT), or Waiting List (WL). The outcome variables were self-reported functional limitations, patient's main complaints, pain, mood, self-rated treatment effectiveness, treatment satisfaction and physical performance including walking, standing up, reaching forward, stair climbing and lifting. Assessments were carried out by blinded research assistants at baseline and immediately post-treatment. The data were analyzed using the intention-to-treat principle. RESULTS: For 212 patients, data were available for analysis. After treatment, significant reductions were observed in functional limitations, patient's main complaints and pain intensity for all three active treatments compared to the WL. Also, the self-rated treatment effectiveness and satisfaction appeared to be higher in the three active treatments. Several physical performance tasks improved in APT and CT but not in CBT. No clinically relevant differences were found between the CT and APT, or between CT and CBT. CONCLUSION: All three active treatments were effective in comparison to no treatment, but no clinically relevant differences between the combined and the single component treatments were found.

Adult↗

PubMed2006

Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.

UNLABELLED: The aim of this study was to examine whether treatments based on different theories change pain catastrophizing and internal control of pain, and whether changes in these factors mediate treatment outcome. Participants were 211 patients with nonspecific chronic low back pain (CLBP) participating in a randomized controlled trial, attending active physical treatment (APT, n = 52), cognitive-behavioral treatment (CBT, n = 55), treatment combining the APT and CBT (CT, n = 55), or waiting list (WL, n = 49). Pain catastrophizing decreased in all 3 active treatment groups and not in the WL. There was no difference in the change in internal control across all 4 groups. In all the active treatment groups, patients improved regarding perceived disability, main complaints, and current pain at post-treatment, and no changes were observed in the WL group. Depression only changed significantly in the APT group. Change in pain catastrophizing mediated the reduction of disability, main complaints, and pain intensity. In the APT condition, pain catastrophizing also mediated the reduction of depression. Not only cognitive-behavioral treatments but also a physical treatment produced changes in pain catastrophizing that seemed to mediate the outcome of the treatment significantly. The implications and limitations of these results are discussed. PERSPECTIVE: This article shows that treatment elements that do not deliberately target cognitive factors can reduce pain catastrophizing. Reduction in pain catastrophizing seemed to mediate the improvement of functioning in patients with chronic low back pain. The results might contribute to the development of more effective interventions.

Adaptation, Psychological↗

PubMed2006

Determinants of overweight in a cohort of Dutch children.

BACKGROUND: To improve the effective prevention and treatment of obesity, it is important to focus on body weight (BW) development and its determinants during childhood. OBJECTIVE: The aim of the present study was to investigate the effects of early development, parental and genetic variables, and behavioral determinants on overweight at 12 y. DESIGN: In a Dutch cohort of 105 children, anthropometric measurements were conducted from birth until age 7 y. At age 12 y, anthropometric measurements were obtained again, as were measurements of body composition, leptin concentration, 3 polymorphisms, and physical activity, and the Three-Factor Eating Questionnaire was conducted. In addition, parental body mass indexes (BMIs, in kg/m2) and Three-Factor Eating Questionnaire scores were determined. RESULTS: The children's mean (+/-SD) BMI at 12 y was 19.0 +/- 2.6, and 15.2% were classified as overweight. From the first year of life, BMI tracked significantly with BMI at age 12 y (r = 0.24, P < 0.05). Linear regression analyses showed that a rapid increase in BW during the first year of life, a high BMI of the father, and a high dietary restraint score of the mother were significantly associated with overweight at age 12 y (P < 0.05). No significant genetic relation was observed. In addition, overweight was positively associated with dietary restraint of the child, and percentage body fat was negatively associated with the child's activity score (P < 0.05). CONCLUSIONS: In this homogeneous cohort of normal-weight to moderately overweight children, tracking of BMI during childhood took place from the first year of life. Overweight at age 12 y was predicted by an early rapid increase in BW and parental influences. Overweight during childhood may be maintained or even promoted by a high dietary restraint score and low physical activity.

Body Composition↗

PubMed2006

Can a comprehensive voucher programme prompt changes in doctors' knowledge, attitudes and practices related to sexual and reproductive health care for adolescents? A case study from Latin America.

OBJECTIVES: To evaluate whether participation in a competitive voucher programme designed to improve access to and quality of sexual and reproductive health care (SRH-care), prompted changes in doctors' knowledge, attitudes and practices. METHODS: The voucher programme provided free access to SRH-care for adolescents. Doctors received training and guidelines on how to deal with adolescents, a treatment protocol, and financial incentives for each adolescent attended. To evaluate the impact of the intervention on doctors, nearly all participating doctors (n = 37) were interviewed before the intervention and 23 were interviewed after the intervention. Answers were grouped in subthemes and scores compared using nonparametric methods. RESULTS: The initial interviews disclosed deficiencies in doctors' knowledge, attitudes and practices relating to adolescent SRH-issues. Gender and age of the doctor were not associated with the initial scores. Comparing scores from before and after the intervention revealed significant increases in doctors' knowledge of contraceptives (P = 0.003) and sexually transmittable infections (P < 0.001); barriers to contraceptive use significantly diminished (P < 0.001 and P = 0.003); and some attitudinal changes were observed (0 = 0.046 and P = 0.11). Doctors became more aware of the need to improve their communication skills and were positive about the programme. CONCLUSIONS: This study confirmed provider related barriers that adolescents in Nicaragua may face and reinforces the importance of focusing on the quality of care and strengthening doctors' training. Participation in the voucher programme resulted in increased knowledge, improved practices and, to a lesser extent, in changed attitudes. A competitive voucher programme with technical support for the participating doctors can be a promising strategy to prompt change.

Adolescent↗

PubMed2006

Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua.

BACKGROUND: To meet the needs of female adolescents from low-income urban areas for sexual and reproductive health (SRH) care, vouchers providing free-of-charge access to SRH care at 19 primary care clinics were distributed in Managua, Nicaragua. These vouchers substantially increased the use of services, demonstrating that many adolescents are willing to use such services, if readily accessible. The voucher redemption made it possible to identify the nature of existing, but largely unmet, needs for SRH care. METHOD: The medical files from 3301 consultations with female adolescents were analysed using descriptive statistical methods and multiple logistic regression. RESULTS: Female adolescents presented SRH problems that merited medical attention. The mean number of problems presented was 1.5 per consultation: 34% of the vouchers were used for contraceptives, 31% for complaints related to sexually transmitted infection (STI) or reproductive tract infection (RTI), 28% for advice/counselling, 28% for antenatal check-up and 18% for pregnancy testing. A new category of health care users emerged: sexually active girls who were neither pregnant nor mothers and who sought contraceptives or STI/RTI treatment. Contraceptive use doubled among the sexually active non-pregnant voucher redeemers. Consultation with a female doctor younger than 36 years was associated with a higher chance of having contraceptives prescribed. CONCLUSION: Accessible and appropriate SRH care has the potential to make an important contribution to the increased contraceptive use, decreased risk of unwanted teenage pregnancies and decreased prevalence of STIs/RTIs among underserved adolescents. Once adolescents access the services, providers have a crucial role in ensuring current and continuing needs are met.

Adolescent↗

PubMed2006

The usability of six physical performance tasks in a rehabilitation population with chronic low back pain.

OBJECTIVE: To examine the influence of task experience on the difference between test and retest and to assess test-retest reliability and limits of agreement of six performance tasks in chronic low back pain patients. These measures will be used to define the clinical usability. DESIGN: Test-retest of six performance tasks in a group of patients with no experience and a group of patients after previous experience with these tasks. SETTING: Three rehabilitation centres. SUBJECTS: Fifty-three patients with non-specific chronic low back pain. MAIN MEASURES: Five-minute walking, 50-ft (15 m) fast walking, sit-to-stand, loaded forward reach, 1-min stair-climbing and Progressive Isoinertial Lifting Evaluation (PILE). To assess the influence of task experience, differences between test and retest between both groups were tested using Mann-Whitney test. For both groups together, intraclass correlation coefficients (ICCs) and the limits of agreement using Bland and Altman plots were calculated. RESULTS: Thirty patients with no task experience and 23 patients who had already undertaken the tasks on at least two occasions participated. Both groups showed similar differences between test and retest. The test-retest reliability for the total study population was good to very high: ICC varied from 0.74 to 0.99. For the total study population, the limits of agreement expressed as percentage of the mean score of each task was low to moderate for 5-min walking and 1-min stair-climbing (21% and 20% respectively), moderate for 50-ft (15 m) fast walking, sit-to-stand and forward reach (33%, 29% and 36% respectively) and high for the PILE (48%). CONCLUSIONS: Task experience did not significantly influence test-retest differences. All tasks showed sufficient test-retest reliability. Based on the natural variability of the tasks, the 5-min walking and stair-climbing task, and to a lesser degree the 50-ft (15 m) walking, sit-to-stand and loaded forward reach, seem clinically useful. There are major concerns about the usability of the PILE.

Activities of Daily Living↗

PubMed2005

Do clinical findings in lower respiratory tract infection help general practitioners prescribe antibiotics appropriately? An observational cohort study in general practice.

BACKGROUND: Antibiotics are over-prescribed for lower respiratory tract infection (LRTI). The influence of clinicians' history and examination findings on antibiotic prescribing for LRTI has not been directly assessed, and the extent to which these clinical findings predict appropriate antibiotic prescribing is unknown. A clearer understanding is crucial to achieving evidence-based prescribing. OBJECTIVES: To directly assess the influence of general practitioners' history and examination findings on antibiotic prescribing for LRTI, and to explore the extent to which these clinical findings predict appropriate antibiotic prescribing. METHODS: In this observational cohort study 25 GPs in The Netherlands were recruited during routine consultations and 247 adult patients with a clinical diagnosis of LRTI. The GPs recorded clinical information. Odds ratios (ORs) with 95% confidence intervals (CIs) for clinical variables predicting a prescription for an antibiotic were calculated. The relationship between antibiotic prescription and radiographic evidence of pneumonia was explored in order to gauge appropriateness of antibiotic prescribing. RESULTS: Auscultation abnormalities (OR 11.5; 95% CI 5.4-24.7), and diarrhoea (OR>11) were strongly associated with antibiotic prescribing. An antibiotic was prescribed for 195 (79%) patients. Assuming that an antibiotic definitely needs to be prescribed only for patients with pneumonia, antibiotics may have been inappropriately prescribed for 166/193 (86%) of the patients. Antibiotics were not prescribed for 5 of the 32 (16%) patients with a radiographic diagnosis of pneumonia. CONCLUSIONS: Abnormal findings on auscultation in patients with LRTI strongly predict antibiotic prescribing and this is probably inappropriate for most patients. These results should prompt GPs to consider the extent to which finding 'crackles/rhonchi on auscultation' influences their decisions to prescribe antibiotics for their patients with LRTI, and to consider the predictive value of individual clinical signs in reaching evidence-based prescribing decisions.

Adolescent↗

PubMed2005

Increased mortality in partners of female myocardial infarction patients.

BACKGROUND: Many studies have been performed on the impact of Alzheimer's disease, stroke and cancer on carers. Information on the influence of a myocardial infarction in a patient on the health of the partner is still scarce. METHODS: Exposed and non-exposed partners were compared with respect to the occurrence of mortality and predefined diseases, using Cox proportional hazards survival analysis. RESULTS: None of the disease incidence rates differed between exposed partners and control partners. Over 12 times as many male partners of (female) heart patients died as compared to their male control partners, when they had a low educational level. CONCLUSION: When exposed to myocardial infarction in a patient, the risk of dying in low educated male partners was over 12 times as large as for male low educated unexposed partners.

Caregivers↗

PubMed2005

Psychological effects of a short behavior modification program in patients with acute myocardial infarction or coronary artery bypass grafting. A randomized controlled trial.

OBJECTIVE: The effects of a short intervention on behavioral risk factor modification in patients with coronary artery disease (CAD) on Type A behavior, vital exhaustion, and depression were studied in a randomized controlled trial. METHODS: Acute myocardial infarction patients or patients who underwent coronary artery bypass grafting (CABG) were randomly assigned to an 8-week multiple risk modification group program (n = 94) or to a control group (n = 90) that received usual care with standard physical exercise training. Patients were assessed before intervention, directly after intervention, and at 9-month follow-up. RESULTS: The intervention was effective in reducing hostility and total Type A behavior at postintervention (P = .01) and at 9-month follow-up (P = .03). The intervention had no overall impact on vital exhaustion and depression, measured by the Beck Depression Inventory (BDI), whereas we unexpectedly found that the percentage of patients with major depression was reduced in the control group but not in the intervention group. CONCLUSION: The results indicate that a short behavioral intervention for coronary patients can result in relatively large and persistent reductions in cognitive aspects of Type A behavior and hostility, in particular. In view of the unwanted findings on the diagnosis of depression, however, we do not unequivocally advise the intervention to the general population of AMI and CABG patients.

Aged↗

PubMed2005

A longitudinal study on the predictive validity of the fear-avoidance model in low back pain.

Recently, fear-avoidance models have been quite influential in understanding the transition from acute to chronic low back pain (LBP). Not only has pain-related fear been found to be associated with disability and increased pain severity, but also treatment focused at reducing pain-related fear has shown to successfully reduce disability levels. In spite of these developments, there is still a lack in well-designed prospective studies examining the role of pain-related fear in acute back pain. The aim of the current study was to prospectively test the assumption that pain-related fear in acute stages successfully predicts future disability. Subjects were primary care acute LBP patients consulting because of a new episode of LBP (<or=3 weeks). They completed questionnaires on background variables, fear-avoidance model variables and LBP outcome (Graded Chronic Pain Scale, GCPS) at baseline, 3, 6, and 12 months follow-up and at the end of the study. Two-hundred and twenty-two acute LBP patients were included, of whom 174 provided full follow-up information (78.4%). A backward ordinal regression analysis showed previous LBP history and pain intensity to be the most important predictors of end of study GCPS. Of the fear-avoidance model variables, only negative affect added to this model. Our results do not really support the longitudinal validity of the fear-avoidance model, but they do feed the discussion on the role of pain-related fear in early stages of LBP.

Adolescent↗

PubMed2005

A breast-feeding promotion and support program a randomized trial in The Netherlands.

BACKGROUND: In the Netherlands, the initiation rate of breast-feeding (BF) was 80% in 2002, but only 35% of the mothers continued to breast-feed for 3 months. This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding. METHODS: A cluster-randomized intervention trial was used. Ten child health care centers in three regions of the home health care were randomly allocated to the program or usual care. Elements in the program were health counseling, measures to enhance cooperation, early signaling of breast-feeding problems and continuity of care, and lactation consultancy. Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum (n = 683). The primary outcome measure was the continuation of breast-feeding until at least 3 months. RESULTS: The 3-month breast-feeding rate was 32% in the intervention and 38% in the control groups (OR = 0.79, 95% CI = 0.58-1.08). CONCLUSION: The program was not effective. We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program, such as the categories of caregivers involved and the number and duration of contacts after parturition.

Breast Feeding↗

PubMed2005

Relation of weight maintenance and dietary restraint to peroxisome proliferator-activated receptor gamma2, glucocorticoid receptor, and ciliary neurotrophic factor polymorphisms.

BACKGROUND: Genetic variation in the peroxisome proliferator-activated receptor gamma2 (PPARgamma2), glucocorticoid receptor (GRL), and ciliary neurotrophic factor (CNTF) genes may play a role in the etiology of obesity. OBJECTIVE: We examined biological, psychological, and genetic determinants associated with weight maintenance (WM) after weight loss. DESIGN: Subjects (n = 120) followed a 6-wk diet and then a 1-y period of WM. Body weight (BW), body composition, leptin concentration, attitude toward eating (measured with the Three-Factor Eating Questionnaire), physical activity, and the polymorphisms of the PPARgamma2, GRL, and CNTF genes were measured. RESULTS: BW loss was 7.0 +/- 3.1 kg. After 1 y, 21 subjects showed successful WM (<10% regain); 99 were unsuccessful (> or =10% regain). Compared with unsuccessful subjects, successful subjects had a higher increase in dietary restraint over time (4.8 +/- 5.0 and 1.8 +/- 3.9, respectively; P < 0.01) but significantly less sensation of general hunger (-4.0 +/- 4.9 and -1.2 +/- 2.7, respectively; P < 0.05). Successful subjects had a significantly different frequency distribution for the PPARgamma2 (P = 0.05) and GRL (P < 0.05) genes than did unsuccessful subjects. The more successful genotypes showed a higher baseline body mass index and waist circumference (PPARgamma2), a greater decrease in disinhibition of dietary restraint (GRL), and less sensation of hunger (GRL). The G/G genotype (GRL) was an independent predictor of successful WM. CONCLUSION: The different genotypes of the PPARgamma2 and GRL genes contribute to WM, either directly (GRL) or indirectly (PPARgamma2 and GRL) via baseline body mass index and waist circumference, and to changes in Three-Factor Eating Questionnaire scores.

Adult↗

PubMed2004

Growth rate of human preimplantation embryos is sex dependent after ICSI but not after IVF.

BACKGROUND: There is concern that IVF and/or ICSI might have an adverse effect on embryonic development via epigenetic alterations. Such alterations might also be involved in the sex-related growth differences in preimplantation embryos found in some animal species. In the present study we analysed cell numbers of human male and female surplus embryos that developed to the blastocyst stage after either IVF or ICSI in order to investigate possible sex-dependent differential growth rates. METHODS: Blastocysts resulting from surplus embryos obtained after either IVF or ICSI during a 5 year study period were analysed using fluorescence in situ hybridization (FISH). RESULTS: The number of cells and sex could be determined in 330 blastocysts collected from 92 IVF cycles and in 322 blastocysts collected from 121 ICSI cycles. Whereas female and male embryos originating from IVF showed comparable mean log cell numbers per embryo +/- SEM (3.76+/-0.05 in 147 female and 3.72+/-0.04 in 183 male embryos), significant differences were observed in embryos originating from ICSI (3.57+/-0.05 in 162 female and 3.90+/-0.03 in 160 male embryos). The sex-related growth difference was significantly greater in ICSI than in IVF embryos. In a subset of 84 embryos, inner cell mass (ICM) and trophectoderm (TE) were analysed separately. A significantly higher mean log cell number of TE cells in ICSI male embryos was found as compared to their female counterparts (3.44+/-0.12 in 16 female and 3.90+/-0.11 in 29 male embryos), whereas this difference was not found in IVF embryos. CONCLUSION: A clear sex-related growth difference was found in human blastocysts originating from ICSI, but not in blastocysts originating from IVF. It is as yet unknown which mechanism is responsible for our findings. We hypothesize that the ICSI procedure might interfere with the process of imprinted X-inactivation.

Blastocyst↗

PubMed2004

Early cleavage is a valuable addition to existing embryo selection parameters: a study using single embryo transfers.

BACKGROUND: To reduce the twin pregnancy rate, elective single embryo transfer (eSET) is increasingly implemented. Improvement of the results obtained with eSET can be achieved by better selection of the most viable embryo. This study investigated the predictive value of early cleavage (EC) as an additional parameter for selecting the embryo with the highest implantation potential by using data from SET's. METHODS: Data from 165 SET's were retrospectively evaluated. Cleavage to the 2-cell stage was determined 23-26 h after injection or 25-28 h after insemination. Selection of the embryo to be transferred was based on cell morphology and cell number on the day of transfer, not on the EC status. Additional information on the predictive value of EC on developmental potential was obtained by analysing 253 transfers with two embryos (double embryo transfer, DET) and blastocyst formation of 1160 surplus embryos. Logistic regression was used to determine the predictors of pregnancy or blastocyst development. RESULTS: A significantly higher pregnancy rate was observed after transfer of single EC embryos compared to single non-EC embryos (46 versus 18%). This result was confirmed by the significantly higher pregnancy rate after DET with two EC embryos as compared to DET with two non-EC embryos (45 versus 25%) and the blastocyst formation of EC embryos compared to non-EC embryos (66 versus 40%). Logistic regression showed that EC is an independent predictor for both pregnancy and blastocyst development in addition to cell morphology and cell number. CONCLUSIONS: In order to improve the selection of the embryo with the highest implantation potential, selection for transfer should not be based on cell number and morphology on the day of transfer alone, but also on early cleavage status.

Adult↗

PubMed2004

Reproducibility, validity, and responsiveness to change of a short questionnaire for measuring fruit and vegetable intake.

The reproducibility, relative validity, and responsiveness to change of an eight-item food frequency questionnaire designed to measure fruit and vegetable consumption was assessed among 157 women (mean age = 41 years) in the Netherlands from spring 2001 to spring 2002. Plasma concentrations of vitamin C and total and specific carotenoids served as biomarkers against which validity was assessed. The questionnaire was completed and biomarker concentrations were determined three times: immediately preceding and following a controlled intervention of 1 month aimed at increasing fruit and vegetable consumption and 1 year after the start of the intervention. The 1-month and 1-year reproducibility of total fruit and vegetable consumption assessed in the control group was 0.80 and 0.79 (Spearman's r ). Correlations between consumption and plasma carotenoids and vitamin C at baseline were 0.39 and 0.37, respectively, for fruits and 0.24 and 0.26, respectively, for vegetables. Correlations between changes in consumption and plasma carotenoids and vitamin C were 0.32 and 0.33, respectively, for fruits and 0.28 and 0.30, respectively, for vegetables. On the basis of similar correlations reported in the literature, the authors conclude that the questionnaire appears to be suitable for ranking individuals according to their consumption of fruits and vegetables and according to changes in their consumption. However, the validity of the questionnaire remains to be established in males, other age groups, and populations of lower educational levels.

Adult↗