Biomedical subjects

F Sturmans

Publications and source records attributed to F Sturmans.

At least 37 records · Page 2Linked to original sources

PubMed1995

Benzodiazepines and the risk of falling leading to femur fractures. Dosage more important than elimination half-life.

BACKGROUND: In the past decade, the use of benzodiazepines has been identified as a major independent risk factor for accidental falls. OBJECTIVE: To study the role of dosing, timing, elimination half-life, and type of benzodiazepine in relation to the occurrence of accidental falls leading to hospitalization for femur fractures. METHODS: A 1:3 age-, sex-, and pharmacy-matched case-control study was performed using data from a Dutch record linkage system (PHARMO) (N = 300,000). Cases included 493 patients (55 years and older), newly admitted to the hospital for a femur fracture resulting from an accidental fall (between 1986 and 1992). Relative risk estimates were calculated using conditional logistic regression analyses to control for the potential confounding effects of concomitant drug use and presence of a wide range of underlying diseases. RESULTS: Falls were significantly associated with current use of benzodiazepines (odds ratio, 1.6; 95% confidence interval, 1.2 to 2.1) and in particular with short half-life benzodiazepines (odds ratio, 1.5; 95% confidence interval, 1.1 to 2.0), sudden dose increases (odds ratio, 3.4; 95% confidence interval, 1.0 to 11.5), and concomitant use of several benzodiazepines (odds ratio, 2.5; 95% confidence interval, 1.3 to 4.9). A strong dose-response relationship (P < .0001) and dose-response relations among users of either short or long half-life benzodiazepines suggests that these increased risks are explained primarily by dose. CONCLUSIONS: Benzodiazepines are a major, independent risk factor for falls leading to femur fractures, and the increased risk is probably explained by prescribing too-high doses to the elderly.

Accidental Falls↗

PubMed1995

A rapid method to estimate the incidence rate and prevalence of insulin-dependent diabetes mellitus in children 0-19 years of age.

OBJECTIVE: To trace new cases of insulin-dependent diabetes mellitus (IDDM) on an ongoing basis and to estimate the incidence rate and prevalence of IDDM in children 0-19 years of age. RESEARCH DESIGN AND METHODS: The estimation of the prevalence and incidence rate of IDDM was based on, respectively, the prevalence and the rate of new users of insulin. The data were obtained from pharmacy, patient-based, drug dispensing histories in a well-defined population encompassing 257,113 individuals in the Netherlands. RESULTS: The IDDM incidence rate was estimated at 11.5 (CI95 6.6-17.8) per 100,000 person years in 1989-1990 in children 0-19 years of age. The prevalence was estimated at 11.0 (CI95 8.6-13.4) per 10,000 children 0-19 years of age. DISCUSSION: The incidence rate is comparable to that found in a large, national survey among all paediatricians and internists in the Netherlands. The method offers ongoing monitoring of the incidence and prevalence of IDDM in children, 0-19 years of age, against low costs. The method is suitable for rapid and cost-efficient recruitment of cohorts of incident IDDM patients, which fosters research to identify and quantify the attribution of different types of aetiologic and prognostic factors of IDDM.

Adolescent↗

PubMed1995

Adverse effects of the indoor environment on respiratory health in primary school children.

Exposure to various factors from the indoor environment on respiratory health of 470 Dutch primary school children was studied. We investigated which of the factors, such as home dampness, passive smoking, unvented kitchen geysers, or pets, affected children's respiratory health the most, and whether airway sensitivity to these indoors exposures differed between boys and girls. Information on respiratory morbidity and characteristics of the housing was obtained by a written questionnaire, completed by the parents of the children. Lung function of the children was measured at school, by forced oscillation technique (FOT) and spirometry. In boys, all investigated lung function parameters were significantly affected by exposure to passive smoking during the child's entire life. Although mostly nonsignificant, all of the reported asthma-like symptoms were related especially to maternal smoking, with a trend of a dose-response relationship. Furthermore, damp stains (P < 0.05) and mold growth (ns) were associated with chronic cough and with small but significant impairments in part of the lung function parameters. No consistent patterns were observed with unvented kitchen geysers and pets. Although passive smoking (cumulative dose) in girls was also associated with lung function impairments, the effects were smaller than those in boys and not all significant. Associations between the asthma-like symptoms and the dose of maternal and paternal smoking also were less consistent. Furthermore, no associations were found with the dampness indicators and with pets, but unvented kitchen geysers were significantly related to impairments in some of the impedance indices. This study shows detrimental effects of several indoor factors on the prevalence of chronic respiratory symptoms and lung function in children, which are most pronounced for passive smoking, and somewhat less pronounced for dampness and the presence of unvented kitchen geysers. Airway sensitivity to these exposures appeared to be higher in boys than in girls.

Air Pollution, Indoor↗

PubMed1995

Usefulness of cinefluoroscopic detection of coronary artery calcification in the diagnostic work-up of coronary artery disease.

AIM: To determine in which patients (cine)fluoroscopic detection of coronary artery calcifications is recommended for the diagnosis of coronary artery disease and the consequence of this finding for referral for cinecoronary arteriography. MATERIALS AND METHODS: Data were retrospectively obtained from 778 patients who had been referred for cinecoronary arteriography. Excluded were patients with a previous myocardial infarction, a previous abnormal cinecoronary arteriogram and patients with unstable angina. The discriminating value was assessed with the help of the crude likelihood ratio (LR), as well as the LRs stratified for gender, age and symptomatology. The gold standard was the coronary arteriogram. Furthermore, the post-test probability was estimated using logistic regression to take dependence on age, sex and symptomatology into account. RESULTS: The crude LR of a positive and negative test result, with 95% confidence intervals, was, respectively 5.8 (4.1-8.2) and 0.52 (0.47-0.58), but was dependent on the clinical variables. Estimated probabilities of having coronary artery disease (CAD) varied substantially for a negative as well as a positive test result with the categories of clinical variables. CONCLUSION: (Cine)fluoroscopy discriminates between patients with and without disease; the test proved to be especially useful in females with atypical angina and patients of both sexes with non-specific chest pain.

Calcinosis↗

PubMed1995

Comparison of the diagnostic value of cinefluoroscopy and simple fluoroscopy in the detection of calcification in coronary arteries.

AIM: Comparison of the diagnostic value of cinefluoroscopy and simple fluoroscopy in the detection of calcification in coronary arteries. PATIENTS AND METHODS: Data were prospectively obtained from 143 patients in whom simple fluoroscopy as well as cinecoronary arteriography were performed. Excluded were patients with a previous myocardial infarction, a previous abnormal cinecoronary arteriogram and patients with unstable angina. With the coronary arteriogram as the gold standard, the likelihood ratios (LR) of simple fluoroscopy were determined, mismatches with cinefluoroscopy were analysed and Kappa, as a measure for inter-test agreement, was calculated. RESULTS: The LRs with 95% confidence intervals for a positive and negative result were 5.3 (2.6-11.0) and 0.43 (0.28-0.69), respectively. There was a mismatch in 12 (8.3%) patients. Kappa with a 95% confidence interval was 0.90 (0.73-1.0). CONCLUSIONS: Both test modalities are almost identical and conclusions with respect of the diagnostic value of cinefluoroscopy also holds for simple fluoroscopy.

Calcinosis↗

PubMed1995

Educational level of spouses and risk of mortality: the WHO Kaunas-Rotterdam Intervention Study (KRIS).

BACKGROUND: A 9.5-year follow-up of the Kaunas-Rotterdam Intervention Study (KRIS) provided the opportunity of investigating whether the educational level of wives was associated with their husbands' risk of mortality and coronary heart disease (CHD), independently of the educational level of the husbands themselves. METHODS: The data represent populations consisting of 2452 Lithuanian men and 3365 Dutch men. These men were extensively screened for cardiovascular risk factors in the period 1972-1974. During the follow-up 303 Kaunasians and 350 Rotterdammers died. We used the Cox proportional hazards and the logistic regression models to analyse the data. RESULTS: We found that men whose spouses had little education apparently had an increased risk of all-cause mortality, even when their own educational level was taken into account. The relative risks (RR) were 1.57 in Kaunas and 2.15 in Rotterdam. The results for fatal and non-fatal myocardial infarctions were compatible with this finding, especially in Rotterdam. The prevalence of smoking was higher among men whose wives had primary schooling only. Nonetheless, adjusting the effect of the wife's educational level on her husband's mortality risk for all coronary risk factors in the husband only partially explained the association. CONCLUSIONS: The spouse's educational level appears to have independent effects on a man's risk of mortality in both eastern and western European communities. The results strongly suggest that including characteristics of the socioeconomic status of an individual's spouse would improve studies of socioeconomic differences in health.

Cardiovascular Diseases↗

PubMed1995

Care dependence and individual care provision.

For policy purposes as well as for the provision of individual care, it is relevant to known which individual characteristics have impact upon the level of care dependence. For purposes of individual care provision, characteristics which can be influenced and which also have an important impact upon the care dependence are of interest. This study showed that the profoundly mentally handicapped are almost all totally dependent upon care, and therefore additional information about individual characteristics is superfluous. The results of logistic regression analyses showed a statistically significant and important impact of ADL-functions. Exactly which other characteristics are relevant to consider depends upon the level of care dependence and the level of mental handicap.

Activities of Daily Living↗

PubMed1995

Acute respiratory effects of low level summer smog in primary school children.

We aimed to study the possible effects of exposure to a summer smog episode on the respiratory health of 212 school children. Furthermore, the suitability of the forced oscillation technique (FOT) to demonstrate such effects was evaluated. Acute respiratory symptoms were evaluated by questionnaire and lung function was assessed by spirometry and respiratory impedance measurements. For each child, comparisons were made between measurements performed at baseline (low levels of air pollutant: 55 micrograms.m-3 for SO2 and 58 micrograms.m-3 for NO2 (maximum 24 h means); O3 levels ranged from 2-56 micrograms.m-3 (8 h mean)); and after a summer smog episode (characterized by 8 h O3 levels > 120 micrograms.m-3 (163 micrograms.m-3) and 1 h levels > 160 micrograms.m-3 (215 micrograms.m-3). No significant effects were observed on the prevalence of acute respiratory symptoms. When individual changes in lung function indices (delta LF) were regressed on changes in previous day ozone (8 h mean) and changes in mean daily temperature (delta MTemp), using multiple linear regression analysis, a significant negative association was observed with peak expiratory flow (PEF), but not with other spirometry indices. Although significant associations were observed with reactance at 8 Hz (Xrs8), resonant frequency (f0) and frequency dependence of resistance (FD), the signs of the beta s were opposite to the direction expected when O3 adversely affected the impedance outcomes. In conclusion, in this study short-term exposure to moderately high levels of ozone did not result in clear adverse effects on the respiratory health of the children.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1995

Reproducibility of a food frequency questionnaire and stability of dietary habits determined from five annually repeated measurements.

OBJECTIVES: In studies on diet and cancer, diet assessment should address long-term intake. Therefore, the authors determined the 5-year reproducibility of a self-administered 150-item food frequency questionnaire (FFQ) used to assess dietary habits in the Netherlands Cohort Study on diet and cancer. Since the FFQ was repeated more than once, the pure test-retest reliability of the FFQ could be distinguished from the intra-individual change in nutrient intake over time. These results were furthermore used to investigate the measurement error structure of the FFQ. DESIGN: After baseline administration in 1986, the FFQ was annually repeated from 1987 to 1991 in independent random samples of the cohort (n = 400). Pearson correlation coefficients (r) between baseline and repeated measurements of nutrient intake, calculated for each time interval, were regressed on time interval to provide separate estimates of the test-retest correlation (intercept of regression line) and of the decline in correlation over time (slope). The proportion of correlated measurement error was derived from combining the test-retest results with those from a validation study, in which the FFQ was validated against three 3-day diet records. RESULTS AND CONCLUSIONS: Response was stable at 82%. The test-retest r ranged from 0.42 for selenium intake to 0.90 for alcohol intake. The slopes of the regression lines were relatively flat, but negative for most nutrients; on average, the decline in r amounted to 0.07 after 5 years, indicating that the potential of a single FFQ measurement to rank subjects according to nutrient intake dropped only slightly over time. This is important for studies on cancer since a long induction period may be involved. It was furthermore shown that the proportion of within-subject (error) variance of the FFQ method that could be attributed to correlated error ranged from 0 to 50%. This finding confirms that a reliability study may underestimate the measurement error of a method. SPONSORSHIP: Dutch Cancer Society (grants CIVO 86-1 and CIVO 90-3).

Aged↗

PubMed1994

Toenail selenium levels and the risk of breast cancer.

The association between toenail selenium and breast cancer was studied in a prospective study on diet and cancer among 62,573 Dutch women aged 55-69 years that started in September 1986. The analysis was based on 355 breast cancer cases, detected during 3.3 years of follow-up (1986-1989), for whom selenium data were available. Selenium levels were significantly lower among cases diagnosed early during follow-up. After exclusion of cases that occurred in the first year of follow-up, multivariable-adjusted rate ratios of breast cancer in increasing quintiles of selenium were 1.00, 0.90, 0.76, 0.86, and 0.91 (trend p = 0.618). The authors found no evidence for an inverse association between selenium status and breast cancer.

Aged↗

PubMed1994

A prospective cohort study on the relation between meat consumption and the risk of colon cancer.

The high incidence of colon cancer in affluent societies has often been attributed to a high fat diet and, more in particular, the consumption of meat. The association of the consumption of meat and the intake of fat with risk of colon cancer was investigated in a prospective cohort study on diet and cancer, which is being conducted in the Netherlands since 1986 among 120,852 men and women, aged 55-69. The analysis was based on 215 incident cases of colon cancer (105 men and 110 women) accumulated in 3.3 years of follow-up, excluding cases diagnosed in the first year of follow-up. Dietary habits were assessed at baseline with a 150-item semiquantitative food frequency questionnaire. No trends in relative rates of colon cancer were detected for intake of energy or for the energy-adjusted intake of fats, protein, fat from meat, and protein from meat. Consumption of total fresh meat, beef, pork, minced meat, chicken, and fish was not associated with risk of colon cancer either. Processed meats, however, were associated with an increased risk in men and women (relative rate, 1.17 per increment of 15 g/day; 95% confidence interval, 1.03-1.33). The increased risk appeared to be attributable to one of the five questionnaire items on processed meat, which comprised mainly sausages. This study does not support a role of fresh meat and dietary fat in the etiology of colon cancer in this population. As an exception, some processed meats may increase the risk, but the mechanism is not yet clear.

Age Factors↗

PubMed1994

Prospective study on alcohol consumption and the risk of cancer of the colon and rectum in the Netherlands.

The association between alcohol consumption and cancer of the colon and rectum was investigated in a prospective cohort study, conducted in the Netherlands from 1986 onwards among 120,852 men and women, aged 55 to 69 years. During 3.3 years of follow-up, 312 and 166 cases of colon and rectal cancer had accumulated, respectively. After exclusion of cases diagnosed in the first year of follow-up, the analysis was based on 217 incident cases of colon cancer (107 men and 110 women) and 113 cases of rectal cancer (75 men and 38 women). For colon cancer, no association with total intake of alcohol nor with the consumption of beer and wine, specifically, could be demonstrated; for liquor intake, a significant (P = 0.04) decreasing risk with increasing consumption was observed. For rectal cancer in men, positive trends were observed for total alcohol intake (P = 0.04), beer (P = 0.05), and liquor (P = 0.06). Results for rectal cancer in women were consistent with those in men, but data were too sparse to provide stable estimates. Simultaneous adjustment for beverage type and quantity appeared to strengthen the association of rectal cancer with drinking beer (relative rate (yes/no) = 2.0, 95 percent confidence interval = 1.1-3.9), although a dose-response effect was not observed. When alcohol intake from beer, wine, and liquor were included as continuous variables, the association was somewhat stronger for liquor than for beer, but none of the associations were statistically significant. It is concluded that consumption of alcoholic beverages (beer, in particular) is associated with an increased risk for rectal but not colon cancer.

Aged↗

PubMed1994

Risk factors for cervical dysplasia: implications for prevention.

This study assessed the aetiologic and public health importance of various risk factors for cervical dysplasia. A case-control design was used in which all cases had a histologically confirmed mild, moderate or severe cervical dysplasia. Controls were sampled from the general population. A total of 257 cases and 705 controls returned a postal questionnaire about marital status, sexual behaviour and contraceptive use, smoking behaviour and dietary intake of some nutrients. An increased risk was observed for women who were smokers and women who reported more than one sexual partner. For women who reported more than six sexual partners, the adjusted odds ratio was 11.5 (95% CI: 6.6-20.2); for women who smoked more than 20 cigarettes per day, an adjusted odds ratio of 2.5 (95% CI: 1.6-3.9) was found. Use of oral contraceptives for more than 10 years increased the risk: the adjusted odds ratio was 2.3 (95% CI: 1.2-4.5). The population attributable risk percentage (PAR%) of these three risk factors together was 72%, while number of sexual partners, number of cigarettes smoked and oral contraceptive use alone amounted to a PAR% of 57%, 29% and 8% respectively. Considering the preventive potential against the background of causality of the relationships and the social acceptability of the proposed changes, it is concluded that cervical cancer and its precursors might for the greater part be prevented by behavioural changes, such as reducing smoking and using contraceptive barrier methods.

Adult↗

PubMed1994

Differences in mortality and coronary heart disease between Lithuania and The Netherlands: results from the WHO Kaunas-Rotterdam Intervention Study (KRIS).

BACKGROUND: A 9.5-year follow-up of the Kaunas-Rotterdam Intervention Study (KRIS) provided an opportunity to compare mortality patterns and rates in a population from Lithuania, one of the former republics of the Soviet Union, with a population from the Netherlands. These populations consisted of 2452 and 3365 males, respectively, aged 45-60 years. In 1972-1974, these males were extensively screened for cardiovascular risk factors, using uniform methods. METHODS AND RESULTS: During the follow-up, 303 males in Kaunas (Lithuania) and 350 males in Rotterdam (the Netherlands) died. Using Cox proportional hazards and logistic regression analysis, it was found that all-cause mortality rates during follow-up were 30% higher in Kaunas; this was mainly due to higher mortality rates from external causes (relative risk = 6.69), stomach cancer (RR = 2.78), stroke (RR = 2.30) and infectious diseases (RR = 12.43). The risk of fatal and non-fatal coronary heart disease (CHD) was, however, smaller in Kaunas (RR = 0.72). This lower risk closely corresponded with the Lithuanian risk profile which could be described by less smoking, lower cholesterol levels, and higher physical activity. As Lithuanians had a more advantageous cardiovascular risk profile, the higher Lithuanian all-cause mortality rates could not be explained by this risk profile. CONCLUSIONS: The results provide evidence for geographical differences in mortality and morbidity between Lithuania and the Netherlands. Population-specific health behaviours were shown to be involved in differences in the risk of CHD. The lower CHD rates in Eastern European communities in the 1970s, in this study confirmed for Lithuania, suggests that the apex of the CHD epidemic had not yet reached the Lithuanian population.

Blood Pressure↗

PubMed1994

The role of cigarette smoking in the etiology of cervical dysplasia.

We evaluated the effect of smoking on the risk of cervical dysplasia in a large case-control study, obtaining smoking information from a mail questionnaire. We observed higher risks with increasing numbers of cigarettes smoked, but not with longer duration of smoking. The risk for ex-smokers was between those of current smokers and nonsmokers and was lower for women who had stopped more than 10 years ago than for those who had quit more recently. Starting to smoke at an early age did not increase the risk of cervical dysplasia.

Adult↗

PubMed1994

The need for assessment of sensory functioning in ageing people with mental handicap.

Within the framework of a study on the ageing process of people with mental handicap in the Netherlands, information about visual and hearing impairments in 1583 people with mental handicap living in group homes or institutions was obtained from their physicians by means of a written questionnaire. Of the people with Down's syndrome (DS) who were older than 50 years of age, 46% had a visual impairment, whereas approximately 13% of subjects with other causes of mental handicap at the same age experienced similar visual impairment. Hearing loss in this age group was reported in 28% of people with DS, but only in 8% of subjects with other causes of mental handicap. The most common eye condition was cataracts, and the most frequent cause of hearing impairment was infection. In people with severe and profound mental handicap of all ages, sensory impairments were more frequent than in persons with mild or moderate mental handicap. Glasses or hearing aids were rarely used by people with severe or profound mental handicap. Assessment of visual and hearing impairments in people with mental handicap seemed clearly indicated, especially in those aged 50 years and older, in those with DS, and in those with severe or profound mental handicap.

Adolescent↗

PubMed1994

Care dependence and services planning.

For policy purposes as well as for the provision of individual care, it is relevant to know which individual characteristics have an impact upon the level of care dependence. For policy purposes, it is preferable to predict the level of care dependence as efficiently as possible. This study of residents of institutions and group homes for people with mental handicap showed that profoundly mentally handicapped residents are almost all totally dependent upon care: additional information about the individual characteristics of this group is superfluous. The results of logistic regression analyses for residents with severe or mild mental handicap showed that age, gender and aetiological diagnosis (Down's syndrome or other) do not have significant predictive power. For the level of care dependence, adding the score on Activities of Daily Life (ADL) to the various models improved the predictive power. It depends on the level of mental handicap and on the level of care dependence which one wants to predict which other individual characteristics have to be included in order to improve predictive power.

Activities of Daily Living↗

PubMed1994

Asthma-related symptoms and lung function in primary school children.

The aim of the present study was to determine the prevalence of asthma-related symptoms in a group of primary school children, by means of a questionnaire completed by their parents, and their lung function using spirometry and the forced oscillation technique (FOT). Also investigated were diagnostic labeling and medical prescription. We approached 535 children, from two primary schools in Maastricht, the Netherlands. Completed questionnaires were received from 482 children (90%). Valid lung function values were obtained in 470 of these children (98%). The lifetime prevalence of wheeze and attacks of shortness of breath with wheeze was 29% and 19%, respectively. The period prevalence of wheeze was 15%, 13% reported chronic cough, and 10% attacks of shortness of breath with wheeze. The doctor-diagnosed asthma and bronchitis prevalence was 6% and 19%, respectively. Of the children diagnosed as having asthma, 69% used antiasthma medication; none of the children diagnosed as having bronchitis used antiasthma medication. A symptom-based asthma prevalence of 11% was calculated. Statistically significant differences in spirometric and FOT indices were found between the children with and without complaints. In conclusion, among the 482 investigated children a relatively high prevalence of unrecognized or misclassified, and therefore undertreated, asthma-related symptoms was found. These observations were confirmed by the lung function data, in that we found significant differences in spirometric and FOT indices between children with and without complaints.

Age Distribution↗