PubMed Health⌕ Search

Biomedical subjects

F Sturmans

Publications and source records attributed to F Sturmans.

At least 73 records · Page 4Linked to original sources
PubMed1991

Does competence of general practitioners predict their performance? Comparison between examination setting and actual practice.

OBJECTIVE: To study the differences and the relation between what a doctor actually does in daily practice (performance) and what he or she is capable of doing (competence) by using national standards for general practice. DESIGN: General practitioners were consulted by four standardised (simulated) patients portraying four different cases during normal surgery hours. Later the doctors participated in a controlled practice test, for which they were asked to perform to the best of their ability. In the test they saw exactly the same standardised cases but in different patients. The patients reported on the consultations. SETTING: Province of Limburg, the Netherlands. SUBJECTS: 442 general practitioners invited by a letter. 137 (31%) agreed to participate, of whom 36 were selected and visited. MAIN OUTCOME MEASURES: Number of actions taken during the consultations across complaints and for each category of complaint: the competence and performance total scores. Combination of scores with duration of consultations (efficiency-time score). Correlation between scores in the competence and performance part. RESULTS: Mean (SD) total score across complaints for competence was 49% higher than in the performance test (81.8 (11) compared with 54.7 (10.1), p less than 0.0001). The Pearson correlation across complaints between the competence total score and the performance total score of the participating physicians was -0.04 (not significant). When efficiency and consultation time of the consultations were taken into account, the correlation was 0.45 (p less than 0.01). CONCLUSIONS: Assessment of competence under examination circumstances can have predictive value for performance in actual practice only when factors such as efficiency and consultation time are taken into account. Below standard performance of physicians does not necessarily reflect a lack of competence. Performance and competence should be considered as distinct constructs.

Clinical Competence↗
PubMed1991

Combination of dietary factors in relation to breast-cancer occurrence.

Combinations of dietary factors were studied in relation to breast-cancer occurrence among 133 breast cancer cases and 289 population controls in The Netherlands. Dietary factors were classified according to their possible mechanism of action, i.e., relating either to the intestinal microflora (total fat, fiber, fermented milk products) or to the anti-oxidant hypothesis (beta-carotene, selenium and polyunsaturated fatty acids). From 6 interactions evaluated, the combination of high fiber intake and high intake of fermented milk products was the only one suggesting synergistic protection (age-and-fat-adjusted OR for interaction = 0.48, 95% confidence interval (CI) = 0.21 - 1.13). In order to estimate the extent to which the above dietary factors together might be related to breast cancer, subjects with a supposedly favorable dietary pattern (low fat intake, high fiber intake, high intake of fermented milk products; high intake of beta-carotene and selenium, low intake of polyunsaturated fatty acids) were compared with subjects with an unfavorable dietary pattern. This resulted in an age-adjusted odds ratio of 0.40 (95% CI = 0.14 - 1.15), which was largely attributable to the combination of low intake of fat and high intake of fermented milk products and fiber (age-adjusted OR = 0.33, 95% CI = 0.15 - 0.73). The other factors did not appreciably affect the odds ratio. These analyses show in a quantitative way that a dietary pattern which combines low intake of fat and high intake of fiber and fermented milk products might provide substantial protection against breast cancer.

Adult↗
PubMed1991

[Course and distribution of mortality of pleural mesothelioma in The Netherlands, 1970-1987].

In this article the sex- and age-specific trends and geographical distribution of asbestos related pleural mesothelioma mortality in the Netherlands between 1970 and 1987 are investigated. For men total mortality increased from 10.8 per million during 1970-1978 to 20.9 per million during 1979-1987. The highest mortality occurred with 147.7 per million in 1987 in the age group between 65 and 74 years. Mortality rates for the age group between 55 and 64 years amounted to 96.5 per million in 1987. The geographical distribution over the country showed a strong concentration of male mesothelioma cases in the regions with many harbours, shipyards and heavy industries round Amsterdam, IJmuiden, Rotterdam, Dordrecht and Walcheren. Using linear regression techniques, it was calculated that several thousands new mesothelioma cases will occur in the Netherlands during the next two decades. A significant decrease in mesothelioma mortality can not be expected before 2010.

Adult↗
PubMed1991

Long-term mortality in miners with coal workers' pneumoconiosis in The Netherlands: a pilot study.

In order to investigate whether the prolonged exposure to coal mine dust increases the cancer risk for coal miners, a pilot study in a selected cohort of 334 Dutch miners with coal workers' pneumoconiosis (CWP), followed from 1956 until 1983, was conducted. In total, 165 miners had died (49.4%); for 162 (98.2%) the cause of death was traced. In comparison to the general Dutch male population, total mortality in the cohort was statistically significantly increased (SMR: 153). This was in general due to the significantly higher than expected cancer mortality (SMR: 163), cancer of stomach and small intestine (SMR: 401) and nonmalignant respiratory disease (SMR: 426). The lung cancer mortality was within the expected range.

Adult↗
PubMed1991

The effect of beta-carotene on the regression and progression of cervical dysplasia: a clinical experiment.

In order to gain insight into the causality of the relation between beta-carotene and cancer, we performed a randomized placebo-controlled trial in which the effect of beta-carotene on the regression and progression rates of cervical dysplasia were examined. The experimental group (n = 137) received a supplemental dose of 10 mg of beta-carotene daily for 3 months. The control group (n = 141) received placebo capsules. As the outcome parameter, two definitions of regression and progression were used, which were based on the degree of dysplasia before and after the medication period. The number of patients who showed progression was too small to allow conclusions. No effect of beta-carotene on the regression percentages was observed: OR = 0.68 (95% CI: 0.28-1.60) using the broad definition; and OR = 1.22 (95% CI: 0.43-3.41) with the strict definition. A secondary analysis, in which the effect of the total intake of beta-carotene (diet + medication) on the regression percentages of cervical dysplasia was studied, did not show a positive effect either. The paper discusses to what extent issues in the study design may have masked a potential effect and how our results affect the evidence for a causal relation between beta-carotene and cancer.

Adult↗
PubMed1991

The role of beta-carotene and other dietary factors in the aetiology of cervical dysplasia: results of a case-control study.

The effects of beta-carotene and several other dietary factors on the risk of cervical dysplasia were evaluated in a case-control study. Cases (n = 257) were the participants of a randomized trial assessing the effect of beta-carotene on cervical dysplasia. Controls (n = 705) were sampled from the general population. A postal questionnaire was used to obtain information about the frequency of consumption of several food items containing beta-carotene, retinol, vitamin C and dietary fibre. Information was also collected about other risk factors for cervical dysplasia, in order to adjust for possible confounding. To our surprise, we observed an increased risk of cervical dysplasia for women with a high intake of beta-carotene (odds ratio (OR) = 2.31; 95% confidence interval (CI): 1.27-4.19). No relationship was found with the intake of retinol, while both vitamin C and dietary fibre showed a weak and not statistically significant inverse relationship with cervical dysplasia. These findings do not support the hypothesis that beta-carotene protects against cervical dysplasia.

Adult↗
PubMed1991

A scale for the functional status of the elderly living at home.

Many scales have been developed to describe the functional status of geriatric patients. These scales are of limited use for describing the functional status of elderly people living at home, because of their poor capacity for differentiation. This article reports the results of a postal questionnaire among elderly people living at home. The findings will be analysed to see whether the inventory on performance of household and daily living activities describes the functional status of elderly people in a useful manner. A combined scale was constructed, which has satisfactory Guttman coefficients when applied to elderly people living at home. In addition, the scale is informative for those providing home care with regard to the elderly person's quantitative and qualitative needs for assistance. As such, it could be an instrument to be applied in community nursing. The applicability of the scale to institutionalized elderly people remains to be investigated.

Activities of Daily Living↗
PubMed1991

Mortality of coke plant workers in The Netherlands.

During the production of coke, large quantities of coke oven gas are emitted. People who work on the top or on the sides of coke ovens are exposed to this oven gas, which contains a range of carcinogenic chemicals. To investigate the cancer risks under these work conditions, a retrospective study was undertaken. In total 11,399 former workers were enrolled in the study. Of these, 5639 had worked in the coke plant for at least six months between 1945 and 1969. The other 5740 had worked in another plant during the same period and formed a non-exposed group for comparison. The study group was followed up until 1984 for mortality. The causes of death were obtained from the Central Bureau of Statistics. Among the coke oven workers significantly higher death rates were found for lung cancer and non-malignant respiratory disease. Mortality in the byproduct section was similar to that expected. Among workers in the tar distillery the rate for lung cancer was higher than expected. The risk for gastric cancer and non-malignant respiratory disease among the workers of the coke shipping department was increased but the SMRs did not reach statistical significance. No data were collected about individual smoking habits or socioeconomic state of the study subjects and the possibility that the risk found could be attributed to these factors cannot be ruled out. It has been stated by other investigators, however, that the effect of not controlling for smoking tends to be modest.

Coke↗
PubMed1991

[Nursing home admission; a study among elderly applicants].

This article describes the care needs, social network, housing conditions, utilization of care and diagnoses of 157 elderly applicants to nursing homes in Maastricht. The study was conducted during the period of February 1987 to July 1988. Possible differences in these characteristics in relation to the goal of the admission (rehabilitation versus continuous support) and in relation to prior living arrangements (home versus hospital) were investigated. In addition, the question to what extent substitution of care is possible is discussed. Within the group of nursing home applicants, a fairly clear distinction could be made between a number of subgroups, although care needs, social network (with the exception of the number of visits paid), and demographic characteristics showed no differences in relation to admission goals and prior living arrangements. The distinction was based particularly on the nature of the disorders (psychogeriatric versus somatic and chronic versus more or less acute), which was reflected not only in the main diagnosis itself, but also in differences in housing conditions, numbers of visits paid to others, and utilization of care prior to admission. Under the proposed policies for substitution, about a quarter of the applicants would be eligible for substitution. However, the major care needs, and the levels of formal and informal care prior to admission, as well as the shortage of alternative services, would seem to indicate that the actual possibilities for substitution are more limited.

Activities of Daily Living↗
PubMed1991

A method for introducing standardized (simulated) patients into general practice consultations.

A study has been undertaken to determine whether it is possible for a set of standardized (simulated) patients to visit general practitioners, without being detected, in a health care system where doctors have fixed patient lists. Since sending standardized patients into doctors' offices is a new way to assess the performance of general practitioners; this paper describes in detail the methodology that has been used for visits. The paper looks first at the general preparation for visits and secondly at the specific preparation concerning the fine detail of the individual visit. The method was tested in 156 consultations with 39 general practitioners and in no cases were the standardized patients detected. None of the doctors visited felt offended and all were prepared to cooperate in future studies with standardized patients. It is concluded that the standardized patient method, following the step-by-step procedure described, is feasible in actual practice.

Clinical Competence↗
PubMed1991

Assessment of the performance of general practitioners by the use of standardized (simulated) patients.

A study was undertaken whereby a set of standardized (simulated) patients visited general practitioners without being detected, in a health care system where doctors had fixed patient lists. Thirty nine general practitioners were each visited during normal surgery hours by four standardized patients who were designed to be indistinguishable from real patients. The objective of the study was to see whether the actual performance of general practitioners, as assessed by standardized patients, met predetermined consensus standards of care for actual practice. The patients presented standardized accounts of headache, diarrhoea, shoulder pain and diabetes. The mean group scores of the doctors on the predefined standards of care for the different complaints ranged from 33 to 68%. The results show that standardized patients may be the method of choice in the assessment of the quality of actual care of doctors. It is hypothesized that the substandard scores of the doctors do not reflect inadequate competence, but are a result of the difference between competence and performance.

Clinical Competence↗
PubMed1990

Dietary fiber, beta-carotene and breast cancer: results from a case-control study.

To study the association between dietary fiber, beta-carotene and breast cancer, the average daily intake of these dietary components was compared among 133 incident breast cancer cases and 238 population controls. Average daily intake of cereal products, fruit and vegetables was also studied. A statistically significant lower energy-adjusted intake of dietary fiber was observed in cases than in controls (mean +/- SD: 25.4 +/- 6.7 g vs. 27.7 +/- 7.4 g, 95% confidence interval (CI) of the age-adjusted difference = -3.8, -0.8). Intake of beta-carotene was similar for cases and controls. The multivariate adjusted odds ratio (OR) of breast cancer among women in the highest quartile of intake of cereal products, as compared to those in the lowest quartile, was 0.42 (95% CI = 0.19-0.92) and the trend was statistically significant (p = 0.03). The corresponding OR for intake of dietary fiber was 0.55 (95% CI = 0.26-1.17) but the trend was not significant. The OR for the highest quartile of intake of beta-carotene, fruit, vegetables, and all vegetable products combined was less than unity, but there was no significant inverse trend. These results suggest that a high intake of cereal products, especially those rich in fiber, may be inversely related to incidence of breast cancer.

Age Factors↗
PubMed1990

Neuropsychiatric disorders among solvent-exposed workers. First results from a Dutch case-control study.

This case-control study was undertaken to determine whether exposure to organic solvents, as experienced by Dutch painters, causes an increased risk of disability due to neuropsychiatric disorders. Cases and controls were selected from the Dutch Painters' and Construction Workers' Organizations. Cases were defined as male persons receiving disability benefits due to neuropsychiatric disorders. The controls consisted of a random sample of 1000 male persons from the total study population. Cases (n = 252) and controls (n = 822) participated in our study by returning the completed questionnaires. The questionnaire was used to collect information about occupational history and the presence of potentially confounding factors. The adjusted Odds Ratio for the total group of neuropsychiatric disorders did not reach a statistically significant level (OR = 1.17; P less than 0.30). Although a stronger association was suggested between "neuroses" (ICD 300) and exposure to organic solvents (OR = 2.30; P less than 0.05), there are indications that this relationship is merely the result of classification bias. The results of this study do not confirm, but also do not completely exclude, that Dutch painters are at increased risk of being prematurely disabled due to neuropsychiatric disorders.

Adult↗
PubMed1990

The functional status and utilization of care of elderly people living at home.

A postal questionnaire was used to obtain information on the functional status of and the utilization of care by elderly people living at home. The aim of the questionnaire was to enable the investigators to select elderly people for a further interview to identify the factors that lead to a demand for professional care. The questionnaire provided relevant information as to the prevalence of physical limitations in elderly people and their use of professional and informal care. The information obtained was reliable and valid as is shown by comparison with information given in subsequent interviews. It appears that the prevalence of limitations was of the same size as that found in other studies, both national and international. The more limitations, the higher the proportion of professional care utilization. The factors "use of informal care" and "not living alone" were inversely related to the utilization of professional care. The amount of informal care provided was very high among elderly people with handicaps. Rather than being a substitute, it seems that informal care is a condition for professional home care to be successful. The postal questionnaire appeared to be an efficient means of investigating the functional status of and utilization of care by elderly people living at home. As such it could be used for planning and allocation of home care.

Activities of Daily Living↗
PubMed1990

A large-scale prospective cohort study on diet and cancer in The Netherlands.

In 1986, a prospective cohort study on diet and cancer was started in The Netherlands. The cohort (n = 120, 852) of 55-69 year old men (48.2%) and women (51.8%) originates from 204 computerized municipal population registries. At baseline, participants completed a self-administered questionnaire on diet and potential confounding variables. In addition, about 67% of the participants provided toenail clippings. Cancer follow-up consists of record linkage to a pathology registry and to cancer registries. The initial interest is in stomach, colorectal, breast and lung tumors. A case-cohort approach is applied, in which detailed follow-up information of a random subcohort (n = 5000) provides an estimate of the person-time experience of the cohort. Exposure data of the subcohort will be combined with those of incident cases, yielding exposure-specific incidence rate ratios. The intraindividual variation in determinants is estimated by annually repeated measurements (n = 250) within the subcohort. The rationale, efficiency aspects and study characteristics are discussed.

Aged↗
PubMed1990

Interobserver variation in histopathological grading of cervical dysplasia.

In order to assess the variability among histopathologists in grading cervical dysplasia, four experienced histopathologists examined the same set of 106 biopsy specimens and assigned them to one of five diagnostic categories. These were: no dysplasia, mild dysplasia, moderate dysplasia, severe dysplasia and carcinoma in situ. The histopathologists did not discuss the grading criteria beforehand. There was considerable disagreement among the pathologists: unweighted group kappa 0.28, weighted group kappa 0.56. It appeared that all grades of dysplasia were equally difficult to distinguish from adjacent categories. Various explanations for this interobserver variation are put forward.

Biopsy↗
PubMed1990

Competence and performance: two different concepts in the assessment of quality of medical care.

In the debate about 'what is a competent general practitioner?' little attention has been paid ot the actual practice situation of general practitioners. This paper, based on the 18 most important studies in the literature about medical competence, tries to re-initiate this debate by proposing a clear distinction between 'competence', (what a physician is capable of doing) and 'performance' (what a physician does in his day-to-day practice). With this distinction we looked at whether studies defined both competence and performance, how they dealt with these concepts, what measurement instruments were used and what the conclusions of the studies were. Although it is the common reasoning that competence is a good predictor of performance this concept could not be affirmed. This survey shows that the majority of studies use wrong concepts and come to invalid conclusions. With the empirical distinction between competence and performance however, this paper proposes new directions for the quality assessment of general practitioners.

Clinical Competence↗