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Biomedical subjects

H van den Hoogen

Publications and source records attributed to H van den Hoogen.

17 recordsLinked to original sources
PubMed2004

Probability and determinants of relapse after discontinuation of inhaled corticosteroids in patients with COPD treated in general practice.

OBJECTIVE: The objective of the study was to assess the probability, and explore determinants of adverse respiratory outcome after discontinuation of inhaled corticosteroid (ICS) treatment in subjects with chronic obstructive pulmonary disease (COPD) diagnosed and treated in general practice. DESIGN: Prospective unblinded ICS withdrawal study. SUBJECTS: 201 ICS treated COPD patients with various degrees of airflow limitation from 45 Dutch general practices. MAIN OUTCOME MEASURES: Probability of and time to exacerbation or unremitting worsening of respiratory symptoms after ICS discontinuation. RESULTS: Mean age was 60.6 (S.D. 9.5) years, post-bronchodilator forced expiratory volume in 1s (FEV1) 65.6 (S.D. 15.7) % predicted. Overall probability of adverse respiratory outcome after ICS discontinuation was 0.37 (95% confidence interval (CI) 0.31, 0.44). Survival analysis showed that age, gender, smoking status and reversibility of airflow limitation were independent predictors of adverse respiratory outcome. For females, the adjusted hazard ratio was 2.14 (95% CI 1.31, 3.50) compared to males. For age, the hazard ratio was 1.05 (95% CI 1.02, 1.08) per year lived. CONCLUSION: Discontinuation of inhaled corticosteroids may harm patients with COPD. The probability of an adverse respiratory outcome may be higher in women, elderly patients, smokers and patients with higher bronchodilator reversibility while on inhaled steroid treatment.

Journal Article↗
PubMed2002

Is the increase in bronchial responsiveness or FEV1 shortly after cessation of beta2-agonists reflecting a real deterioration of the disease in allergic asthmatic patients? A comparison between short-acting and long-acting beta2-agonists.

Regular use of beta2-agonists might result in increased bronchial hyper-responsiveness (BHR) and decreased forced expiratory volume in 1 sec (FEV1). It has been suggested that these possible detrimental effects are not a real deterioration of the disease, but that it might be only a transient (rebound) effect shortly after discontinuing this regular use. Moreover, these effects are thought to occur especially during short-acting and not during long-acting beta2-agonists use. The aim of this study was to invest gate whether a rebound effect (a pharmacological deterioration effect diminishing after several hours) in FEV1 and PC20 (concentration of histamine causing a 20% fall in FEV1 with regard to baseline) occurred after cessation of regular use of beta2-agonists, and whether this occurred both after short-acting and long-acting beta2-agonists. Allergic asthmatic patients (n = 134) were randomly allocated to the use of a short-acting (salbutamol), a long-acting beta2-agonist (formoterol) or placebo for 12 weeks (double-blind, double-dummy). No other asthma medication was allowed, including inhaled corticosteroids. At the start and every 4 weeks later FEV and PC20 were measured, each time at least 12 h after the last doses of study medication, which is in the possible rebound period. To investigate whether a (transient) rebound effect occurred, parameters were additionally measured at least 72 h later after discontinuation of the study medication. After 12 weeks of short-acting beta2-agonist use, a drop was seen in FEV1 from 85.6 (+/- 2.21)% predicted to 78.8 (+/- 2.9)% predicted, measured 15 h (median) after the last doses of medication. This was significantly different compared to placebo. When measured 168 h (median) later FEV1 recovered to 85.5 (+/- 2.4)% predicted, comparable to baseline. PC20 decreased with -1.17 (+/- 0.44) doubling dose after 12 weeks of short-acting beta2-agonist use, measured 15 h after the last doses of medication, which was significantly different compared to placebo. However, 168 h later PC20 recovered slightly with +0.55 (+/- 0.34) doubling dose, but this value was still lower compared to placebo. In contrast, during long-acting beta2-agonist and placebo use no significant changes were seen. In conclusion, the use of short-acting beta2-agonists resulted in a transient (rebound) effect in FEV while the effects on PC20 may point to a real deterioration of the disease. Long-acting beta2-agonist and placebo use showed no changes. We conclude that a mono-therapy of short-acting and not of long-acting beta2-agonists might have deleterious effects in asthma.

Adrenergic beta-Agonists↗
PubMed2001

Continuous quality improvement in small general medical practices: the attitudes of general practitioners and other practice staff.

OBJECTIVES: Continuous quality improvement (CQI) offers opportunities to improve care in small-scale office-based practice. Little is yet known about the implementation of CQI in small primary care practices. We studied the attitudes of physicians and staff in small family practices to a model of CQI tailored to office-based practice setting. PRACTICES AND DESIGN: An exploratory study in 20 family practices in The Netherlands. Practices were stimulated to adopt the model for continuous quality improvement. MAIN OUTCOME MEASURES: The use of the model at the end of the study period, the perception of the physicians and staff of their success with adopting the model, their view of its usefulness, their willingness to continue and personal and practical obstacles. Measurements were made using written questionnaires. RESULTS: The rate of implementation of the model varied between practices. Participants rated their success in performing improvement projects, holding regular quality meetings and setting targets and priorities. They were positive about the usefulness of the model and they were generally willing to continue to use it. Barriers included the size of workload and the tendency to postpone actions until external support by an outreach visitor was provided. Physician and staff attitudes were homogeneous at a practice level. CONCLUSION: Our findings stress the importance of starting CQI with small, easy-to-handle projects. Workload reduction might be an important issue to focus on. Personal obstacles should be addressed throughout the introduction. We found attitudes in small-scale practices to be homogeneous, so that it was important to pay explicit attention to commitment to CQI from the start of the introduction.

Attitude of Health Personnel↗
PubMed1999

Measuring breathlessness during histamine challenge: a simple standardized procedure in asthmatic patients.

One of the problems in research on symptom perception during histamine challenge has been the difficulty in finding both a valid and practical parameter of the "perceptiveness" for bronchoconstriction in a subject. The purpose of this study was to validate whether the slope in the linear regression model between stimulus and sensation during histamine challenge is an appropriate index for the "perceptiveness" for bronchoconstriction by comparing it with the classical Stevens' law. One hundred and thirty-four asthmatic patients were included in the study and underwent a bronchial challenge with histamine. The relationship between the change in visual analogue scale (VAS) values and the change in forced expiratory volume in one second (FEV1) as percentage of baseline value was analysed by determining both the exponent n in deltaVAS=k x (%deltaFEV1)n and the slope alpha in deltaVAS=k + alpha(%deltaFEV1). The best-fitting line of both the exponential and the linear regression model were determined by the least-squares method in which the percentage explained variation (R2) was compared. The median value of R2 of the exponential regression line and the linear regression line was 0.76 and 0.83, respectively, and significantly different. The Spearman rank correlation coefficient between exponent n in the exponential model deltaVAS=k x (%deltaFEV1)n and the slope alpha in the linear regression model deltaVAS=k + alpha(%deltaFEV1) was 0.87 (95% confidence interval 0.83-0.91). On the basis of the results, it was concluded that the linear regression coefficient can be used as a valid expression to describe the "perceptiveness" of an asthmatic subject instead of Stevens' power function during histamine challenge.

Adult↗
PubMed1999

Setting up improvement projects in small scale primary care practices: feasibility of a model for continuous quality improvement.

OBJECTIVES: To evaluate the feasibility of a model for continuous quality improvement in small scale general practice and the improvement projects that practices ran after the introduction of continuous quality improvement. DESIGN: A descriptive study. SETTING: Twenty general practices in the Netherlands tested the model in an intervention period of 18 months. INTERVENTION: A model for continuous quality improvement adapted for general practice was introduced into the practices using a structured strategy. Practices were supported by trained facilitators. MAIN OUTCOME MEASURES: Acceptance at introduction and continued application of the model; the topics of improvement projects that were set up in the practices; whether the improvement projects had been completed; whether they had met the criteria (the use of the "quality cycle" and the Oxford audit score); and whether the self set objectives had been met. RESULTS: The model was introduced and accepted in all participating practices. Practices started 51 improvement projects. At the end of the study period 33 improvement projects had been completed. Practices chose a wide variety of objectives for these projects; most of them concerned medical or organisational topics. Practices started projects mainly because the topic was felt to be a problem or was causing a bottleneck in the organisation. The quality cycle was used in all projects, but practices did not always collect data and evaluate the outcomes. Fourteen projects could be discerned as "full audit". No differences existed in the quality of improvement projects among the various types of practice or between the topics addressed. At the end of the study period half of the practices continued applying the model. CONCLUSION: This study showed that the model was feasible for small scale general practice. However, application of the model tended to disintegrate after the facilitator had left the practice. Practices succeeded reasonably well in running improvement projects. Introduction of continuous quality improvement should particularly focus on this. It is suggested that intensive support is necessary to implement and maintain continuous quality improvement in small scale practices.

Evaluation Studies as Topic↗
PubMed1999

Perception of bronchoconstriction in asthma patients measured during histamine challenge test.

This study investigated two aspects of the perception of bronchoconstriction ("sensitivity" and "absolute perceptual magnitude") in asthmatic patients and identified which clinical characteristics are related to these two aspects of perception of bronchoconstriction. The perception of histamine induced bronchoconstriction was measured in 128 asthmatic patients. Subjects quantified their breathlessness on a Visual Analogue Scale (VAS) before forced expiratory volume in one second (FEV1 was measured after each inhalation of histamine. The perceptive "sensitivity" for changes in FEV1 was analysed by the "VAS percentage fall in FEV1" slope. The "absolute perceptual magnitude" was determined by the VAS value at a 20% fall in FEV1. Spearman correlations were used for analysis between the two aspects of perception and asthma symptoms, peak flow variability, bronchial responsiveness and FEV1 % predicted. Patients with a low "sensitivity" for changes in FEV1 were more likely to show a frequent peak flow variability (Rs=-0.21; p<0.05), a high bronchial responsiveness (Rs= 0.37; p<0.001) and a low baseline FEV1 % pred (Rs=0.22; p<0.05). Patient's "absolute perceptual magnitude" correlated positively with symptoms during daily life (significant correlations varied 0.21-0.32) but not with the lung function parameters. The severity of asthma reflected by a low lung function and a high bronchial responsiveness, is associated with a low "sensitivity" for changes in forced expiratory volume in one second. A patient's "absolute perceptual magnitude" is positively related with asthma symptoms during daily life.

Adult↗
PubMed1998

Ten year follow-up of depression after diagnosis in general practice.

BACKGROUND: Depression is a serious illness with a high recurrence rate, mortality, and suicide rate, and a substantial loss of quality of life. Long-term course of depression, in particular of patients not referred to specialist care, is not completely clear. We performed a study in which the course of depression in general practice was studied for 10 years after the first diagnosis. AIM: To learn more about long-term course and outcome of patients with depressive illness for a full 10 years after diagnosis. METHOD: A historic cohort study with 386 patients classified as depressive before January 1984, recruited from four general practices belonging to the Continuous Morbidity Registry of the University of Nijmegen in The Netherlands. This cohort was followed up for 10 years. Mortality was compared with a control group matched for age, sex, social class, and practice. Of 222 patients out of this cohort who could be followed up for a full 10 years after diagnosis, the case records were studied in detail. RESULTS: No statistically significant difference was found in mortality between the 386 patients and the control group. Recurrence of depressive episodes did not occur in about 60% of the 222 patients (confidence interval 54% to 67%). Of the depressive patients, 15% were referred to secondary care and 9% were admitted to hospital. CONCLUSION: Mortality, suicide, and recurrence rate were lower than expected, taking into account what is known from depression studies in psychiatry. These results stress the importance of long-term prospective follow-up studies of all patients with depression because of the emphasis on case-finding and treatment without exact knowledge of long-term course and outcome of patients who were not referred.

Adolescent↗
PubMed1997

The influence of cuff size on blood pressure measurement.

The objective of the study was to determine the effect of the use of cuffs with different bladder sizes on the outcome of blood pressure (BP) measurements. Two sizes of bladders previously in common use in the study location (13 x 23 cm and 16 x 23 cm) were compared with the current size (13 x 36 cm). A fully randomised, experimental study was carried out on a study population comprising 130 subjects (61 men, 69 women, aged between 22 and 70, mean 49) who were not undergoing special treatment for cardiovascular disease or hypertension at that time. The mean arm circumference was 32.9 cm (range 25-40 cm). BP measurements were carried out by one person, using a Hawksley random zero sphygmomanometer under standardised conditions. With the smallest bladder (13 x 23 cm) the highest systolic and diastolic BP was measured (mean SBP 127.2 mean DBP 77.0 mm Hg), followed by the bladder of 13 x 36 cm (125.1 resp. 75.4 mm Hg). The lowest BP was measured with the bladder of 16 x 23 cm (123.7 resp. 74.4 mm Hg). Differences between bladders were significant for all arm circumferences. Over the entire range of arm circumferences in the present study there is a small systematic difference in the BP measurements taken by the various bladder sizes. For individual readings the difference is less marked, in comparison to other factors that can affect BP measurements. However, in longitudinal studies a systematic error in BP can occur when measurements are made with different bladders during the study.

Adult↗
PubMed1994

Feasibility of comparing risk profiles for cervical cancer between participants and nonparticipants in a screening programme.

OBJECTIVE: Feasibility of comparing risk profiles by questionnaire of participants and nonparticipants in a cervical screening programme: does asking information on sexual behaviour by means of a questionnaire lead to high non-response? is the non-response selective (related to participation in the screening) and if so how can we limit this? DESIGN: A postal survey on risk factors for cervical cancer, including sexual behaviour, in a group of participants and nonparticipants. SETTING: Two villages, Wijchen and Beuningen, situated near Nijmegen in The Netherlands. SUBJECTS: 139 participants and 99 nonparticipants in the national screening programme in 1989 or 1990. RESULTS: Overall, the response to the questionnaire was high: 83%. Collecting the questionnaire by asking the women to return it by mail in a stamped addressed envelope and one reminder by phone showed a response rate of 79%. This response was selective: 93% of the participants in the screening responded and 61% of the nonparticipants. Collecting them personally showed an extremely high response of 96% which was not selective. Only 3 respondents did not answer the questions about sexual behaviour. MAIN CONCLUSION: Obtaining information on sexual behaviour by questionnaire is feasible. Selective response can be limited by an extremely high response rate, which can be achieved by collecting the questionnaires personally.

Adult↗
PubMed1993

Migraine in family practice: prevalence and influence of sex hormonal status.

BACKGROUND: The objective of this study was to determine the prevalence of migraine headache in a family practice patient population. In addition, this study evaluated the simultaneous presence of Raynaud's phenomenon (RP) and migraine and examined the influence of sex hormonal status on migraine symptoms. METHODS: Data from the Continuous Morbidity Registration Project (CMR) of Nijmegen, the Netherlands, were used to identify all patients in the registration who had migraine headache and a comparison group of patients with nonvasospastic tension headache. Questionnaires were used to verify the diagnosis and to determine signs and symptoms of both headaches. RESULTS: There was an average annual prevalence of migraine headache of four per 1,000 men and 16 per 1,000 women. Eighty-five percent of patients diagnosed by family physicians as having migraine were found to fulfill the International Classification of Health Problems in Primary Care (ICHPPC) criteria for migraine headache. Migraine differed from tension headache with regard to the duration of the attacks, concomitant photo- and phonophobia, provoking factors, and the need to use analgesic medications. RP was present in 15% of the migraine group and in 16% of the tension headache group and occurred almost exclusively in women. The headaches were worse during and before menstruation in both groups and improved during pregnancy and menopause in the migraine group to greater extent than in the tension headache group. CONCLUSIONS: The use of the ICHPPC criteria for migraine headache is reliable in morbidity surveys in family practice. Although there was an overlap, migraine differed in various aspects from tension headache. Digital vasospasm and the influence of female hormonal changes were present in both headache groups.

Adolescent↗
PubMed1992

Screening for diabetic retinopathy by general practitioners.

To assess the quality of screening for diabetic retinopathy by 19 general practitioners (GPs) using ophthalmoscopy, the GPs' performance was compared with the performance of ophthalmologists. The GPs had received special training in retinal examination. Direct ophthalmoscopy was performed after mydriasis of both eyes. Later, one of the ophthalmologists at the local hospital performed ophthalmoscopy in the same way as the GP. The ophthalmologist's diagnosis was used as the criterion for retinopathy. 252 NIDDM patients were analysed. The ophthalmologists found 23 cases of retinopathy, of which one patient was referred immediately for photocoagulation. The GPs diagnosed 12 and missed 11 of these 23 cases (false negatives): sensitivity 52%. In 37 of the 229 negative cases the GPs reported a retinopathy: specificity 84%. Of the 11 missed cases, 7 had stage I retinopathy and four showed more serious abnormalities (hard and soft exudates, macular oedema) Further training of GPs in the art of ophthalmoscopy is recommended.

Diabetes Mellitus, Type 2↗
PubMed1989

[The correlation of transient ischemic attack and cerebrovascular accident].

Correlation exists between the occurrence of a transient ischemic attack (TIA) and a cerebrovascular accident (CVA). The strength of this correlation however is a point for debate. We studied the sequential relation between the occurrence of TIA and CVA in patients over 50 years in general practice. Based on Continuous Morbidity Registration (CMR) in four general practices we analysed the morbidity in patients who presented symptoms of TIA and (or) CVA during the period 1971-1983. In this period a TIA was diagnosed in 134 persons and a CVA in 214 persons. The maximal observation period of the TIA patients after presentation of the symptoms was 12 1/2 years. In 8% of the CVA cases a TIA had been diagnosed in the period preceding the CVA. Of the TIA patients 13% developed a CVA in the subsequent observation period, half of them within two years after the TIA diagnosis. Comparison of the incidence rate of CVA in the general population with that in the population with a TIA reveals that a CVA development is about six times more frequent in the latter. This higher risk has only a relative meaning because the absolute number of cases is small.

Cerebrovascular Disorders↗
PubMed1988

Effect of bereavement on the health of the remaining family members.

This investigation focuses on the effect of the death of a family member on the number and type of diagnosed illnesses of the remaining members. The data on mortality and morbidity were obtained from a continuous morbidity register. A total of 225 cases of death were selected, involving 313 family members. A control group of 4909 people who had not been confronted with a death of a family member were selected. A comparison of morbidity rates for the two groups showed that morbidity rates, both for minor and serious illnesses, were affected by the death of a family member. Increases in minor illnesses occurred more often when people had been confronted with death after a chronic illness; increases in serious illnesses were mainly found among people confronted with sudden death. Surprisingly, people with nervous disorders in their medical history showed fewer diagnoses for minor illnesses after a sudden death of a family member. An explanation may be found in the basic principles of family medicine.

Attitude to Death↗
PubMed1987

[CVA and TIA in family practice. Incidence and perspectives].

Although the Cerebro-Vascular Accident (CVA) and the Transient Ischaemic Attack (TIA) are relatively rare in general practice, they subjectively demand great attention because of their specific problems. To get a picture of for example their incidence in the general population and referral patterns in general practice, we collected and analysed the data from a (continuing) morbidity registration over 12 years in four general practices (Department of General Practice/Family Medicine University Nijmegen). The diseases occur mainly over age 50. The incidence of CVA is slightly higher than the incidence of TIA. The incidence of the diseases over the two sexes is practically equal. Because of the overpresentation of older women in the general population, more women than men present these diseases. Male patients are younger than female. Only a part of the patients has been referred or admitted to hospital. The referral depends on age of the patient: The older the patient the lower the referral-rate. The case-fatality of CVA is about 25%. Patients who die within a month, usually die in hospital. When patients survive this period, they die more often at home than in a nursing home. Patients who die in a nursing home, are more often male than female. In older age groups a CVA means more often than not the end of life. In our view a referral is often not in the interest of the patient. If a patient stays at home, the GP has to create a team with family members, a district nurse or a physiotherapist in order to offer the patients optimal medical and psychosocial attendance care.

Aged↗