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Biomedical subjects

J De Vries

Publications and source records attributed to J De Vries.

At least 19 recordsLinked to original sources

Personality predicts quality of life six months after the diagnosis and treatment of breast disease.

BACKGROUND: Quality of Life (QoL) is an important outcome measure in oncology. QoL is influenced by personality traits, such as anxiety. To assess the influence of personality on QoL in women with breast cancer, a longitudinal prospective cohort study was done. METHODS: Ninety-one patients with breast cancer and 111 patients with benign diagnoses completed prior to the diagnosis and 1, 3, and 6 months after diagnosis and treatment a set of questionnaires. RESULTS: Overall QoL showed no significant differences between the two groups. The influence of trait anxiety was considerable for all measurement moments. Trait anxiety is accountable for up to 40.6% of the variance in QoL scores. Forty-five women in the benign group scored high on trait anxiety, and 40 women in the breast cancer group. Women with a high trait anxiety score were 3 times as likely to have a low general QoL six months after diagnosis and possible surgery, irrespective of the diagnosis (breast cancer or benign problems). When the women were divided into four groups based on the diagnosis and the score on trait anxiety, there was a significant difference in scores on general QoL between the groups on all measurement moments, with a significant lower score for the two groups with a high score on trait anxiety (P < 0.001). CONCLUSION: Trait anxiety rather than the diagnosis breast cancer determined whether patients experienced a low QoL.

Adult↗

Relationships between demographic variables and quality of life in a population of Dutch adult psychiatric outpatients.

BACKGROUND: Examinations of the role of demographic characteristics in quality of life (QOL) in psychiatric samples are not new. However, serious limitations of previous research have been that (1) QOL was not assessed according to current recommendations, (2) assessment of QOL was often hampered by a substantial overlap in content between symptoms and QOL measures, and (3) the majority of the study samples had quite specific characteristics hampering the generalizability of results, as a result of which clinical implications of the results remained unclear. The aim of the present study was to investigate explicitly the relationships between demographics and QOL in a sample reflecting the general population of psychiatric outpatients, QOL being assessed in a comprehensive, culturally sensitive, and subjective way, paying attention to the relative importance of its various facets. The main hypothesis was that these relationships would be rather weak. METHOD: From a population of 533 adult Dutch psychiatric outpatients, 495 participants completed the World Health Organization Quality of Life (WHOQOL)-Bref for assessing QOL. Furthermore, several demographic characteristics were recorded. RESULTS: Statistically significant correlations were found between partner relationship, habitual status, work, and sick leave and the WHOQOL-Bref domains social relationships and environment. Psychological health was associated to partner relationship, educational level, and sick leave. The total amount of QOL variance explained by demographics was rather low. CONCLUSION: Amongst factors determining QOL, demographic characteristics are relatively unimportant. Therefore, paying attention to demographics during psychiatric treatment will probably have little effect on improvement of QOL.

Adult↗

Impaired health status and invasive treatment in peripheral arterial disease: a prospective 1-year follow-up study.

OBJECTIVE: It has been argued that health status and quality of life (QOL) should be taken into account in the treatment policy of patients with peripheral arterial disease (PAD). In cardiac patients, it has been shown that poor perceived health status is an independent predictor of mortality and hospitalization. We therefore examined (1) the role of health status, QOL, and clinical indices of disease severity as determinants of invasive treatment in patients with PAD and (2) the effect of invasive treatment on health status and QOL. METHODS: At their first visit, patients completed the RAND 36-item Health Survey and World Health Organization Quality of Life assessment instrument questionnaires to assess health status and QOL, respectively. During the 1-year follow-up period, data concerning hospitalization were derived from the patients' medical files. Furthermore, patients completed the RAND 36 and the World Health Organization Quality of Life assessment instrument again at 1-year follow-up. The setting was a vascular outpatient clinic of a teaching hospital in Tilburg, The Netherlands; participants were 200 consecutive patients newly diagnosed with intermittent claudication, a common expression of PAD. Diagnosis was based on history, physical examination, treadmill walking distance, and ankle-brachial pressure indices. Main outcome measures were (1) invasive treatment of PAD that took place during the 1-year follow-up, derived from the patients' medical files, and (2) health status and QOL after 1 year of follow-up. RESULTS: After 1 year of follow-up, 107 patients (53.5%) were event free, whereas 77 patients (38.5%) had been hospitalized for invasive treatment of PAD. Sixteen patients (8%) were hospitalized for other cardiovascular reasons. In a multivariate logistic regression model, age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.91-0.99; P = .024), pain-free walking distance (OR, 2.74; 95% CI, 1.05-7.17; P = .04), and physical functioning (OR, 4.46; 95% CI, 1.79-11.12; P = .001) were independent predictors of invasive treatment of intermittent claudication. After 1 year of follow-up, patients who were treated invasively experienced a significant improvement in their physical functioning ( P = .004), role limitations due to emotional problems ( P = .018), and bodily pain ( P = .026). CONCLUSIONS: Patients with poor self-reported physical functioning, limited walking distance, and a younger age were likely to be treated invasively. The physician's clinical judgment about when to intervene adequately reflects the patient's own opinion about his or her health status. Invasive treatment led to a significant improvement in patients' health status. These findings indicate the effectiveness of the strategy to include patients' perceived physical functioning into the process of clinical decision-making.

Adult↗

Quality of life and health status in breast carcinoma.

Quality of life is of increasing importance in clinical oncology studies. When analysing publications concerning quality of life in breast cancer, however, the majority of the articles appear to study health status and not quality of life. Therefore five recommendations were formulated to apply reading a 'quality of life' article. With the use of these recommendations an article can be evaluated and the clinical significance can be assessed.

Activities of Daily Living↗

Peri-operative levels of s-100 protein in serum: marker for surgical manipulation and postoperative complications.

Although minimally invasive neurosurgical techniques are highly sophisticated nowadays, almost any operative procedure causes an inevitable surgical trauma to the brain. As a consequence unfavorable functional outcomes are not rare. Intraoperative biochemical monitoring can be helpful first to detect but also to prevent brain damage. We investigated if serum S-100 protein (S-100) levels are a reliable marker for the extent of acute cerebral damage caused by surgical trauma or postoperative complication. S-100 is present in the cytosol of glial cells. This protein leaks into the extracellular space after cell damage and can be detected both in the cerebrospinal fluid (CSF) and serum. To determine S-100 protein levels, serum samples from 20 patients with various intracranial tumors were collected before surgery, and at one day, as well as at seven days after surgery. It was hypothesised that the size of the tumor-brain contact surface (TBCS) was closely related to the dimension of the surgical trauma. TBCS was measured from radiological imaging. The pre- and postoperative (day 1 and day 7) clinical condition of each patient was assessed. The S-100 levels were correlated with the TBCS and the clinical condition. Levels of S-100 on day 1 and day 7 were significantly higher as compared with levels on day 0 ( p = 0.02, respectively p = 0.01). There was a significant relationship between rise of S-100 level and worsening of clinical condition between day 0 and day 1 ( p = 0.001). Also a significant positive relationship between TBCS and the level of S-100 could be found on day 1 and on day 7 ( R = 0.71, p = 0.0009, respectively R = 0.73, p = 0.004). Furthermore, a significant relationship between the rise of S-100 level between day 0 and day 1, as well as between day 0 and day 7, and TBCS could be documented ( R = 0.61, p = 0.01, respectively R = 0.64, p = 0.005). In conclusion, serum S-100 levels are a reliable marker for acute or recent CNS damage caused by neurosurgical manipulation or as a result of secondary postoperative complications. Therefore, intraoperative monitoring of serum S-100 levels seems very promising. In such a setting the negative effects of surgical manipulation can be measured instantaneously, which should bring the neurosurgeon to change his strategy. As a consequence the surgical trauma can be minimized and functional outcome can be optimized.

Adult↗

Assessment of fatigue among working people: a comparison of six questionnaires.

AIMS: To compare the psychometric qualities of six fatigue questionnaires in a sample of working persons. METHODS: Internal consistency and test-retest reliability, content validity, convergent validity, and the dimensionality of the fatigue instruments were explored. RESULTS: All scales had a satisfactory internal consistency. Furthermore, based on factor analyses and Mokken scale analyses, all scales were unidimensional and appeared to measure an identical construct. The Fatigue Assessment Scale (FAS) had the highest factor loading on the one factor solution obtained in a factor analysis of the total scores of all scales. CONCLUSIONS: All the questionnaires were unidimensional and had good reliability and validity. The FAS was the most promising fatigue measure.

Adult↗

The impact of walking impairment, cardiovascular risk factors, and comorbidity on quality of life in patients with intermittent claudication.

OBJECTIVE: The objective of this study was to assess the impact of walking impairment, cardiovascular risk factors, and comorbidity on quality of life (QOL) in patients with intermittent claudication (IC). MATERIAL AND METHODS: The prospective observational study was conducted in the setting of a vascular outpatient department of a teaching hospital. QOL was assessed in 200 consecutive patients with IC, with a reduced version of the World Health Organization Quality of Life Assessment Instrument-100. The reduced instrument assesses 17 facets of QOL within five domains (Physical and Psychological Health, Level of Independence, Social Relationships, and Environment). Age, gender, degree of IC, risk factors, comorbidity, as recommended by the Society for Vascular Surgery/North American Chapter of the International Society for Cardiovascular Surgery (SVS/ISCVS), and the presence of back, hip, or knee symptoms were analyzed as possible predictors of QOL. Multiple regression analyses were run with each of the QOL facets and domains as dependent variable. A probability value of less than.05 was considered to be statistically significant. RESULTS: Male gender was found to be a predictor of better scores for Energy and Fatigue and for Sleep and Rest. Women had more Negative Feelings. The presence of back, hip, or knee symptoms was a significant predictive value for many aspects of QOL. With more concomitant diseases, patients had lower scores on the facets of Overall QOL and General Health and of Energy and Fatigue and showed more dependence on medication and treatments. The degree of IC, as expressed in the SVS/ISCVS classification, was a statistically significant predictor of QOL on the domain Level of Independence and its facets Mobility, Activities of Daily Living, and Working Capacity and the facets Pain and Discomfort, Sexual Activity, and Transport. Hypertension was the second most important single predictor of QOL in patients with IC. CONCLUSION: QOL in patients with IC is only partially determined by the severity of walking limitation as expressed in the SVS/ISCVS classification. The significant impact of cardiovascular risk factors and comorbidity and the presence of back, hip, or knee symptoms on QOL should be recognized and taken into account in the treatment policy.

Adult↗

On the determination of the angular orientation of a vertebra.

In this paper we consider the spatial orientation of vertebrae. We take the view that, in determining their rotation angles from X-rays, the procedure applied by Drerup yields the most reliable empirical results, viz. the three angles through which a vertebra rotates about its own symmetry axes in a specific sequence. With a view to the further use of this information to analyze deformations or the motion of a spine we recommend that the Drerup angles be converted into the well-known Eulerian angles. How this can be done is the subject of this report.

Algorithms↗

Mental health issues in Tamil refugees and displaced persons. Counselling implications.

Fifty-one Sri Lankan Tamil refugees/displaced persons living in South India completed the Hopkins Symptom Checklist-58. In addition, in interviews they answered open-ended questions about personal loss, personal traumatic experiences, negative feelings, living in camps, and the availability of support. The health of the respondents was poor. Moreover, experiences such as watching the killing of family members and being wounded were mentioned as reasons to flee. Many respondents said they experienced negative feelings. Social support was reasonably available although family members were often not situated in the same camp.

Adolescent↗

Management of Nelson's syndrome: observations in fifteen patients.

OBJECTIVE: To analyse the results of different treatment modalities for Nelson's syndrome, which was defined as radiological evidence of a pituitary macroadenoma, fasting plasma ACTH levels of more than 200 pmol/l after stopping glucocorticoid substitution for at least 24 h in a patient who had undergone bilateral adrenalectomy for Cushing's disease. DESIGN: The medical reports of all Nelson's patients known in our hospital were studied with regard to treatment modalities and result of treatment. Clinical remission of Nelson's syndrome was defined as a reduction of tumour size to a diameter of 10 mm or less and fasting plasma ACTH levels less than 200 pmol/l after stopping glucocorticoid substitution for at least 24 h. PATIENTS: Fifteen women with Nelson's syndrome were studied. Bilateral adrenalectomy had been performed 1-29 years before Nelson's syndrome was diagnosed. Before adrenalectomy eight patients had undergone unsuccessful transsphenoidal pituitary surgery. RESULTS: Eight patients were initially followed without surgical or radiotherapeutical intervention during 1-7 years. In seven of them, plasma ACTH levels and tumour volumes increased progressively during this rather short observation period, with development of extrasellar extension in four patients. In one of these patients, who was planned for elective pituitary surgery, massive pituitary haemorrhage occurred which was fatal despite emergency pituitary surgery. Elective pituitary surgery was performed in 11 patients, of whom three were operated twice. Clinical remission was documented in five patients in the first year after operation. In one patient postoperative MR-imaging revealed no residual tumour mass but the postoperative plasma ACTH level was still elevated. In another patient a residual intrasellar macroadenoma and an increased plasma ACTH level remained stable for 22 years. The remaining four patients received postoperative radiotherapy because of residual tumour masses. Of these patients, one had a clinical remission. In two others relatively small residual intrasellar tumour masses remain, with a fasting plasma ACTH level of more than 200 pmol/l in one of them. The fourth patient died of the consequences of progressive tumour growth. Radiotherapy was the only treatment in two patients and did not result in clinical remission. Tumour volumes and plasma ACTH levels at the time of diagnosis of Nelson's syndrome were positively correlated (r = + 0.61, P < 0.05). This correlation was stronger at the moment of decision of either pituitary surgery or radiotherapy (r = + 0.85, P < 0.001). At the end of the follow-up period the correlation between tumour volumes and plasma ACTH levels in the combined pituitary surgery and/or irradiation only group was + 0.77 (P < 0.001). In the pituitary surgery group tumour volumes before and after surgery were directly correlated (r = + 0.70, P < 0.05). CONCLUSIONS: Our results demonstrate that pituitary surgery of Nelson's macroadenomas is more successful when Nelson's adenomas are relatively small. Pituitary surgery should be performed before extrasellar expansion of the tumour occurs in order to attain long lasting remissions. Pituitary irradiation should be performed postoperatively in all patients with residual tumour. Our data also illustrate that in patients with Nelson's syndrome, plasma ACTH levels can reliably be used as an indirect approximation for tumour volume.

Adrenalectomy↗

Quality of life in patients with intermittent claudication using the World Health Organisation (WHO) questionnaire.

OBJECTIVE: to assess quality of life (QOL) in patients with intermittent claudication. DESIGN: a prospective, open study. MATERIAL AND METHOD: one hundred and fifty-one consecutive claudicants (100 men, 51 women), and 161 healthy controls (70 men and 91 women) completed an adapted version of the World Health Organisation Quality of Life Assessment Instrument-100. RESULTS: patients scored significantly worse on the domains Physical health and Level of independence, as well as on the facets Pain and discomfort, Energy and fatigue, Mobility, Activities of daily living, Dependence on medication and treatments, Working capacity, Negative feelings, Recreation and leisure and Overall QOL and general health. Increasing disease to incapacitating claudication affected only the facet Mobility and the domain Level of independence. CONCLUSION: QOL in patients with intermittent claudication is reduced in many aspects. Where co-morbidity seems to affect QOL strongly, the effect of walking distance on QOL might be small. These findings may justify a reserved attitude towards invasive, even minimally invasive treatment of these patients.

Adult↗

Quality of life of idiopathic pulmonary fibrosis patients.

Little attention has been paid to quality of life (QOL) in idiopathic pulmonary fibrosis (IPF). Therefore, the aim of this study was to address this issue and study the relationship between QOL, depressive symptoms, and breathlessness in these patients. Forty-one IPF patients and 41 healthy persons matched for age and sex completed the World Health Organization Quality of Life assessment instrument-100. The IPF patients also completed the Beck Depression Inventory, the Bath Breathlessness Scale, a social support questionnaire and a question concerning perceived seriousness of illness. Compared to the control group, QOL in IPF patients was mainly impaired in the domains "physical health" and "level of independence". A number of relationships were found between pulmonary function tests and QOL. The QOL facet "negative feelings" was highly associated with scores on depression. Subjective breathlessness was related to depressive symptoms and QOL. Moreover, sex and effective/emotional breathlessness predicted overall QOL. In conclusion, the impairment of the quality of life areas "physical health" and "level of independence" are important issues in idiopathic pulmonary fibrosis. Subjective breathlessness, especially the effective/emotional scale, seems related to quality of life and depressive symptoms. Rehabilitation programmes are needed that are aimed at physiological aspects and psychosocial aspects of idiopathic pulmonary fibrosis in order to enhance the quality of life of these patients.

Activities of Daily Living↗

Assessing health status and quality of life in idiopathic pulmonary fibrosis: which measure should be used?

Many studies conducted on the health status and quality of life (QOL) of patients with certain chronic diseases have demonstrated that their disease had an impact on their lives. However, less is known about the QOL and health status of patients suffering from idiopathic pulmonary fibrosis (IPF). In the present study, three focus groups of IPF patients (n=10) were run to identify the aspects of QOL or health status that are relevant to this population and to establish which measure is preferable to assess these aspects. The patients completed and discussed the St. George's Respiratory Questionnaire (SGRQ) and the World Health Organization Quality of Life assessment instrument (WHOQOL-100). Results indicated that hobbies/leisure activities, mobility, transport, social relationships, working capacity, energy and doing things slower were aspects relevant to IPF patients' QOL. The WHOQOL-100, with an additional social support questionnaire, appeared to be preferable.

Activities of Daily Living↗

The UICC/WHO-CCCE Cancer Education project: a different approach.

The Union Internationale Contre le Cancer (UICC) and the WHO-Collaborating Centre for Cancer Education (WHO-CCCE) have started an international pilot project offering assistance to medical schools that want to implement in their curricula a two-week multidisciplinary cancer course aimed at cancer care in general practice. The approach will be bottom-up (based on the possibilities in individual medical schools) instead of top-down (based on general recommendations and rules established in published studies). In April 2000 one or more medical schools from each of four continents had registered. Registration is open to any medical school and to other schools that have satisfactory ongoing cancer courses. The aim is to develop a network among medical schools in order for them to learn from each other's cancer education strategies and experiences.

Americas↗

The electronic mood device: design, construction, and application.

The electronic mood device (EMD) is designed to help answer questions about the variability and dynamics of emotions. It is a small, portable instrument used for repeated recording of moods and feelings. Both construction and operation of the EMD are described. The EMD can best be conceived of as an electronic mood adjective checklist. Persons using the EMD are signaled at designated (e.g., hourly) or random intervals to register their mood or feelings. Paper and pencil are not required. An application is given. It shows how feelings vary within and between persons and during the day. It is concluded that the EMD offers several advantages over paper-and-pencil instruments. Retrospective use is impossible. Timing and registration are accurate. Data handling is fast. Potential future applications are suggested.

Adult↗