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Biomedical subjects

J F Metsemakers

Publications and source records attributed to J F Metsemakers.

At least 19 recordsLinked to original sources
PubMed2001

Psychosocial patient characteristics and GP-registered chronic morbidity: a prospective study.

OBJECTIVE: The aim of this study was to get a profile of patients who are vulnerable to get multiple chronic, recurrent or high-impact diseases in a limited time period. We studied the incidence rates of morbidity and multimorbidity, and the influence of psychosocial characteristics on their occurrences. METHOD: Cohort study with 3551 subjects. Baseline measurement of psychosocial characteristics and a 2-year follow-up period for morbidity. The relations were evaluated using multiple logistic regression analysis. RESULTS: After adjustment for basic socio-demographic variables, a high internal locus of control belief was found to be protective [odds ratio (OR)=0.82] for the occurrence of morbidity, negative life events increased the risk (OR=1.22). Characteristics specifically protective for the occurrence of multimorbidity as compared to monomorbidity were: a high internal locus of control belief (OR=0.73), living as a couple or in a family as compared to living alone (OR=0.68) and a large social network (OR=0.41). CONCLUSION: It appears that certain patient characteristics are specifically related to the occurrence of multimorbidity. This provides opportunities for the future development of preventive interventions.

Adaptation, Psychological↗
PubMed2001

Visual determinants of reduced performance on the Stroop color-word test in normal aging individuals.

It is unknown to what extent the performance on the Stroop color-word test is affected by reduced visual function in older individuals. We tested the impact of common deficiencies in visual function (reduced distant and close acuity, reduced contrast sensitivity, and color weakness) on Stroop performance among 821 normal individuals aged 53 and older. After adjustment for age, sex, and educational level, low contrast sensitivity was associated with more time needed on card I (word naming), red/green color weakness with slower card 2 performance (color naming), and reduced distant acuity with slower performance on card 3 (interference). Half of the age-related variance in speed performance was shared with visual function. The actual impact of reduced visual function may be underestimated in this study when some of this age-related variance in Stroop performance is mediated by visual function decrements. It is suggested that reduced visual function has differential effects on Stroop performance which need to be accounted for when the Stroop test is used both in research and in clinical settings. Stroop performance measured from older individuals with unknown visual status should be interpreted with caution.

Aged↗
PubMed2001

Barriers in the care of patients who have experienced a traumatic event: the perspective of general practice.

BACKGROUND: Previous research has indicated that GPs encounter barriers in the care of patients who have experienced a traumatic event. OBJECTIVES: The aims of the present study were to map barriers GPs encounter in the care of patients who experience a traumatic event and solutions for these barriers, and to estimate the influence of GP characteristics on the number of barriers experienced. METHODS: Telephone interviews were conducted among a sample of 500 Dutch GPs stratified by sex. Topics covered barriers in the care of victims of: accidents, incest in the past, ongoing physical or sexual abuse of adults, and ongoing physical or sexual abuse of children. RESULTS: The response rate was 44%. GPs are regularly confronted with patients who have experienced a traumatic event. GPs experience 10% barriers in care of patients who have difficulties getting over an accident, 13% in the care of incest victims, 16% in the care of adults who are physically or sexually abused, and 20% in the care of physically or sexually abused children. Most of the GPs recently updated their knowledge of care of victims of traumatic events, but still the majority feel in need of additional expert training. CONCLUSION: GPs experience the greatest number of barriers in the care of children who are abused. GP characteristics were not related to the number of barriers. However, seeing more victims was related to fewer barriers. To facilitate GP care of victims of traumatic events, GP training and continuing medical education should focus especially on skills education regarding the detection and initial treatment of traumatic events of ongoing physical or sexual abuse.

Accidents↗
PubMed2000

Marginal impact of psychosocial factors on multimorbidity: results of an explorative nested case-control study.

This study examines differences between subjects with zero, one or two or more new diseases in a period of three years, with regard to demographic characteristics, socioeconomic status, life style, medical family history and current diseases in the family, psychological and sociological characteristics. This was studied using a primary care based nested case-control study. Data were available from 3745 cases and controls, all aged 20 years and older. All subjects were sampled from the Registration Network Family Practices, which is a computerised continuous primary care database. Cases were defined as subjects with new multimorbidity (two or more new diseases) registered in a period of three years and two groups of controls were operationalised as subjects with either one or no new diseases registered in the same period. Determinants were assessed by means of a postal questionnaire. Increasing age, higher number of previous diseases and low socioeconomic status were strongly associated with both morbidity and multimorbidity. After adjustment for these basic variables, the occurrence of multimorbidity was more frequent among subjects who did not report (volunteer) work or study, who had an active coping style, a high occupational class and an external locus of control. Profiles for subjects at risk for morbidity and multimorbidity seem to differ.

Adaptation, Physiological↗
PubMed2000

Mild hearing impairment can reduce verbal memory performance in a healthy adult population.

We studied to what extent immediate and delayed recall in an auditory verbal learning paradigm was affected by basic information processing speed (digit copying) and hearing acuity (average hearing acuity at 1, 2 and 4 KHz at the better ear). A group of 453 individuals in the age between 23 and 82 years with no overt hearing pathology was recruited from a larger study of cognitive aging (Maastricht Aging Study, MAAS). After controlling for age, sex, educational level, and processing speed it was found that a mild to moderate hearing loss predicted lower verbal memory performance. Auditory administered verbal memory tests can underestimate true memory performance, particularly in older individuals with unknown hearing status.

Adult↗
PubMed2000

Health status and management of chronic non-specific abdominal complaints in general practice.

BACKGROUND: While chronic non-specific abdominal complaints are common in general practice, data on patients' perspective and management of these complaints are lacking. Knowledge of these data is important for the development of guidelines for management and assessment of the burden of chronic non-specific abdominal complaints on society. AIM: To draw a comprehensive picture of chronic non-specific abdominal complaints in general practice, including volume, patients' perspective, and health care involvement. METHOD: In a retrospective study, 644 patients were selected in 16 general practices. Patients and general practitioners (GPs) received a questionnaire regarding the nature of complaints and health care management during the previous 12 months. RESULTS: Overall, 619 questionnaires were returned and 291 patients participated. Of the study population, 15% of patients were diagnosed as suffering from non-ulcer dyspepsia, 39% from irritable bowel syndrome, and 45% from other abdominal complaints. Over 50% of patients suffered from chronic non-specific abdominal complaints on a daily or weekly basis. In these patients, general health perception is impaired and above norm scores on SCL-anxiety and SCL-depression scales were recorded. Only 4% of patients showed complete resolution of complaints during the previous 12 months. Fifty-two per cent of patients consulted their GP for abdominal complaints. Diagnostic modalities were used frequently. Medication was prescribed in 83% of patients with abdominal complaints. Twenty per cent of patients were referred to secondary or tertiary care. There was a considerable inter-doctor variation in the management of chronic non-specific abdominal complaints. CONCLUSION: Once non-specific abdominal complaints have become chronic they are mainly managed by the GP. The impact on patients' physiological and psychological well being is large. Diagnostic and therapeutic modalities are frequently used. Given the considerable inter-doctor variation, research into the evidence base of management strategies is recommended.

Adolescent↗
PubMed1999

[Differences in incidence of (violent) traumatic events in the national registration systems, population surveys and studies from family practice; a review of literature].

OBJECT: Comparison of (cumulative) incidences of traumatic events from population surveys and registration systems as well as from studies in general practice. DESIGN: Literature study. METHOD: Literature searches were done about the frequencies of accidents, sudden death, physical and sexual abuse listed in electronic databases and relevant catalogs covering 1986-1998, after which more references were searched via the references found, going back to 1984. RESULTS: There were large discrepancies between frequencies found in the several studies, such as national registration systems (n = 4), surveys in the open population (n = 10) and studies in general practice (n = 4). The incidence (per 1000 persons per year) of physical abuse were 66, 2.7 and 1-3 for surveys in the open population, police and general practitioners' registration systems respectively. For sexual abuse the figures were 21, 0.025 and 0.2-2.9 respectively. Different definitions and methods were used in the studies. CONCLUSION: General practitioners are aware of only a fraction of what their patients experience.

Accidents↗
PubMed1999

Screening for mobility disorders by the Mobility Control subscale of the short version of the Sickness Impact Profile.

OBJECTIVE: To test the usefulness of the Mobility Control subscale (MC scale) of the short version of the Sickness Impact Profile (SIP68) as a simple self-administered questionnaire for screening mobility disorders in a population of independent living elderly. DESIGN: The SIP68-MC scale was compared with the results of one functional test as independent criteria. SUBJECTS AND SETTING: A group of 81 people of 70 years and older was selected from a potential population of over 200 people. All were independent living elderly persons selected from a general practice. INTERVENTIONS: The short version of the Sickness Impact Profile and questions about falling last year were applied. Three functional tests were carried out: walking 10 metres, get up and sit down in a chair five times and a test for standing balance. A trained observer rated all tests. RESULTS: It is shown that the sensitivity of the MC scale (cut-off point: 1) with the total functional score is 91%, with a relative low specificity (59%). The relationship between the SIP-MC score and falling frequency is significant when there is a falling frequency equal to or more than two times a year. CONCLUSION: It is concluded that the MC scale is a useful test for screening mobility disorders in the elderly.

Activities of Daily Living↗
PubMed1998

Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases.

Increasing numbers of people are found to have two or more diseases at the same time, which is termed multimorbidity. We studied the prevalence, incidence, and determinants of multimorbidity and the statistical clustering of chronic and recurrent diseases in a general practice setting. Prevalence of multimorbidity increased with all age groups from 10% in the 0-19-year-old age group up to 78% in subjects aged 80 and over. Increasing age, lower level of education, and public health insurance were related to the occurrence of morbidity, but even more strongly to the occurrence and degree of multimorbidity. The one-year incidence of multimorbidity (the new occurrence of two or more diseases in one year) was related to increasing age, public health insurance, and the presence of prevalent diseases at baseline. Statistical clustering of diseases was stronger than expected, especially among the younger subjects.

Adolescent↗
PubMed1998

Chronic low back pain in primary care: a prospective study on the management and course.

BACKGROUND: There is little evidence about the management and course of chronic low back pain in primary care. OBJECTIVES: Our aim was to describe the course of chronic low back pain and the performed diagnostic and therapeutic procedures for patients with chronic low back pain in general practice. METHODS: Twenty-six GPs involved in the Registration Network Family Practices participated in this prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 4, 8 and 12 months follow-up. RESULTS: The GPs provided information about diagnostic and therapeutic procedures concerning 524 patients with chronic low back pain. Diagnostic tests other than history-taking and physical examination were not frequently used. Medication, mostly NSAIDs, was the most frequently used type of treatment (21.6%). The most frequent referrals concerned physiotherapy (16.3%) and neurology or neurologic surgery (6.3%). Information about the course of their chronic low back pain was provided by 368 patients participating in our study. The course of chronic low back pain appeared to be quite stable, as there was only a slight improvement in pain intensity and physical functioning over the 12 months of follow-up. CONCLUSIONS: A variety of options for the treatment and referral of chronic low back pain patients is available for and used by GPs. Efforts should be made to establish which diagnostic and therapeutic procedures are the most effective for chronic low back pain.

Adult↗
PubMed1998

Morbidity in responders and non-responders in a register-based population survey.

BACKGROUND: Non-response analysis is often restricted to the influence of age, sex and socio-economic status on response status. In this study the health status of responders and non-responders was also compared. RESULTS: Responders were comparable to non-responders with regard to the number of diagnosed disorders as well as to the prevalences of disorders within body systems. Non-responders only showed psychological disorders more often. CONCLUSION: It is useful to assess the relation between non-response and morbidity patterns in other studies as well, in order to detect selective non-response and bias.

Adult↗
PubMed1998

The relation between morbidity and cognitive performance in a normal aging population.

BACKGROUND: Factors related to physical health have been implicated in both normal and pathological aging of cognitive abilities. To substantiate this notion, we studied existing morbidity, as diagnosed by the general practitioner according to well-defined criteria, as a potential predictor of cognitive test performance. METHODS: A sample of 1360 individuals, aged 24-81 years and living in the community, was stratified for age, sex, and general ability. Active and total morbidity in this group were classified according to the International Classification of Primary Care. Neurocognitive tests were used to assess the domains of verbal memory, sensorimotor speed, and cognitive flexibility. RESULTS: Multiple regression analyses with adjustment for age, sex, and educational level showed both insulin-dependent and noninsulin-dependent diabetes to be negatively associated with all cognitive measures. More specific negative associations were found for chronic bronchitis (performance speed) and presbyacusia (memory). Single or aggregated cardiovascular morbidity (including hypertension) was unrelated to test performance. CONCLUSIONS: Existing morbidity as a whole contributes only modestly (up to 3.5%) to total variance in cognitive function. However, some specific, relatively common diseases of the elderly, such as diabetes and chronic bronchitis, may aggravate the age-related decline in cognitive ability.

Adult↗
PubMed1998

[The Maastricht aging study (MAAS). The longitudinal perspective of cognitive aging].

The Maastricht Aging Study (MAAS) was designed to specify the usual and pathological aging of cognitive function. In short, the main questions of MAAS are: who deteriorates when in which aspects of cognitive function, and what biomedical or psychosocial factors can be identified that may act as mediators in this process? The study comprises four independent panel studies in which a group of 1,900 initially healthy individuals are followed for a period of 12 years with respect to health characteristics and neurocognitive status. For this purpose a sample was drawn from a patient register of collaborating general practitioners, stratified by age (range 24 to 81 years), sex and general ability level. Rationale and design of MAAS are discussed and some findings from the cross-sectional baseline measurement are summarized: general aspects of memory and attention in aging, cognitive functioning after brain trauma and general anesthesia, physical condition (fitness, morbidity and vascular risk factors, such as blood pressure) as predictors of cognitive function, and finally cognitive complaints and metamemory.

Adult↗
PubMed1997

Management of chronic nonspecific low back pain in primary care: a descriptive study.

STUDY DESIGN: A retrospective, descriptive study. OBJECTIVES: To describe the diagnostic and therapeutic procedures for patients with chronic low back pain in primary care. SUMMARY OF BACKGROUND DATA: Most previous studies have described the management of acute low back pain, but little is known about the management of chronic low back pain in primary care. METHODS: Twenty-six general practitioners involved in the Registration Network of Family Practices of the University of Limburg in The Netherlands participated in this study. All patients and general practitioners were asked to complete a retrospective questionnaire, and there was a 12-month follow-up. RESULTS: The total study population consisted of 524 patients with chronic low back pain. Twenty-three percent of the patients had had radiographs taken during the previous 12 months, and 5% had been examined by other imaging techniques. Twenty-nine percent of the study population had not received and therapy at all, 46% had received medication, mostly (36%) nonsteroidal anti-inflammatory drugs (NSAIDs), and for 18% (bed)-rest had been advised. Thirty-six percent of the study population had been referred to a physiotherapist. CONCLUSIONS: The therapeutic management of chronic low back pain seems to lack consistency. Clinical guidelines are needed to improve the management of chronic low back pain in primary care.

Adult↗
PubMed1997

People with intellectual disability in general practice: case definition and case finding.

In a general practice database containing data on 62,000 patients, those with intellectual disability (ID) were traced. Health problems in this database were recorded according to the International Classification of Health Problems in Primary Care (ICPC) code. By using selected codes, 318 people with ID (0.65% of the study population) were found; the sample contained nearly as many false positives. Adding up the percentage of people with ID living in residential facilities, the total prevalence of people with ID was estimated as 0.82%. Documentation on the cause and level of ID was available in about half of the cases. The demographic characteristics of the people with ID were significantly different from the general population: there was a higher percentage of males and a lower percentage of people over 50 years of age among those with ID. Information about the use of home care was virtually non-existent in the general practice data. The results are compared with those of other studies. The discussion deals with reasons for complete documentation of cases with ID in general practice and the role of the general practitioner in health care supply to people with ID.

Adult↗
PubMed1996

Unlocking patients' records in general practice for research, medical education and quality assurance: the Registration Network Family Practices.

General practitioners (GPs) possess a wealth of information on the health of their patients. Hence, they are in a unique position to gather information for research, education or management. The chief goal of the Registration Network Family Practices is to establish a computerized database containing certain patient characteristics and all relevant health problems excluding minor, temporary illnesses. The database can be seen as a dynamic population sampling frame of chronic and/or severe morbidity, also including risk factors and psychosocial problems. The best way to make use of the Registration Network Family Practices is by researchers identifying and sampling patients with particular health problems. The database contained patient characteristics and problemlists of 61,887 persons, on September 1, 1995. At that time 214,389 health problems had been entered in the database. The database is increasingly being used as a source of information for studies by researchers and students. Researchers find the database a useful tool, but they have to keep in mind that data on the process of care are not directly available. Furthermore, there is a limit to the number of studies which can be performed in the network practices, due to time limitations and the burden on the doctors and patients.

Data Collection↗