Biomedical subjects

J Mulder

Publications and source records attributed to J Mulder.

At least 55 records · Page 3Linked to original sources

PubMed1999

Improving population-based cervical cancer screening in general practice: effects of a national strategy.

OBJECTIVE: To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational guidelines for effective cervical cancer screening in general practice. To identify the characteristics of general practices determining success. DESIGN: A prospective questionnaire study with pre- and post-measurement (before and 15 months after the introduction of the national programme). SETTING AND STUDY PARTICIPANTS: A random sample of one-third of all 4758 Dutch general practices. One GP was asked to participate per practice. INTERVENTION: A national GP prevention programme to improve population-based prevention of cervical cancer combining various methods for quality improvement in general practice, performed on a national, district and practice level. Outreach visitors were a key strategy in bringing about behavioural changes. MAIN OUTCOME MEASURES: The proportion of practices adhering to 10 recommendations (in four guidelines) to organize effective cervical cancer screening. RESULTS: After 15 months, all Dutch practices showed significant improvement in adherence to nine out of 10 recommendations. Two recommendations, in particular 'identifying women who should be medically excluded from screening' and 'sending a reminder to non-compliers' showed the largest absolute increases of 26% and 33%, respectively. Besides more intensive support of outreach visitors, practice characteristics such as 'computerization' and 'delegation of many clinical tasks to the practice assistant' were important in improving the adherence to guidelines. CONCLUSION: The national programme, with a combination of various methods for quality improvement, appeared to be effective in improving the organization of cervical screening in general practice. Computerization and, to a lesser extent, delegation of many clinical tasks to the practice assistant and more intensive support to practices, positively influenced the effectiveness of the national programme.

Documentation↗

PubMed1999

[Dental caries prevalence in youth from the Hague. Have the differences in dental health between social groups closed?].

In 1998 a dental survey amongst 6- and 12-year-old schoolchildren in the Hague was carried out. The 1998-survey showed differences in caries experience between SES groups that had increased in the period 1989-1998. The decline in caries experience among 6-year-old children of low SES groups had come to an end after 1983, whereas among 12-year-old children the decrease in mean DMFS values had stopped in the early nineties. However, the survey showed that during 1989-1998, the percentages of caries-free children in medium and high SES groups continued to rise. Of the medium SES 6- and 12-year-old children, In 1998, the percentage of caries-free 6- and 12-year-old children in medium SES group were 79 and 87, respectively. The comparable results in the high SES group were 87 (6-yr-olds) and 93 (12-yr-olds).

Age Distribution↗

PubMed1998

Survival of three types of veneer restorations in a clinical trial: a 2.5-year interim evaluation.

OBJECTIVES: In this clinical trial, 180 veneer restorations (VRs) were evaluated. The purpose of the study was to collect survival data and to find possible relations between survival and (1) 'type of VR', (2) 'preparation design', (3) 'operator' and (4) the patient-related variables 'tooth-type' and 'vitality of the tooth'. METHODS: The restorations were provided by seven dentists in 1 12 patients on central and lateral maxillary incisors. Experimental variables were: 'type of VR' (either direct resin composite (DC), indirect resin composite (IC) or porcelain (P)), 'preparation design' (with and without incisal overlap) and 'operator'. Failures were recorded at two levels: absolute failure (need for new restoration) and relative failure (need for repair). Survival was defined at three levels: (1) survival of original restoration (Sr, endpoints: 'absolute' failures), (2) functional survival (Sf, endpoints: 'relative' failures) and (3) overall survival (SO, endpoints: both 'absolute-' and 'relative failures'). RESULTS: The variable 'type of VR' showed significant influence on Sf and So but not on Sr. Sf and So rates of P, IC and DC were, respectively: Sf-P, 94%; So-P, 94%; Sf-IC, 94%; So-IC, 90%; Sf-DC, 80%; So-DC, 74%. VRs on vital teeth showed a significantly better survival than VRs on non-vital teeth at all survival levels. CONCLUSIONS: Preparation of the incisal edge for incisal coverage is considered to be unnecessary to assure or improve the strength of VRs. Veneers on non-vital teeth showed higher risk to fail than veneers placed on vital teeth. Porcelain veneers showed the best overall survival.

Adolescent↗

PubMed1998

Induction of SLPI (ALP/HUSI-I) in epidermal keratinocytes.

Secretory leukocyte protease inhibitor (SLPI) is a small, cationic protein that is known to be constitutively expressed by several glandular epithelia. SLPI inhibits leukocyte-derived proteinases, has anti-HIV-1, antibacterial, and anti-fungal properties, and interferes with the induction of synthesis of proinflammatory mediators in monocytes and macrophages. We now report that at both the mRNA and the protein level, SLPI shows inducible expression in a nonglandular epithelium. A weak expression of SLPI was found in the stratum granulosum of adult normal human epidermis; however, in lesional psoriatic epidermis and in migrating keratinocytes of healing wounds, a strong cytoplasmic staining was seen in the suprabasal keratinocytes. Remarkably, in the dermis adjacent to SLPI-expressing keratinocytes, SLPI was found extracellularly associated with elastin fibers, whereas the dermis in normal skin was negative. In cell culture, SLPI was hardly expressed in monolayers of proliferating keratinocytes. Differentiating cultures with a phenotype of normal skin expressed low levels of SLPI, whereas cultures with a regenerative/psoriatic phenotype expressed high levels. Functional studies with recombinant SLPI indicated that its antibacterial spectrum and potency are distinct from other anti-microbial peptides such as lysozyme and defensins. In view of the multiple functions of SLPI and the inducibility, we propose that it acts as an important first line defence mechanism in cutaneous injury.

Adult↗

PubMed1998

A longitudinal study of iron status in children at 12, 24 and 36 months.

OBJECTIVES: To assess iron status in a sample of clinically well, Caucasian children and explore the complex factors which contribute to iron deficiency during infancy. DESIGN: Infants recruited at birth and followed longitudinally at 1, 2, 3, 4, 5, 6, 9, 12, 24 and 36 months; feeding practices and socioeconomic data recorded. Iron status assessed using venous blood at 12, 24 and 36 months. SETTING: Baseline data recorded in the maternity unit. Follow-up visits took place in the infants' homes and blood sampling in a paediatric hospital. SUBJECTS: Subjects comprised a mixed socioeconomic group of healthy children (n = 121). Blood samples taken from 85, 72 and 67% at 12, 24 and 36 months, respectively. RESULTS: Prevalence of anaemia (Hb < 110 g l(-1)) in the longitudinal sample (n = 76) increased from 2.6% at age 12 months to 9.2% at 24 months, and at age 36 months (n = 70) was 8%. The most significant finding was that at age 12 months, cows' milk consumption was negatively associated with iron status. Other variables also had an influence. At both 24 and 36 months the most significant predictor of iron status was earlier iron status. CONCLUSIONS: Infants born to anaemic mothers or mothers who smoke and infants who consume cows' milk during infancy are at increased risk of developing anaemia. Breast milk is the ideal, but for the infant who is not breast fed an iron fortified formula should be used. Advice to mothers should focus on the importance of introducing nutrient dense complementary foods, such as meat, which contains readily absorbable iron.

Anemia↗

PubMed1998

Do general practices adhere to organizational guidelines for effective cervical cancer screening?

BACKGROUND: Well-organized cervical screening has been shown to be effective in the reduction of both morbidity and mortality from cancer of the uterine cervix. In The Netherlands, the GP plays an important role in the cervical screening. The question is whether the general practices are able to organize an effective cervical cancer screening. OBJECTIVES: We explored the extent to which Dutch general practices adhere to organizational guidelines for effective population-based prevention of cervical cancer and which practice characteristics are important for this adherence. METHODS: A postal survey was conducted in a random sample of one-third of all 4758 Dutch general practices. Two sets of information were collected: practice characteristics and adherence to four organizational guidelines for effective cervical screening concerning inviting the women, monitoring attendance and sending reminders, organizing the taking of the smear and follow-up monitoring. RESULTS: A total of 1251 (79%) general practices returned a questionnaire; 90 questionnaires were excluded from analyses owing to missing data. The 1161 practices were representative of the Netherlands. A minority of the practices adhered to the four guidelines (in total, ten recommendations). The presence of the practice characteristics 'a general practice-based inviting system', 'a high delegation index' (delegating many tasks to the assistants) and a 'computerized patient information recording system' were positively associated with the adherence to most of the guidelines. CONCLUSION: This study showed that most of the Dutch general practices are not yet ready to organize an effective cervical cancer screening system. A general practice-based inviting system, a high delegation index and a computerized patient information recording system proved to be important for the adherence to the guidelines. In order to organize a cervical screening programme to achieve optimal effectiveness, emphasis should be placed on the adherence to the four guidelines described in this study and on stimulating a general practice-based inviting system, delegation to the practice assistant and computerization.

Community Health Services↗

PubMed1998

Vaccinia virus protein synthesis has a low requirement for the intact translation initiation factor eIF4F, the cap-binding complex, within infected cells.

The role of the cap-binding complex, eIF4F, in the translation of vaccinia virus mRNAs has been analyzed within infected cells. Plasmid DNAs, which express dicistronic mRNAs containing a picornavirus internal ribosome entry site, produced within vaccinia virus-infected cells both beta-glucuronidase and a cell surface-targeted single-chain antibody (sFv). Cells expressing sFv were selected from nonexpressing cells, enabling analysis of protein synthesis specifically within the transfected cells. Coexpression of poliovirus 2A or foot-and-mouth disease virus Lb proteases, which cleaved translation initiation factor eIF4G, greatly inhibited cap-dependent protein (beta-glucuronidase) synthesis. Under these conditions, internal ribosome entry site-directed expression of sFv continued and cell selection was maintained. Furthermore, vaccinia virus protein synthesis persisted in the selected cells containing cleaved eIF4G. Thus, late vaccinia virus protein synthesis has a low requirement for the intact cap-binding complex eIF4F. This may be attributed to the short unstructured 5' noncoding regions of the vaccinia virus mRNAs, possibly aided by the presence of poly(A) at both 5' and 3' termini.

5' Untranslated Regions↗

PubMed1998

Time trends in caries experience of 6- and 12-year-old children of different socioeconomic status in The Hague.

The caries experience among 6- and 12-year-old children in the The Netherlands from the mid seventies showed a continued decreasing trend. A halt in the decline of caries experience of the primary dentition of 6-year-olds occurred after 1983, whereas among 12-year-old children the decrease in mean DMFS values continued in the period 1980-1989. The 1996 survey in The Hague showed that the decline in caries in 12-year-old native children of low socioeconomic status (SES) has come to an end (average DMFT of 1.1). However, in medium- and high-SES groups, the percentages of caries-free children have continued to rise. Of the medium-SES 6- and 12-year-old children, 79 and 89% were caries-free, respectively; in the high-SES children the respective figures were 84 and 86%. A DMFT of 0.3 in 12-year-olds of medium and high SES was found, the general value was 0.7 and 74% with zero caries experience.

Analysis of Variance↗

PubMed1998

Long-term survival of extensive amalgam restorations.

In cost-effectiveness analysis and contemporary treatment planning strategies, the postponement of placement of cast crowns plays an important role. Extensive amalgam restorations that involve the rebuilding of cusps and the provision of auxiliary retention are thought to make this postponement possible. This study reports the long-term survival (100 months) of extensive amalgam restorations in a randomized, controlled clinical trial. The operational hypothesis was that the type of retention and the operator have a long-term influence on the survival and clinical functioning of extensive amalgam restorations. Three hundred extensive amalgam restorations were placed by three operators in molar teeth in which one or more cusps were reconstructed. Five different auxiliary retention methods were used for retention of these restorations. Since the purpose of extensive amalgam restorations is considered to be two-fold (to restore a broken-down molar to function acceptably as an independent restoration and to create a substructure for subsequent crown construction), survival was assessed at different levels. The survival rate of extensive amalgam restorations as an independent restoration was 88+/-2%. The functional survival rate (as an independent restoration or as a substructure) was 92+/-2%. The influence of experimental variables ('retention method' and 'operator') and background variables ('tooth type', 'extension of extensive amalgam restorations', and 'age of patient') on the survival was analyzed by Log Rank and Breslow tests. The analyses revealed that there were no statistically significant influences on the survival rates except for the variable 'age of patient' (p < or = 0.05). Extensive amalgam restorations were more prone to failure in the group of older patients than in the group of younger ones. It is concluded that the clinical survival of extensive amalgam restorations is independent from several clinical variables in the study.

Adolescent↗

PubMed1997

Inactivation of eIF2B and phosphorylation of PHAS-I in heat-shocked rat hepatoma cells.

Various factors are involved in the heat shock-induced inhibition of protein synthesis. Changes upon heat shock in phosphorylation, leading to inactivation, of eukaryotic initiation factors (eIFs) eIF2 and eIF4E have been shown for several cell types. However, in mammalian cells these changes occur at temperatures of 43 degrees C or higher while protein synthesis is already affected at milder heat shock temperatures. In searching for the cause for the inhibition of protein synthesis, the regulation of eIF2 and eIF4E by additional factors was analyzed. In this respect, the activity of eIF2B was measured during and after heat shock. A very clear correlation was found between the activity of this guanine exchange factor and the levels of protein synthesis, also at mild heat shock conditions. Changes in the phosphorylation of eIF4E and of the eIF4E-binding protein PHAS-I were also analyzed. Surprisingly, in H35 cells as well as in some other cell lines, PHAS-I phosphorylation was increased by heat shock, whereas in others it was decreased. Therefore, decreasing the eIF4E availability under stressful conditions does not seem to be a general mechanism to inhibit protein synthesis by heat shock. Regulation of eIF2B activity appears to be the main mechanism to control translation initiation after heat shock at mild temperatures.

Animals↗

PubMed1997

Measuring morbidity from asthma in children.

AIMS: To develop new measures of asthma morbidity which would be applicable to children with asthma of all grades of severity. METHODS: This study used a cross sectional sample of asthmatic children. Traditional asthma morbidity measures (admission to hospital, use of Emergency Room, general practitioner, after hours deputising service and ambulance) were compared with new measures (school attendance, teacher assessment, parental perception of morbidity and parents emotional response to child's asthma). RESULTS: Data was obtained for 381 children with asthma. Children with poor school attendance were found in the severe group as judged by a composite score using traditional measures (r = 0.30, p < 0.0001). A new composite morbidity score based on two questions about parental perception of severity (how often has asthma prevented participation in activities and rating of severity of asthma in general over the last year) and two questions about parent emotional response to the child's asthma (how often has your child's asthma (a) made you feel frightened and (b) stopped family activities) was developed. This new measure of asthma morbidity was correlated with the composite score using traditional morbidity measures (r = 0.43, p < 0.0001) and with school attendance (r = 0.28, p < 0.0001). CONCLUSION: These new morbidity measures are quick and easy to use, and provide an opportunity to measure asthma severity at the moderate to mild end of the severity spectrum. We recommend their use for both clinical assessment and research.

Absenteeism↗

PubMed1997

"Prosthetic condition" and patients' judgment of complete dentures.

PURPOSE: This study introduces the concept "prosthetic condition", which combines the quality of complete dentures and residual alveolar ridges. MATERIAL AND METHODS: A pilot study was performed to select quality criteria with an acceptable interobserver agreement. With these criteria, a clinical examination was performed to assess the quality of the existing complete dentures and the residual alveolar ridges of 397 complete denture wearers. During clinical examination, the interobserver agreement of the selected criteria was retested. The "prosthetic condition" was assessed by combining the scores for denture quality and quality of the residual alveolar ridges. Subsequently, participants' satisfaction with and complaints about their dentures were scored according to their answers to specific questions. RESULTS: Logistic regression analysis demonstrated that no variable of the "prosthetic condition" proved to explain the denture satisfaction. Some variables of the "prosthetic condition" had a significant but not relevant correlation with some denture complaints. CONCLUSIONS: More research is necessary to substantiate the concept "prosthetic condition" as an acceptable measure of professionally quality assessment of dentures and denture-bearing surfaces. However, in determining the treatment need of community-dwelling groups, this concept seems a more realistic measure than denture quality only.

Adult↗

PubMed1997

patients' satisfaction with different types of veneer restorations.

OBJECTIVES: The aim of this study was to measure the satisfaction of patients with respect to the aesthetics of veneer restorations (VRs) and to identify potential factors influencing their satisfaction. MATERIALS AND METHODS: One hundred and eighty VRs of three different types (direct composite, indirect composite and porcelain) were placed on anterior teeth. Patients were asked to fill in questionnaires at baseline and at one- and two-year recalls. RESULTS: At baseline the overall satisfaction was 76%, after two years this was 78%. The variable 'type of VR' was the only factor measured that had a significant influence on the satisfaction of the patient. At the two-year evaluation patients with porcelain VRs were more satisfied than those with direct composite VRs (P < 0.05). CONCLUSIONS: From the results of this study it is concluded that differences in clinical procedures had no effect on satisfaction. Also the number of VRs had not influenced the level of satisfaction. After two years a significant difference was observed for the variable 'type of VR', with the best results for porcelain.

Composite Resins↗

PubMed1997

Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period.

OBJECTIVES: This study was performed to assess the intra-operative surgical complications and postoperative maternal morbidity rate of caesarean section. STUDY DESIGN: A total of 2647 women, delivered by caesarean section in our department between 1983 and 1992, were studied retrospectively. Three caesarean section groups were formed: (1) primary elective, (2) primary acute, without any effort to deliver vaginally, and (3) secondary acute, due to a failed vaginal delivery. The Student's-t-, Fisher-exact- and chi 2-test were used for statistical analysis. RESULTS: The overall maternal intra-operative complication rate was 14.8%. The most common complications were lacerations of the uterine corpus (10.1%) and bloodloss > or = 1000 ml (7.3%). The complication rate of the secondary group (23.4%) was significantly higher (p < 0.001) compared to both primary groups (7.4%). The overall maternal postoperative morbidity rate was 35.7%. Fever (24.6%), bloodloss between 1000 and 1500 ml (4%), haematoma (3.5%) and urinary tract infections (3.0%) were the most frequent complications. The primary elective group showed significantly (p < 0.001) lower major (2.6%) and minor (23.7%) complication rates compared to the emergency groups (major 5.2%, minor 34%). CONCLUSION: Emergency caesarean sections carried the greatest risks regarding maternal complications compared to elective procedures.

Cesarean Section↗

PubMed1997

Patient satisfaction with implant-supported mandibular overdentures. A comparison of three treatment strategies with ITI-dental implants.

In a randomized, controlled clinical trial, 110 edentulous patients with atrophic mandibles were treated with International Team for Oral Implantology-dental implants using three different treatment strategies: a mandibular overdenture supported by two implants with ball attachments, two implants with an interconnecting bar, or four interconnected implants. The patients' opinions and their social functioning were evaluated by means of a questionnaire directly before and 16 months after treatment. Before treatment most patients had complaints about the retention of their mandibular denture. Sixteen months after treatment almost all patients were generally satisfied with their dentures. Since no significant difference was found between the three treatment strategies, it was concluded that simple implant treatment such as an overdenture retained by two ball attachments is sufficient.

Analysis of Variance↗

PubMed1997

Recognition of veneer restorations by dentists and beautician students.

Three types of veneer restorations (VRs) were evaluated for recognition by two groups of observers to study the aesthetic result. The different types of VRs were: porcelain, direct resin composite and indirect resin composite. One month after insertion of the VRs, colour transparencies were made of smiling patients randomly selected from a group of 112 patients participating in a clinical trial. The slides were evaluated by five dentists who were not familiar with the patients and by 25 beautician students (BS). Dentists were asked to locate the VRs which were present in the patients and to specify the type of VR. BS were only asked to locate the VRs. To trace a possible relationship between the aesthetic result of the treatment and a number of variables, ANOVA was applied to evaluate the variables: 'discolouration of the teeth' before treatment, 'type of VR' and 'number of VRs'. Agreements in judgement were expressed in Cohen-Kappa coefficients. The results showed that the dentists could locate the VRs quite well (Kappa coefficient 0.64 +/- 0.28) but for BS this was lower (Kappa coefficient 0.43 +/- 0.27). The more VRs were made in one patient, the more difficult it was to locate them correctly. The other variables had no significant effect on the recognition of the VRs. It was not possible for the dentist observers to differentiate between the types of VRs.

Adult↗

PubMed1997

Fit of direct retainers in removable partial dentures after 8 years of use.

In a cross-sectional study the fit of direct retainers was assessed after 8 years of use. A total of 101 metal frame removable partial dentures (RPD) were investigated, including 54 extension base prostheses without any tooth supported replacement and 47 tooth supported prostheses that replaced only premolars and molars. Of the frameworks studied, about 60% of the clasps showed a space between retainers and abutments. Logistic regression analyses demonstrated that the age of the RPD and the type of opposing dentition significantly influenced the fit of the clasps. The relative risks and a backward regression analysis revealed that the variable non-rigid extension base RPD had the greatest influence on clasp fit. It was concluded that in extension base RPDs a rigid design should be preferred.

Adult↗

PubMed1997

A rapid and simple method for extracting human immunodeficiency virus type 1 RNA from plasma: enhanced sensitivity.

We present here a rapid and simple technique for processing human immunodeficiency virus (HIV)-infected plasma by high-speed centrifugation. HIV type 1 virions are pelleted from up to 1 ml of plasma, gently lysed with a nonionic detergent, and directly amplified. The procedure has few manipulations and requires approximately 1.5 h for the processing of 24 samples. Viral recovery ranges from 80 to 90%, with an analytical sensitivity approaching 20 copies/ml.

HIV Infections↗