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Biomedical subjects

J P Slaets

Publications and source records attributed to J P Slaets.

At least 19 recordsLinked to original sources
PubMed2001

Treatment of cancer in old age, shortcomings and challenges.

The burden of cancer in old age is increasing as a result from both the expanding number of older persons in the population and the high and still increasing cancer incidence in this group. The goal of this article is to outline the shortcomings and challenges of the management of cancer in the elderly. Several factors contribute to the complexity of this management, such as the enormous heterogeneity in this population, increased co-morbidity, reduced functional status, increased frailty and different treatment goals from those in younger patients. Other problems include the lack of data on the efficacy and toxicity of cancer treatment in this age group, the lack of awareness of life-expectancy and the lack of an easy applicable and validated frailty scale. Improvement of the quality of oncological care in this age group could be achieved by initiation of clinical trials specifically directed at the elderly, in which a frailty scale is implemented. The results of these trials may lead to more evidence-based decision making in cancer treatment in the elderly.

Activities of Daily Living↗
PubMed2001

Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study.

AIMS AND OBJECTIVES: The relationship between mental disturbances - anxiety and depression, somatization and alcohol abuse - on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case-management on admission. DESIGN: The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study. RESEARCH METHODS AND INSTRUMENTS: In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based on the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care. RESULTS: Patients with high scores on anxiety and depression (SCL-8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse. CONCLUSIONS: The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes.

Activities of Daily Living↗
PubMed2001

The relationship between thyrotropin and low density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects.

High levels of TSH are associated with an increased cardiovascular risk. Many cardiovascular risk factors cluster within the insulin resistance syndrome. It is not known whether levels of TSH cluster as well. We conducted this research to test the hypothesis that TSH, insulin sensitivity, and levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) are interdependent in euthyroid subjects. Levels of TSH, free thyroid hormone, and serum lipids were measured in fasting serum samples taken before performance of a hyperinsulinemic euglycemic clamp to assess insulin sensitivity in 46 healthy euthyroid subjects with a mean TSH of 1.8 +/- 0.7 mU/L. Significant age- and sex-adjusted partial correlations of TSH with LDL-C (r = 0.48; P < 0.01) and HDL-C (r = -0.36; P < 0.05) were observed. TSH was not significantly correlated with insulin sensitivity or fasting triglyceride concentrations. In line with these results, we found the associations of TSH with LDL-C and HDL-C to be independent of insulin sensitivity. However, we observed significant effect-modification of the association of TSH with LDL-C by insulin sensitivity (P = 0.02). This effect-modification implies a range of associations of TSH with LDL-C that varies from absent in insulin-sensitive subjects to strongly positive in insulin-resistant subjects. We conclude that the increased cardiovascular risk associated with subclinical hypothyroidism seems to extend itself into the normal range of thyroid function. Importantly, the effect-modification of the association of TSH with LDL-C by insulin sensitivity suggests that insulin-resistant subjects are most susceptible to this increased risk.

Adolescent↗
PubMed1999

Prenatal exposure to the 1957 influenza pandemic and non-affective psychosis in The Netherlands.

Second-trimester exposure to the 1957 A2 influenza pandemic is a controversial risk factor for schizophrenia. Two earlier studies of the Dutch psychiatric registry failed to find an increased risk for exposed subjects, but diagnostic misclassification within the spectrum of non-affective psychoses has not yet been ruled out as an explanation for the negative findings. Using an enlarged data-set we examined not only whether second-trimester exposure to the epidemic is associated with an increased risk of schizophrenia (ICD:295), but also whether it is associated with an increased risk of paranoid states (ICD:297) or other non-organic psychoses (ICD:298). In this retrospective cohort study the risks of the above-mentioned disorders were compared for those exposed and unexposed to A2 influenza during the second trimester of fetal life. The risks for the exposed subjects were not significantly higher than the risks for the unexposed. The power of the study to detect a significant increase in the risk of schizophrenia was sufficient. If the relative risk of a lifetime hospitalization for schizophrenia for second-trimester exposed subjects (born January-April 1958) is assumed to be 1.3, the power of the study would be 0.97 (alpha=0.05; one-tailed testing). If the relative risk for subjects born five months after the peak of the epidemic (mid-February to mid-March 1958) is assumed to be 1.88, as reported for England and Wales, the power of the study would be close to 1.00. This was the largest study of its kind in Europe: 275 subjects were born in the period January-April 1958 and had a lifetime hospitalization for schizophrenia. This study indicates that there is no relation between second-trimester exposure to the 1957 influenza pandemic and risk of non-affective psychosis in the Dutch population. It adds to a growing body of work which does not support an association between maternal influenza and schizophrenia.

Adolescent↗
PubMed1999

INTERMED--an assessment and classification system for case complexity. Results in patients with low back pain.

STUDY DESIGN: Cross-sectional investigation and follow-up of patients with low back pain. OBJECTIVES: To evaluate the capacity of the INTERMED--a biopsychosocial assessment and classification system for case complexity--to identify patients with a chronic, disabling course of low back pain and to predict treatment outcome. SUMMARY OF BACKGROUND DATA: An impressive number of biologic and nonbiologic factors influencing the course of low back pain have been identified. However, the lack of a concise, comprehensive, reliable and validated classification system of this heterogeneous patient population hampers preventive and therapeutic progress. METHODS: The INTERMED was used to assess patients with low back pain, who participated in a functional rehabilitation program (n = 50) and patients with low back pain who applied for disability compensation (n = 50). Patients of the rehabilitation program were observed to assess the effects of treatments. RESULTS: The INTERMED distinguished between patients in different phases of disability and provided meaningful information about the biopsychosocial aspects of low back pain. In hierarchical cluster analysis two distinct clusters emerged that differed in the degree of case complexity and treatment outcomes. CONCLUSIONS: This first application of the INTERMED indicates its potential utility as a classification system for patients with low back pain.

Adult↗
PubMed1999

Decrease of non-linear structure in the EEG of Alzheimer patients compared to healthy controls.

OBJECTIVE: Non-linear EEG analysis can provide information about the functioning of neural networks that cannot be obtained with linear analysis. The correlation dimension (D2) is considered to be a reflection of the complexity of the cortical dynamics underlying the EEG signal. The presence of non-linear dynamics can be determined by comparing the D2 calculated from original EEG data with the D2 from phase-randomized surrogate data. METHODS: In a prospective study, we used this method in order to investigate non-linear structure in the EEG of Alzheimer patients and controls. Twenty-four patients (mean age 75.6 years) with 'probable Alzheimer's disease' (NINCDS-ADRDA criteria) and 22 controls (mean age 70.3 years) were examined. D2 was calculated from original and surrogate data at 16 electrodes and in three conditions: with eyes open, eyes closed and during mental arithmetic. RESULTS: D2 was significantly lower in the Alzheimer patients compared to controls (P = 0.023). The difference between original and surrogate data was significant in both groups, implicating that non-linear dynamics play a role in the D2 value. Moreover, this difference between original and surrogate data was smaller in the patient group. D2 increased with activation, but not significantly more in controls than in patients. CONCLUSIONS: In conclusion, we found decreased dimensional complexity in the EEG of Alzheimer patients. This decrease seems to be attributable at least partially to different non-linear EEG dynamics. Because of this, non-linear EEG analysis could be a useful tool to increase our insight into brain dysfunction in Alzheimer's disease.

Aged↗
PubMed1997

Schizophrenia in Surinamese and Dutch Antillean immigrants to The Netherlands: evidence of an increased incidence.

BACKGROUND: Reports of an increased incidence of schizophrenia in Afro-Caribbean immigrants to the UK are a matter of much debate. It is of interest, therefore, that in the 1970s and 1980s many immigrants from Surinam and The Netherlands Antilles have settled in The Netherlands. The purpose of our study was to compare the risk of a first admission for schizophrenia for Surinamese- and Antillean-born persons aged 15-39 years to that for their Dutch-born peers in the period 1983-1992. METHODS: We used data from the Dutch psychiatric registry. Age-adjusted relative risks were calculated using Poisson regression analysis. RESULTS: The risk for the immigrants was found to be three to four times higher than that for the Dutch-born. Age-adjusted relative risks were significantly higher for male than for female immigrants. CONCLUSIONS: The results provide evidence of an increased incidence in these immigrant groups and support similar findings on Afro-Caribbeans in the UK. Migration from Surinam was on such a large scale that selective migration of persons at risk for the disorder is unlikely to account entirely for these findings.

Adolescent↗
PubMed1997

Health services research on mental health in primary care.

OBJECTIVE: The article seeks to provide an international perspective on the facilitating role of health services research in the treatment of psychiatric disorders in primary care. It builds on Goldberg and Huxley's model describing pathways to mental care for the psychiatrically ill in the community. METHOD: Seventy studies were selected for review by Medline search, sixteen studies by contacting prominent researchers in the field. All studies are discussed more or less extensively. RESULTS: Case identification strategies including screening tools and diagnostic modules have been developed. Other strategies include educational training programs and psychiatric consultation services designed to facilitate psychopharmacological and other types of treatment of psychiatric disorders in primary care. Several models for the linkage of primary care and specialty mental health providers are discussed, and a primary care psychiatry programme is examined. CONCLUSION: Better psychiatric training of general practitioners (GPs), on-site consultation, and better communication between mental health professionals and GPs can improve the recognition, management, and referral of psychiatrically ill primary care patients. The further development of guidelines focusing on anxiety disorders, somatization, subthreshold disorders, and effectiveness in primary care is recommended.

Forecasting↗
PubMed1996

Diagnostic usefulness of linear and nonlinear quantitative EEG analysis in Alzheimer's disease.

The sensitivity of the EEG in early AD is somewhat limited. In this respect spectral analysis is little better than visual assessment. In this study we address the question whether a new type of EEG analysis derived from chaos theory can improve the sensitivity of the EEG. EEGs were recorded in 15 control subjects and 15 patients with mild AD. The EEG recorded at 02 and 01 during eyes closed and eyes open conditions was subjected to spectral analysis (relative power) and nonlinear analysis (calculation of the correlation dimension D2). AD patients had more relative theta power and impaired reactivity in alpha, delta and theta bands. Also, reactivity of the D2 was impaired in AD subjects. For a specificity of 100%, relative theta power had the highest sensitivity (46.7%). Alpha band reactivity at O1 had a sensitivity of 40% and D2 reactivity at O1 had a sensitivity of 33.3%. Combining theta power with alpha reactivity resulted in a sensitivity of 53.3%; combining theta with D2 reactivity resulted in a sensitivity of 60%. Used in isolation, linear analysis was superior in differentiating AD patients from controls. The best results were obtained by combining linear with nonlinear measures. This approach does not seem practical yet, but deserves further study.

Aged↗
PubMed1995

Investigation of EEG non-linearity in dementia and Parkinson's disease.

Many recent studies based on the surrogate data method failed to identify significant non-linearity in the EEG. In this study we examine whether the use of a different embedding method (spatial instead of time delay), and calculation of Kolmogorov entropy (K2) and the largest Lyapunov exponent (L1) in addition to the correlation dimension (D2), can distinguish the EEG form linearly filtered noise. We have calculated D2, L1 and K2 of original EEG epochs and surrogate (phase randomized) data in 9 control subjects, 9 demented patients and 13 Parkinson patients. The correlation dimension D2 and the largest Lyapunov exponent L1 could distinguish between the EEG tracings and the surrogate data. Demented patients had significantly lower D2 and L1 compared to controls. L1 was higher in Parkinson patients than in demented patients. Contrary to other studies that have used the Theiler surrogate data method, we find evidence for non-linearity in normal and abnormal EEG during the awake/eyes closed state. Apparently it is the spatial structure in the EEG that exhibits much of the non-linear structure. Furthermore, non-linear EEG measures show more or less specific patterns of dysfunction in dementia and Parkinson's disease.

Aged↗
PubMed1995

Specific patterns of cortical dysfunction in dementia and Parkinson's disease demonstrated by the acceleration spectrum entropy of the EEG.

Acceleration spectrum entropy (ASE) was used to quantify EEG desynchronization, which is related to cortical activation. We investigated the ASE in control and patient groups with dementia (AD) and Parkinson's disease (PD). Both patient groups had significantly lower ASE scores corresponding with less desynchronization in all cortical regions. In the AD group, the ASE was significantly lower in the parietal region. ASE was found to be a sensitive and specific measure for differentiating patient groups with AD and PD from controls and from each other.

Aged↗
PubMed1994

Non-linear dynamical analysis of multichannel EEG: clinical applications in dementia and Parkinson's disease.

The irregular, aperiodic character of the EEG is usually explained by a stochastic model. In this view the EEG is linearly filtered noise. According to chaos theory such irregular signals can also result from low dimensional deterministic chaos. In this case the underlying dynamics is nonlinear, and has only few effective degrees of freedom. In contrast, stochastic models are less efficient, because they require in principle infinite degrees of freedom. Chaotic dynamics in the EEG can be studied by calculating the correlation dimension (D2). Although it has become clear that D2 calculations alone cannot prove chaos, the D2 has potential value as an EEG diagnostic. In this study we investigated whether D2 could be used to discriminate EEGs from normal controls, demented patients and Parkinson patients. We have analyzed epochs (20 channels; 2.5 s) from 52 EEGs (20 controls; 15 patients with dementia; 17 patients with Parkinson's disease). Controls had a mean D2 of 6.5 (0.9); demented patients of 4.4 (1.5), and Parkinson patients of 5.3 (0.9). Both groups were significantly different from controls (p < 0.001). There was a significant positive correlation between D2 and relative power in the beta band (r = 0.81) and a significant negative correlation between D2 and power in the delta (r = -0.60) and theta band (r = -0.37). These results suggest the possible usefulness of multichannel D2 estimation in a clinical setting.

Aged↗
PubMed1994

Evidence against maternal influenza as a risk factor for schizophrenia.

We tested the hypothesis that second-trimester exposure to influenza is a risk factor for schizophrenia in the child. The dates of birth of Dutch schizophrenic in-patients were examined for any effect of the 1957 A2 influenza epidemic. Individuals who were in their second trimester of foetal life at the peak of the epidemic were at no greater risk of developing schizophrenia than controls. As the present study has a larger sample size than all previous European studies, and is supported by a large study in the USA, it provides strong evidence against the hypothesis that second-trimester exposure to influenza is a risk factor for schizophrenia.

Adult↗