PubMed Health⌕ Search

Biomedical subjects

Jan P Vandenbroucke

Publications and source records attributed to Jan P Vandenbroucke.

At least 19 recordsLinked to original sources
PubMed2006

Sick leave as a predictor of job loss in patients with chronic arthritis.

OBJECTIVES: To study the occurrence and duration of sick leave as potential risk factors for permanent job loss after 24 months among 112 individuals with chronic arthritis and a disease related problem at work. METHODS: Data collection was embedded in a multicentre randomised controlled trial in which the cost-effectiveness of a multidisciplinary job retention vocational rehabilitation programme for employees with chronic arthritis and a disease related problem at work was compared to usual outpatient care. Sick leave (complete or partial) was defined as absenteeism reported to the employer and permanent job loss as receiving a full work disability pension or unemployment. The association between sick leave at baseline and job loss after 24 months was investigated by multivariate logistic regression analysis, including those variables that were univariately significantly associated with job loss after 24 months. RESULTS: At baseline, 60 of the 112 subjects (54%) were on sick leave, with a mean duration of 18.7 weeks, in half of these patients the sick leave was complete. After 24 months, 26 of the 112 patients (23%) had lost their job. The presence of complete sick leave (OR 4.74, 95% CI 1.86-12.07) and the depression score of the hospital anxiety and depression scale (OR 1.18, 95% CI 1.02-1.36) were significantly and independently associated with job loss after 2 years follow-up. CONCLUSION: The occurrence of complete sick leave was found to be an independent risk factor for job loss in patients with chronic arthritis who have a disease related problem at work.

Adult↗
PubMed2006

Preemptive versus Non-preemptive simultaneous pancreas-kidney transplantation: a single-center, long-term, follow-up study.

BACKGROUND: Data regarding the timing-before or after initiation of dialysis-of simultaneous pancreas-kidney transplantation (SPKT) in type 1 diabetes mellitus patients with end-stage renal failure are sparse. We studied the effect of preemptive transplantation on patient survival, cardiovascular endpoints, and graft survival, as compared with non-preemptive transplantation. METHODS: All 180 SPKT recipients (aged 23-58 years) who received a SPKT in Leiden between December 1986 and May 2004 were included in the analysis. Sixty-five patients (36.1%) were transplanted preemptively. Mean follow-up time was 6.3 years. RESULTS: Up to 8.2 years after transplantation, we found no differences in patient survival. Later on, divergence occurred: 10-year patient survival was 71.3% in the preemptive group versus 63.8% in the dialysis group and 15-year patient survival was 64.8% versus 45.1% in the dialysis group, leading to an adjusted hazard ratio for mortality of 0.50 (95% CI 0.23-1.06, P=0.070). Cause of death was less often of cardiac origin in the preemptive group (adjusted HR 0.16; 95% CI 0.026-0.95, P=0.044). Graft survival did not follow the same trend. No significant differences were found between the two groups considering allograft survival, cerebrovascular accident, or myocardial infarction. The percentage of patients with minor or major amputation(s) after transplantation was slightly lower in the preemptive group (24.6 vs. 32.1%; adjusted HR 0.87; 95% CI 0.42-1.82, P=0.72). CONCLUSION: Preemptive SPKT offered a patient survival benefit as compared with transplantation performed while already on dialysis and was associated with a lower rate of cardiac deaths.

Adult↗
PubMed2006

Population screening for single genes that codetermine common diseases in adulthood had limited effects.

BACKGROUND AND OBJECTIVE: Familial hemochromatosis (FHEM), familial hypercholesterolemia (FH), familial mediterranean fever (FMF), and familial thrombophilia (FT) are relatively common genetically determined diseases of (early) adulthood. Chances, shortcomings, and practical aspects of population screening were considered. METHODS: The literature, as well as existing data concerning the treatment of these diseases in The Netherlands, were studied. RESULTS: In these four diseases there are so many modifying genes and environmental and lifestyle influences that accurate predictive testing at the population level is currently not sufficiently effective. The data indicate that the implementation of family clinics for FHEM and FH are necessary. There is need for further sociologic studies in the moslim population of Mediterranean and North African origin about acceptance of DNA diagnostics in relation to consanguinity and into the problem of "pseudodominance." There seems no need for early detection and preventive measures for FT in asymptomatic persons. CONCLUSION: No population screening for these four genetically determined diseases of (early) adulthood is sufficiently effective at the present time. We propose to call these diseases "chronic diseases with a single gene component."

Familial Mediterranean Fever↗
PubMed2006

Serum troponin T concentration as a predictor of mortality in hemodialysis and peritoneal dialysis patients.

BACKGROUND: Troponin T is a good predictor of all-cause and cardiovascular mortality in cardiac patients. Although it is known that troponin T is an independent risk factor in dialysis patients as well, its prognostic value when measured routinely in clinical practice, particularly in addition to other risk indicators, is unclear. METHODS: A cohort of 847 patients who started dialysis therapy between 1997 and 2001 and participated in a multicenter follow-up study was examined. Clinical data were determined 3 months after the start of dialysis therapy. Patients were followed up until date of death or censoring in November 2003. RESULTS: For patients with troponin T values of 0.05 to 0.10 microg/L, hazard ratio for all-cause mortality was 2.2 (95% confidence interval [CI], 1.7 to 2.8) compared with patients with values less than 0.05 microg/L. For patients with values greater than 0.10 microg/L (11%), hazard ratio was 3.3 (95% CI, 2.5 to 4.5). A survival model with clinical and laboratory risk indicators yielded an area under the curve of 0.81, which did not increase when troponin T level was added to the model. The area under the curve for troponin T level alone was 0.67. No important differences were found between patients on hemodialysis or peritoneal dialysis therapy and between patients with high and low residual renal function. CONCLUSION: Although troponin T level is an independent risk factor for mortality in dialysis patients, it has limited added predictive power as a routine screening test over other clinical risk factors in dialysis patients.

Female↗
PubMed2005

A regression model with unexplained residuals was preferred in the analysis of the fetal origins of adult diseases hypothesis.

BACKGROUND AND OBJECTIVE: A continued controversy exists whether the assessment of the influence of low birth weight on adult blood pressure necessitates adjustment for adult weight in the analysis on the fetal origins of adult diseases hypothesis. Here we first explain the difficulty in understanding an adjusted multivariate regression model, and then propose another way of writing the regression model to make the interpretation of the separate influence of birth weight and changes in weight later in life more straightforward. STUDY DESIGN AND SETTING: We used a multivariate regression model containing birth weight (standard deviation score; SDS), and residual adult weight (SDS) to explore the effect on blood pressure (or any other outcome) separately. Residual adult weight was calculated as the difference between actual adult weight and the expected adult weight (SDS) given on a certain birth weight (SDS). RESULTS: The coefficients of birth weight and residual adult weight show directly the effect on the analyzed outcome variable. CONCLUSIONS: We prefer to use this regression model with unexplained residuals when the adjusted variable is in the causal pathway in the analyses of data referring to the fetal origins of adult diseases hypothesis.

Adult↗
PubMed2005

Case-control and two-gate designs in diagnostic accuracy studies.

BACKGROUND: In some diagnostic accuracy studies, the test results of a series of patients with an established diagnosis are compared with those of a control group. Such case-control designs are intuitively appealing, but they have also been criticized for leading to inflated estimates of accuracy. METHODS: We discuss similarities and differences between diagnostic and etiologic case-control studies, as well as the mechanisms that can lead to variation in estimates of diagnostic accuracy in studies with separate sampling schemes ("gates") for diseased (cases) and nondiseased individuals (controls). RESULTS: Diagnostic accuracy studies are cross-sectional and descriptive in nature. Etiologic case-control studies aim to quantify the effect of potential causal exposures on disease occurrence, which inherently involves a time window between exposure and disease occurrence. Researchers and readers should be aware of spectrum effects in diagnostic case-control studies as a result of the restricted sampling of cases and/or controls, which can lead to changes in estimates of diagnostic accuracy. These spectrum effects may be advantageous in the early investigation of a new diagnostic test, but for an overall evaluation of the clinical performance of a test, case-control studies should closely mimic cross-sectional diagnostic studies. CONCLUSIONS: As the accuracy of a test is likely to vary across subgroups of patients, researchers and clinicians might carefully consider the potential for spectrum effects in all designs and analyses, particularly in diagnostic accuracy studies with differential sampling schemes for diseased (cases) and nondiseased individuals (controls).

Case-Control Studies↗
PubMed2005

Thrombophilia, clinical factors, and recurrent venous thrombotic events.

CONTEXT: Data on the recurrence rate of venous thrombotic events and the effect of several risk factors, including thrombophilia, remain controversial. The potential benefit of screening for thrombophilia with respect to prophylactic strategies and duration of anticoagulant treatment is not yet known. OBJECTIVES: To estimate the recurrence rate of thrombotic events in patients after a first thrombotic event and its determinants, including thrombophilic abnormalities. DESIGN, SETTING, AND PATIENTS: Prospective follow-up study of 474 consecutive patients aged 18 to 70 years without a known malignancy treated for a first objectively confirmed thrombotic event at anticoagulation clinics in the Netherlands. The Leiden Thrombophilia Study (LETS) was conducted from 1988 through 1992 and patients were followed up through 2000. MAIN OUTCOME MEASURES: Recurrent thrombotic event based on thrombophilic risk factors, sex, type of initial thrombotic event (idiopathic or provoked), oral contraceptive use, elevated levels of factors VIII, IX, XI, fibrinogen, homocysteine, and anticoagulant deficiencies. RESULTS: A total of 474 patients were followed up for mean (SD) of 7.3 (2.7) years and complete follow-up was achieved in 447 (94%). Recurrence of thrombotic events occurred in 90 patients during a total of 3477 patient-years. The rate of thrombotic event recurrence was 25.9 per 1000 patient-years (95% confidence interval [CI], 20.8-31.8 per 1000 patient-years). The incidence rate of recurrence was highest during the first 2 years (31.9 per 1000 patient-years; 95% CI, 20.3-43.5 per 1000 patient-years). The risk of thrombotic event recurrence was 2.7 times (95% CI, 1.8-4.2 times) higher in men than in women. Patients whose initial thrombotic event was idiopathic had a higher risk of a thrombotic event recurrence than patients whose initial event was provoked (hazard ratio [HR], 1.9; 95% CI, 1.2-2.9). Women who used oral contraceptives during follow-up had a higher thrombotic event recurrence rate (28.0 per 1000 patient-years; 95% CI, 15.9-49.4 per 1000 patient-years) than those who did not (12.9 per 1000 patient-years; 95% CI, 7.9-21.2 per 1000 patient-years). Recurrence risks of a thrombotic event by laboratory abnormality ranged from an HR of 0.6 (95% CI, 0.3-1.1) in patients with elevated levels of factor XI to an HR of 1.8 (95% CI, 0.9-3.7) for patients with anticoagulant deficiencies. CONCLUSIONS: Prothrombotic abnormalities do not appear to play an important role in the risk of a recurrent thrombotic event. Testing for prothrombotic defects has little consequence with respect to prophylactic strategies. Clinical factors are probably more important than laboratory abnormalities in determining the duration of anticoagulation therapy.

Adult↗
PubMed2005

In an observational study elderly patients had an increased risk of falling due to home hazards.

OBJECTIVE: The objective of this study was to explore the relationship between home hazards and the incidence of falls in the oldest old population. STUDY DESIGN AND SETTING: The Leiden 85-plus Study is a population-based study of all 85-year-old inhabitants of Leiden in the birth-cohort 1912-1914. Participants and general practitioners were interviewed at baseline and annually there after. We analyzed the incidence of falling in the first year dependent on the presence of home hazards at baseline. There were no exclusion criteria other than the inability to walk alone. RESULTS: During the 1-year follow-up, 44% of the participants experienced one or more falls. Participants without preceding falls (n=246) had a 4-fold risk for falls in the presence of six or seven home hazards (relative risk 3.58, 95% confidence interval 1.75-5.05) compared with those without home hazards. Participants with preceding falls (n=234) had no increased risk of falls with increasing numbers of home hazards, although they had a higher risk to fall. The data confirmed the known increased risk for falls in participants with physical impairments. CONCLUSION: We conclude that participants without a history of preceding falls have an increased risk of falling due to the presence of home hazards.

Accidental Falls↗
PubMed2005

Incidence of recombinant erythropoietin (EPO) hyporesponse, EPO-associated antibodies, and pure red cell aplasia in dialysis patients.

BACKGROUND: Since 1998, an increase of anti-erythropoietin (anti-EPO) antibody-induced pure red cell aplasia (PRCA) has been reported. As data up to now consisted mostly of spontaneously reported cases the question arose about the frequency of this increase in EPO-induced PRCA. The objectives of this study were to determine the incidence and causes of recombinant EPO hyporesponse, of antibodies to EPO in patients on dialysis, and to relate the detection of anti-EPO antibodies to the presence of PRCA. METHOD: This multicenter cohort study used existing patient data and serum samples collected at 6-month intervals from 1677 patients with incident end-stage renal disease (ESRD) participating in The Netherlands Cooperative Study on the Adequacy of Dialysis-2 (NECOSAD-2). RESULTS: Fifty-seven patients had an inadequate EPO response, which resulted in an incidence of 16.7 per 1000 patient-years on EPO while on dialysis. All available sera specimens (N = 232) of these patients were screened for anti-EPO antibodies. The sera specimens of two of these 57 patients tested positive. Of the 57 patients with inadequate EPO response, one had clinical PRCA (incidence 0.29 per 1000 patient-years on EPO and on dialysis). Of the 1346 patients without symptoms of inadequate EPO response, one patient tested borderline positive for anti-EPO antibodies. In total, three patients developed EPO antibodies during follow-up, leading to an estimated incidence of 1.27/1000 (95% CI 0.3 to 3.7/1000) patient-years since the start of dialysis. CONCLUSION: The incidence of inadequate EPO response in our population of dialysis patients is in concordance with tentative calculations found in the literature. Furthermore, we found the incidence of EPO-induced PRCA and EPO antibodies to be low.

Adult↗
PubMed2005

ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis.

BACKGROUND: In dialysis patients, only a few follow-up studies have addressed the relationship between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene and mortality, but the available data are contradictory. METHODS: A cohort of 453 consecutive patients starting dialysis between January 1999 and January 2002 and participating in a Dutch multicenter prospective study was examined. Patients who died within 3 months after the start of dialysis were excluded. Patients were followed until date of death or censoring in November 2003. RESULTS: The ACE II, ID, and DD genotype frequencies were 24.3% (N = 110), 50.1% (N = 227), and 25.6% (N = 116). Besides a slightly higher number of Caucasians in the DD group, all other patient characteristics of the 3 ACE groups were similar at the start of dialysis. After adjustment for age, comorbidity, and ethnic background, patients with the ID and DD genotype showed an increased hazard ratio (HR) for all-cause mortality of 1.55 (95% CI 1.00-2.42) and 2.30 (95% CI 1.41-3.75), compared to patients with the II genotype. Slightly lower HRs were found for cardiovascular mortality. All groups of primary kidney disease showed a 2- to 3-fold increased adjusted HR for DD. CONCLUSION: The DD genotype identifies dialysis patients at an increased risk for mortality.

Aged↗