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Johannes H Smit

Publications and source records attributed to Johannes H Smit.

13 recordsLinked to original sources
PubMed2006

Effectiveness of a Minimal Intervention for Stress-related mental disorders with Sick leave (MISS); study protocol of a cluster randomised controlled trial in general practice [ISRCTN43779641].

BACKGROUND: The main aims of this paper are to describe the setting and design of a Minimal Intervention in general practice for Stress-related mental disorders in patients on Sick leave (MISS), as well as to ascertain the study complies with the requirements for a cluster randomised controlled trial (RCT). The potential adverse consequences of sick leave due to Stress-related Mental Disorders (SMDs) are extensive, but often not recognised. Since most people having SMDs with sick leave consult their general practitioner (GP) at an early stage, a tailored intervention given by GPs is justified. We provide a detailed description of the MISS; that is more accurate assessment, education, advice and monitoring to treat SMDs in patients on sick leave. Our hypothesis is that the MISS will be more effective compared to the usual care, in reducing days of sick leave of these patients. METHODS: The design is a pragmatic RCT. Randomisation is at the level of GPs. They received the MISS-training versus no training, in order to compare the MISS vs. usual care at patient level. Enrollment of patients took place after screening in the source population, that comprised 20-60 year old primary care attendees. Inclusion criteria were: moderately elevated distress levels, having a paid job and sick leave for no longer than three months. There is a one year follow up. The primary outcome measure is lasting full return to work. Reduction of SMD- symptoms is one of the secondary outcome measures. Forty-six GPs and 433 patients agreed to participate. DISCUSSION: In our study design, attention is given to the practical application of the requirements for a pragmatic trial. The results of this cluster RCT will add to the evidence about treatment options in general practice for SMDs in patients on sick leave, and might contribute to a new and appropriate guideline. These results will be available at the end of 2006.

Adult↗
PubMed2006

Do obsessional beliefs discriminate OCD without tic patients from OCD with tic and Tourette's syndrome patients?

UNLABELLED: There is considerable overlap in symptomatology between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD). Increased rates of tics are found in OCD and up to 60% obsessive-compulsive symptoms in TS. However, in OCD obsessive-compulsive symptoms are more often anxiety-related and, as a consequence, aimed at anxiety-reduction, whereas in TS these symptoms are more stimulus-bound. Therefore, it is of clinical interest to study whether these phenomenological differences are reflected in differences between dysfunctional cognitions accompanying OC symptoms in OCD with or without tics and TS. Current cognitive theory of OCD ascertains that specific dysfunctional beliefs are important in the etiology and maintenance of OCD. To assess these beliefs, the obsessive-compulsive beliefs questionnaire-87 (OBQ-87) has been developed. In the present study, OBQ-87 scores of OCD patients without tics, OCD with tics, and TS (without OCD) patients were compared to those of normal controls. RESULTS: OCD without tic patients exhibited higher OBQ-87 scores than TS patients. No differences were found between OCD with or without tic patients on any of the OBQ-87 subscales. These results suggest that: (1) dysfunctional beliefs have no discriminative power with respect to OCD with or without tic patients; (2) the direct relationship between types of OC symptoms and specific dysfunctional beliefs is questionable. Therefore, one can doubt the specificity of cognitive theory of OCD to explain specific OC behavior.

Adult↗
PubMed2006

Gender and cultural patterns of suicidal behavior: young Hindustani immigrant women in the Netherlands.

Patterns of suicidal behavior vary among cultures and along gender. Young Hindustani immigrant women attempt suicide four times more often than young Dutch women. This article explores multi-disciplinary explanations for suicidal behavior in this group. The interconnection of Durkheimian concepts of social integration and regulation with ecological insights into family relations and psychological and psychiatric theories on individual distress are relevant. It is suggested that young Hindustani women who display suicidal behavior possess certain personality and cognitive constellations that are interlocked with specific parenting styles in stressful family environments. These families are embedded in a context of moral transformations resulting from migration to a Western culture and may be facing difficulties accompanying the transitional processes encountered in the West, particularly those regarding gender roles. Durkheimian fatalistic and anomic suicides elucidate this. The Hindustani women who appear most at risk are those facing contradictory norms and overregulation, which prevent them from developing autonomy.

Adult↗
PubMed2005

Homocysteine and vitamin B12 status relate to bone turnover markers, broadband ultrasound attenuation, and fractures in healthy elderly people.

UNLABELLED: Hyperhomocysteinemia may contribute to the development of osteoporosis. The relationship of Hcy and vitamin B12 with bone turnover markers, BUA, and fracture incidence was studied in 1267 subjects of the Longitudinal Aging Study Amsterdam. High Hcy and low vitamin B12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk. INTRODUCTION: Hyperhomocysteinemia may contribute to the development of osteoporosis. Vitamin B12 is closely correlated to homocysteine (Hcy). The main objective of our study was to examine the association of Hcy and vitamin B12 status and the combined effect of these two with broadband ultrasound attenuation (BUA), bone turnover markers, and fracture. MATERIALS AND METHODS: Subjects were 615 men and 652 women with a mean age of 76 +/- 6.6 (SD) years of the Longitudinal Aging Study Amsterdam (LASA). At baseline (1995/1996), blood samples were taken after an overnight fast for dairy products. Plasma Hcy was measured with IMx, serum vitamin B12 with competitive immunoassay (IA) luminescence, serum osteocalcin (OC) with immunoradiometric assay (IRMA), and urinary excretion of deoxypyridinoline (DPD) with competitive IA and corrected for creatinine (Cr) concentration. CVs were 4%, 5%, 8%, and 5%, respectively. BUA was assessed in the heel bone twice in both the right and left calcaneus. Mean BUA value was calculated from these four measurements. CV was 3.4%. After baseline measurements in 1995, a 3-year prospective follow-up of fractures was carried out until 1998/1999. Subjects were grouped by using two different approaches on the basis of their vitamin B12 concentration, normal versus low (<200 pM) or lowest quartile (Q1) versus normal quartiles (Q2-Q4), and Hcy concentration, normal versus high (>15 microM) or highest quartile (Q4) versus normal quartiles (Q1-Q3). Analysis of covariance was performed to calculate mean values of BUA, OC, and DPD/Cr(urine) based on the specified categories of Hcy and vitamin B12 and adjusted for several confounders (potential confounders were age, sex, body weight, body height, current smoking [yes/no], mobility, cognition). The relative risk (RR) of any fracture was assessed with Cox regression analysis. Quartiles were used when Hcy and vitamin B12 were separately studied in their relationship with fracture incidence. RESULTS: Fourteen percent of the men and 9% of the women had high Hcy (>15 microM) and low vitamin B12 (<200 pM) concentrations. Women with vitamin B12 levels <200 pM and Hcy concentrations >15 microM had lower BUA, higher DPD/Cr, and higher OC concentrations than their counterparts. In men, no differences were found between the different Hcy and vitamin B12 categories in adjusted means of BUA, OC, or DPD/Cr(urine). Twenty-eight men and 43 women sustained a fracture during the 3-year follow-up period. The adjusted RR for fractures (95% CI) for men with high Hcy and/or low vitamin B12 concentrations was 3.8 (1.2-11.6) compared with men with normal Hcy and vitamin B12 concentrations. Women with high Hcy and/or low vitamin B12 concentrations had an adjusted RR for fractures of 2.8 (1.3-5.7). CONCLUSIONS: High Hcy and low vitamin B12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk.

Aged↗
PubMed2004

Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer.

OBJECTIVE: First, to validate the LASA Physical Activity Questionnaire (LAPAQ) by a 7-day diary and a pedometer in older persons. Second, to assess the repeatability of the LAPAQ. Third, to compare the feasibility of these methods. STUDY DESIGN AND SETTING: The study was performed in a subsample (n=439, aged 69-92 years) of the Longitudinal Aging Study Amsterdam (LASA). The LAPAQ was completed twice (1998/1999, 1999/2000). Respondents completed a 7-day activity diary and wore a pedometer for 7 days (1999/2000). RESULTS: The LAPAQ was highly correlated with the 7-day diary (r=0.68, P<.001), and moderately with the pedometer (r=0.56, P<.001). The repeatability of the LAPAQ was reasonably good (weighted kappa: 0.65-0.75). The LAPAQ was completed in 5.7+/-2.7 min, and 0.5% of the respondents had missing values. CONCLUSION: The LAPAQ appears to be a valid and reliable instrument for classifying physical activity in older people. The LAPAQ was easier to use than the 7-day diary and pedometer.

Activities of Daily Living↗
PubMed2004

Do patients with OCD and pathological gambling have similar dysfunctional cognitions?

The obsessive-compulsive spectrum disorder (OCSD) theory postulates that a wide range of disorders is closely related to OCD. Current cognitive models ascertain that certain beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of OCD. This study examined whether pathological gambling, a disorder belonging to the OC spectrum, is characterized by similar dysfunctional cognitions as OCD. Dysfunctional beliefs of OCD patients were compared to those of patients with pathological gambling, panic disorder and normal controls. These beliefs were measured by the Obsessive-compulsive Beliefs Questionnaire-87 (OBQ-87), which was developed by a group of leading OCD researchers [Behav. Res. Ther. 35 (1997) 667]. It was hypothesized that according to the OCSD theory, pathological gamblers would exhibit similar cognitions to OCD patients, as well as increased levels of OCD symptoms. Analysis showed that OCD patients exhibited higher OBQ-87 scores than both panic patients and normal controls, but equal to pathological gambling patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC spectrum theory for pathological gambling, moreover being contradictory to contemporary cognitive OCD models.

Adult↗
PubMed2004

Instruments to assess decision-making capacity: an overview.

OBJECTIVE: The main objective of this article is to evaluate and describe instruments for assessing decision-making capacity in psychiatry and psychogeriatrics, and to evaluate them for use in daily practice. METHODS: The instruments were selected in Medline articles. We focus on the relationship between these instruments and the concept of competence, represented in the following elements: context in which an instrument is developed, disclosure of information, standards to assess decision-making capacity, the scale or threshold model, and validity and reliability. RESULTS: The developmental context influences how information is provided and standards defined. Although it is not clear how decision-making capacity relates to competency judgments, most instruments provide good reliability. CONCLUSIONS: Comparison of the different instruments opens directions for future research. Although instruments can never replace a physician's judgment, they may provide a clear starting point for a discussion on competence. In daily practice assessments, attention should be given to information disclosure, the influence of our own normative values in evaluating standards of decision-making capacity, and the relation between decision-making capacity and competence.

Aged↗
PubMed2004

Consequences of falling in older men and women and risk factors for health service use and functional decline.

OBJECTIVES: (1) to examine consequences of falls in older men and women and (2) to examine risk factors for health service use and functional decline among older fallers. METHODS: the study was performed within the Longitudinal Aging Study Amsterdam. In 1998/1999, potential risk factors were assessed during the third data collection. In 1999/2000, 204 community-dwelling persons (> or =65 years) who reported at least one fall in the year before the interview, were asked about consequences of their last fall, including physical injury, health service use, treatment and functional decline (i.e. decline in functional status, social and physical activities). RESULTS: as a consequence of falling, respondents reported physical injury (68.1%), major injury (5.9%), health service use (23.5%), treatment (17.2%), and decline in functional status (35.3%), and social (16.7%) and physical activities (15.2%). Using multivariate logistic regression, specific risk factors for health service use after falling could not be identified. Female gender (OR = 2.8, 95% CI = 1.5-5.1), higher medication use (OR = 1.5, 95% CI = 1.0-2.2) and depressive symptoms (OR = 1.9, 95% CI = 1.3-2.8) were independently associated with functional decline after falling. Depressive symptoms (OR = 2.0, 95% CI = 1.2-3.3) and falls inside (OR = 2.6, 95% CI = 1.1-6.5) were risk factors for decline in social activities, while female gender (OR = 2.7, 95% CI = 1.1-7.0) and depressive symptoms (OR = 1.9, 95% CI = 1.2-3.0) were risk factors for decline in physical activities after falling. CONCLUSIONS: almost 70% of the respondents suffered physical injury, almost one-quarter used health services and more than one-third suffered functional decline after falling. No risk factors were found for health service use needed after falling. Female gender, higher medication use, depressive symptoms and falls inside were risk factors for functional decline after falling.

Accidental Falls↗
PubMed2003

Prevention of hip fractures by external hip protectors: a randomized controlled trial.

CONTEXT: Several randomized controlled trials have been performed to examine the effectiveness of external hip protectors in reducing the incidence of hip fractures, but the results are controversial. OBJECTIVE: To examine the effectiveness of hip protectors in reducing the incidence of hip fractures in an elderly high-risk population. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of elderly persons aged 70 years or older, who have low bone density, and are at high risk for falls. Participants lived in apartment houses for the elderly, homes for the elderly, and nursing homes in Amsterdam and surrounding areas in the Netherlands. They were enrolled in the study between March 1999 and March 2001; the mean follow-up was 69.6 weeks. Of the 830 persons who were screened, 561 persons were enrolled. INTERVENTION: External hip protector. Both groups received written information on bone health and risk factors for falls. MAIN OUTCOME MEASURE: Time to first hip fracture. Survival analysis was used to include all participants for the time they participated. RESULTS: In the intervention group, 18 hip fractures occurred vs 20 in the control group. Four hip fractures in the intervention group occurred while an individual was wearing a hip protector. At least 4 hip fractures in the intervention group occurred late at night or early in the morning. Both in univariate analysis (log-rank P =.86) and in multivariate analysis (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.55-2.03), no statistically significant difference between the intervention group and control group was found with regard to time to first hip fracture. In addition, the per protocol analysis in compliant participants did not show a statistically significant difference between the groups (HR, 0.77; 95% CI, 0.25-2.38). CONCLUSION: The hip protector studied was not effective in preventing hip fractures.

Accidental Falls↗
PubMed2003

A classification tree for predicting recurrent falling in community-dwelling older persons.

OBJECTIVES: To develop a classification tree for predicting the risk of recurrent falling in community-dwelling older persons using tree-structured survival analysis (TSSA). DESIGN: A prospective cohort study. SETTING: A community in the Netherlands. PARTICIPANTS: One thousand three hundred sixty-five community-dwelling older persons (>/=65) from the Longitudinal Aging Study Amsterdam (LASA). MEASUREMENTS: In 1995, physical, cognitive, emotional, and social aspects of functioning were assessed. Subsequently, a prospective fall follow-up, specifically on recurrent falls (two falls within 6 months) was conducted for 3 years. RESULTS: The classification tree included 11 end groups differing in risk of recurrent falling based on a minimum of two and a maximum of six predictors. The first split in the tree involved two or more falls versus fewer than two falls in the year preceding the interview. Respondents with two or more falls in the year preceding the interview (n=193) and with at least two functional limitations (n=98) had a 75% risk of becoming a recurrent faller, whereas respondents with fewer than two functional limitations were further divided into a group with regular dizziness (n=11, risk of 68%) and a group with no regular dizziness (n=84, risk of 30%). In respondents with fewer than two falls in the year preceding the interview (n=1,172), the risk of becoming a recurrent faller varied between 9% and 70%. Predictors in this branch of the tree were low performance, low handgrip strength, alcohol use, pain, high level of education, and high level of physical activity. CONCLUSION: This classification tree included 11 end groups differing in the risk of recurrent falling based on specific combinations of a maximum of six easily measurable predictors. The classification tree can identify subjects who are eligible for preventive measures in public health strategies.

Accidental Falls↗
PubMed2002

Attrition in the Longitudinal Aging Study Amsterdam. The effect of differential inclusion in side studies.

This study addresses the relation between attrition and characteristics of the study protocol, specifically contact frequency, and respondent burden. The study is based on data from a longitudinal study with side studies on various topics, so that respondents have differential exposure to these study characteristics. Attrition outcomes are refusal and ineligibility through frailty. The effect of side study contact frequency and respondent burden on these outcomes is examined in two analytical samples: (1) baseline participants surviving to the first follow-up after 10 months (sample I), and (2) first follow-up participants surviving to the second follow-up after 3 years (sample II). Attrition during the first study interval was higher than during the second study interval, 15.5 and 5.4%, respectively. In sample I, the request to participate in a side study on social network implied an increased risk of refusal to participate at first follow-up if subjects refused the request (RR 8.34). However, if subjects participated in the network study, their risk of refusal was decreased (RR 0.42). In sample II, requests to participate in one to four side study cycles increased the risk of refusal to participate at second follow-up if subjects participated in fewer cycles than requested (RR 9.21). If subjects participated in all side study cycles that they were approached for, even if the number of cycles was five or more, this had an opposite effect: it decreased the risk of refusal (RR 0.18). Ineligibility was not significantly associated with contact frequency or respondent burden. Furthermore, neither contact frequency nor respondent burden related refusal was selective with respect to socio-demographic characteristics and physical and mental health indicators. It is concluded that contact frequency is nonlinearly associated with attrition. The findings further suggest that designing a series of side studies within the "longitudinal paradigm" does not severely damage the study's validity in terms of selective attrition.

Aged↗
PubMed2002

Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls.

It is not clear which specific cognitive function is strongest related to falls. To investigate this, not only "general cognitive functioning," but also "nonverbal and abstract reasoning," "information processing speed," and "immediate memory" were related to falls. Furthermore, relevant effect modifiers, confounders, and mediators were identified. This study was performed within the Longitudinal Aging Study Amsterdam (LASA), a multidisciplinary, prospective cohort study. In this study (n = 1437), an interaction between "immediate memory" and age was found. In persons aged 75 years and over, "immediate memory," as measured by the 15 Words Test, showed to be an independent risk factor for falls. Part of this relationship was explained by the mediating effects of activity, mobility, and grip strength. The association between the other cognitive functions and falls was only statistically significant in univariate analysis. We conclude that "immediate memory" is an independent risk factor for recurrent falls in persons aged 75 years and older.

Accidental Falls↗