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Biomedical subjects

M van den Akker

Publications and source records attributed to M van den Akker.

At least 19 recordsLinked to original sources
PubMed2006

Which clinical signs and symptoms predict hypoxemia in acute childhood asthma?

OBJECTIVE: To find the clinical signs that are the best predictors of hypoxemia (SpO2 =92%) in acute asthma in children. METHODS: Color of skin, dyspnea (by single breath counting), alertness, respiratory rate, presence of audible wheeze, wheezing on auscultation, accessory muscle use, nasal flaring, pulse rate, systolic and diastolic blood pressure, pulsus paradoxus and oxygen saturation at room air (by pulse oximetry) were recorded at the time of presentation and one hour after presentation after completion of 3 doses of nebulized salbutamol and budesonide. RESULTS: Hypoxemia (SpO2 92% pounds sterling) was seen in 45% children at presentation and 14(28.6%) after one hour. The clinical signs that correlated significantly with hypoxemia at both time points were dyspnea assessed by single breath count (OR 3.3, 95% CI 0.9-12.9), accessory muscle use score > or = 3 (OR 3.0, 95% CI 0.9-15.4) and pulsus paradoxus> 10 (OR 3.0, 95% CI 0.7-13.6). In a multiple logistic regression model accessory muscle score > or = 3 and pulsus paradoxus> 10 were identified as independent predictors of hypoxemia (sensitivity 64.3%, specificity 91%). CONCLUSION: Physical assessment in a child with acute exacerbation of asthma should at least include accessory muscle use and pulsus paradoxus, since these predict hypoxemia the best.

Acute Disease↗
PubMed2006

The prevalence of intellectual disability in Limburg, the Netherlands.

BACKGROUND: Current changes in care philosophy and diversity in care arrangements caused the need for a new estimate of the number of people with intellectual disability (ID), based on recent data. Previous estimates were based on client registrations, which was thought unreliable at this time. This manuscript studies the question how many people with ID can be found in (part of) the Netherlands. METHODS: Identification of people with ID through a combination of general practice (GP) data bases and service registrations in the province of Limburg. RESULTS: The prevalence of people with ID appeared to be between 0.64% and 0.70%. About 0.21-0.27% were living with family or on their own; 55% of them did not use common ID services. CONCLUSION: Results are based on a combination of identification methods. Thirteen per cent of uncertain cases led to minimum and maximum estimates of the population. Limitations of the method and alternative ways of data collection are discussed.

Adolescent↗
PubMed2006

Cardiac diseases in people with intellectual disability.

BACKGROUND: In people with ID there is more morbidity than in the general population, including cardiac diseases. Dutch figures on this subject are scarce. METHODS: Descriptive study of the prevalence of cardiac diseases in 436 residential clients in Echt, the Netherlands, and comparisons between men and women, age groups, and level and aetiology of ID, were carried out. RESULTS: It was found that the total prevalence of cardiac diseases was 14%, with a higher prevalence among women, the elderly, and people with mild/moderate ID. CONCLUSIONS: The prevalence of cardiac diseases in residential clients is substantial. With the increasing number of ageing people with ID and people with ID living more independently in community-integrated residences, it is expected that the morbidity and mortality from cardiac diseases will increase further.

Adult↗
PubMed2005

Nutritional deficiency in Dutch primary care: data from general practice research and registration networks.

OBJECTIVE: To explore incidence and prevalence rates of nutritional deficiency in adults in general practice. METHODS: Six Dutch general practice research and registration networks supplied incidence and prevalence rates of nutritional deficiency by the International Classification of Primary Care (ICPC) or 'E-list' labels ('loss of appetite, feeding problem adult, iron, pernicious/folate deficiency anaemia, vitamin deficiencies and other nutritional disorders, weight loss'). In case of disease-related nutritional deficiency, we asked whether this was labelled separately ('co-registered') or included in the registration of the underlying disease. RESULTS: 'Iron deficiency anaemia' had highest incidence (0.3-8.5/1000 person years), and prevalence rates (2.8-8.9/1000 person years). Nutritional deficiency was mostly documented in the elderly. In two networks 'co-registration' was additional, two only documented the underlying disease and two did not specify 'co-registration'. No clear difference was found between networks considering the difference in 'co-registration'. CONCLUSION: Nutritional deficiency is little documented in general practice, and generally is not registered separately from the underlying disease.

Adolescent↗
PubMed2005

Regional differences in cardiovascular risk factor profile cannot fully explain differences in cardiovascular morbidity in the Netherlands: a comparison of two urban areas.

BACKGROUND: Our objective was to investigate whether a region in the south of the Netherlands (Heerlen/Kerkrade) had a high burden of cardiovascular disease in comparison with a nearby region (Maastricht) and the average Dutch population, respectively. We also wanted to determine if there are interregional differences in cardiovascular risk factor profile. DESIGN: Cross-sectional study. METHODS: Data from a nationwide registry (CBS) were used to analyse cardiovascular mortality in the two regions and the average in the Netherlands. Data from a primary care morbidity registration network (RNH) were used to compare cardiovascular morbidity and cardiovascular risk factors in both regions. A standardisation procedure was carried out for age and sex. Data were analysed using logistic regression analyses. RESULTS: The overall cardiovascular mortality rate was higher in the Heerlen/Kerkrade region (7.8 per thousand) compared with Maastricht (6.1 per thousand, OR=1.3, 95% CI 1.2-1.5) and the average in the Netherlands (5.7 per thousand). Similarly, most cardiovascular morbidity rates for Heerlen/Kerkrade were more elevated compared with the RNH overall and with Maastricht. Prevalence rates of risk factors such as diabetes mellitus (7.2%, OR=1.5, 95% CI 1.3-1.7) and overweight (10.8%, OR= 2.0, 95% CI 1.8-2.2) were significantly higher in the Heerlen/Kerkrade region compared with Maastricht. There were no differences with regard to hypertension (15.2%, OR=1.0, 95% CI 0.9-1.1). CONCLUSION: Heerlen/Kerkrade is indeed a region with a high burden of cardiovascular disease. Differences in morbidity between Heerlen/Kerkrade and Maastricht cannot be fully explained by differences in cardiovascular risk factor profile.

Adult↗
PubMed2004

Is depression related to subsequent diabetes mellitus?

OBJECTIVE: To compare the risk of developing diabetes mellitus (DM) in the general population between subjects who had a depression and subjects who never had a depression. METHOD: Retrospective cohort design. People with depression were diagnosed with a depression between 1975 and 1990; controls never had a depression. Both groups were followed for a diagnosis of type II diabetes until 2000. Data on 1334 depressed and 66 670 non-depressed subjects were available from a large general practice-based database. RESULTS: No overall relation was found, but among males below age 50 there was a 78% increase in the rate of development of DM compared with non-depressed patients (hazard ratio 1.78, 95% CI: 1.21-2.62). CONCLUSION: Depression in males between the age of 20 and 50 years is related to an increased risk of developing DM.

Adolescent↗
PubMed2002

Increased risk of Parkinson's disease after depression: a retrospective cohort study.

BACKGROUND: Depression has been linked to the occurrence of a number of somatic diseases. There are no data for PD. OBJECTIVE: To determine if depression is associated with a subsequent risk for PD. METHODS: A retrospective cohort study design based in general practice was applied. All subjects diagnosed with depression between 1975 and 1990 were included and matched with subjects with the same birth year who were never diagnosed with depression. Follow-up ended at April 30, 2000. Hazard ratios (HR) and 95% CI were calculated using Cox proportional hazards models adjusted for age, sex, and socioeconomic status. Subgroups based on sex and age at diagnosis of depression were evaluated separately. RESULTS: Among the 1,358 depressed subjects, 19 developed PD, and among the 67,570 nondepressed subjects, 259 developed PD. The HR (95% CI) for depressed vs nondepressed subjects was 3.13 (1.95 to 5.01) in multivariable analysis. Associations in subgroups were comparable with the overall association. CONCLUSION: A strong positive association was found between depression and subsequent incidence of D.

Adult↗
PubMed2001

[Roaming through methodology. XXXII. False test results].

The number of requests for diagnostic tests is rising. This leads to a higher chance of false test results. The false-negative proportion of a test is the proportion of negative test results among the diseased subjects. The false-positive proportion is the proportion of positive test results among the healthy subjects. The calculation of the false-positive proportion is often incorrect. For example, instead of 1 minus the specificity it is calculated as 1 minus the positive predictive value. This can lead to incorrect decision-making with respect to the application of the test. Physicians must apply diagnostic tests in such a way that the risk of false test results is minimal. The patient should be aware that a perfectly conclusive diagnostic test is rare in medical practice, and should more often be informed of the implications of false-positive and false-negative test results.

Data Interpretation, Statistical↗
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

Problems in determining occurrence rates of multimorbidity.

This article describes methodological decisions that have to be made when studying multiple pathology and presents appropriate analytical techniques. The main question of this article is: how can comorbidity and multimorbidity be operationalized with respect to the number and type of diseases studied, and which analytic approaches are available for the evaluation of multiple pathology? Choices regarding the number and type of diseases studied have great impact on the observed incidence and prevalence rates of comorbidity and multimorbidity. These rates are largely dependent on age, sex, and other determinants. In addition to crude descriptive measures, odds ratios and relative risks can be used to study comorbidity, whereas multimorbidity can be studied using observed/expected ratios. While basic analyses of comorbidity can be performed using standard statistical packages, two additional programs were developed for the analysis of the distribution of multimorbidity and statistically unexpected comorbidity, respectively. As some analyses are addressing multicomparisons, external validity testing is recommended.

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↗
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

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↗
PubMed1997

Prevalence and incidence of health problems in people with intellectual disability.

The objective of this study was to determine the prevalence and incidence of the most frequent chronic health problems in relation to age in people with intellectual disabilities living in residential facilities in the Netherlands. A prospective cohort study was done with four data collections, each with an interval of one year. Data were collected by means of questionnaires which were completed by each person's physician. Striking results included the reported high prevalence and incidence of visual and hearing impairment, which was even more pronounced in people with Down's syndrome than in people with intellectual disability resulting from other causes. Gastrointestinal problems also appeared to have high incidence rates. Dementia was frequently reported in people with Down's syndrome aged 40 years and older. The results reflect the need for a more predictive policy which can anticipate health problems in people with intellectual disability.

Adolescent↗
PubMed1997

[Surgical treatment of genito-urinary prolapse by abdominal approach with promotofixation and setting of an anterior subvesical prosthesis combined with retropubic colpopexia: anatomical and functional results in 104 patients].

A homogeneous series of 104 patients with genito-urinary prolapse or urinary incontinence is reported. Surgical treatment combined promotofixation with (n = 45) or without (n = 59) subtotal hysterectomy, retropubic colpopexia and in certain cases posterior colpoperineorraphia with myorraphia of the levator ani (n = 28). Anatomic results were excellent for bladder and uterine ptosis. Moderate results were obtained for rectoceles and procedures involving the posterior perineum. A rectovaginal prosthesis or complete repair of the rectovaginal wall appeared to be required to improve results for rectoceles. Urine function was good for urinary incontinence: 91% success. Results depended on the pressure of the uretral closure. A complete urodynamic work-up is required prior to surgery in case of sphincter failure. Poor results were also related to excessive posterior traction which can open the cervico-uretral angle. Treatment of genito-urinary prolapse with promotofixation in combination with retropubic colpopexia is a reliable reproducible technique which gives excellent long-term results if excessive promontory traction is avoided and if, in certain cases, the rectovaginal wall is repaired or a prosthesis implanted when maximum uretral closure pressure is weak.

Adult↗