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PURPOSE: This focus group study aimed to explore experiences and perceptions on post-stroke fatigue guidance in Dutch rehabilitation and follow-up care among people/patients with stroke and health professionals. METHODS: Ten persons with stroke and twelve health professionals with different professions within stroke rehabilitation or follow-up care in the Netherlands were purposively sampled and included. Eight online focus group interviews were conducted. We analysed the data using reflexive thematic analysis. RESULTS: Three themes were identified. Guidance in fatigue management did not always match the needs of people/patients with stroke. Professionals were positive about the provided fatigue guidance (e.g. advice on activity pacing), but found it could be better tailored to the situation of people/patients with stroke. Professionals believe the right time for post-stroke fatigue guidance is when people/patients with stroke are motivated to change physical activity behaviour to manage fatigue - mostly several months after stroke - while people/patients with stroke preferred information on post-stroke fatigue well before discharge. Follow-up care and suggestions for improvement described that follow-up support after rehabilitation by a stroke coach is not implemented nationwide, while people/patients with stroke and professionals expressed a need for it. CONCLUSIONS: The study findings will help guide improvement of fatigue guidance in stroke rehabilitation programmes and stroke follow-up care aiming to improve physical activity, functioning, participation, and health.
We recommend fatigue guidance, including peer support, to be accessible to all people after stroke and for health professionals to pay attention to acceptance of the stroke.To improve fatigue guidance, we suggest providing information on post-stroke fatigue to people after stroke and their relatives well before discharge from stroke rehabilitation.Tailored advice on activity pacing during and after stroke rehabilitation is important to fill the current unmet need of people after stroke to manage fatigue and to gradually improve participation, physical activity behaviour and health.We recommend to health professionals working in stroke rehabilitation to tailor the rehabilitation schedule to their patients' energy level and perception of fatigue levels.
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AIM: To examine the hypothesis that, based on their glucose curves during a seven-point oral glucose tolerance test, people at elevated type 2 diabetes risk can be divided into subgroups with different clinical profiles at baseline and different degrees of subsequent glycaemic deterioration. METHODS: We included 2126 participants at elevated type 2 diabetes risk from the Diabetes Research on Patient Stratification (IMI-DIRECT) study. Latent class trajectory analysis was used to identify subgroups from a seven-point oral glucose tolerance test at baseline and follow-up. Linear models quantified the associations between the subgroups with glycaemic traits at baseline and 18 months. RESULTS: At baseline, we identified four glucose curve subgroups, labelled in order of increasing peak levels as 1-4. Participants in Subgroups 2-4, were more likely to have higher insulin resistance (homeostatic model assessment) and a lower Matsuda index, than those in Subgroup 1. Overall, participants in Subgroups 3 and 4, had higher glycaemic trait values, with the exception of the Matsuda and insulinogenic indices. At 18 months, change in homeostatic model assessment of insulin resistance was higher in Subgroup 4 (ß = 0.36, 95% CI 0.13-0.58), Subgroup 3 (ß = 0.30; 95% CI 0.10-0.50) and Subgroup 2 (ß = 0.18; 95% CI 0.04-0.32), compared to Subgroup 1. The same was observed for C-peptide and insulin. Five subgroups were identified at follow-up, and the majority of participants remained in the same subgroup or progressed to higher peak subgroups after 18 months. CONCLUSIONS: Using data from a frequently sampled oral glucose tolerance test, glucose curve patterns associated with different clinical characteristics and different rates of subsequent glycaemic deterioration can be identified.
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Glicemia/metabolismo , Peptídeo C/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Intolerância à Glucose/metabolismo , Resistência à Insulina , Secreção de Insulina , Insulina/metabolismo , Idoso , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Intolerância à Glucose/classificação , Teste de Tolerância a Glucose , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Medição de RiscoRESUMO
PURPOSE: To identify Health-related Quality of Life (HR-QoL) trajectories in a large heterogeneous cohort of people with a physical disability and/or chronic disease during and after rehabilitation and to determine which factors before discharge are associated with longitudinal trajectory membership. METHODS: A total of 1100 people with a physical disability and/or chronic disease were included from the longitudinal cohort study Rehabilitation, Sports and Active lifestyle. All participants participated in a physical activity promotion programme in Dutch rehabilitation care. HR-QoL was assessed using the RAND-12 Health Status Inventory questionnaire at baseline (T0: 3-6 weeks before discharge) and at 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. A data-driven approach using Latent Class Growth Mixture modelling was used to determine HR-QoL trajectories. Multiple binomial multivariable logistic regression analyses were used to determine person-, disease- and lifestyle-related factors associated with trajectory membership. RESULTS: Three HR-QoL trajectories were identified: moderate (N = 635), high (N = 429) and recovery (N = 36). Trajectory membership was associated with person-related factors (age and body mass index), disease-related factors (perceived fatigue, perceived pain and acceptance of the disease) and one lifestyle-related factor (alcohol consumption) before discharge from rehabilitation. CONCLUSIONS: Most of the people who participated in a physical activity promotion programme obtained a relatively stable but moderate HR-QoL. The identified HR-QoL trajectories among our heterogeneous cohort are disease-overarching. Our findings suggest that people in rehabilitation may benefit from person-centred advice on management of fatigue and pain (e.g. activity pacing) and the acceptance of the disability.
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Pessoas com Deficiência/psicologia , Promoção da Saúde/métodos , Qualidade de Vida/psicologia , Doença Crônica , Estudos de Coortes , Exercício Físico , Feminino , Humanos , Estilo de Vida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Children with cerebral palsy (CP) present altered gait patterns and electromyography (EMG) activity compared to typically developing children. To temporarily reduce muscular activity and to correct the abnormal muscle force balance, Botulinum Toxin type A (BTX-A) injections are used. RESEARCH QUESTION: What is the effect of BTX-A injections on dynamic muscle forces during gait, when calculated using an EMG-constrained approach?. METHODS: Retrospective data of ten typically developing (TD) and fourteen children with spastic diplegic CP were used for musculoskeletal modeling and dynamic simulations of gait, before and after BTX-A treatment. Individual muscle forces were calculated using an EMG-constrained optimization, in which EMG of eight muscles was used as muscle excitation signal to constrain the muscle activation patterns. Paired t-tests were used to compare average modelled muscle forces in different phases of the gait cycle pre- and post-BTX-A, summarized in the muscle profile score. Two-sample t-tests were used to determine significant differences between TD and pre- and post-BTX-A modelled muscle forces. RESULTS: For most muscles, the force was decreased in CP compared to TD children in all phases of the gait cycle, both before and after BTX-A treatment. Differences in muscle forces before and after BTX-A treatment were limited, with only few significant differences between pre- and post-BTX-A. Compared to a standard static optimization approach, imposing the EMG activity increased modelled muscle forces for most muscles. SIGNIFICANCE: Our findings indicate that BTX-A treatment has a limited effect on the muscle balance in CP children. Besides that, the use of EMG-constrained optimization is recommended when studying muscle balance in children with CP.
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Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/tratamento farmacológico , Marcha/fisiologia , Fármacos Neuromusculares/uso terapêutico , Toxinas Botulínicas Tipo A/farmacologia , Criança , Feminino , Humanos , Masculino , Fármacos Neuromusculares/farmacologia , Estudos RetrospectivosRESUMO
BACKGROUND: Children with overweight or obesity are at risk for developing obesity in adulthood. Certain maternal characteristics, such as ethnicity, education, body mass index (BMI) or neighbourhood, are determinants for childhood overweight risk. There are large variations in how mothers differing in these characteristics feed their infants. Therefore, associations of age at complementary feeding, exclusive breast feeding duration with childhood overweight may differ in these groups. Understanding these associations would be essential to develop overweight prevention strategies. OBJECTIVES: The objective of this study is to study the associations of age at complementary feeding, exclusive breastfeeding duration with BMI-standard deviation score (SDS) at 5-6 years within risk groups. METHODS: Using data from the Amsterdam Born Children and their Development study, a population-based birth cohort (n = 4495), we formed groups of children at varying risk of overweight according to maternal characteristics of ethnicity, education, pre-pregnancy BMI and neighbourhood. Linear and logistic regression analyses were conducted. RESULTS: Complementary feeding after 5 months of age was associated with lower BMI-SDS in children of mothers of Dutch ethnicity (B: -0.12; 95% CI: -0.21, -0.04), medium-level education (-0.19; -0.30, -0.08), normal BMI (-0.08; -0.16, -0.01) and high-risk neighbourhood (-0.16; -0.29, -0.02). Compared with exclusive breastfeeding for <3 months, exclusive breastfeeding for ≥6 months was associated with lower BMI-SDS in groups of medium-level education (-0.28; 0.44, -0.11), normal BMI (-0.18; -0.29, -0.08) and medium-risk (-0.18; -0.33, -0.04) and high-risk (-0.22; -0.42, -0.02) neighbourhoods. CONCLUSIONS: Associations between infant feeding practices and childhood BMI may differ between risk groups, implying that overweight prevention strategies should be group-specific.
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Índice de Massa Corporal , Aleitamento Materno/estatística & dados numéricos , Alimentos Infantis/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Escolaridade , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Países Baixos , Estudos Prospectivos , Características de Residência/estatística & dados numéricos , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVES: Health-related quality of life (HR-QoL) of patients with heart failure (HF) is low despite the aim of HF treatment to improve HR-QoL. To date, most studies have focused on medical and physical factors in relation to HR-QoL, few data are available on the role of emotional factors such as dispositional optimism. This study examines the prevalence of optimism and pessimism in HF patients and investigates how optimism and pessimism are associated with different patient characteristics and HR-QoL. METHODS: Dispositional optimism was assessed in 86 HF patients (mean age 70 ± 9 years, 28% female, mean left ventricular ejection fraction 33%) with the Revised Life Orientation Test (LOT-R). HR-QoL was assessed with the Minnesota Living with Heart Failure Questionnaire and the EuroQol. RESULTS: The (mean ± SD) total score on the LOT-R was 14.6 ± 2.9 (theoretical range 0-24) and the scores on the subscales optimism and pessimism were 8.1 ± 1.9 and 5.5 ± 2.5, respectively. Higher age was related to more optimism (r = 0.22, p < 0.05), and optimism was associated with higher generic HR-QoL (B = 0.04, p < 0.05).Significance of resultsThe association found between optimism and generic HR-QoL of HF patients can lead to promising strategies to improve HF patients' HR-QoL, particularly because the literature has indicated that optimism is a modifiable condition.
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Insuficiência Cardíaca/psicologia , Otimismo/psicologia , Qualidade de Vida/psicologia , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Psicometria/instrumentação , Psicometria/métodos , Psicometria/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Information on the course of neck pain (NP) and low back pain (LBP) typically relies on data collected at few time intervals during a period of up to 1 year. METHODS: In this prospective, multicentre practice-based cohort study, patients consulting a chiropractor responded weekly for 52 weeks to text messages on their cell phones. Data from 448 patients (153 NP, 295 LBP) who had returned at least one set of answers in the first 26 weeks were used. Outcome measures were pain intensity (VAS) and functional outcome, assessed using four different questions: pain intensity, limitation in activities of daily living (ADL), number of days with pain in the previous week and number of days limited in ADL. Distinct patterns of pain were analysed with quadratic latent class growth analysis. RESULTS: The final model was a 4-class model for NP and LBP. The 'recovering from mild baseline pain' is most common (76.3% of NP patients/58.3% of LBP patients) followed by the 'recovering from severe baseline pain' class (16.3% NP/29.8% LBP). They follow similar trajectories when considered over a period of 6 months. Pain at baseline, duration of complaints, functional status, limitations in ADL and the score on psychosocial scales were the variables that most contributed to distinguish between groups. CONCLUSIONS: Most patients with NP or LBP presenting in chiropractic care show a trajectory of symptoms characterized by persistent or fluctuating pain of low or medium intensity. Only a minority either experience a rapid complete recovery or develop chronic severe pain. SIGNIFICANCE: Ninety percentage of patients with neck pain or low back pain presenting to chiropractors have a 30% improvement within 6 weeks and then show a trajectory of symptoms characterized by persistent or fluctuating pain of low or medium intensity. Only a minority either experience a rapid complete recovery or develop chronic severe pain.
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Dor Lombar/fisiopatologia , Cervicalgia/fisiopatologia , Atividades Cotidianas , Adulto , Progressão da Doença , Feminino , Humanos , Dor Lombar/terapia , Masculino , Manipulação Quiroprática , Pessoa de Meia-Idade , Modelos Teóricos , Cervicalgia/terapia , Medição da Dor , Estudos ProspectivosRESUMO
OBJECTIVES: Impediments due to complaints of non-traumatic arm, neck and/or shoulder (CANS) during work often leads to consultation in primary care. This study examines the occurrence of sick leave among workers with new CANS, and evaluates sick leave trajectories and their characteristics. METHODS: This prospective 2-year cohort study included workers with a new CANS presenting in general practice. Participants filled out postal questionnaires on sick leave at 6-monthly intervals. Latent class growth mixture modelling was used to identify distinct trajectories of sick leave. Multinomial regression analyses identified characteristics of the subgroups. RESULTS: During follow-up, of the 533 participants 190 reported at least one episode of sick leave due to CANS. Three sick leave trajectories were distinguished: (a) 'low risk' trajectory (n = 366), with a constant low probability over time; (b) 'intermediate risk' trajectory, with a high probability at first consultation followed by a steep decrease in probability of sick leave (n = 122); (c) 'high risk' trajectory (n = 45), with a constant high probability of sick leave. Compared to the 'low-risk' trajectory, the other trajectories were characterised by more functional limitations, less specific diagnoses, more work-related symptoms and low coworker support. Specific for the 'high-risk' subgroup were more recurrent symptoms, more musculoskeletal comorbidity, high score on somatisation and low score on job demands. CONCLUSIONS: Three trajectories of sick leave were distinguished, graded from favourable to unfavourable. Several complaint-related and work-related factors and somatisation contributed modestly to identify an unfavourable trajectory of sick leave when presenting in primary care with CANS.
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OBJECTIVES: Impediments due to complaints of non-traumatic arm, neck and/or shoulder (CANS) during work often leads to consultation in primary care. This study examines the occurrence of sick leave among workers with new CANS, and evaluates sick leave trajectories and their characteristics. METHODS: This prospective 2-year cohort study included workers with a new CANS presenting in general practice. Participants filled out postal questionnaires on sick leave at 6-monthly intervals. Latent class growth mixture modelling was used to identify distinct trajectories of sick leave. Multinomial regression analyses identified characteristics of the subgroups. RESULTS: During follow-up, of the 533 participants 190 reported at least one episode of sick leave due to CANS. Three sick leave trajectories were distinguished: (1) 'low-risk' trajectory (n=366), with a constant low probability over time; (2) 'intermediate risk' trajectory, with a high probability at first consultation followed by a steep decrease in probability of sick leave (n=122); (3) 'high-risk' trajectory (n=45), with a constant high probability of sick leave. Compared to the 'low-risk' trajectory, the other trajectories were characterised by more functional limitations, less specific diagnoses, more work-related symptoms and low coworker support. Specific for the 'high-risk' subgroup were more recurrent symptoms, more musculoskeletal comorbidity, high score on somatisation and low score on job demands. CONCLUSIONS: Three trajectories of sick leave were distinguished, graded from favourable to unfavourable. Several complaint-related and work-related factors and somatisation contributed modestly to identify an unfavourable trajectory of sick leave when presenting in primary care with CANS.
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Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Licença Médica/estatística & dados numéricos , Adolescente , Adulto , Braço/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/etiologia , Pescoço/fisiopatologia , Países Baixos/epidemiologia , Doenças Profissionais/etiologia , Atenção Primária à Saúde , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Ombro/fisiopatologia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: Glucagon-like peptide (GLP)-1 receptor agonist treatment improves ß-cell function. In this study, we investigated whether the improvements are sustained during a 3-year treatment period. RESEARCH DESIGN AND METHODS: Sixty-nine metformin-treated type 2 diabetes patients were randomised to the GLP1 receptor agonist, exenatide (EXE) twice daily (BID) or to insulin glargine (GLAR). ß-cell function parameters were derived using the Mari model from standardised breakfast and lunch meals that were administered before treatment, and after 1 and 3 years of treatment. EXE was administered before breakfast. RESULTS: Fifty-nine (EXE: n = 30; GLAR: n = 29) and thirty-six (EXE: n = 16; GLAR: n = 20) patients completed the meal at 1- and 3-year treatment respectively. After 3 years, groups had comparable glycaemic control (HbA1c: EXE 6.6 ± 0.2% and GLAR 6.9 ± 0.2%; P = 0.216). Compared with GLAR, at 1 and 3 years, EXE induced a stronger reduction in post-breakfast glucose concentrations (P < 0.001), with lower C-peptide levels (P < 0.001). Compared with GLAR, EXE increased insulin secretion at 8 mmol/L glucose throughout the study period (P < 0.01). Both treatments improved ß-cell glucose sensitivity after 1-year treatment. However, only EXE treatment sustained this improvement for 3 years. No consistent changes in other ß-cell parameters including rate sensitivity and potentiation were observed. CONCLUSIONS: Compared with GLAR, EXE improved the parameters of ß-cell function, especially insulin secretion at 8 mmol/L glucose and ß-cell glucose sensitivity, which was sustained during the 3-year treatment period.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Células Secretoras de Insulina/efeitos dos fármacos , Peptídeos/uso terapêutico , Peçonhas/uso terapêutico , Glicemia , Diabetes Mellitus Tipo 2/fisiopatologia , Exenatida , Feminino , Humanos , Hipoglicemiantes/farmacologia , Células Secretoras de Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Peptídeos/farmacologia , Período Pós-Prandial , Resultado do Tratamento , Peçonhas/farmacologiaRESUMO
AIMS: Heart failure with preserved ejection fraction (HFpEF) is common and its management remains difficult. B-type natriuretic peptide (BNP) levels are used to diagnose heart failure, and as an entry criterion for inclusion into trials. We investigated a population of HFpEF patients who had been randomised into a study based on clinical parameters, and compared those with low BNP levels to those with elevated BNP levels. METHODS: We examined patients who had been enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure (COACH), with preserved left ventricular ejection fraction (LVEF ≥ 40 %), and compared those with low BNP (< 100 pg/ml; n = 30) to those with elevated BNP (≥ 100 pg/ml; n = 127). Baseline characteristics, comorbidities, biomarkers, quality of life, and outcome parameters (hospitalisations and death) were compared between the groups. To validate our findings, we repeated all analyses for NT-proBNP (< 300 pg/ml and ≥ 300 pg/ml). RESULTS: Patients were similar with regard to most clinical characteristics (including age, sex, and LVEF), biomarkers, and comorbidities. In contrast, patients with a low BNP had higher body mass index levels (31 kg/m(2) vs. 27 kg/m(2); p < 0.01) and lower cardiac troponin I (9 pg/ml vs. 15 pg/ml; p = 0.02). In addition, these patients were less frequently prescribed diuretics and beta-blockers. No differences in quality of life, heart failure related symptoms and the primary and secondary outcomes were observed between these groups. These observations were confirmed for NT-proBNP. CONCLUSION: Among the patients with clinically diagnosed HFpEF, those with low BNP are strikingly similar to those with elevated BNP levels, except for BMI, which was significantly higher in these patients.
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AIMS: To identify HbA1c trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy. METHODS: The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (n = 9849). Inclusion criteria were: age ≥ 40 years; initiation of insulin during follow-up after failure to reach HbA1c levels ≤ 53 mmol/mol (7%) with oral glucose-lowering agents; and a follow up ≥ 2 years after initiating insulin. Latent class growth modelling was used to identify trajectories of HbA1c . Subjects considered to be 'off target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during one-third or more of the follow-up time, and those considered to be 'on target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during less than one-third of the follow-up time. RESULTS: Four HbA1c trajectories were identified. Most people (88.7%) were classified as having a stable HbA1c trajectory of ~57 mmol/mol (7.4%). Only 24.4% of the people were on target in response to insulin; this was associated with lower HbA1c levels and a higher age at the start of insulin treatment. CONCLUSIONS: Using latent class growth modelling, four HbA1c trajectories were identified. A quarter of the people starting insulin were on target. Low HbA1c levels and advanced age at the start of insulin therapy were associated with better response to insulin therapy. Initiating insulin earlier improves the likelihood of achieving and sustaining glycaemic control.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Idoso , Glicemia/metabolismo , HDL-Colesterol/metabolismo , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Triglicerídeos/metabolismoRESUMO
INTRODUCTION: Although body fat and body fat distribution are known to be related to cardiovascular diseases (CVDs), it is unknown whether specific 30-year developmental patterns of body fat are associated with CVDs. This study examines the existence of distinct developmental patterns of total fat measured by the sum of four skinfolds (S4SFs) and body fat distribution measured by the skinfold thickness ratio (SFratio), and relates these patterns to micro- and macrovascular functions. METHODS: In 2006, 259 apparently healthy subjects were examined on micro- and macrovascular functions, using video microscopy and carotid ultrasound sonography. Body fat, using both S4SFs and SFratio, was measured for 10 times over 30 years, from 13 years onwards. Latent class growth analyses (LCGA) were used to obtain distinct developmental patterns of S4SFs and SFratio. This is a data-drive hypothesis-generating approach and could possibly give a new perspective on body fatness over time. In addition, a mixed-method approach is used to obtain individual growth parameters. Linear regression analyses were used to examine the relationship of these patterns and individual growth parameters with micro- and macrovascular functions. RESULTS: LCGA identified normal and unfavourable developmental patterns in S4SFs and SFratio. Both men and women with an unfavourable developmental pattern of S4SFs showed impaired carotid compliance (ß=-0.216, P=0.004 and ß=-0.109, P=0.039, respectively), carotid distensibility (ß=-5.078, P=0.001 and ß=-5.118, P<0.001, respectively) and Young's elastic modulus (ß=0.066, P=0.065 and ß=0.107, P<0.001, respectively). In contrast, no relationship for microvascular function with developmental patterns of S4SFs was found. Developmental patterns of the SFratio were associated with neither measures of micro- nor macrovascular functions. No associations were using the individual growth parameters. CONCLUSIONS: For macrovascular function, there is a relationship of 30-year developmental patterns of S4SFs, whereas no such relationship was found for the 30-year developmental patterns of S4SFs or SFratio with microvascular function.
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PURPOSE: To validate a shortened version of the Participation Scale (P-scale) that will be quicker to use and to describe the factor structure found in the P-scale data in various study samples. METHODS: A large multi-country and multi-cultural database was compiled consisting of 5125 respondents. Item analysis, explanatory factor analysis and confirmatory factor analysis were applied to identify items for deletion and investigate the factor structure of the P-scale. RESULTS: The multi-country database included 11 databases from six different countries. Respondents were affected by a range of health conditions, including leprosy, HIV/AIDS, dermatological conditions and various disabilities. Of the respondents included 57% were male. The P-scale Short (PSS) contains 13 items. A two-factor structure, with factors named "work-related participation" (three items) and "general participation" (10 items), showed the best model fit (Comparative Fit Index = 0.983, Tucker Lewis Index = 0.979, Rooted Mean Square Error of Approximation = 0.061). The Cronbach's alphas were very good for both the whole scale and the subscales, 0.91, 0.83 and 0.90, respectively. Correlation between the two factors was high (r = 0.75) indicating that interpreting the P-scale as measuring an overall factor "participation" is still valid. A very high correlation (r = 0.99) was found between the full P-scale and the PSS. CONCLUSIONS: The findings suggest good validity of the P-scale across a range of languages and cultures. However, field testing needs to confirm the validity of the PSS to measure the level of social participation restrictions across cultures and health conditions.
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Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Participação do Paciente/psicologia , Psicometria/instrumentação , Inquéritos e Questionários , Atividades Cotidianas , Adulto , Idoso , Pessoas com Deficiência/classificação , Pessoas com Deficiência/psicologia , Análise Fatorial , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto JovemRESUMO
The chronic infection status suffered by HIV-infected individuals promotes chronic arterial inflammation and injury, which leads to dysfunction of the endothelium, atherosclerosis and thrombosis. Although HIV-1 subtype C is prevalent in South Africa and accounts for almost a third of the infections worldwide, this subtype differs genetically from HIV-1 subtype B on which the majority of studies have been done. The objective of this study was to assess whether newly identified, never-treated, HIV-1-infected South African participants showed signs of endothelial dysfunction, accelerated atherosclerosis and increased blood coagulation. We compared 300 newly diagnosed (never antiretroviraltreated) HIV-infected participants to 300 age-, gender-, body mass index- and locality-matched uninfected controls. Levels of high-density lipoprotein cholesterol (HDL-C), triglycerides, interleukin-6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), fibrinogen and plasminogen activator inhibitor-1 (PAI-1), and carotid radialis pulse wave velocity (cr-PWV) were determined. The HIV-infected participants showed lower HDL-C and higher IL-6, CRP, ICAM-1 and VCAM-1 levels compared to the uninfected controls. No differences in fibrinogen and PAI-1 levels were detected. A continuous positive trend of increasing age with cr-PWV was detected in the HIV-infected group. Our findings suggest inflammatory injury of the endothelium, pointing to endothelial dysfunction of never-treated HIV-1-infected South Africans of African ancestry. Although no indication of a prothrombotic state could be detected, there was an indication of accelerated vascular aging and probable early atherosclerosis in the older HIV-infected participants.
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População Negra , Endotélio Vascular/fisiopatologia , Infecções por HIV/etnologia , Infecções por HIV/fisiopatologia , HIV-1 , Adulto , Aterosclerose/etnologia , Aterosclerose/virologia , Coagulação Sanguínea , Estudos de Casos e Controles , Feminino , Infecções por HIV/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , África do SulRESUMO
Knowledge of how nurses experience the process of secluding a patient can be useful in improving the quality of patient care and in the prevention of work related stress in nurses. This study describes personal experiences of nurses throughout the seclusion process. The emotions which came to surface in semi-structured interviews with 8 nurses were categorized in three main themes (Tension, Trust and Power) and a stress response curve was identified in the seclusion process, with specific feelings in each phase. Feelings denied in former studies such as feeling superior, anger and disgust were found in the interviews in this study.
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Agressão/psicologia , Atitude do Pessoal de Saúde , Emoções , Transtornos Mentais/enfermagem , Isolamento de Pacientes/psicologia , Adulto , Nível de Alerta , Comportamento Perigoso , Medo , Feminino , Humanos , Entrevista Psicológica , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Países Baixos , Papel do Profissional de Enfermagem/psicologia , Isolamento de Pacientes/ética , Isolamento de Pacientes/legislação & jurisprudência , Poder Psicológico , Gestão da Segurança , ConfiançaRESUMO
OBJECTIVES: To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (>or=55 years) in primary care. DESIGN: Longitudinal cohort study, with three years' follow-up. SETTING: 32 general practices in West Friesland, the Netherlands. PARTICIPANTS: 234 patients aged 55 years or more with a prevalent major depressive disorder. MAIN OUTCOME MEASURES: Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Asberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariable analyses were used to identify variables predicting prognosis. RESULTS: The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but not in those who had recovered. CONCLUSION: Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.
Assuntos
Transtorno Depressivo/mortalidade , Idoso , Antidepressivos/uso terapêutico , Doença Crônica , Transtorno Depressivo/terapia , Métodos Epidemiológicos , Medicina de Família e Comunidade , Feminino , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prognóstico , Encaminhamento e Consulta , Fatores de TempoRESUMO
The association between black tea consumption and iron status was investigated in a sample of African adults participating in the cross-sectional THUSA (Transition and Health during Urbanization of South Africans) study in the North West Province, South Africa. Data were analysed from 1605 apparently healthy adults aged 15-65 years by demographic and FFQ, anthropometric measurements and biochemical analyses. The main outcome measures were Hb and serum ferritin concentrations. No associations were seen between black tea consumption and concentrations of serum ferritin (men P = 0.059; women P = 0.49) or Hb (men P = 0.33; women P = 0.49). Logistic regression showed that tea consumption did not significantly increase risk for iron deficiency (men: OR 1.36; 95 % CI 0.99, 1.87; women: OR 0.98; 95 % CI 0.84, 1.13) nor for iron deficiency anaemia (men: OR 1.28; 95 % CI 0.84, 1.96; women: OR 0.93; 95 % CI 0.78, 1.11). Prevalence of iron deficiency and iron deficiency anaemia was especially high in women: 21.6 and 14.6 %, respectively. However, the likelihood of iron deficiency and iron deficiency anaemia was not significantly explained by tea consumption in sub-populations which were assumed to be at risk for iron deficiency. Regression of serum ferritin levels on tea consumption in women Assuntos
Ferro/sangue
, Chá/efeitos adversos
, Adolescente
, Adulto
, Idoso
, Anemia Ferropriva/epidemiologia
, Anemia Ferropriva/etiologia
, Antropometria
, Estudos Transversais
, Dieta/estatística & dados numéricos
, Feminino
, Ferritinas/sangue
, Hemoglobinas/metabolismo
, Humanos
, Deficiências de Ferro
, Ferro da Dieta/administração & dosagem
, Masculino
, Pessoa de Meia-Idade
, Fatores de Risco
, Fatores Sexuais
, África do Sul/epidemiologia
RESUMO
BACKGROUND: Indications exist that deferral rates in blood donors are highest in summer. However, a detailed quantitative analysis is not available. The association between Hb values, deferral rates, and daily temperatures was investigated in a large data set of blood donors. STUDY DESIGN AND METHODS: The study population consisted of both plasma and whole-blood donors from the southeast region of the Netherlands. Individual Hb levels and other examination data between January 2002 and December 2004 were extracted from the donor file. Data on daily maximum temperatures were related to Hb levels and Hb deferrals. Results are reported separately for plasma and whole-blood donors as well as for men and women. RESULTS: Data were available from 106,398 whole blood donors and 6983 plasma donors, resulting in data of more than 600,000 examinations. Hb levels decreased with increasing daily temperature. Highest deferral rates were observed in summer months, which were consistent over the several groups and over the three years. The highest Hb deferral of 11.1 percent was observed for female whole-blood donors on days with a maximum temperature of 25 degrees and above. In all four donor categories a gradual increase with temperature was observed with 1.7-2.2 times higher deferral rates on hot days (> or = 25 degrees C) compared to cold days (<5 degrees C). CONCLUSION: A clear seasonal pattern in Hb levels and in the percentage of Hb deferrals was observed. The observed seasonal effect could not be explained by differences in donor characteristics. Our observations might have practical implications for donor management.