http://share.eldoc.ub.rug.nl/ SHARE repository nl_NL The present study examined construct equivalence of the teacher Strengths and Difficulties Questionnaire and compared mean scores in an ethnically diverse sample of children living in the Netherlands. Elementary schoolteachers completed the Strengths and Difficulties Questionnaire for 2,185 children aged 6 to 10 years of the four largest ethnic groups in the Netherlands, namely native Dutch (n = 684) and Moroccan (n = 702), Turkish (n = 434), and Surinamese (n = 365) immigrant children. Multigroup confirmatory factor analysis suggested the factor structure of the Strengths and Difficulties Questionnaire to be invariant across children's ethnicity and gender. Additionally, the factor structure appeared to be similar for Dutch and Surinamese teachers. However, mean scores on emotional problems, hyperactivity, conduct problems, prosocial behavior, and impairment varied significantly according to ethnicity and gender. Mean scores on peer problems differed significantly for boys and girls, but not across ethnicity. Whether mean differences reflect a method bias or actual differences in classroom behaviors is discussed and needs further research http://share.eldoc.ub.rug.nl/root2/2011/Teacraofc/ BACKGROUND AND PURPOSE: Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be ascertained. Aim of this pilot study was to investigate if patient guided Piezo-electric, focused ESWT, without local anesthesia is a safe and well tolerated treatment which improves pain and function in patients with patellar tendinopathy. METHODS: Nineteen male athletes with severe chronic patellar tendinopathy received 3 patient guided focused medium to high energy ESWT treatments at a weekly interval. Before and after 3 months VISA-P and VAS (pain) scores were recorded. Data on side effects and complications of treatment were also collected. RESULTS: No serious complications were reported and patients tolerated the treatment well. Mean VISA-P score improved from 36.1 to 50.1 (p < 0.05), VAS decreased from to 7.2 to 3.7 (p < 0.05). CONCLUSION: Patient guided Piezo-electric ESWT without local anesthesia is a safe and well tolerated treatment which should be considered as a treatment for patients with patellar tendinopathy http://share.eldoc.ub.rug.nl/root2/2010/PatiguPiE/ BACKGROUND: The purpose of this observational study was to determine the clinical results of the operative treatment of periprosthetic femoral fractures over a long period of time. METHODS: The medical records of patients treated between 1993 and 2006 for a periprosthetic femoral fracture were obtained after a survey in two major hospitals. Radiographic evaluation was performed according to the Vancouver classification. All patients were contacted to fill out the Oxford hip score. RESULTS: A total of 80 PPFs were identified in 79 patients. For 71 patients with 71 fractures, medical records and radiographs were available. The mean age at the time of fracture was 73.4 years (range: 38-95 years). The mean interval between initial arthroplasty and the time of fracture was 6.3 years. As many as 44 fractures occurred in patients with primary hip arthroplasty (62%) and 27 fractures in patients with revision implants (38%). All but two patients were treated operatively and 34 patients (48%) suffered from a complication, leading to a re-operation in 22 cases (33%). The most frequent indication for re-operation was re-fracture or implant failure. Vancouver type-C fractures lead to re-operations in 52% of the cases (11 of 20). A total of 36 patients (51%) were able to complete an Oxford hip score after a mean period of 64.9 months (range: 16-157 months). The other patients were lost to follow-up (45% were deceased and 4% were mentally impaired). The mean Oxford hip score was 27.8 (range: 12-57) and was significantly higher in patients suffering from a complication (p=0.02) and in patients with a periprosthetic fracture (PPF) after revision surgery (p=0.02). CONCLUSION: The treatment of periprosthetic femoral fractures has a high complication rate and a large number of re-operations occur. The long-term clinical results are compromised by the event of a complication. The clinical results of treated fractures after a primary arthroplasty were better than after multiple arthroplasty procedures. Particularly, Vancouver type-C fractures showed high complication rates. This high complication rate should be taken into account for future studies in PPFs http://share.eldoc.ub.rug.nl/root2/2010/Highinofc/ Background: Depression after acute coronary syndrome (ACS) is associated with worse cardiac outcomes. This systematic review evaluated whether depressed ACS patients are at differential risk depending on the recurrence and timing of onset of depressive episodes. Methods: MEDLINE, EMBASE and PsycINFO were searched from inception to 11 April 2009. Additionally, reference lists and recent tables of contents of 34 selected journals were manually searched. Eligible studies evaluated cardiovascular outcomes for subgroups of ACS patients with depression or depressive symptoms according to recurrence or onset. Results: Six studies were included that reported outcomes for subgroups of ACS patients with first-ever versus recurrent depression. Four of these reported also outcomes for post-ACS onset versus pre-ACS onset depression, and incident versus nonincident depression. Worse outcomes (odds ratio >1.4) were reported for ACS patients with first-ever depression in 3 of 6 studies (1 study p < 0.05), for patients with post-ACS onset depression in 3 of 4 studies (1 study p < 0.05, but better outcomes in one study) and for patients with incident depression in 2 of 4 studies (no studies p < 0.05). Conclusions: Although it is still suggested that ACS patients with first and new-onset depression are at particularly increased risk of worse prognosis, the inconsistent results from the studies included in this systematic review show that there is no consistent evidence to support such statements. Copyright (C) 2011 S. Karger AG, Basel http://share.eldoc.ub.rug.nl/root2/2011/Onseanreo/ Background and objectives Low physical activity (PA) is a risk factor for mortality in the general population. This is largely unexplored in renal transplant recipients (RTRs). We studied whether PA is associated with cardiovascular and all-cause mortality in a prospective cohort of RTR. Design, setting, participants, & measurements Between 2001 and 2003, 540 RTRs were studied (age, 51 12 years; 54% male). PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire). Cardiovascular and all-cause mortality were recorded until August 2007. Results Independent of age, PA was inversely associated with metabolic syndrome, history of cardiovascular disease, fasting insulin, and triglyceride concentration, and positively associated with kidney function and 24-hour urinary creatinine excretion (i.e., muscle mass). During follow-up for 5.3 years (range, 4.7 to 5.7 years), 81 RTRs died, with 37 cardiovascular deaths. Cardiovascular mortality was 11.7, 7.2, and 1.7%, respectively, according to gender-stratified tertiles of PA (P = 0.001). All-cause mortality was 24.4, 15.0, and 5.6% according to these tertiles (P < 0.001). In Cox regression analyses, adjustment for potential confounders including history of cardiovascular disease, muscle mass, and traditional risk factors for cardiovascular disease did not materially change these associations. Conclusions Low PA is strongly associated with increased risk for cardiovascular and all-cause mortality in RTRs. Intervention studies are necessary to investigate whether PA improves long-term survival after renal transplantation. Clin J Am Soc Nephrol 6: 898-905, 2011. doi: 10.2215/CJN.03340410 http://share.eldoc.ub.rug.nl/root2/2011/Lowphaca/ Background: Data about follow-up after acute pharmacological treatment of psychotic depression are scarce. Methods: A 4 month open follow-up was done, preferentially with same medication as during acute treatment, of patients (n=59) with DSM-IV-TR major depressive disorder with psychotic features, aged 18 to 65 years, who had completed as responders an acute double-blind 7 week trial with imipramine, venlafaxine or venlafaxine plus quetiapine. Main outcome measures were Hamilton Rating Scale for Depression and Clinical Global Impression Scale. Results: Six patients dropped out during the 4 month follow-up. Almost all patients (86.4%; 51/59) remained responder while remission rate increased from 59.3% (35/59) to 86.8% (46/53), independent of treatment. Relapse rate was low (3.8%; 2/53). Tolerability was good. Weight increased with all treatments. Limitations: Limitations were the limited sample size and consequent limited statistical power. The treatment during follow-up was not double-blind. Conclusions: Continuation treatment with the same medication that was effective in the acute treatment trial, remained effective during the 4 month follow-up in many patients leading to further improvement, and was well tolerated. (C) 2009 Elsevier B.V. All rights reserved http://share.eldoc.ub.rug.nl/root2/2010/Longretos/ Children of asylum seekers are at risk for psychosocial problems because of their flight history and exceptional living circumstances. This study aims to assess the association of sociodemographic factors and asylum procedural factors with psychosocial problems of asylum seekers' children, and differences herein by informant (parents, teachers, and children). To this end, we obtained data on psychosocial problems among a random sample of 267 children aged 4 to 16, living in Dutch asylum seekers' centers, using the multi-informant Strength and Difficulties Questionnaire. The results show that the prevalence rate of psychosocial problems among asylum seekers' children was high. The occurrence was not associated with asylum-procedural variables but only with child-contextual factors such as mental health of the mother and leaving behind a parent in the country of origin. The associations varied in strength by informant. Therefore, preventive and supportive measures to improve psychosocial health of young asylum-seekers should concentrate on these contextual issues http://share.eldoc.ub.rug.nl/root2/2011/Psycprina/ There is an ongoing drive to measure and improve quality of care. Donabedians' quality framework with structure, process and outcome domains provides a useful hold to examine quality of care. The aim of this study was to address the effect of an intervention in hospital structure (integration of three units into one) with the purpose of improving processes (increase meeting, cooperation and communication between professionals and patients) and its effect on the outcome (cancer patient satisfaction). Pre-test-post-test. University Medical Center Utrecht, The Netherlands, Department of Medical Oncology. Cancer patients (n = 174, n = 97). Physical integration by bringing separately located units (outpatient clinic, day-care clinic, clinical ward) together in one wing of the hospital and adjustments in communication and coordination structures. Patient satisfaction questionnaire. Satisfaction with care improved for six scales (27%) after integration. Effect sizes (ESs) ranged from 0.36 to 0.80, indicating a small to moderate effect. The most important improvement was found at the day-care clinic on aspects like 'the degree in which the nurses were informed about a patients situation', 'privacy', 'interior design', 'quality of hospital equipment', 'sanitary supplies' and 'waiting periods'. With regard to continuity and coordination of care, satisfaction increased for five items (28% of items concerning continuity and coordination of care). ESs ranged from 0.42 to 0.75. Integration of three oncology units into one unit had a positive impact on care delivery processes and resulted in improved patient satisfaction concerning care and treatment http://share.eldoc.ub.rug.nl/root2/2010/Impaofino/ Aim. Improving quality of care for cancer patients requires insight into their specific wishes, needs, and preferences concerning cancer care. The aim of this study was to explore the impact of gender on cancer patients' needs and preferences. Patients and Methods. Data were obtained from 386 questionnaires assessing cancer patients' preferences for health care. Multivariate regression analyses were performed with data obtained from medical oncology patients treated in seven Dutch hospitals, using the scales of the questionnaire as dependent variables. Results. Patients rated safety, expertise, performance, and attitude of physicians and nurses highest on their list of preferences. There were significant differences between male and female patients concerning preferences in health care in 15 of the 21 scales and in two of the eight single items. Without exception, women found the care aspects mentioned in these scales and items more important than men. Multivariate regression analysis showed that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences. Conclusion. Gender impacts cancer patients' needs and preferences and should be taken into account for optimal cancer care. Cancer care might be tailored toward gender, for example, with regard to the means and extent of communication, manner and extent of support, counseling and rehabilitation, consultation length, and physician assignment. The results of this study may guide health care professionals and organizations to develop a gender-specific health care approach to further improve cancer patient-centered care. The Oncologist 2010;15:648-655 http://share.eldoc.ub.rug.nl/root2/2010/Gendneanp/ Background: Health care for cancer patients is primarily shaped by health care professionals. This raises the question to what extent health care professionals are aware of patients' preferences, needs and values. The aim of this study was to explore to what extent there is concordance between patients' preferences in cancer care and patients' preferences as estimated by health care professionals. We also examined whether there were gender differences between health care professionals with regard to the degree in which they can estimate patients' preferences correctly. Methods: To obtain unbiased insight into the specific preferences of cancer patients, we developed the 'Cancer patients' health care preferences' questionnaire'. With this questionnaire we assessed a large sample of cancer patients (n = 386). Next, we asked health care professionals (medical oncologists, nurses and policymakers, n = 60) to fill out this questionnaire and to indicate preferences they thought cancer patients would have. Mean scores between groups were compared using Mann-Whitney tests. Effect sizes (ESs) were calculated for statistically significant differences. Results: We found significant differences (ESs 0.31 to 0.90) between patients and professionals for eight out of twenty-one scales and two out of eight single items. Patients valued care aspects related to expertise and attitude of health care providers and accessibility of services as more important than the professionals thought they would do. Health care professionals overestimated the value that patients set on particularly organisational and environmental aspects. We found significant gender-related differences between the professionals (ESs 0.69 to 1.39) for eight out of twenty-one scales and two out of eight single items. When there were significant differences between male and female healthcare professionals in their estimation of patients health care preferences, female health care professionals invariably had higher scores. Generally, female health care professionals did not estimate patients' preferences and needs better than their male colleagues. Conclusions: Health care professionals are reasonably well able to make a correct estimation of patients preferences, but they should be aware of their own bias and use additional resources to gain a better understanding of patients' specific preferences for each patient is different and ultimately the care needs and preferences will also be unique to the person http://share.eldoc.ub.rug.nl/root2/2010/Arehecap/ BACKGROUND: Infertility is a growing problem in western societies. Few studies have examined the drug utilization of common treatments for infertility. Clomiphene citrate (CC) is the first-line treatment for normogonadotropic women with absent or irregular ovulation. We examined CC use among women at reproductive age in the northern Netherlands. METHODS: Drug dispensing data of CC between 1998 and 2007 were retrieved from the IADB.nl database. Two-year prevalences of CC use per 1000 women covered by the database were calculated and stratified by 5-year age group. The duration of CC use was analyzed using Kaplan-Meier survival analysis. RESULTS: From the IADB.nl database, a total of 1854 women aged 20-44 years initiated ovulation induction treatment with CC only in the northern Netherlands during 1998 and 2007. The 2-year prevalence of CC use increased from 6.66 per 1000 women during 1998-1999 to 7.24 per 1000 during 2002-2003, followed by a decrease to 4.82 per 1000 in 2006-2007 (P < 0.05). Median duration of CC use was four cycles for women,30 years of age, three cycles for women aged 30-39 and two cycles for women aged above 40. CONCLUSIONS: There is no increase of CC use during 1998-2007, and indeed a decrease of CC use during recent years, among women at reproductive age in northern Netherlands http://share.eldoc.ub.rug.nl/root2/2011/Clomciuti/ Researchers have recognized the importance of developing an accurate classification system for externalizing disorders, though much of this work has been framed by a priori preferences for categorical vs. dimensional constructs. Newer statistical technologies now allow categorical and dimensional models of psychopathology to be compared empirically. In this study, we directly compared the fit of categorical and dimensional models of externalizing behaviors in a large and representative community sample of adolescents at two time points separated by nearly 2.5 years (N = 2027; mean age at Time 1 = 11.09 years; 50.8% female). Delinquent and aggressive behaviors were assessed with child and parent Child Behavior Checklist reports. Latent trait, latent class, and factor mixture models were fit to the data, and at both time points, the latent trait model provided the best fit to the data. The item parameters were inspected and interpreted, and it was determined that the items were differentially sensitive across all regions of the dimension. We conclude that classification models can be based on empirical evidence rather than a priori preferences, and while current classification systems conceptualize externalizing problems in terms of discrete groups, they can be better conceptualized as dimensions http://share.eldoc.ub.rug.nl/root2/2011/dimenaofe/ Background. Besides the important beneficial effects of regular physical activity on general health, some of the musculoskeletal effects of physical activity are of particular interest for older adults after total hip arthroplasty (THA). However, research on physical activity behavior of patients after THA is scarce. Objective. The purpose of this study was to gain insight into the physical activity behavior and fulfillment of guidelines for health-enhancing physical activity of patients 1 year after THA. Design. This was a prospective multicenter cohort study. Methods. To determine level of physical activity, 653 participants (response rate = 77%) completed the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). Comparisons were made between participants in 2 age groups (<= 75 and > 75 years). Determinants of physical activity behavior were assessed. Results. The participants were physically active a mean of 1,468 minutes per week. Most time was spent in household and leisure activities. Younger participants were physically more active than older participants. A lower body mass index was predictive of a higher level of physical activity. Participants adhered to the guidelines of health-enhancing physical activity in 67% of cases. The guidelines were met more often by younger participants, male participants, and those without problems in the lower extremities. Limitations. A nonresponse analysis was not conducted; thus, there might have been a selection bias. Use of a self-administered recall questionnaire to assess physical activity behavior may have been subject to memory and recall skill limitations of the participants, and patients tend to overestimate their physical activity level. Conclusions. This study gives detailed insight into the physical activity of patients 1 year after primary THA. As among the general population, a considerable number of patients were found to be insufficiently physically active http://share.eldoc.ub.rug.nl/root2/2011/Physacbeo/ Moxifloxacin (MFX) is a potential oral agent use in the treatment of multidrug-resistance tuberculosis (MDR-TB). Due to variability in pharmacokinetics and in vitro susceptibility of causative bacteria, therapeutic drug monitoring (TDM) of MFX is recommended. Conventional plasma sampling for TDM is facing logistical challenges, especially in limited resource areas, and dried blood spots (DBS) sampling may offer a chance to overcome this problem. The objective of this study was to develop a LC-MS/MS method for determination of MFX in dried blood spots (DOS) that is applicable for TDM. The influence of paper type, the hematocrit (Hct) and the blood volume per spot (V-b) on the estimated blood volume in a disc (V-est) was investigated. The extracts of 8 mm diameter discs punched out from DBS were analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS) with cyanoimipramin as internal standard. The method was validated with respect to selectivity, linearity, accuracy, precision, sensitivity, recovery and stability. The effect of Hct and V-b on LC-MS/MS analytical result was also investigated. The relationship between MFX concentrations in venous and finger prick DBS and those in plasma was clinically explored. V-est was highly influenced by Hct while the effect of V-b appeared to be different among paper types. Calibration curves were linear in the range of 0.05-6.00 mg/L with inter-day and intra-day precisions and biases of less than 11.1%. The recovery was 84.5, 85.1 and 92.6% in response to blood concentration of 0.15, 2.50 and 5.00 mg/L, respectively. A matrix effect of less than 11.9% was observed. MFX in DBS was stable for at least 4 weeks at room condition (temperature of 25 degrees C and humidity of 50%). A large range of Hct value produced a significant analytical bias and it can be corrected with resulting DOS size. A good correlation between DBS and plasma concentrations was observed and comparable results between venous DOS and finger prick DBS was attained. This fully validated method is suitable for determination of MFX in dried blood spot and applicable for TDM. (C) 2011 Elsevier B.V. All rights reserved http://share.eldoc.ub.rug.nl/root2/2011/Deteofmoi/ Background: Low rates of treatment modification in patients with insufficiently controlled risk factors are common in type 2 diabetes. Although adherence problems are often mentioned in surveys as a reason for not intensifying treatment, observational studies have shown inconclusive results. Objective: To assess how medication adherence affects treatment modifications for hypertension and hyperglycemia in patients with type 2 diabetes. Methods: This was a cohort study of 11,268 primary care patients with type 2 diabetes in the Netherlands. Inclusion criteria were diagnosis before 2007, >= 1 prescription to antihypertensive or glucose-regulating medication in the preceding 6 months, and a systolic blood pressure level >= 140 mm Hg or glycosylated hemoglobin >= 7% in 2007. Patients on maximal treatment were excluded. Treatment modifications as observed from prescriptions were classified as none, dose increase, dose decrease, class switch, class addition, or class discontinuation. Refill adherence was assessed as medication possession ratio or length of last gap between refills. We performed multilevel multinomial regression analysis to test for associations. Results: We included 4980 diabetic patients with elevated blood pressure and 2945 diabetic patients with elevated glycosylated hemoglobin levels. Patients with lower adherence for antihypertensive drugs were more likely to have those medications discontinued (odds ratio [OR] for every 10% lower medication possession ratio =1.22; 95% CI, 1.11-1.33) or the dose decreased (OR = 1.14; CI 1.01-1.28). For glucose-regulating medication, dose increases (OR = 0.92; 95% CI, 0.85-0.98) and medication additions (OR = 0.90; 95% CI, 0.82-0.99) were less likely in patients with lower adherence levels. Conclusions: Low adherence inhibits the intensification of glucose-regulating but not antihypertensive medication in type 2 diabetic patients with insufficiently controlled risk factors in the Netherlands. Adherence problems may lead to diminished or even discontinued antihypertensive treatment. (Clin Ther. 2011;33:121-134) (c) 2011 Elsevier HS Journals, Inc http://share.eldoc.ub.rug.nl/root2/2011/Mediadaft/ In an age of global capitalism, pandemics, far-flung biobanks, multinational drug trials and telemedicine it is impossible for bioethicists to ignore the global dimensions of their field. However, if they are to do good work on the issues that globalisation requires of them, they need theoretical resources that are up to the task. This paper identifies four distinct understandings of 'globalised' in the bioethics literature: (1) a focus on global issues; (2) an attempt to develop a universal ethical theory that can transcend cultural differences; (3) an awareness of how bioethics itself has expanded, with new centres and journals emerging in nearly every corner of the globe; (4) a concern to avoid cultural imperialism in encounters with other societies. Each of these approaches to globalisation has some merit, as will be shown. The difficulty with them is that the standard theoretical tools on which they rely are not designed for cross-cultural ethical reflection. As a result, they leave important considerations hidden. A set of theoretical resources is proposed to deal with the moral puzzles of globalisation. Abandoning idealised moral theory, a normative framework is developed that is sensitive enough to account for differences without losing the broader context in which ethical issues arise. An empirically nourished, self-reflexive, socially inquisitive, politically critical and inclusive ethics allows bioethicists the flexibility they need to pick up on the morally relevant particulars of this situation here without losing sight of the broader cultural contexts in which it all takes place http://share.eldoc.ub.rug.nl/root2/2011/Theorefoa/ Pharmacogenetics and pharmacogenomics show great potential for developing individual treatment modalities to achieve optimal therapy effectiveness. Economic analyses are performed to determine whether pharmacogenetic screening strategies provide good value for money. The current review provides an update of published economic studies. Economic analyses of pharmacogenetic screening programs published between 2000 and July 2010 were included in the review. Information was extracted on research area, genetic information, type of economic analysis, key aspects of adherence to economic guidelines, costs and commercial availability of genetic tests, and the role of the funding party. A total of 42 economic studies on pharmacogenetic screening strategies were included. Over time, more cost-utility analyses were performed, longer time windows were employed, and more extensive sensitivity analyses were conducted. Considerable differences in costs of screening tests for the same polymorphism were found, which often, but not always, had a large influence on the costs of screening strategies. Most studies were conducted from an academic or hospital perspective without direct links to pharmaceutical or diagnostic manufacturers. The quality of economic analyses of pharmacogenetic screening programs has improved over time. However, input variables are not always clearly described. In particular, substantial variation exists in the reported costs of the pharmacogenetic tests. Often these test costs are considered a major cost driver and could therefore be of particular importance for the interpretation of cost-effectiveness results. Furthermore, the economic studies seem to be conducted to increase awareness of possibilities and perspectives of genetic testing rather than to influence policy decisions on reimbursement. Drug Dev Res 71: 492-501, 2010. (C) 2010 Wiley-Liss, Inc http://share.eldoc.ub.rug.nl/root2/2010/Econevofp/ Purpose Employees with a chronic disease may experience work-related problems that contribute to the risk of job loss. We developed a group-based intervention programme aimed at clarifying problems, making these a subject of discussion at work, and realizing solutions. This process evaluation investigates the intervention's feasibility and the satisfaction of 64 participants in eight groups. Methods Data were collected through process evaluation forms and self-report questionnaires. Results The recruitment of participants was time-consuming. Highly educated women working in the service sector were overrepresented. The programme was administered as planned, although components were sometimes only discussed briefly, due to lack of time. Satisfaction with the overall programme among participants was high; it was perceived as effective and there were only three dropouts. In particular, the focus on feelings and thoughts about having a chronic disease was highly valued, as were the exchange of experiences and role-playing directed at more assertive communication. Conclusions A vocational rehabilitation programme aimed at job retention is feasible and is perceived to be effective. Such a programme should address psychosocial aspects of working with a chronic disease beside practical problems. The recruitment of participants is time-consuming. Cooperation with outpatient clinics is necessary in order to reach all groups of employees with a chronic disease that might benefit from job retention programmes. Trial registration: ISRCTN77240155 http://share.eldoc.ub.rug.nl/root2/2011/Empoemwic/ OBJECTIVE: This study examined (a) the predictive value of observed versus reported measures of impulsivity on the onset of cannabis use and determined if lifetime tobacco and cannabis users can be differentiated by their level of impulsivity and (b) the predictive value of observed versus reported measures of impulsivity on repeated cannabis use and determined if repeated tobacco and cannabis users can be differentiated by their level of impulsivity. METHOD: The present study involves 667 (50.5% female) adolescents assessed at two time points of the TRacking Adolescents' Individual Lives Survey (TRAILS). Adolescents in our study participated in the Bangor Gambling Task (BGT), as well as completed self-report questionnaires assessing cannabis use behavior (Mage = 16.11 years) and the Behavioral Inhibition System (BIS)/Behavioral Activation System (BAS) questionnaire (Mage = 13.56 years). RESULTS: Higher levels of BAS functioning increased the likelihood that adolescents would ever use substances such as tobacco or cannabis during their lifetime. In contrast, low BIS functioning increased the likelihood of repeated cannabis use. Repeated tobacco users did not significantly differ from lifetime users by their BIS functioning. The BGT measures were not significant in relation to lifetime or repeated use of cannabis or tobacco. CONCLUSIONS: High BAS seems to be more important for experimental substance use, whereas low BIS seems to be more important for progression into regular cannabis use specifically. In contrast to the BIS/BAS, our laboratory test of impulsivity, the BGT, is not correlated with early-onset tobacco/cannabis use. Furthermore, the BGT is not correlated with the BIS/BAS measures http://share.eldoc.ub.rug.nl/root2/2011/Areadgaw/ Aim To determine the contribution of patients' adverse drug reaction (ADR) reports to signals detection, through a study of the signals sent by Lareb to the Dutch Medicines Evaluation Board. Methods The percentage of patient's ADR reports contributing to generate signals of adverse drug reactions was determined. A case-control design was used to study if the proportion of patient reports in associations that had been selected as 'signals' differed from non-signals. A logistic regression analysis was used to calculate the Odds Ratio with 95% CI for patient reports in the cases and controls. Results The number of patient reports which contributed to a signal has increased from 0 reports in 2003 to 31 reports in 2008 (9% of total). Since 2005 patient reports have triggered particular associations to be selected as a signal. In 2007, 28% of all trigger reports were reported by a patient. The case-control analysis showed that patient reports were equally present in the reports used in signal formation (cases) as in the controls, reports not contributing to a signal. Odds Ratio (OR) was 1.10 (95% CI 0.81 - 1.49) and OR 0.96 (95% CI 0.50 - 1.87) for the 'trigger reports'. Conclusions The proportion of patient reports contributing to generate signals was equal to the proportion of patient reports in the database. Patient's reports of adverse drug reactions can provide a valuable contribution to the detection of signals in addition to healthcare professionals' reports. In the Netherlands, direct patient reports have added to the signals of adverse drug reactions sent to the Medicines Evaluation Board. Copyright (C) 2010 John Wiley & Sons, Ltd http://share.eldoc.ub.rug.nl/root2/2011/propofpar/ Docosahexaenoic acid (DHA) and arachidonic acid (AA) are important for neurodevelopment. The effects of DHA (220 mg/day, n=41), DHA+AA (220 mg/day, n=39) or placebo (n=34) during pregnancy and lactation on neurodevelopment at 18 months, and the relations between umbilical cord DHA, AA and Mead acid and neurodevelopment were studied. An age-specific, standardized neurological assessment for the evaluation of minor neurological dysfunction (MND), and the Bayley Scales of Infant Development (BSID) were used. The intervention did not influence any of the outcomes. Umbilical venous (UV) Mead acid was negatively and n-6 fatty acids were weakly positively associated to the BSID mental developmental index. Children with simple MND had lower UV DHA compared to normally classified children. We conclude that relatively short-term maternal DHA or DHA+AA supplementation does not influence neurodevelopment at toddler age, although some parameters of brain development are related to perinatal DHA and AA status. (C) 2011 Elsevier Ltd. All rights reserved http://share.eldoc.ub.rug.nl/root2/2011/inflofsud/ Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation between patellar tendinopathy and work limitations. Basketball and volleyball players between 18 and 35 years were invited to complete an online-questionnaire concerning knee complaints, etiological risk factors for patellar tendinopathy and related work limitations. A total of 1505 subjects were included in the analysis. Risk factors for patellar tendinopathy were gender and heavy physically demanding work. The odds for having patellar tendinopathy were significantly higher for heavy physically demanding occupations compared to mentally demanding occupations. 30% of subjects with patellar tendinopathy with a physically demanding job reported to be impaired in their work and 17% reported to be less productive. Basketball and volleyball players with heavy physically demanding work seem to have an increased risk for developing patellar tendinopathy. This finding has important clinical relevance in the treatment of this injury. Working activities should be adjusted in order to reduce the total load on the patellar tendon and help prevention and recovery http://share.eldoc.ub.rug.nl/root2/2011/impaofphd/ Objectives: To investigate the association between cognitive complaints and objective cognitive functioning in bipolar patients, with a focus on the moderating role of depressive symptoms. Methods: The association between cognitive complaints (measured by the total score and four subscales of the Cognitive Failure Questionnaire; CFQ) and objective cognitive functioning (domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory and executive functioning/working memory, and the total score) was assessed in 108 euthymic (n = 45) or mildly to moderately depressed bipolar patients (n = 63). We studied potential moderation of this association by depressive symptoms (total score of the Inventory of Depressive Symptomatology-self rating). Analyses were performed using Pearson correlations and multiple linear regression. Results: Cognitive complaints were not associated with objective cognitive functioning, except for CFQ 'memory for names' which was positively correlated with speed of information processing (r=0.257, p = 0.007). Although depressive symptoms were positively associated with cognitive complaints (total score and three subscales; p < 0.01), the association between cognitive complaints and objective cognitive functioning was not moderated by depressive symptoms (p for interaction 0.054 to 0.988). Limitations: It can be argued whether the retrospective questionnaire (CFQ) is sufficiently accurate to measure the type of cognitive dysfunctions seen in bipolar patients. Conclusions: Cognitive complaints are not associated with objective cognitive functioning, irrespective of depressive symptoms. However, cognitive complaints are indicative for depressive symptoms. Clinicians should be to be alert to depressive symptoms rather than objective cognitive problems in patients expressing cognitive complaints. (C) 2011 Elsevier B.V. All rights reserved http://share.eldoc.ub.rug.nl/root2/2011/Isthlao/ The purpose of this study is to examine the relationship between parental religiosity, parental harmony on the subject of religiosity, and the mental health of pre-adolescents. In a community-based sample of 2,230 pre-adolescents (10-12 years), mental health problems were assessed using self-report (Youth Self-Report, YSR), parental report (Child Behavior Checklist, CBCL) as well as teacher report (Teacher Checklist for Psychopathology, TCP). Information about the religiosity of mother, the religiosity of father and religious harmony between the parents was obtained by parent report. The influence of maternal religiosity on internalizing symptoms depended on the religious harmony between parents. This was particularly apparent on the CBCL. Higher levels of internalizing symptoms were associated with parental religious disharmony when combined with passive maternal religiosity. Boys scored themselves as having more externalizing symptoms in case of religiously disharmonious parents. The levels of internalizing and externalizing symptoms in pre-adolescents were not influenced by parental religiosity. Religious disharmony between parents is a risk factor for internalizing problems when the mother is passive religious. Religious disharmony is a risk factor on its own for externalizing problems amongst boys. Parental religious activity and parental harmony play a role in the mental health of pre-adolescents http://share.eldoc.ub.rug.nl/root2/2011/relabepar/ Introduction: Controversy remains regarding the relationship between central venous saturation (ScvO(2)) and mixed venous saturation (SvO(2)) and their use and interchangeability in patients with sepsis or septic shock. We tested the hypothesis that ScvO(2) does not reliably predict SvO(2) in sepsis. Additionally we looked at the influence of the source (splanchnic or non-splanchnic) of sepsis on this relationship. Methods: In this prospective observational two-center study we concurrently determined ScvO(2) and SvO(2) in a group of 53 patients with severe sepsis during the first 24 hours after admission to the intensive care units in 2 Dutch hospitals. We assessed correlation and agreement of ScvO(2) and SvO(2), including the difference, i.e. the gradient, between ScvO(2) and SvO(2) (ScvO(2) -SvO(2)). Additionally, we compared the mean differences between ScvO(2) and SvO(2) of both splanchnic and non-splanchnic group. Results: A total of 265 paired blood samples were obtained. ScvO(2) overestimated SvO(2) by less than 5% with wide limits of agreement. For changes in ScvO(2) and SvO(2) results were similar. The distribution of the (ScvO(2) - SvO(2)) (< 0 or >= 0) was similar in survivors and nonsurvivors. The mean (ScvO(2) - SvO(2)) in the splanchnic group was similar to the mean (ScvO(2) - SvO(2)) in the non-splanchnic group (0.8 +/- 3.9% vs. 2.5 +/- 6.2%; P = 0.30). O2ER (P = 0.23) and its predictive value for outcome (P = 0.20) were similar in both groups. Conclusions: ScvO(2) does not reliably predict SvO(2) in patients with severe sepsis. The trend of ScvO(2) is not superior to the absolute value in this context. A positive difference (ScvO(2) -SvO(2)) is not associated with improved outcome http://share.eldoc.ub.rug.nl/root2/2010/Noagofm/ Background: Depressive disorder after myocardial infarction (MI) is associated with increased cardiac morbidity and mortality. Immune activity such as inflammation might be implicated as an underlying mechanism. The purpose of this study is to investigate whether the response to an antidepressant in post-MI depression is associated with changes of inflammatory markers in serum. Methods: In a double-blind placebo-controlled study with mirtazapine 30 mg/day (50 patients), the antidepressive effect was related to immune activation parameters. The cytokines interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), the soluble cytokine receptors sIL-6R, sTNF-R1 and sTNF-R2, and the inflammation-sensitive plasma proteins C-reactive protein and neopterin were assessed. Results: Subgroup analyses revealed a highly significant correlation of pronounced sTNF-R1 increase with a decrease in depressive symptoms in antidepressant responders. Conclusion: Significant effects on inflammation accompany the therapeutic efficacy of mirtazapine in contrast to the therapeutic efficacy of placebo and the nontherapeutic efficacy of mirtazapine. Copyright (C) 2011 S. Karger AG, Basel http://share.eldoc.ub.rug.nl/root2/2011/Antiefofm/ This study examined the Beck Depression Inventory-II (BDI-II) with Confirmatory Factor Analysis and followed up cardiac morbidity and mortality for a median of 4.9 years among 226 coronary artery bypass graft patients. Cardiac morbidity and mortality events (n = 65, 28.8%) were associated with BDI-II cognitive factor z-score (adjusted hazard ratio = 1.36, 95% confidence interval 1.02 - 1.82, p = .04), controlling for left ventricular impairment, age, respiratory disease, heart failure, renal disease and diabetes. A cognitive depression factor marked by pessimism, past failure, self-criticalness and worthlessness was consistently associated with cardiac morbidity and mortality, contrasting to other work http://share.eldoc.ub.rug.nl/root2/2011/Conffaano/ Introduction and Aims. This study aimed at comparing adolescent abstainers, consumers and excessive drinkers in terms of family characteristics (structure of family, socioeconomic factors), perceived social support, personality characteristics (extraversion, self-esteem, aggression) and well-being. Design and Methods. Cross-sectional data were obtained from 3694 elementary school students in the 8th and 9th grades from several cities in Slovakia (mean age 14.5, 49.0% men; response rate 93%). Respondents completed questions on the use of alcohol and on family structure (parental divorce), the socioeconomic position of the family (parents' education and family affluence), perceived social support, extraversion, self-esteem, aggression and psychological well-being. They were split into three groups based on the pattern of alcohol use-abstainers, consumers and excessive drinkers (i.e. being drunk at least once during the past 4 weeks). Results. The results showed significant differences between abstainers, consumers and excessive drinkers in almost every characteristic explored. A risky pattern of alcohol consumption occurs more frequently among adolescents who have divorced parents, higher socioeconomic position, higher scores for perceived social support from friends, extraversion, negative self-esteem and aggression, and lower scores for social support from family and for well-being. Discussion and Conclusions. A risky pattern of alcohol consumption is more likely among relatively easily identifiable groups of adolescents from high socioeconomic position and divorced families. Their personalities and social networks have characteristics that could be accommodated in preventive interventions as well. [Tomcikova Z, Madarasova Geckova A, van Dijk JP, Reijneveld SA. Characteristics of adolescent excessive drinkers compared with consumers and abstainers. Drug Alcohol Rev 2010] http://share.eldoc.ub.rug.nl/root2/2011/Charofade/ Background: Evidence on the association between antibiotic use and combined oral contraceptive (COC) failure is controversial. We examined the effect of concomitant antibiotic treatment on the risk of breakthrough pregnancy among COC users. Study Designs: We performed a case-crossover study of 1330 COC failure cases among 17,721 women from the Slone Epidemiology Center Birth Defects Study (1997-2008) and among 25,941 women from the National Birth Defects Prevention Study (NBDPS, 1997-2005). Self-matched odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by comparing antibiotic use between the 4 weeks before conception ("case period") and the 4-8 weeks before conception ("control period") using conditional logistic regression. A case time-control analysis was conducted using nonusers of COCs with unplanned pregnancies as controls. Results: For the combined data, the self-matched OR was 1.08 (95% CI: 0.63-1.84) and the case time-control OR was 1.12 (0.63-1.98) for antibiotics overall. The results did not appreciably differ when adjusted for characteristics that might vary between the case and control period. However, among COC failure cases from the NBDPS, allowing a 1-month gap between the case and control period resulted in a self-matched OR of 1.45 (0.85-2.50) and a case time-control OR of 1.55 (0.86-2.79) for antibiotics overall. Conclusions: We did not find an association between concomitant antibiotic use and the risk of breakthrough pregnancy among COC users. However, due to limited power and potential carryover effects, findings from this study cannot rule out an elevated risk of COC failure among antibiotic users. (C) 2011 Elsevier Inc. All rights reserved http://share.eldoc.ub.rug.nl/root2/2011/Antianorc/ Drug benefit-risk (BR) analysis is based on firm clinical evidence regarding various safety and efficacy outcomes. In this paper, we propose a new and more formal approach for constructing a supporting multicriteria model that fully takes into account the evidence on efficacy and adverse drug reactions. Our approach is based on the stochastic multi-criteria acceptability analysis methodology, which allows us to compute the typical value judgments that support a decision, to quantify decision uncertainty, and to compute a comprehensive BR profile. We construct a multi-criteria model for the therapeutic group of second-generation antidepressants. We assess fluoxetine and venlafaxine together with placebo according to incidence of treatment response and three common adverse drug reactions by using data from a published study. Our model shows that there are clear trade-offs among the treatment alternatives. Copyright (C) 2011 John Wiley & Sons, Ltd http://share.eldoc.ub.rug.nl/root2/2011/stocmumof/ Genetic variation in the catechol-O-methyltransferase (COMT) Val158Met polymorphism has been shown to influence performance on cognitive and emotional tasks. Specifically, it has been suggested that the Met allele might be less advantageous than the Val allele with respect to emotional processing. This study addresses the question whether the presence of the Met allele is directly related to both lower emotional verbalizing proficiency and differences in brain activation during emotional processing. Specifically, we investigated whether COMT genotype would be associated with differences in activation in cortical midline structures during valence evaluation of words. Forty participants ranging from low to high on the verbalizing subscale of the Bermond-Vorst Alexithymia Questionnaire (BVAQ) were genotyped for the COMT Val158Met polymorphism. During fMRI, they evaluated the valence of emotional words. Met homozygotes reported more difficulties in verbalizing their feelings. In addition, the Met allele was associated with attenuated brain activation in posterior cingulate gyrus and precuneus during valence evaluation. We conclude that the Met allele modulates neural activation in regions associated with emotional awareness. Our findings may contribute to understanding the neural correlates of susceptibility for affective disorders. (C) 2010 Elsevier Inc. All rights reserved http://share.eldoc.ub.rug.nl/root2/2011/COMTVapov/ No description abstract http://share.eldoc.ub.rug.nl/root2/2010/DeveofaJ/ Background: The prevalence of diabetes mellitus type 2 (DM2) in Indonesia is high and still rising. Periodontitis is associated with DM2. No study has investigated this association in Indonesia, nor has any study investigated this association using a variety of methods to operationalize periodontitis. Therefore this study compared prevalence and severity of periodontitis in DM2 patients to healthy controls, using different methods to operationalize periodontitis. Methods: 78 DM2 and 76 healthy subjects underwent a full mouth periodontal screening assessing probing pocket depth, gingival recession, plaque index and bleeding on probing. Using these measurements, periodontitis prevalence and severity was operationalized in various ways. Differences in periodontitis prevalence and severity between DM2 and healthy subjects were analyzed using univariate analyses. In regression analyses, periodontitis prevalence and severity were predicted on the basis of DM2 presence, controlling for confounders and effect modification. Results: Prevalence of periodontitis was significantly higher in DM2 compared to healthy subjects, showing odds ratios of 5.0 and 6.1. Likewise, periodontitis severity was significantly higher in DM2 subjects. Conclusion: Indonesian DM2 subjects had more prevalent and more severe periodontitis than Indonesian healthy subjects, independent of confounding factors or the methods used to operationalize periodontitis http://share.eldoc.ub.rug.nl/root2/2010/Periprans/ No description abstract http://share.eldoc.ub.rug.nl/root2/2011/Issosti/ Peer support groups are rarely available for patients with psychosis, despite potential clinical and economic advantages of such groups. In this study, 106 patients with psychosis were randomly allocated to minimally guided peer support in addition to care as usual (CAU), or CAU only. No relevant differences between mean total costs of both groups were found, nor were there significant differences in WHOQoL-Bref outcomes. Intervention adherence had a substantial impact on the results. It was concluded that minimally guided peer support groups for psychosis do not seem to affect overall healthcare expenses. Positive results of additional outcomes, including a significant increase in social contacts and esteem support, favour the wider implementation of such groups http://share.eldoc.ub.rug.nl/root2/2011/Econasofp/ To evaluate the effectiveness of the 7-valent pneumococcal conjugate vaccine (PCV7) program, we conducted a cross-sectional observational study on nasopharyngeal carriage of Streptococcus pneumoniae 3 years after implementation of the program in the Netherlands. We compared pneumococcal serotypes in 329 prebooster 11-month-old children, 330 fully vaccinated 24-month-old children, and 324 parents with age-matched pre-PCV7 (unvaccinated) controls (ages 12 and 24 months, n = 319 and n = 321, respectively) and 296 of their parents. PCV7 serotype prevalences before and after PCV7 implementation, respectively, were 38% and 8% among 11-month-old children, 36% and 4% among 24-month-old children, and 8% and 1% among parents. Non-PCV7 serotype prevalences were 29% and 39% among 11-month-old children, 30% and 45% among 24-month-old children, and 8% and 15% among parents, respectively; serotypes 11A and 19A were most frequently isolated. PCV7 serotypes were largely replaced by non-PCV7 serotypes. Disappearance of PCV7 serotypes in parents suggests strong transmission reduction through vaccination http://share.eldoc.ub.rug.nl/root2/2011/Carrofstp/ BACKGROUND: We examined the different trajectories of vital exhaustion (VE) over a 12-month period and their impact on prognosis in a sample of myocardial infarction (MI) and chronic heart failure (CHF) patients.MethodConsecutive MI (n=407) and CHF patients (n=297) were assessed at baseline, and at 3- and 12-month follow-up for symptoms of VE. Latent growth mixture modelling was used to examine the course of VE over time. The combined clinical endpoint was defined as cardiac hospital readmission or death. RESULTS: Four distinct trajectories for VE were found: low VE, decreasing VE, increasing VE, and severe VE. Sex, marital status, left ventricular ejection fraction, psychotropic medication, sample group (CHF v. MI) and depressive symptoms were associated with VE, varying according to classes. The mean follow-up period was 25.3 months in which 34.7% of the patients experienced an event. Multivariate Cox regression showed that, compared with patients in the low VE class, patients in the increasing VE class [hazard ratio (HR)=1.16, 95% confidence interval (CI) 1.58-3.61, p=0.01], and the severe VE class (HR=1.69, 95% CI 1.31-2.64, p=0.02) had an increased risk for adverse cardiovascular events (i.e. cardiovascular hospital readmission or cardiovascular death). Decreasing VE was not related to adverse cardiovascular events (HR=0.97, 95% CI 0.66-1.69, p=0.81). CONCLUSIONS: VE trajectories varied across cardiac patients, and had a differential effect on cardiovascular outcome. Increasing VE and severe VE classes were predictors of poor cardiovascular prognosis. These results suggest that identification of cardiac patients with an increased risk of adverse health outcomes should be based on multiple assessments of VE http://share.eldoc.ub.rug.nl/root2/2011/Vitaexanc/ No description abstract http://share.eldoc.ub.rug.nl/root2/2010/Hetbevam/ The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included. Descriptive analyses were conducted on the associations found, differentiating for study quality and level of analysis. Structure indicators were mostly tested in studies with weak designs, showing no associations with surrogate outcomes or mixed results. Process indicators focusing on intensification of drug treatment were significantly associated with better surrogate outcomes in three high-quality studies. Process indicators measuring numbers of tests or visits conducted showed mostly negative results in four high-quality studies on surrogate and hard outcomes. Studies performed on different levels of analysis and studies of lower quality gave similar results. For many widely used quality indicators, there is insufficient evidence that they are predictive of better patient outcomes http://share.eldoc.ub.rug.nl/root2/2011/Relabequi/ The potential effect of parental separation during early adolescence on adolescent externalizing and internalizing problems was investigated in a longitudinal sample of adolescents (n = 1274; mean age = 16.27; 52.3% girls). Pre-separation mental health problems were controlled for. Building on a large number of studies that overall showed a small effect of parental separation, it was argued that separation may only or especially have an effect under certain conditions. It was examined whether child temperament (effortful control and fearfulness) moderates the impact of parental separation on specific mental health domains. Hypotheses were derived from a goal-framing theory, with a focus on goals related to satisfying the need for autonomy and the need to belong. Controlling for the overlap between the outcome domains, we found that parental separation led to an increase in externalizing problems but not internalizing problems when interactions with child temperament were ignored. Moreover, child temperament moderated the impact of parental separation, in that it was only related to increased externalizing problems for children low on effortful control, whereas it was only related to increased internalizing problems for children high on fearfulness. The results indicate that person-environment interactions are important for understanding the development of mental health problems and that these interactions can be domain-specific http://share.eldoc.ub.rug.nl/root2/2011/Chiltemot/ Objective: Most studies in cancer patients on psychological changes focused on positive changes (so-called 'posttraumatic growth'), with surprisingly little attention on the possibility that patients may experience both positive and negative changes. This study investigated the relationship between positive and negative changes, and their association with positive and negative affect. We also examined the correlates of positive and negative changes, specifically the role of coping and goal reengagement. Methods: This cross-sectional study was conducted in 108 patients. We used Pearson correlations and Regression analyses to examine the research questions. Results: Positive and negative changes were relatively unrelated to each other. More positive changes were related to more positive affect, whereas more negative changes were related to more negative affect and less positive affect. Approach coping by more positive reappraisal and goal reengagement was significantly associated with more positive changes. More use of avoidant coping by self-distraction was related to more negative changes. Conclusions: Patients experienced both positive and negative changes as a result of cancer. These changes were significantly related to patients' well-being, as well as to their coping and goal reengagement strategies. This knowledge may be incorporated in psychological interventions. Cancer patients can be assisted to learn to acknowledge both positive and negative changes in their life and to approach rather than avoid difficult situations. Patients may also be supported to engage in alternative meaningful goals in life. This is likely to help them find positive meaning. Copyright (C) 2010 John Wiley & Sons, Ltd http://share.eldoc.ub.rug.nl/root2/2011/Cancpaexo/ The escalating interest in mindfulness-based intervention in regular psychological care calls for critical reflection. This paper comments on the paper of Remco Havermans 'Mindfulness meditation in mental health care: too much, too often and too early', stating that "the widespread belief that mindfulness meditation has been proven to be beneficial is completely unwarranted considering the status quo of mindfulness research". In this paper, we describe how mindfulness can be defined and we address issues and challenges regarding its measurement. Moreover, the empirical evidence for the positive effects of mindfulness-based intervention and the mechanisms through which the intervention is believed to work is reviewed. Current reviews and meta-analytical studies indicate that mindfulness-based intervention is effective in decreasing psychological symptoms, with some evidence that the intervention is equally effective as other interventions such as relaxation exercises and cognitive behavioral interventions. There is promising yet scarce evidence on the underlying mechanisms, suggesting that mindfulness-based intervention indeed teaches people to be more mindful and to use less avoidant strategies to manage difficult experiences. The current state and developments in research on mindfulness bear a resemblance to research on cognitive behavioral therapy, of which the mechanisms and active components are also still not proven. We conclude that there is sufficient evidence for the enthusiasm on clinical applications of mindfulness in health care. Yet this does not imply that it should be applied in all circumstances, overlooking other evidence-based treatments. Therefore, more research is needed to reach a better insight into for whom mindfulness-based intervention is most likely to work, how it works, and the active components of the intervention http://share.eldoc.ub.rug.nl/root2/2011/Mindinpe/ Background: Sickness absence leads to understaffing and interferes with nursing efficiency and quality. It has been reported in literature that managerial leadership is associated with self-reported sickness absence in the working population. Purposes: This study investigated the relationship between managerial leadership and sickness absence in health care by associating nurse managers' leadership styles with registered sickness absence among their nursing staff. Methodology: The cross-sectional study included 699 nurses working in six wards (staff range = 91-140 employees) of a Dutch somatic hospital employing a total of 1,153 persons. The nurse managers heading the wards were asked to complete the Leadership Effectiveness and Adaptability Description questionnaire for situational leadership. The Leadership Effectiveness and Adaptability Description scores were linked to employer-registered nursing staff sickness absence. Findings: High relationship-high task behavior (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.65-0.85) and high relationship-low task behavior (OR = 0.37, 95% CI = 0.14-0.98) were inversely related to the number of short (one to seven consecutive days) episodes of sickness absence among the staff. Low relationship-high task styles (OR = 2.44, 95% CI = 1.14-5.22) as well as low relationship-low task styles (OR = 2.44, 95% CI = 1.26-4.71) were positively associated with the number of short episodes of sickness absence. However, the leadership styles only explained 10% of the variance in short episodes of sickness absence http://share.eldoc.ub.rug.nl/root2/2011/Leadstofn/ Background. Recent studies have found that alitretinoin can induce clinically significant responses in subjects with severe chronic hand eczema (CHE) unresponsive to topical corticosteroids. Aims. To assess the pharmacokinetics (PK), efficacy and safety of alitretinoin 10 or 30 mg once daily. Methods. This was a randomized, double-blind study, which enrolled 32 subjects aged 18-75 years with CHE unresponsive to potent topical corticosteroids. Subjects received alitretinoin 10 mg (n = 16) or 30 mg (n = 16) once daily for 12 or 24 weeks. Standard PK variables [area under the curve (AUC) of plasma concentration vs. time, maximum plasma concentration (C-max), time to maximum plasma concentration (t(max)), elimination half-life (t(1/2)), total systemic clearance (CL/F) and volume of distribution (Vd/F)] were determined for alitretinoin and metabolites. Efficacy was assessed using the Physician's Global Assessment (PGA) scale. Results. Chronic administration of alitretinoin for up to 24 weeks did not result in accumulation or time-dependent changes in the disposition of alitretinoin. Exposure was found to be proportional to dose. Systemic exposure (AUC) to alitretinoin was proportional to dose for 10 and 30 mg alitretinoin; 62.8% of subjects achieved clear/almost clear hands in the 30 mg group and 12.5% in the 10 mg group. Alitretinoin was well tolerated. Conclusions. Chronic administration of alitretinoin for 12-24 weeks did not lead to accumulation or time-dependent changes in drug exposure. Alitretinoin was effective and well tolerated in the treatment of subjects with moderate or severe CHE unresponsive to potent topical corticosteroids http://share.eldoc.ub.rug.nl/root2/2011/Pharefans/ Study Design. A cross sectional multicenter study in six outpatient Rehabilitation Centers (RCs) in the Netherlands. Objective. This study aims to confirm or refute the finding that a strong relationship exists between psychosocial distress and self-reported disability in patients with nonspecific chronic low back pain (CLBP) by analyzing this relationship in patients with CLBP admitted for treatment in six RCs. Summary of Background Data. A strong relationship between psychosocial distress and self-reported disability in patients with CLBP is suggested. However, in former research weak relationships were found in two of the RCs participating in this study. Methods. Total study sample consisted of 293 patients (30-66 per RC) with CLBP, admitted for outpatient multidisciplinary rehabilitation in one of the six participating RCs. Psychosocial distress was measured with the Symptom Checklist-90-Revised (SCL-90-R), self-reported disability with the Roland Morris Disability Questionnaire (RMDQ). Pearson correlation coefficients between psychosocial distress and self-reported disability were calculated. Multivariate regression analysis was performed to analyze the relationship between SCL-90-R and VAS pain (independent variables) and RMDQ (dependent variable) for the total group and for each RC separately. A multivariate regression analysis was performed to analyze the relationship between all baseline characteristics and RMDQ in the total group. Results. Correlation coefficient between the SCL-90-R and RMDQ was r = 0.38 for the total sample, indicating a significant (P < 0.05), but weak relationship. For the six individual RCs, correlation coefficients ranged between r = 0.22 and 0.67 (three of the six correlation coefficients were significant). The explained variance (r(2)) of the regression models (SCL-90 and pain intensity as predictors of RMDQ) was 29% for the total sample, and varied between the RCs from 17% to 52%. Results of the multivariate regression analysis of all baseline characteristics of the total group revealed that the model explained 36% of the total variance observed in RMDQ score. Overall, the contributions of psychosocial distress to the models were smaller and more variable compared with pain intensity. Conclusion. The overall relationship between psychosocial distress and self reported disability was weak, and differences between RCs were considerable. This indicates that the relationship between psychosocial distress and disability in patients with CLBP is not uniform http://share.eldoc.ub.rug.nl/root2/2011/Diffinthr/ Background. The aim of this study was to develop empirically validated criteria for the diagnoses of clinically relevant somatization. Method. This study was performed in a population-representative cohort consisting of 461 males (47.8%) and 503 females (52.2%), with an average age of 55.8 years (S.D. = 11.1). Somatization, anxiety and depression were derived from the Composite International Diagnostic Interview. Mplus was used to perform confirmative factor analyses on the current DSM-IV symptom groups; on alternative symptom clusters previously suggested; and to perform latent class analysis in order to define an empirically derived cut-off for somatization. Results. The existence of symptom groups as described in DSM-IV was not supported by our data, whereas a differentiation between cardiopulmonary, musculoskeletal, gastrointestinal and general somatic symptoms did fit our data. Latent class analysis revealed two classes characterized by few (n = 859) and many (n = 105) symptoms. The class of subjects could be approached by a simple cut-off of four functional symptoms (sensitivity 79%, specificity 98%, positive predictive value 82%, negative predictive value 97%) regardless of the number of organ systems involved. Conclusions. This study in a large population-representative cohort suggests that a simple symptom count can be used as a dimensional diagnosis of somatization. In those instances in which a categorical diagnosis is preferred, a simple cut-off of four out of 43 functional symptoms best fitted our data. We did not find any added value for incorporating the number of symptom clusters into the diagnostic criteria http://share.eldoc.ub.rug.nl/root2/2011/Empifofot/ Background. The intestine is extremely sensitive to ischemic preservation and reoxygenation injury. Current vascular perfusion and cold storage with University of Wisconsin (UW) solution neglect the intestinal lumen and the ongoing mucosal metabolism during hypothermia. This study was designed to test the effects of luminal preservation with an alternative preservation solution in addition to the common vascular flush with UW solution on graft viability after preservation and ex vivo reoxygenation. Methods. Rat intestine was preserved on ice for 6 hr in UW solution or Williams Medium E with additional buffering, impermeants, and a colloid (WMEplus) after being stapled or after flushing and filling the lumen with the respective preservation solution. Tissue slices were prepared from fresh and preserved intestines and were incubated with oxygen for 6 hr at 37 C to assess the viability after reoxygenation. Results. Directly after preservation, histologic damage was mild and unaffected by preservation strategy. Contrary to luminal preservation, closed preservation resulted in significantly decreased ATP levels compared with control. Reoxygenation aggravated damage and revealed differences between the strategies. Luminal preservation better maintained the ATP levels and histologic integrity (vs. closed preservation) for both solutions. Histomorphologic integrity was superior after preservation with WMEplus (vs. UW solution). Expression of stress responsive genes was least up-regulated in the slices from tissue preserved luminally with WMEplus. Conclusions. In conclusion, preservation and reoxygenation injury can be attenuated by luminal preservation with WMEplus http://share.eldoc.ub.rug.nl/root2/2010/Reduisini/ Context Disclosure of conflicts of interest (COIs) from pharmaceutical industry study funding and author-industry financial relationships is sometimes recommended for randomized controlled trials (RCTs) published in biomedical journals. Authors of meta-analyses, however, are not required to report COIs disclosed in original reports of included RCTs. Objective To investigate whether meta-analyses of pharmacological treatments published in high-impact biomedical journals report COIs disclosed in included RCTs. Data Sources and Study Selection We selected the 3 most recent meta-analyses of patented pharmacological treatments published January 2009 through October 2009 in each general medicine journal with an impact factor of at least 10; in high-impact journals in each of the 5 specialty medicine areas with the greatest 2008 global therapeutic sales (oncology, cardiology, respiratory medicine, endocrinology, and gastroenterology); and in the Cochrane Database of Systematic Reviews. Data Extraction Two investigators independently extracted data on disclosed study funding, author-industry financial ties, and author employment from each meta-analysis, from RCTs included in each meta-analysis, and on whether meta-analyses reported disclosed COIs of included RCTs. Results Of 29 meta-analyses reviewed, which included 509 RCTs, only 2 meta-analyses (7%) reported RCT funding sources; and 0 reported RCT author-industry ties or employment by the pharmaceutical industry. Of 318 meta-analyzed RCTs that reported funding sources, 219 (69%) were industry funded; and 91 of 132 (69%) that reported author financial disclosures had 1 or more authors with pharmaceutical industry financial ties. In 7 of the 29 meta-analyses reviewed, 100% of included RCTs had at least 1 form of disclosed COI (pharmaceutical industry funding, author-industry financial ties, or employment), yet only 1 of these 7 meta-analyses reported RCT funding sources, and 0 reported RCT author-industry ties or employment. Conclusion Among a group of meta-analyses of pharmacological treatments published in high-impact biomedical journals, information concerning primary study funding and author COIs for the included RCTs were only rarely reported. JAMA. 2011;305(10):1008-1017 www.jama.com http://share.eldoc.ub.rug.nl/root2/2011/Repoofcoo/ Background: Placental pathology is associated with long-term neurological morbidity. Little is known about the association of placental pathology and illness severity directly after birth in preterm infants. Objective: To determine the association between placental pathology and illness severity in preterm infants during the first 24 h after birth. Study design: Placentas of 40 preterm infants, born after singleton pregnancies (gestational age 25.4-31.7 weeks, birth weight 560-2250 g) were assessed for histopathology. Illness severity was measured using the Score of Neonatal Acute Physiology Perinatal Extension (SNAPPE). A high SNAPPE reflects high illness severity. Results: Examination of the 40 placentas revealed: pathology consistent with maternal vascular under-perfusion (MVU) (n = 24), ascending intrauterine infection (AIUI) (n = 17), villitis of unknown aetiology (VUE) (n = 6), foetal thrombotic vasculopathy (FTV) (n = 6), elevated nucleated red blood cells (NRBCs) (n = 6), and chronic deciduitis (n = 10). SNAKE ranged from 1 to 53 (median 10). Infants with elevated NRBCs had a higher SNAPPE than infants without elevated NRBCs (median 30 vs. 10,p = 0.014). The same was found for the presence of FTV (median 30 vs. 10, p = 0.019). No relation existed between SNAPPE and the other placental pathologies. Conclusions: Elevated NRBCs and FTV were associated with higher illness severity during the first 24 h after birth in preterm infants. Ascending intrauterine infection was not associated with high illness severity. (C) 2011 Elsevier Ireland Ltd. All rights reserved http://share.eldoc.ub.rug.nl/root2/2011/Placpaisa/ No description abstract http://share.eldoc.ub.rug.nl/root2/2010/Effeabma_/