Objective: The study aim was to investigate the course of pain in rest and motion in seven different rheumatic diseases (RMD), prior and after multimodal spa therapy including low-dose radon... Show moreObjective: The study aim was to investigate the course of pain in rest and motion in seven different rheumatic diseases (RMD), prior and after multimodal spa therapy including low-dose radon treatment and at 3-, 6-; and 9-month follow up. Methods: Complete data from the radon indication registry including information on 561 subjects with RMD were analysed to explore the association of timepoint of measurement with pain in rest and motion. For this purpose, linear regression models adjusted for RMD-type, age, sex and body mass index (BMI) were applied. Results: The mean age of the sample was 55 years, the average body mass index was 26.8, and 275 subjects were women. Pain scores were significantly improved at all-time points compared to baseline. Pain courses were different for each RMD with the largest improvement seen in fibromyalgia. Conclusion: Timing spa facility visits according to RMD-specific pain courses may result in sustained pain reduction. Show less
Zee-neuen, A. van der; Fuchs, J.; Wildburger, S.; Gaisberger, M.; Kloppenburg, M.; Fioravanti, A.; ... ; Ritter, M. 2023
Objective: The study aim was to investigate the course of pain in rest and motion in seven different rheumatic diseases (RMD), prior and after multimodal spa therapy including low-dose radon... Show moreObjective: The study aim was to investigate the course of pain in rest and motion in seven different rheumatic diseases (RMD), prior and after multimodal spa therapy including low-dose radon treatment and at 3-, 6-; and 9-month follow up.Methods: Complete data from the radon indication registry including information on 561 subjects with RMD were analysed to explore the association of timepoint of measurement with pain in rest and motion. For this purpose, linear regression models adjusted for RMD-type, age, sex and body mass index (BMI) were applied.Results: The mean age of the sample was 55 years, the average body mass index was 26.8, and 275 subjects were women. Pain scores were significantly improved at all-time points compared to baseline. Pain courses were different for each RMD with the largest improvement seen in fibromyalgia.Conclusion: Timing spa facility visits according to RMD-specific pain courses may result in sustained pain reduction. Show less
Background: Understanding if and how pain influences activities of daily living (ADL) in dementia is essential to improving pain management and ADL functioning. This study examined the relationship... Show moreBackground: Understanding if and how pain influences activities of daily living (ADL) in dementia is essential to improving pain management and ADL functioning. This study examined the relationship between the course of pain and change in ADL functioning, both generally and regarding specific ADL functions.Methods: Participants were Dutch nursing home residents (n = 229) with advanced dementia. ADL functioning was assessed with the Katz ADL scale, and pain with the Dutch version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-D). Changes of PACSLAC-D and Katz ADL scores were computed based on the difference in scores between baseline, 3-month and 6-month follow-up. Multivariate linear regression models were used to assess the relationships between change in pain score, change in total ADL score and specific ADL item scores during follow-up.Results: At baseline, residents had a median ADL score of 18 (interquartile range 13-22, range 6-24) and 48% of the residents were in pain (PACSLAC-D >= 4). Residents with pain were more ADL dependent than residents without pain. A change in pain score within the first 3 months was a significant predictor for a decline in ADL functioning over the 6-month follow-up (B = 0.10, SE = 0.05, P = 0.045), and specifically, a decline on the items 'transferring' over the 6-month follow-up and `feeding' during the first 3 months of follow-up.Conclusions: Pain is associated with ADL functioning cross-sectionally, and a change in pain score predicts a decline in ADL functioning, independent of dementia severity. Awareness of (changes in) ADL activities is clearly important and might result in both improved recognition of pain and improved pain management. Show less
Santen, S.S. van; Olsson, D.S.; Hammarstrand, C.; Wijnen, M.; Fiocco, M.; Heuvel-Eibrink, M.M. van den; ... ; Neggers, S.J.C.M.M. 2020
Context: Patients with craniopharyngioma suffer from obesity and impaired bone health. Little is known about longitudinal changes in body composition and bone mineral density (BMD).Objective: To... Show moreContext: Patients with craniopharyngioma suffer from obesity and impaired bone health. Little is known about longitudinal changes in body composition and bone mineral density (BMD).Objective: To describe body composition and BMD (change).Design: Retrospective longitudinal study.Setting: Two Dutch/Swedish referral centers.Patients: Patients with craniopharyngioma (n = 112) with a dual X-ray absorptiometry (DXA) scan available (2 DXA scans, n = 86; median time 10.0 years; range 0.4-23.3) at age >= 18 years (58 [52%1 male, 50 [45%] childhood onset).Main outcome measures: Longitudinal changes of body composition and BMD, and associated factors of Delta Z-score (sex and age standardized).Results: BMI (from 28.8 +/- 4.9 to 31.2 +/- 5.1 kg/m(2), P< .001), fat mass index (FMI) (from 10.5 +/- 3.6 to 11.9 +/- 3.8 kg/m(2), P= .001), and fat free mass index (FFMI) (from 18.3 +/- 3.2 to 19.1 +/- 3.2 kg/m(2) , P< .001) were high at baseline and increased. Fat percentage and Z-scores of body composition did not increase, except for FFMI Z-scores (from 0.26 +/- 1.62 to 1.06 +/- 2.22, P< .001). Z-scores of total body, L2-L4, femur neck increased (mean difference 0.61 +/- 1.12, P< .001; 0.74 +/- 1.73, P< .001; 0.51 +/- 1.85, P= .02). Linear regression models for AZ-score were positively associated with growth hormone replacement therapy (GHRT) (femur neck: beta 1.45 [95% CI 0.51-2.39]); and negatively with radiotherapy (femur neck: beta -0.79 [-1.49 to -0.09]), glucocorticoid dose (total body: beta -0.06 (-0.09 to -0.02]), and medication to improve BMD (L2-L4: beta -1.06 [-1.84 to -0.28]).Conclusions: Z-scores of BMI, fat percentage, and FMI remained stable in patients with craniopharyngioma over time, while Z-scores of FFMI and BMD increased. Higher glucocorticoid dose and radiotherapy were associated with BMD loss and GHRT with increase. Show less
Bearing the rising health care costs of our aging global population is one of the most urgent challenges society is facing. We study the implementation of new medical technologies as one way to... Show moreBearing the rising health care costs of our aging global population is one of the most urgent challenges society is facing. We study the implementation of new medical technologies as one way to increase the effectiveness of care, particularly in the area of aortic disease-a condition that affects an increasing number of patients globally. Our research focus is the implementation of complex endovascular treatment techniques by a multidisciplinary aortic treatment group, in addition to their traditional open treatment of aortic disease. We find that relational and cognitive embeddedness factors support team learning, which in turn enables the team to achieve its self-set goals of treating more patients; offering more tailor-made care; and providing endovascular treatment in emergency situations. At the end of our data collection period, the first steps toward the team's ultimate goal of offering patient-centered care were also taken. Show less
The main objective of this thesis is to improve the understanding of the role of helminth infections on the human gut microbiome and consequently on the human immune responses. We utilized the... Show moreThe main objective of this thesis is to improve the understanding of the role of helminth infections on the human gut microbiome and consequently on the human immune responses. We utilized the observations from a household randomized controlled trial in a helminth endemic area in Indonesia, where the microbiome data is the main outcome of interest. The microbiome data obtained via high throughput sequencing possess a compositional structure. Therefore, each bacteria category correlates with each other. In addition, the repeated measurement of the microbiome data imposes an extra correlation within bacteria category over time. We first developed a new statistical methodology to model the effect of infection as well as deworming on microbiome composition by taking into account the compositional nature of microbiome data as well as the correlation due to repeated measurements. Secondly, to model the effect of helminth infection on the gut microbiome composition and immune responses, a joint model is developed. This model is able to estimate the correlation between microbiome composition and immune responses. Show less
Gooijer-van de Groep, K.L. de; Groot, J.H. de; Krogt, H. van der; Vlugt, E. de; Arendzen, J.H.; Meskers, C.G.M. 2018
Background: To compare childhood arrestees with matched comparison groups on levels of autistic symptoms and to assess the unique predictive value of autistic symptoms for future delinquent... Show moreBackground: To compare childhood arrestees with matched comparison groups on levels of autistic symptoms and to assess the unique predictive value of autistic symptoms for future delinquent behavior in childhood arrestees. Methods: Childhood first-time arrestees (n=308, baseline age 10.7±1.5years) were followed up for 2years. Autistic symptoms, externalizing disorders and delinquent behavior were assessed yearly. Childhood arrestees were compared on autistic symptoms with matched (age, gender) general population and clinical autism spectrum disorder samples. The predictive value of autistic symptoms for delinquent behavior was analyzed using generalized estimating equations. Results: At each assessment, levels of autistic symptoms in childhood arrestees were in between levels found in the general population and autism spectrum disorder samples. Autistic symptoms were positively associated with delinquent behavior in childhood arrestees, even after adjustment for externalizing disorders: IRR (incidence rate ratio) 1.23; 95% CI 1.11–1.36 and IRR 1.29; 95% CI 1.15–1.45 for core autistic symptoms and total symptom score, respectively. Conclusions: Autistic symptoms are more prevalent in childhood arrestees compared to the general population and are uniquely associated with future delinquent behavior. Attention should, therefore, be given to the possible presence of autism related symptomatology in these children. Implications for diagnostic assessment and intervention need further investigation. Show less
