477 research outputs found
Does pain medication influence outcomes in elderly people seeking care for back pain? BACE cohort study
Response to Dr. Watts letter on “The impact of computer use on myopia development in childhood”
Reducing behavior problems in children born after an unintended pregnancy:the generation R study
Objectives: To examine differences in behavior problems between children from intended versus unintended pregnancies, and to estimate how much the difference in problem behavior would be reduced if postnatal depression was eliminated and social support was increased within 6 months after birth. Methods: Data from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N = 9621). Differences in child internalizing and externalizing behavior at ages 1.5, 3, 6, 9 and 13 years between pregnancy intention groups were estimated using linear regression. Associations of postnatal depression and social support with internalizing and externalizing problems were also estimated using linear regression. Child behavior outcomes where compared before and after modelling a situation in which none of the mothers experienced a postnatal depression and all mother experienced high social support. Results: Most pregnancies (72.9%) were planned, 14.8% were unplanned and wanted, 10.8% were unplanned with initially ambivalent feelings and 1.5% with prolonged ambivalent feelings. Children from unplanned pregnancies had more internalizing and externalizing problems at all ages as compared to children from a planned pregnancy, especially when ambivalent feelings were present. Hypothetically eliminating on postnatal depression reduced the differences in internalizing and externalizing problems by 0.02 to 0.16 standard deviation. Hypothetically increasing social support did not significantly reduce the difference in internalizing and externalizing problems. Conclusions: Children from an unplanned pregnancy have more behavior problems, in particular when mothers had prolonged ambivalent feelings. Eliminating postnatal depression may help to reduce the inequality in child behavior related to pregnancy intention.</p
Rates of spectacle wear in early childhood in the Netherlands
BACKGROUND: Refractive errors are relatively common all around the world. In particular, early onset myopia is associated with a significant burden in later life. Little is known about refractive errors in preschool children. The aim of this study was to assess the prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children. METHODS: We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6934 6-year-olds from the Generation R study, and 2974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. RESULTS: The prevalence of spectacle wear ranged from 1.5 to 11.8% between 3 to 7 years with no significant gender differences. Among children with spectacle wear at 6 years (N = 583) and 7 years (N = 350) 29.8 and 34.6% had myopia respectively, of which 21.1 and 21.6% combined with astigmatism; 19.6 and 6.8% had hyperopia, 37.2 and 11.1% hyperopia and astigmatism, and 12.5 and 32.7% astigmatism only. CONCLUSIONS: Spectacle wear in European children starts early in preschool and increases to a relatively frequent visual aid at school age. Advocating early detection and monitoring of refraction errors is warranted in order to prevent visual morbidities later in life
Reducing behavior problems in children born after an unintended pregnancy:the generation R study
Objectives: To examine differences in behavior problems between children from intended versus unintended pregnancies, and to estimate how much the difference in problem behavior would be reduced if postnatal depression was eliminated and social support was increased within 6 months after birth. Methods: Data from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N = 9621). Differences in child internalizing and externalizing behavior at ages 1.5, 3, 6, 9 and 13 years between pregnancy intention groups were estimated using linear regression. Associations of postnatal depression and social support with internalizing and externalizing problems were also estimated using linear regression. Child behavior outcomes where compared before and after modelling a situation in which none of the mothers experienced a postnatal depression and all mother experienced high social support. Results: Most pregnancies (72.9%) were planned, 14.8% were unplanned and wanted, 10.8% were unplanned with initially ambivalent feelings and 1.5% with prolonged ambivalent feelings. Children from unplanned pregnancies had more internalizing and externalizing problems at all ages as compared to children from a planned pregnancy, especially when ambivalent feelings were present. Hypothetically eliminating on postnatal depression reduced the differences in internalizing and externalizing problems by 0.02 to 0.16 standard deviation. Hypothetically increasing social support did not significantly reduce the difference in internalizing and externalizing problems. Conclusions: Children from an unplanned pregnancy have more behavior problems, in particular when mothers had prolonged ambivalent feelings. Eliminating postnatal depression may help to reduce the inequality in child behavior related to pregnancy intention.</p
The use of quality information by general practitioners: does it alter choices? A randomized clustered study
Background: Following the introduction of elements of managed competition in the Netherlands in 2006, General Practitioners (GPs) and patients were given the role to select treatment hospital using public quality information. In this study we investigate to what extent hospital preferences of GP's are affected by performance indicators on medical effectiveness and patient experiences. We selected three conditions: breast cancer, cataract surgery, and hip and knee replacement. Methods. After an inquiry 26 out of 226 GPs in the region signed up to participate in our study. After a 2:1 randomization, we analyzed the referral patterns in the region using three groups of GPs: GPs (n=17) who used the report cards and received personal clarification, GPs that signed up for the study but were assigned to the control group (n=9), and the GPs outside the study (n=200).We conducted a difference in differences analysis where the choice for a particular hospital was the dependent variable and time (2009 or 2010), the sum score of the CQI, the sum score of the PI's and dummy variables for the individual hospitals were used as independent variables. Results: The analysis of the conditions together and cataract surgery and hip and knee replacement separately, showed no significant relationships between the scores on the report cards and the referral patterns of the GPs. For breast cancer our analysis revealed that GPs in the intervention group refer 1.0% (p=0.01) more to hospitals that score one percent point better on the indicators for medical effectiveness. Conclusion: Our study provides empirical evidence that GP referral patterns were unaffected by the available quality information, except for the outcome indicators for breast cancer care that were presented. This finding was surprising since our study was designed to identify changes in hospital preference (1) amongst the most motivated GP's, (2) that received personal clarification of the performance indicators, and (3) selected indicators/conditions from a large set of indicators that they believed were most important. This finding may differ when quality information is based on outcome indicators with a clinically relevant difference, as shown by our indicators for breast cancer treatment. We believe that the current set of (largely process) hospital quality indicators do not serve the GP's information needs and consequently quality plays little role in the selection of hospitals for treatment. © 2013 Ikkersheim and Koolman; licensee BioMed Central Ltd
Evidence that emmetropization buffers against both genetic and environmental risk factors for myopia
YesPURPOSE. To test the hypothesis that emmetropization buffers against genetic and environmental
risk factors for myopia by investigating whether risk factor effect sizes vary
depending on children’s position in the refractive error distribution.
METHODS. Refractive error was assessed in participants from two birth cohorts: Avon
Longitudinal Study of Parents and Children (ALSPAC) (noncycloplegic autorefraction) and
Generation R (cycloplegic autorefraction). A genetic risk score for myopia was calculated
from genotypes at 146 loci. Time spent reading, time outdoors, and parental myopia were
ascertained from parent-completed questionnaires. Risk factors were coded as binary
variables (0 = low, 1 = high risk). Associations between refractive error and each risk
factor were estimated using either ordinary least squares (OLS) regression or quantile
regression.
RESULTS. Quantile regression: effects associated with all risk factors (genetic risk,
parental myopia, high time spent reading, low time outdoors) were larger for children
in the extremes of the refractive error distribution than for emmetropes and low
ametropes in the center of the distribution. For example, the effect associated with
having a myopic parent for children in quantile 0.05 vs. 0.50 was as follows: ALSPAC:
age 15, –1.19 D (95% CI –1.75 to –0.63) vs. –0.13 D (–0.19 to –0.06), P = 0.001; Generation
R: age 9, –1.31 D (–1.80 to –0.82) vs. –0.19 D (–0.26 to –0.11), P < 0.001. Effect sizes
for OLS regression were intermediate to those for quantiles 0.05 and 0.50.
CONCLUSIONS. Risk factors for myopia were associated with much larger effects in children
in the extremes of the refractive error distribution, providing indirect evidence that
emmetropization buffers against both genetic and environmental risk factors.UK Medical Research Council and Wellcome (grant ref: 102215/2/13/2), and the University of Bristol provided core support for ALSPAC. This research was specifically funded by the UK National Eye Research Centre (grant SAC015), the Global Education Program of the Russian Federation government, a PhD studentship grant from the UK College of Optometrists (“Genetic Prediction of Individuals At-Risk for Myopia Development”), and an NIHR Senior Research Fellowship award SRF-2015-08-005. The Generation R study is supported by the Erasmus Medical Center, Rotterdam, Erasmus University, Rotterdam, the Netherlands; the Netherlands Organization of Scientific Research (NWO); Netherlands Organization for the Health Research and Development (ZonMw); the Ministry of Education, Culture and Science; the Ministry for Health,Welfare and Sports; the European Commission (DG XII); European Research Council (ERC) under the European Union’s Horizon 2020 Research and Innovation Programme (grant 648268); the Netherlands Organization for Scientific Research (NWO, grant 91815655); and Oogfonds, ODAS, Uitzicht 2017-28 (LSBS, MaculaFonds, Oogfonds)
Adolescent Nonsuicidal Self-Injury and Suicidality:A Latent Class Analysis and Associations with Clinical Characteristics in an At-Risk Cohort
Nonsuicidal self-injury (NSSI) is frequently encountered in adolescents, but its predictive value for suicidality or other clinical characteristics is challenging due to its heterogeneous nature. This study used latent class analysis to identify subgroups of NSSI and compared these on sociodemographic characteristics, adverse outcomes and protective factors. The study included 966 high-risk adolescents, Mage 14.9 y, SD 0.9 y, 51.8% female. Four classes emerged: (1) "Low NSSI-Low suicidality", (2) "Moderate NSSI-Low suicidality", (3) "Moderate NSSI-High suicidality", and (4) "High NSSI-High suicidality". Girls predominated in the high suicidality classes. Generally, Class 4 had the poorest outcomes: more internalizing and externalizing problems, less social support from friends and families and worst self-esteem. These findings emphasize the need for interventions tailored to specific phenotypes of adolescents engaging in NSSI
Performance of classification systems for age-related macular degeneration in the rotterdam study
Purpose: To compare frequently used classification systems for age-related macular degeneration(AMD) in their abilty to predictlate AMD. Methods:Intotal,9066participantsfromthepopulation-basedRotterdamStudywere followedupforprogressionofAMDduringastudyperiodupto30years.AMDlesions weregradedoncolorfundusphotographsafterconfirmationonotherimagemodalities andgroupedatbaselineaccordingtosixclassificationsystems.LateAMDwasdefinedas geographicatrophyorchoroidalneovascularization.Incidencerate(IR)andcumulative incidence(CuI)oflateAMDwerecalculated,andKaplan-Meierplotsandareaunderthe operating characteristics curves(AUCs)wereconstructed. Results: A total of 186 persons developed incident late AMD during a mean follow-up timeof8.7years.TheAREDSsimplifiedscaleshowedthehighestIRforlateAMDat104 cases/1000 py for ages 75 years. The 3-Continent harmonization classification provided the most stable progression. Drusen area >10% ETDRS grid (hazard ratio 30.05, 95% confidence interval [CI] 19.25–46.91) was most prognostic of progression. The highest AUC of late AMD (0.8372, 95% CI: 0.8070-0.8673) was achieved when all AMD features present at base line were included. Conclusions: Highest turnover rates from intermediate to late AMD were provided by the AREDS simplified scale and the Rotterdam classification. The 3-Continent harmonization classification showed the most stable progression. All features, especially drusenarea,contribute to late AMD prediction. Translational Relevance: Findings will help stakeholders select appropriate classification systems for screening,deep learning algorithms, or trials
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