Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research

Health-related functional status: concepts, measurement and psychometric propertie

Social support as a predictor of perceived health status in patients with multiple sclerosis

Objective: The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. Methods: Two hundred and seven MS patients (38.4 +/- 10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzke's expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis. Results: Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS front family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36. Conclusion: PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients. Practice implications: The results show the importance of supporting social ties and relationships between MS patients and others. (C) 2008 Elsevier Ireland Ltd. All rights reserved

The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review

This systematic review focuses on the role of the intensity of fear in patient's delay in cancer and in myocardial infarction. In a search of literature published between 1990 and June 2009, 161 articles were found. After the use of inclusion and exclusion criteria, 11 articles in cancer and 4 articles in myocardial infarction remained. High levels of fear are associated with earlier help-seeking in both diseases; for low levels of fear, the picture is unclear. The level of fear is an important factor, which should be taken into account when facilitating help-seeking by patients

Operative treatment of anterior thoracic spinal cord herniation:three new cases and an individual patient data meta-analysis of 126 case reports

OBJECTIVE: Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS: Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P < 0.036). CONCLUSION: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder

Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life

BACKGROUND: Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries. DESIGN: An observational multicentre study at university cardiac centres in the Netherlands and Slovakia. METHODS: In 226 coronary artery disease patients, health-related quality of life was measured by the Short Form Health Survey 36, anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and type D personality was assessed with the 14-item Type D Scale. Multivariate analysis was used to explore the effect of patient characteristics on the physical and mental component summaries. Estimates of each predictor's beta value of the physical and mental component summaries in the Slovak and Dutch patient sample were separately calculated using the Cummings criterion for comparison of two independent betas. RESULTS: Stronger predictors of physical health-related quality of life in Slovak patients were educational level, current smoking, poor functional status, history of diabetes and amount of social support. In Dutch patients, only more symptoms of depression was a stronger predictor ( P<0.05). Regarding Slovak mental health-related quality of life, stronger predictors were educational level, current smoking and amount of social support. Female gender, history of myocardial infarction and more symptoms of depression were stronger predictors in Dutch patients ( P<0.05). CONCLUSION: Descent and differences between both populations in determinants of health-related quality of life should be considered while planning care, follow-up, health education and rehabilitation

Brain Regeneration - in vitro and in vivo studies of exercise-related effects on brain plasticity

Neural stem and progenitor cells in the germinal regions of the adult brain, such as the hippocampus, are of great interest, because they provide the possibility for enhanced brain plasticity or can contribute to endogenous cell replacement after injury or disease. Voluntary exercise was recently shown to robustly induce cellular and structural plasticity, thereby contributing to overall brain health. This thesis focuses on exercise-related effects on cell genesis of neurons and oligodendrocytes in vitro and in vivo. In Paper I, we demonstrated that the exercise-induced, endogenously released opioid peptide β-endorphin enhanced oligodendrogenesis in adult hippocampal progenitors in vitro. Results revealed a requirement for the helix-loop¬ helix transcriptional regulator “Inhibitor of Differentiation” (Id) 1 in opioid-induced oligodendrogenesis. In Paper II, we studied the effects of voluntary exercise during adulthood on neurogenesis and behavior, subsequent to irradiation in the young mouse brain. Voluntary exercise following irradiation restored the hippocampal stem cell pool, increased neurogenesis, and ameliorated irradiation-induced alterations in behavior. Moreover, orientation of immature neurons in the hippocampal dentate gyrus was perturbed after irradiation; however, voluntary exercise restored proper orientation. In Paper III, we proceeded to investigate potential effects of voluntary exercise on oligodendrogenesis after irradiation to the immature brain. We demonstrate an efficient irradiation-induced reduction in the total number of Olig2-positive cells of the corpus callosum, considered to be mainly oligodendroglial cells, without affecting the number of newborn glial progenitor cells. Our results also reveal that, in contrast to the beneficial effects of exercise on neurogenesis in the hippocampus, voluntary running does not seem to affect cell proliferation or oligodendrogenesis in the corpus callosum. In conclusion, this thesis demonstrates the usefulness of physical exercise for functional and structural brain recovery, with special emphasis on insults to the juvenile brain. In addition, these results highlight the capacity of the adult brain to regenerate through activation of endogenous neural progenitors and stem cells