Real-life achievement of lipid-lowering treatment targets in the DIAbetes and LifEstyle Cohort Twente:Systemic assessment of pharmacological and nutritional factors

BACKGROUND/OBJECTIVES: Lowering low-density lipoprotein cholesterol (LDLc) in type 2 diabetes mellitus is of paramount importance in preventing cardiovascular disease. However, treatment targets for LDLc are often not reached. We studied the prevalence of LDLc target achievement in a real-life population of type 2 diabetes mellitus patients in secondary care, and investigated whether in those not on target, there is room for intensifying pharmacological and lifestyle management according to current treatment guidelines. SUBJECTS/METHODS: We performed a cross-sectional analysis in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1; n = 450, age 63 ± 9 years, 58% men, diabetes duration 11 (7-18) years). At baseline, we determined plasma LDLc concentration, pharmacological treatment (i.e., statin use), and lifestyle (physical activity and dietary intake). Patients were divided according to LDLc < 1.8, LDLc 1.8-2.5, and LDLc > 2.5 mmol/l. Dietary intake was collected from a validated Food Frequency Questionnaire (177 items) and we determined guideline adherence for different food groups. Physical activity was assessed with the Short Questionnaire to ASsess Health enhancing behavior. RESULTS: LDLc data were available in 428 type 2 diabetes mellitus patients. LDLc ≤ 2.5 mmol/l was achieved in 317 patients (76%). In total, 76% of patients used statins, in those with LDLc > 2.5 mmol/l, this was 44%. Adherence to lifestyle guidelines was not different between the LDLc groups and was as follows: body mass index 6%, physical activity 59%, vegetables 7%, fruit 28%, legumes 59%, nuts 14%, dairy 19%, fish 36%, tea 8%, fats 66%, red meat 12%, processed meat 2%, alcohol 71%, sweetened beverages 34%, and sodium 12%. CONCLUSIONS: In type 2 diabetes mellitus patients in secondary health care, the target LDLc is achieved by three quarters of patients. Increasing statin treatment could be a first step to improve LDLc. In addition, there are ample opportunities for lifestyle management through increasing adherence to lifestyle guidelines

A review of wearable motion tracking systems used in rehabilitation following hip and knee replacement

Clinical teams are under increasing pressure to facilitate early hospital discharge for total hip replacement and total knee replacement patients following surgery. A wide variety of wearable devices are being marketed to assist with rehabilitation following surgery. A review of wearable devices was undertaken to assess the evidence supporting their efficacy in assisting rehabilitation following total hip replacement and total knee replacement. A search was conducted using the electronic databases including Medline, CINAHL, Cochrane, PsycARTICLES, and PubMed of studies from January 2000 to October 2017. Five studies met the eligibility criteria, and all used an accelerometer and a gyroscope for their technology. A review of the studies found very little evidence to support the efficacy of the technology, although they show that the use of the technology is feasible. Future work should establish which wearable technology is most valuable to patients, which ones improve patient outcomes, and the most economical model for deploying the technolog

Wijkeconomie: de kleine ondernemer aan het woord

Contains fulltext : 82493.pdf (publisher's version ) (Open Access)132 p

Latent Class Analysis to Predict Outcomes of Early High-Intensity Physical Therapy After Total Knee Arthroplasty, Based on Longitudinal Trajectories of Walking Speed

OBJECTIVE: To (1) classify patients who are recovering from total knee arthroplasty (TKA) based on walking speed during an early physical therapy program, and (2) assess whether walking-speed trajectory predicts performance on the timed up-and-go (TUG) test. DESIGN: Cohort study. METHODS: We included 218 patients from a 10-day physical therapy program after TKA. A latent class mixed model was used to classify patients according to their walking-speed trajectory during the program. We assessed the change in TUG test score from pre-TKA to 6 weeks and 1 year after TKA. The association between change in TUG test score and walking-speed trajectory was assessed using multivariable regression. RESULTS: There were 2 groups with distinct walking-speed trajectories: a high-gain group (46%) and a low-gain group (54%). There was no significant association between change in TUG test score and walking-speed trajectory after TKA and physical therapy. Function (based on TUG test performance) improved for all patients 1 year after TKA, irrespective of walking-speed trajectory (ie, high or low gain) early in postoperative physical therapy. CONCLUSION: Although we distinguished different groups based on functional outcomes during physical therapy, the clinical relevance of classifying patients based on walking speed remains unclear, as it did not predict short- and long-term functional outcomes. J Orthop Sports Phys Ther 2021;51(7):362-371. Epub 10 May 2021. doi:10.2519/jospt.2021.10299

A Novel Methodology for the Sustainability Impact Assessment of New Technologies

The introduction of new technologies can have profound impact on society and nature. Therefore, a need exists for a method that can provide a balanced assessment of new tech-nologies that takes into account all different impacts. Within the EU-funded PROSUITE pro-ject, the aim is to develop a methodology for the sustainability assessment of existing and emerging technologies. Here, existing approaches of sustainability assessment are re-viewed. All of them have their merits, but none of them is applicable in a generic way to all aspects of sustainability for a technology. Using concepts developed initially for environ-mental life cycle assessment, we propose an approach consisting of the following major impact categories: 1) impact on human health; 2) impact on social well-being; 3) impact on prosperity; 4) impact on natural environment; 5) impact on exhaustible resources. All pri-mary impacts can be grouped under these categories. For several of these categories still quite some analysis of mechanisms in the cause-effect chain is necessary and there will be substantial remaining uncertainties for the others. For a complete assessment, the five major impact categories need to be integrated. Several approaches are available for this purpose, such as multicriteria analysis with or without weighted aggregation