T is associated with severe dyspepsia

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Genetic and psychological determinants of dyspepsia and implications for treatment

Dyspepsia is a very common condition in the population with a prevalence ranging from 25 to 40%. It refers to a complex of symptoms believed arising in the upper gastrointestinal tract and includes heartburn, acid regurgitation, excessive burping or belching, a feeling of slow digestion, early satiety, nausea and bloating. Dyspepsia is an important and costly health problem due to high medical costs for diagnostic investigations and for drug treatment and its impact on absenteeism from work. The aetiology of dyspepsia is very complex and still poorly understood. Several causal factors are suggested: Helicobacter pylori infection, excessive gastric acid, delayed gastric emptying, visceral hypersensitivity, psychosocial morbidity, use of NSAID's and post-infective mucosal damage. Recently also genetic predisposition has been suggested as a relevant factor in the genesis of dyspeptic complaints. In this thesis we report our studies on the influence of psychological state, major life events, coping style and genetic factors on dyspeptic symptom severity and the extend to which these factors affect the outcome of acid inhibiting treatment in primary care patients with dyspepsia

Long-Term Effects of the RealFit Intervention on Body Composition, Aerobic Fitness, and Behavior

Abstract Background: RealFit is a 13-week weight reduction program for youth that focuses on nutrition, physical activity (PA), psychology, and parental participation. The short-term effectiveness of the RealFit intervention, in terms of body composition, aerobic fitness, and dietary and PA behavior, having been proven, the present study evaluated the long-term effects of the intervention. METHODS: The study had a quasi-experimental design. Height, weight, waist circumference, aerobic fitness, and self-reported dietary and PA behavior were assessed at baseline (T0), immediately after the 13-week RealFit intervention (T1), after 5 months (T2), and 1 year (T3) of follow-up. A total of 86 adolescents participated in the intervention group. The control group (n=32) comprised overweight adolescents who did not receive any treatment. RESULTS: One year after the RealFit intervention, significant decreases in BMI z-score (mean difference [MD]: -0.39) and waist circumference (MD, -3.24) were found. The comparison between the intervention and control groups, controlling for confounders, resulted in a significant difference (BMI z-score: -0.41; 95% confidence interval [CI]: -0.67 to -0.15; waist circumference: -8.07; 95% CI: -11.58 to -4.56). The results for dietary and PA behavior consistently showed favorable changes in the intervention group. CONCLUSIONS: The RealFit intervention appears to have significant favorable long-term effects on BMI z-score and waist circumference. These changes in body composition obviously represent changes in adolescents' energy balance-related behavior. Taking all results and limitations into account, it may cautiously be concluded that RealFit is an effective weight loss intervention

Long-term effects of the RealFit intervention on self-esteem and food craving

Realfit is a 13-week weight-reduction programme for adolescents. This study investigated the programme’s long-term effectiveness regarding the psychological outcomes of self-esteem and food craving. Methods: the study had a quasi-experimental design. Body mass index, self-esteem and food craving were assessed at baseline (t0), immediately after realfit (t1), and after five months (t2) and one year (t3) of follow-up. Control participants (n = 32) were overweight adolescents who received no treatment. Results: comparison between the intervention (n = 86) and control groups showed a significant difference for the self-esteem domain of global self-worth (1.63; 95% confidence interval: 0.28 to 2.99) in favour of the intervention group. The differences regarding overall self-esteem and the physical appearance domain showed a trend towards improvement. No significant difference was found for food craving. Conclusions: taking all results and limitations into account, it may cautiously be concluded that realfit has beneficial long-term effects on some domains of self-esteem, but no substantial effect on food craving. The appropriate duration and delivery of cue-exposure sessions in groups of overweight adolescents to decrease food craving should be investigated to further improve the realfit intervention

Pragmatic trials in primary care. Methodological challenges and solutions demonstrated by the DIAMOND-study.

Contains fulltext : 51512.pdf (publisher's version ) (Open Access)BACKGROUND: Pragmatic randomised controlled trials are often used in primary care to evaluate the effect of a treatment strategy. In these trials it is difficult to achieve both high internal validity and high generalisability. This article will discuss several methodological challenges in designing and conducting a pragmatic primary care based randomised controlled trial, based on our experiences in the DIAMOND-study and will discuss the rationale behind the choices we made. From the successes as well as the problems we experienced the quality of future pragmatic trials may benefit. DISCUSSION: The first challenge concerned choosing the clinically most relevant interventions to compare and enable blinded comparison, since two interventions had very different appearances. By adding treatment steps to one treatment arm and adding placebo to both treatment arms both internal and external validity were optimized. Nevertheless, although blinding is essential for a high internal validity, it should be warily considered in a pragmatic trial because it decreases external validity. Choosing and recruiting a representative selection of participants was the second challenge. We succeeded in retrieving a representative relatively large patient sample by carefully choosing (few) inclusion and exclusion criteria, by random selection, by paying much attention to participant recruitment and taking the participant's reasons to participate into account. Good and regular contact with the GPs and patients was to our opinion essential. The third challenge was to choose the primary outcome, which needed to reflect effectiveness of the treatment in every day practice. We also designed our protocol to follow every day practice as much as possible, although standardized treatment is usually preferred in trials. The aim of this was our fourth challenge: to limit the number of protocol deviations and increase external validity. SUMMARY: It is challenging to design and conduct a pragmatic trial. Thanks to thorough preparation, we were able to collect highly valid data. To our opinion, a critical deliberation of where on the pragmatic--explanatory spectrum you want your trial to be on forehand, in combination with consulting publications especially on patient recruitment procedures, has been helpful in conducting a successful trial

Stabilizing prevalence trends of eczema, asthma and rhinoconjunctivitis in Dutch schoolchildren (2001-2010)

In contrast to many countries, a decrease in childhood wheeze prevalence was previously reported for the Netherlands. In repeated cross-sectional surveys in 2001, 2005 and 2010, we investigated whether this trend continued, and additionally examined prevalence trends of eczema, asthma and rhinoconjunctivitis among 8- to 11-year-old schoolchildren eligible for a routine physical examination. Overall, similar to 90% participated (mean age: 8.8 years in 2001 and 10.5 years in 2005 and 2010). Eczema, wheeze and asthma prevalence did not change significantly between 2001 and 2010, but rhinoconjunctivitis prevalence increased from 8.4% in 2001 to 12.3% in both 2005 and 2010 (P-trend <0.01). In conclusion, after a decrease in wheeze prevalence among Dutch schoolchildren between 1989 and 2001, no further decrease was observed until 2010. Similarly, the prevalence of eczema and asthma remained stable, but rhinoconjunctivitis prevalence increased between 2001 and 2010. The latter may be an effect of older age and not a true increase over time

Living Environment Matters: Relationships Between Neighborhood Characteristics and Health of the Residents in a Dutch Municipality

Characteristics of an individual alone cannot exhaustively explain all the causes of poor health, and neighborhood of residence have been suggested to be one of the factors that contribute to health. However, knowledge about aspects of the neighborhood that are most important to health is limited. The main objective of this study was to explore associations between certain features of neighborhood environment and self-rated health and depressive symptoms in Maastricht (The Netherlands). A large amount of routinely collected neighborhood data were aggregated by means of factor analysis to 18 characteristics of neighborhood social and physical environment. Associations between these characteristics and self-rated health and presence of depressive symptoms were further explored in multilevel logistic regression models adjusted for individual demographic and socio-economic factors. The study sample consisted of 9,879 residents (mean age 55 years, 48 % male). Residents of unsafe communities were less likely to report good health (OR 0.88 95 % CI 0.80-0.97) and depressive symptoms (OR 0.81 95 % CI 0.69-0.97), and less cohesive environment was related to worse self-rated health (OR 0.81 95 % CI 0.72-0.92). Residents of neighborhoods with more car traffic nuisance and more disturbance from railway noise reported worse mental health (OR 0.79 95 % CI 0.68-0.92 and 0.85 95 % CI 0.73-0.99, respectively). We did not observe any association between health and quality of parking and shopping facilities, facilities for public or private transport, neighborhood aesthetics, green space, industrial nuisance, sewerage, neighbor nuisance or satisfaction with police performance. Our findings can be used to support development of integrated health policies targeting broader determinants of health. Improving safety, social cohesion and decreasing traffic nuisance in disadvantaged neighborhoods might be a promising way to improve the health of residents and reduce health inequalities

Neighborhood Environment Is Associated with Overweight and Obesity, Particularly in Older Residents: Results from Cross-Sectional Study in Dutch Municipality

We explored whether overweight and obesity were associated with the physical and social environment at neighborhood level. Data from Maastricht municipality survey (the Netherlands) were used (n = 9771 adults). Multinomial regression models were computed (outcome being normal weight, overweight, or obese). We found inconsistent associations between neighborhood social and physical environment characteristics and overweight and obesity in the total sample. The effects were more consistent and stronger for older residents (>65) and obesity as an outcome. Better scores on traffic nuisance, green space, social cohesion, nuisance, and safety were associated with lower odds of obesity among elderly (OR ranged between 0.71 [95 % CI 0.44 to 0.93] to 0.85 [95 % CI 0.74 to 0.96] for each point of improvement in neighborhood social and physical environment (scale 0-10)). We showed that there are neighborhood-level factors that are associated with obesity, particularly in elderly residents. These could be targeted in preventive strategies outside health care settings