Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study

<p>Abstract</p> <p>Background</p> <p>The pathophysiology of upper gastrointestinal (GI) symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use.</p> <p>Methods</p> <p>Population based case control study based on the second Dutch National Survey of general practice (conducted in 2001). Cases (adults visiting their primary care physician (PCP) with upper GI symptoms) and controls (individuals not having any of these complaints), matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psycho)pharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis.</p> <p>Results</p> <p>Data from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year). Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs) ranging from 1.37 to 3.45). Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90), including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or social co-morbidity was strongest associated with patients suffering from upper GI symptoms.</p> <p>Conclusion</p> <p>Patients with upper GI symptoms visit their PCP more frequently for problems of any organ system, including psychosocial problems. The relationship between upper GI symptoms and psychological problems is equivocal and may reflect increased health care demands in general.</p

Immunization with Small Amyloid-β-derived Cyclopeptide Conjugates Diminishes Amyloid-β-Induced Neurodegeneration in Mice

Background: Soluble oligomeric (misfolded) species of amyloid-beta (A beta) are the main mediators of toxicity in Alzheimer's disease (AD). These oligomers subsequently form aggregates of insoluble fibrils that precipitate as extracellular and perivascular plaques in the brain. Active immunization against A beta is a promising disease modifying strategy. However, eliciting an immune response against A beta in general may interfere with its biological function and was shown to cause unwanted side-effects. Therefore, we have developed a novel experimental vaccine based on conformational neo-epitopes that are exposed in the misfolded oligomeric A beta, inducing a specific antibody response. Objective: Here we investigate the protective effects of the experimental vaccine against oligomeric A beta(1-42)-induced neuronal fiber loss in vivo. Methods: C57BL/6 mice were immunized or mock-immunized. Antibody responses were measured by enzyme-linked immunosorbent assay. Next, mice received a stereotactic injection of oligomeric A beta(1-42) into the nucleus basalis of Meynert (NBM) on one side of the brain (lesion side), and scrambled A beta(1-42) peptide in the contralateral NBM (control side). The densities of choline acetyltransferase-stained cholinergic fibers origination from the NBM were measured in the parietal neocortex postmortem. The percentage of fiber loss in the lesion side was determined relative to the control side of the brain. Results: Immunized responders (79%) showed 23% less cholinergic fiber loss (p = 0.01) relative to mock-immunized mice. Moreover, fiber loss in immunized responders correlated negatively with the measured antibody responses (R-2 = 0.29, p = 0.02). Conclusion: These results may provide a lead towards a (prophylactic) vaccine to prevent or at least attenuate (early onset) AD symptoms

Agreement on endoscopic ultrasonography-guided tissue specimens: Comparing a 20-G fine-needle biopsy to a 25-G fine-needle aspiration needle among academic and non-academic pathologists

Background and Aim: A recently carried out randomized controlled trial showed the benefit of a novel 20-G fine-needle biopsy (FNB) over a 25-G fine-needle aspiration (FNA) needle. The current study evaluated the reproducibility of these findings among expert academic and non-academic pathologists. Methods: This study was a side-study of the ASPRO (ASpiration versus PROcore) study. Five centers retrieved 74 (59%) consecutive FNB and 51 (41%) FNA samples from the ASPRO study according to randomization; 64 (51%) pancreatic and 61 (49%) lymph node specimens. Samples were re-reviewed by five expert academic and five non-academic pathologists and rated in terms of sample quality and diagnosis. Ratings were compared between needles, expert academic and

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Business Intelligence in het hoger onderwijs

Terwijl business intelligence (BI) in het bedrijfsleven de nodige aandacht heeft gekregen, lijkt het erop dat business intelligence nog onvoldoende wordt benut in het hoger onderwijs. Waarschijnlijk is dit vooral te wijten aan de geringe kennis bij besturen en management over de mogelijkheden die BI te bieden heeft. Daarnaast is er sprake van beperkende randvoorwaarden, zoals: het ontbreken van integrale sturing op alle bedrijfsprocessen het ontbreken van een effectieve IT governance; het gemis van eenduidig gedefinieerde gegevens; een te gering aantal medewerkers met kennis van datawarehousing; onduidelijk eigenaarschap van informatie en een onduidelijke gebruikersorganisatie (wie mag wat met de gegevens in het datawarehouse). Hoewel het informatiemanagement van veel hogeronderwijsinstellingen wel met BI-trajecten bezig is, worden BI-omgevingen niet optimaal benut. Veelal blijft het gebruik steken bij ad hoc rapportages en verantwoordingsrapportages achteraf. Minder of geen aandacht is er voor stuurinformatie om tijdig te kunnen ingrijpen als bedrijfsprocessen niet lopen zoals gewenst. Rapportages zoals in het gegeven voorbeeld over studievoortganggegevens om bottlenecks in onderwijsprogramma's op te sporen worden, voor zo ver wij weten, nog nergens systematisch toegepast. De innoverende kracht van business intelligence kan daarom binnen het hoger onderwijs nog veel beter worden benut