Assessment of disease activity by patients with juvenile idiopathic arthritis and the parents compared to the assessment by pediatric rheumatologists

Background: Self assessment of arthritis is important for recognition of disease activity and early initiation of therapy. Proper interpretation of physical symptoms is necessary for this. The purpose was to investigate the assessment by patients and parents of disease activity in juvenile idiopathic arthritis (JIA) and to compare their assessments to rheumatologists' assessments. Methods: Patients and parents assessed 69 joints on a paper homunculus and marked each joint with a different color according to presumed presence of disease: active disease (AD), doubt, and non-active disease (NAD). Their assessments were compared to the rheumatologists' assessments. If patients and/or parents marked an inflamed joint, it counted as AD. Pain, functional impairment, and disease duration were analyzed to differentiate more precise between true and false positive and true and false negative assessments. Results: We collected assessments of 113 patients and/or parents. AD was assessed 54 times, 33 of which were true positives. NAD was assessed 23 times, 22 of which were true negatives. Doubt was expressed 36 times, 9 of which were assessed by the rheumatologist as AD. Sensitivity and specificity of AD was 0.77 and 0.31. Pain and functional impairment scored highest in AD, intermediate in doubt, and lowest in NAD. Conclusion: Patients and/or parents seldom missed arthritis but frequently overestimated disease activity. Pain, functional impairment, disease duration, gender, and age did not differentiate between true and false positives for. Patients perceived JIA as active if they experienced pain and functional impairment. To reduce overestimation of the presence of AD we need to improve their understanding of disease activity by teaching them to distinguish between primary symptoms of JIA and symptoms like pain and functional impairment

On becoming edentulous. An investigation into the dental and behavioural reasons for full mouth extractions.

This investigation deals with reasons for full mouth extractions. In chapter I, the general introduction, changes in edentulous-rates in different countries and disease and non-disease reasons for full mouth extraction are reviewed. The Netherlands has one of the highest percentages of edentulous people in the world (about 30% of the adult population). Apart from caries and periodontal disease, non-disease factors such as attitude and behaviour, characteristics of the health care system and dental attendance patterns may play a role in the decision to become edentulous. It appears from the literature that edentulousness and dental attendance pattern and the treatment received. Indeed some authors argue that tooth loss does not bear a close relationship to the prevalence of dental disease. Many investigators have shown a significant relationship between edentulousness and low occupational levels. ... Zie: Summary

Caries and total extraction in a medium-sized city in the Netherlands

In 1982 a combined sociodental research project was started in the city of Groningen in order to gain insight into the dental and social reasons for total extraction. 91% of the dentists in the city participated in this study by collecting the extracted teeth, filling out a questionnaire and asking their patients to fill out another questionnaire concerning the behavioral aspects of total tooth loss. 78% of the 134 patients returned the questionnaire. In this article the caries status in relation to the social background and dental attendance pattern has been described. The mean age at the time of extraction was 44.2 yr. The patients were a good cross-section of the Dutch population as regards education level, type of health insurance and sex. The average number of teeth was 14.2. The average DEMFT value was 22.8. Although regular attenders had less D-teeth than irregular attenders they had an average of 3.5 teeth with active caries. Regular attenders had more F-teeth but less sound teeth than irregular attenders. The contribution of the dental health care system to the dental health of the population is discussed

Wind farm aural and visual impact in the Netherlands

The WINDFARMperception project, carried out in 2007/08 in the Netherlands, aimed to explore the impact of wind turbines on people living close to wind farms. The study group was selected in three types of area (countryside, countryside with major road, built up area) by means of a Geographic Information System (GIS). Each selected address was sithin 2.5 km of a wind turbine of at least 500 kW electric power and a similar turbine within 500 m of the first. Aural impact was calculated according to three different sound propagation models: the international ISO-9613 standard, the model legally required in the Netherlands, and a simplified model as in the New Zealand Standard NZS-6808. Visual impact was quantified in two ways: the vertical angle determined by the height of the apparently tallest turbine, and the solid angle determined by all turbines where each turbine was replaced by a vertical rectangle just enclosing the turbine. Immission sound levels from the wind farms at 1948 receiver locations varied from 21 to 54 dB(A), relative size from 0.01% to 30% of the total field of view. Results show that all impact measures are highly correlated with distance to the nearest wind turbine

Response to wind turbine noise in the Netherlands

A cross-sectional study with the objective to explore the impact of wind turbine noise on people living in the vicinity of wind farms was carried out in the Netherlands in 2007. A postal questionnaire assessing response to environmental exposures in the living area, including wind turbine noise, was answered by 725 respondents (response rate: 37%). Immission levels of wind turbine noise outside the dwelling of each respondent were calculated in accordance with ISO-9613. The risk for being annoyed by wind turbine noise outdoors increased with increasing sound levels (rs = 0.501, n = 708, p<0.001). The risk for annoyance was decreased for respondents who could not see wind turbines from their dwelling and for respondents who benefited economically from the turbines. No statistically significant correlations between immission levels of wind turbine noise and health or well-being were found. However, noise annoyance due to wind turbine noise was associated with stress symptoms, psychological distress and lowered sleep quality