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The Severity of Disabilities Scale (SDS) of the ICIDH reflects the degree to which an individual's ability to perform a certain activity is restricted. This paper describes the application of two models from item response theory (IRT), the graded response model and the partial credit model, in order to derive a tentative proposal for a revised SDS. The key ingredient of the approach is to scale existing disability items obtained in different studies on a common scale by exploiting the overlap. Both IRT models are fitted to a linked data set containing items for measuring walking disability. Based on these solutions, a tentative SDS is constructed. The paper concludes with a discussion of the implications, limitations and advantages of the approach. Copyright © 2001 John Wiley & Sons, Ltd.

Purpose: To develop a preliminary proposal for the revision of the severity code of the ICIDH-D 1980. Method: Quantitative analysis (polytomous Rasch analysis) of linked existing data sources including items about walking and dressing disability. Results: The Rasch analysis provided estimates of threshold parameters for walking and dressing item categories. Factor analysis showed that more than one dimension was present, but that the first factor could definitely be interpreted as 'disability'. The reliability of the solutions was satisfactory (0.88 for walking and 0.91 for dressing). Conclusion: Based on the results, tentatively a new severity code is proposed with more distinct categories of 'difficulty' than the existing code, and the use of technical aids and personal assistance in the higher ranks. The Rasch method could be a useful tool for calibrating and measuring disability, as well as for converting existing disability data into a new uniform severity of disability code.

Purpose: To assess trends in Disability-Free Life Expectancy, in life expectancy with disabilities according to levels of severity and in Disability-Adjusted Life Expectancy in the Netherlands between 1989 and 2000. Method: The disability-free life expectancy, a composite population health status measure, was calculated with data on long-term disability. Weights reflecting the impact of disability on personal functioning were assigned to different levels of severity of disability, in order to calculate a Disability-Adjusted Life Expectancy and to define cut-off points, in order to distinguish between levels of severity. Results: At an aggregated level, for both males and females at the ages of 16 and of 65 years, an increase in years with disabilities and a decline in disability-free life expectancy were observed. These trends were mainly caused by a rise in the number of years with mild disabilities, with the number of years with moderate and severe disabilities decreasing. The combined changes have resulted in an increase in the Disability-Adjusted Life Expectancy. Conclusion: Trends in disability-free life expectancy and in years with disabilities provide support for a scenario of dynamic equilibrium. The number of years with moderate and severe disabilities has reduced, resulting in an increase in the number of years with minor disabilities. Further research should focus on the underlying causes of the increase of years with minor disabilities. © 2004 Taylor & Francis Ltd.

Objective: To examine the effect of intrauterine and neonatal growth, prematurity and personal and environmental risk factors on intelligence in adulthood in survivors of the early neonatal intensive care era. Methods: A large geographically based cohort comprised 94% of all babies born alive in the Netherlands in 1983 with a gestational age below 32 weeks and/or a birth weight >1500 g (POPS study). Intelligence was assessed in 596 participants at 19 years of age. Intrauterine and neonatal growth were assessed at birth and 3 months of corrected age. Environmental and personal risk factors were maternal age, education of the parent, sex and origin. Results: The mean (SD) IQ of the cohort was 97.8 (15.6). In multiple regression analysis, participants with highly educated parents had a 14.2-point higher IQ than those with less well-educated parents. A 1 SD increase in birth weight was associated with a 2.6-point higher IQ, and a 1-week increase in gestational age was associated with a 1.3-point higher IQ. Participants born to young mothers (<25 years) had a 2.7-point lower IQ, and men had a 2.1-point higher IQ than women. The effect on intelligence after early (symmetric) intrauterine growth retardation was more pronounced than after later (asymmetric) intrauterine or neonatal growth retardation. These differences in mean IQ remained when participants with overt handicaps were excluded. Conclusions: Prematurity as well as the timing of growth retardation are important for later intelligence. Parental education, however, best predicted later intelligence in very preterm or very low birthweight infants.

Objectives: Age-related changes in articular cartilage are likely to play a role in the aetiology of osteoarthritis (OA). One of the major age-related changes in cartilage is the accumulation of advanced-glycation-endproducts (AGEs). Since, cartilage tissue is not readily available from patients for studying AGE levels, alternative approaches such as analyzing skin and urine are needed to study the role of cartilage AGE levels in OA. Methods: Paired human skin and cartilage samples were obtained post mortem. Paired skin and urine samples were obtained from the CHECK cohort (early OA patients). Pentosidine levels were measured by high-performance liquid chromatography (HPLC). As marker of cumulative cartilage damage X-rays of both knees and hips were scored. Urinary CTXII (uCTXII) levels were measured, to assess current cartilage breakdown. Results: Cartilage and skin pentosidine correlate well (R= 0.473, P= 0.05). Skin pentosidine was higher in mild (summed (Kellgren & Lawrence K&L) over four large joints ≥4) compared to no (summed K&L≤3) radiographic OA (P= 0.007). Urinary pentosidine was not different between these two groups. Skin pentosidine levels were not related to cartilage breakdown (highest vs lowest tertile of uCTXII). Urinary pentosidine, however, was higher in the highest compared to the lowest uCTXII tertile (P= 0.009). Multiple regression analysis showed age to be the only predictor of the summed K&L score and age, creatinine clearance and urinary pentosidine as predictors of uCTXII. Conclusion: The higher skin and urinary pentosidine levels in those with mild compared to no radiographic joint damage and low vs high cartilage breakdown respectively suggest that AGEs may contribute to disease susceptibility and/or progression. However, relations are weak and cannot be used as surrogate markers of severity of OA. © 2010 Osteoarthritis Research Society International.

Context: Molecules that are released into biological fluids during matrix metabolism of articular cartilage, subchondral bone, and synovial tissue could serve as biochemical markers of the process of osteoarthritis (OA). Unfortunately, actual breakthroughs in the biochemical OA marker field are limited so far. Objective: By reviewing the status of commercially available biochemical OA markers according to the "Burden of disease, Investigative, Prognostic, Efficacy of intervention, and Diagnostic" ("BIPED") classification, future use of this "BIPED" classification is encouraged and more efficient biochemical OA marker research stimulated. Data sources: Three electronic databases [PubMed, Scopus, EMBASE (1997-May 2009)] were searched for publications on blood and urinary biochemical markers in human primary knee and hip-OA. Study selection: Stepwise selection of original English publications describing human studies on blood or urinary biochemical markers in primary knee or hip-OA was performed. Selected articles were fully read to determine whether biochemical markers were investigated on performance within any of the "BIPED" categories. Eighty-four relevant publications were identified. Data extraction: Data from relevant publications were tabulated according to the "BIPED" classification. Individual analyses within a publication were summarized in general "BIPED" scores. Data synthesis: An uneven distribution of scores on biochemical marker performance and heterogeneity among the publications complicated direct comparison of individual biochemical markers. Comparison of categories of biochemical markers was therefore performed instead. In general, biochemical markers of cartilage degradation were investigated most extensively and performed well in comparison with other categories of biochemical markers. Biochemical markers of bone metabolism performed less adequately. Biochemical markers of synovial tissue metabolism were not investigated extensively, but performed quite well. Conclusions: Specific biochemical markers and categories of biochemical markers as well as their nature, origin and metabolism, need further investigation. International standardization of future investigations should be pursued to obtain more high-quality, homogenous data on the full spectrum of biochemical OA markers. © 2010 Osteoarthritis Research Society International.

Introduction: Workers with chronic low back pain (LBP) mean a heavy human and social-economic burden. Their medical histories often include different treatments without attention to work-relatedness or communication with occupational health providers, leaving them passive and medicalized in (outpatient) health care. So we developed and implemented an innovative, patient-activating alternative: the multidisciplinary outpatient care (MOC) programme, including work(place) intervention and graded activity. It aims at function restore (instead of pain elimination), return to work (RTW) and coordinated communication. Objectives: To qualitatively explore how patients and health care providers perceive the programme effectiveness and which factors influence its implementation. Methods: In-depth, semi structured interview with patients and focus groups of health care providers are used, all recorded, transformed into verbatim transcript and analysed. Results: This qualitative study shows that although patients' expectations were low at the start of the program, and despite long LBP histories, including many different therapies, (primarily) directed at pain reduction, the MOC programme was successful in changing patients' goal setting from pain oriented towards function restore and RTW. The programme was therefore perceived as applicable and effective. Patient compliance was influenced by barriers - despair, supervisory and subordinate resistance at work, waiting period, medicalisation in health care - and facilitators: disciplinary motivation, protocolled communication, information supply, tailor-made exercises. For some patients the barriers were too high. Several improvement suggestions were given. Conclusions: This qualitative study shows that generally, patients and professionals perceived the multidisciplinary outpatient care programme as applicable and effective. After incorporating improvement suggestions this program seems promising for further, broader application and hypothesis testing. For those, negatively evaluating the programme, alternatives should be explored. © 2009 IOS Press. All rights reserved.

Children with Down syndrome (DS) have an increased risk for developing both acute myeloid as well as acute lymphoblastic leukemia. These leukemias differ in clinical characteristics and biology compared to leukemias in non-DS children. Moreover, children with DS have an increased risk of side-effects from cytostatic therapy, which complicates their treatment. Myeloid leukemia in children with DS (ML-DS) is a unique disease entity. ML-DS blasts are relatively sensitive to chemotherapy, which enables dose- reductions. This also leads to a decrease in toxicity;together resulting in improved outcome compared to AML in non-DS children. Therefore, a European treatment protocol specifically for ML- DS was recently implemented. ML-DS is often preceded by a pre- leukemic clone in newborns (transient leukemia: TL), which in most cases resolves spontaneously. However, in case of severe symptoms treatment is indicated. Twenty percent of TL patients subsequentiy develop myeloid leukemia. To improve treatment and survival of children with TL, and to study if transition to ML-DS can be prevented by early treatment in the TL phase, a nation-wide TL surveillance and treatment protocol has been opened in the Netherlands recendy. The prognosis of DS-ALL patients is at best similar to non-DS-ALL patients. The biological characteristics of leukemic lymphoblasts differ between DS-ALL and non-DS-ALL. DS-ALL lymphoblasts do not have increased sensitivity to chemotherapy compared to non-DS lymphoblasts. Therefore dose-reduction should only be considered in case of unacceptable toxicity. Recent findings suggest that DS-ALL patients experience excessive toxicity during the current DCOG ALLio-protocol. Hence, adjustments in the treatment protocol for DS-ALL patients were made.

Insulin requirement affects the careers of diabetic professionals who do safety-sensitive jobs. In most cases, insulin-treated individuals are automatically banned from safety-sensitive jobs because the risk of hypoglycaemia is regarded as incompatible with safety. Recent developments—such as diabetes self-management education, self-monitoring of blood glucose, continuous glucose monitoring, and shortacting and longacting insulin analogues—enable better achievement of individual glycaemic target ...

Aim: To determine the prevalence and independent relationship between hearing loss and risk factors in a representative neonatal intensive care unit (NICU) population. Methods: Automated auditory brainstem response (AABR) hearing screening has been introduced since 1998 in the Dutch NICUs. After a second AABR failure, diagnostic ABR was used to establish diagnosis of hearing loss. Newborns who died before the age of 3 months were excluded. In the present study only the NICU infants who were born with a gestational age <30 weeks and/or a birth weight <1000 g between October 1, 1998 and January 1, 2002 were included. Risk factors included in the study were familial hearing loss, in utero infections, craniofacial anomalies, birth weight <1500g, hyperbilirubinemia, ototoxic medications, cerebral complications, severe birth asphyxia, assisted ventilation ≥5 days and syndromes. Results: A nationwide cohort of 2186 newborns were included. Mean gestational age was 28.5 weeks (SD 1.6) and mean birth weight was 1039 g (SD 256). Prevalence of uni- or bilateral hearing loss was 3.2% (71/2186; 95% CI 2.6-4.1). Multivariate analysis revealed that the only independent risk factors for hearing loss were severe birth asphyxia (OR 1.7; 95% CI 1.0-2.7) and assisted ventilation ≥5 days (OR 3.6; 95% CI 2.1-6.0). Conclusion: The prevalence of hearing loss in a representative NICU population was 3.2%. Independent risk factors for hearing loss were severe birth asphyxia and assisted ventilation ≥5 days. © 2007 The Author(s).

In this investigation, carried out under a Youth Health Care postgraduate course in Nijmegen, the stereopsis of a school population of 730 children, aged 4-18 years, was recorded and clinically evaluated. Stereopsis was measured using the TNO test, a random-dot stereo test especially designed for the early detection of amblyopia. The main aims of this study were to establish the validity of the TNO test as a screening test for amblyopia, obtain information about the variability and age dependence of stereopsis, and to evaluate the efficacy of amblyopia prevention. The most important findings can be summarized as follows: 1 All amblyopes are detected by the TNO test's recommended referral criterion of 240 sec arc (binocular threshold parallax in sec arc). 2 The red-green anaglyphs used in the test do not pose problems for individuals with a colour vision deficiency. 3 The ability to discriminate depth improves by a factor of two over the age interval 4-12 years. 4 A stereoacuity of £ 120 sec arc is a good predictor of normal or correctable normal vision, and may therefore help in evaluating the often incomplete results of eye tests of young children. 5 Where there is an increased perinatal risk, there is a greater chance of disturbed binocular vision. 6 It is estimated that 75% of amblyopes remain amblyopic, possibly because of delayed detection; 60% of the amblyopes in the population examined were not identified before the age of 5 years.

Summary: Food allergic patients have to deal with an avoidance diet. Confusing labelling terms or precautionary labels can result in misinterpretation and risk-taking behaviour. Even those patients that strictly adhere to their diet experience (sometimes severe) unexpected allergic reactions to food. The frequency, severity and causes of such reactions are unknown. The objective of this review was to describe the frequency, severity and causes of unexpected allergic reactions to food in food allergic patients aged > 12 years, in order to develop improved strategies to deal with their allergy. A systematic review was carried out by two researchers, in six electronic databases (CINAHL, Cochrane, EMBASE, Medline, Psychinfo and Scopus). The search was performed with keywords relating to the frequency, severity and causes of unexpected allergic reactions to food. This resulted in 24 studies which met the inclusion criteria; 18 observational and six qualitative studies. This review shows that knowledge about the frequency of unexpected reactions is limited. Peanut, nuts, egg, fruit/vegetables and milk are the main causal foods. Severe reactions and even fatalities occur. Most reactions take place at home, but a significant number also take place when eating at friends' houses or in restaurants. Labelling issues, but also attitude and risky behaviour of patients can attribute to unexpected reactions. We conclude that prospective studies are needed to get more insight in the frequency, severity, quantity of unintended allergen ingested and causes of unexpected allergic reactions to food, to be able to optimize strategies to support patients in dealing with their food allergy. Although the exact frequency is not known, unexpected reactions to food occur in a significant number of patients and can be severe. For clinical practice, this means that patient education and dietary instructions are necessary. © 2014 John Wiley & Sons Ltd.

Unexpected reactions occur in patients with food allergy, but frequency data are scare. This prospective study investigates the frequency, severity and causes of unexpected allergic reactions to food in adults with a doctor's diagnosed food allergy. Participants complete an online questionnaire after every unexpected reaction and send in the culprit product including the food label. The product is analyzed for suspected allergens. Preliminary results show that the mean number of reactions was 1 per person per year. Most reactions occurred after consuming pre-packaged food and composite meals outdoors.© 2014 De Nederlandse Vereniging voor Dermatologie en Venereologie.

Unexpected reactions occur in patients with food allergy, but frequency data are scare. This prospective study investigates the frequency, severity and causes of unexpected allergic reactions to food in adults with a doctor's diagnosed food allergy. Participants complete an online questionnaire after every unexpected reaction and send in the culprit product including the food label. The product is analyzed for suspected allergens. Preliminary results show that the mean number of reactions was 1 per person per year. Most reactions occurred after consuming pre-packaged food and composite meals outdoors.© 2014 De Nederlandse Vereniging voor Dermatologie en Venereologie.

Brain serotonin function has been implicated in the control of sleep and sleep related memory dysfunctions are attributed to deficient brain serotonin activity. Depletion of the serotonin precursor tryptophan reduces brain serotonin function and is found to cause sleep abnormalities and cognitive decline. We hypothesized that enhancing pre-sleep brain tryptophan availability via a dietary increase in the ratio of plasma tryptophan to the sum of the other large neutral amino acids (Trp/LNAA) improves post-sleep memory functioning particularly in subjects with mild sleep complaints. To test whether evening intake of a tryptophan-rich diet increases the plasma Trp/LNAA ratio before sleep and improves early morning behavioral and brain measures of memory function in subjects with mild sleep complaints and controls. Twenty-eight subjects with mild sleep complaints and 28 controls participated in a double-blind placebo-controlled study. They stayed at the laboratory for an overnight sleep to monitor their post-sleep memory performance following either an evening diet containing tryptophan-rich protein or placebo protein. Evening dietary-induced changes in the plasma Trp/LNAA ratio were measured. Besides measuring behavioral changes, also task-related electroencephalographic brain activity (ERP) was measured as an index of cerebral changes in memory function. The tryptophan-rich diet caused a 130% increase in the plasma Trp/LNAA ratio (P = 0.0001) and in all subjects improved behavioral (P=0.001) and ERP (P=0.05) brain measures of memory function. Post-sleep memory function improves after pre-sleep dietary increases in plasma TRP/LNAA probably by improved sleep. Copyright © 2006 by New Century Health Publishers, LLC.

Background: the prevalence of individuals with cognitive decline is increasing since the number of elderly adults is growing considerably. The literature provides promising results on the beneficial effect of exercise and vitamin supplementation on cognitive function both in cognitively healthy as well as in the demented elderly. Methods/Design: the design is a two-by-two factorial randomised controlled trial. The study population consists of independently living elderly, between 70 and 80 years old, with mild cognitive impairment (MCI). In the RCT the effect of two interventions, a walking program and vitamin supplementation, is examined. The walking program (WP) is a group-based program aimed at improving cardiovascular endurance; frequency two lessons a week; lesson duration one hour; program duration one year. Non-walking groups receive a placebo activity program (PAP) (i.e. low intensive non-aerobic group exercises, like stretching) with the same frequency, lesson and program duration. Vitamin supplementation consists of a single daily vitamin supplement containing 50 mg B6, 5 mg folic acid and 0,4 mg B12 for one year. Subjects not receiving vitamin supplements are daily taking an identically looking placebo pill, also for a year. Participants are randomised to four groups 1) WP and vitamin supplements; 2) WP and placebo supplements; 3) PAP and vitamin supplements; 4) PAP and placebo supplements. Primary outcome measures are measures of cognitive function. Secondary outcomes include psychosocial wellbeing, physical activity, cardiovascular endurance and blood vitamin levels. Discussion: no large intervention study has been conducted yet on the effect of physical activity and vitamin supplementation in a population-based sample of adults with MCI. The objective of the present article is to describe the design of a randomised controlled trial examining the effect of a walking program and vitamin B supplementation on the rate of cognitive decline in older adults with MCI. © 2005 van Uffelen et al; licensee BioMed Central Ltd. Chemicals / CAS: cyanocobalamin, 53570-76-6, 68-19-9, 8064-09-3; folic acid, 59-30-3, 6484-89-5; pyridoxine, 12001-77-3, 58-56-0, 65-23-6, 8059-24-3; vitamin B group, 12001-76-2

Objective. Osteoarthritis (OA) is one of the most prevalent and disabling chronic conditions affecting the elderly. Its etiology is largely unknown, but age is the most prominent risk factor. The current study was designed to test whether accumulation of advanced glycation end products (AGEs), which are known to adversely affect cartilage turnover and mechanical properties, provides a molecular mechanism by which aging contributes to the development of OA. Methods. The hypothesis that elevated AGE levels predispose to the development of OA was tested in the canine anterior cruciate ligament transection (ACLT) model of experimental OA. Cartilage AGE levels were enhanced in young dogs by intraarticular injections of ribose. This mimics the accumulation of AGEs without the interference of other age-related changes. The severity of OA was then assessed 7 weeks after ACLT surgery in dogs with normal versus enhanced AGE levels. Results. Intraarticular injections of ribose enhanced cartilage AGE levels ∼5-fold, which is similar to the normal increase that is observed in old dogs. ACLT surgery resulted in more-pronounced OA in dogs with enhanced AGE levels. This was observed as increased collagen damage and enhanced release of proteoglycans. The attempt to repair the matrix damage was impaired; proteoglycan synthesis and retention were decreased at enhanced AGE levels. Mankin grading of histology sections also revealed more-severe OA in animals with enhanced AGE levels. Conclusion. These findings demonstrate increased severity of OA at higher cartilage AGE levels and provide the first in vivo experimental evidence for a molecular mechanism by which aging may predispose to the development of OA.

Objective: To assess whether the risk of severe blood loss is increased in semi-sitting and sitting position, and if so, to which extent blood loss from perineal damage is responsible for this finding. Design: Secondary analysis of data from a large trial. Setting: Primary care midwifery practices in the Netherlands. Population: About 1646 low-risk women who had a spontaneous vaginal delivery. Methods: Blood loss was measured using a weighing scale and measuring jug. Logistic regression analysis was used to examine the net effects of birthing position and perineal damage on blood loss greater than 500 ml. Main outcome measures: Mean total blood loss and incidence of blood loss greater than 500 ml and 1000 ml. Results: Mean total blood loss and the incidence of blood loss greater than 500 ml and 1000 ml were increased in semi-sitting and sitting position. In logistic regression analysis, the interaction between birthing position and perineal damage was almost significantly associated with an increased risk of blood loss greater than 500 ml. Semi-sitting and sitting position were only significant risk factors among women with perineal damage (OR 1.30, 95% CI 1.00-1.69 and OR 2.25, 95% CI 1.37-3.71, respectively). Among women with intact perineum, no association was found. Conclusions: Semi-sitting and sitting birthing positions only lead to increased blood loss among women with perineal damage. © RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology.

Objectives: To assess the degree to which physicians and nurses working in preventive child health care (child health professionals [CHPs]) identify and manage psychosocial problems in children, and to determine its association with parent-reported behavioral and emotional problems, sociodemographic factors, and general and mental health history of children. Design: The CHPs examined the child and interviewed parents and child during their routine health assessments. The parents completed the Child Behavior Checklist. Setting: Nineteen child health care services across the Netherlands, serving nearly all school-aged children routinely. Subjects: Of 4970 children aged 5 through 15 years, eligible for a routine health assessment, 4480 (90.1%) participated. Main Outcome Measures: Identification and management of psychosocial problems by CHPs. Results: In 25% of all children, CHPs identified 1 or more psychosocial problems. One in 5 identified children were referred for further diagnosis and treatment. Identification of psychosocial problems and subsequent referral were 6 times more likely in children with serious parent-reported problem behavior according to the Child Behavior Checklist total problem score (8% of total sample). However, CHPs identified no psychosocial problems in 43% of these children and therefore undertook no action. Other child factors associated with CHPs' identification and referral were past treatment for psychosocial problems, life events, and academic problems. After adjustment for these, sociodemographic characteristics did not predict referral. Conclusions: The CHPs identify psychosocial problems in school-aged children frequently and undertake actions for most of them. Screening for psychosocial problems may be a promising option to reduce these problems, but accurate identification should be enhanced.