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Amsterdam-Zuidoost, Netherlands

Sanchez-Ramirez D.C.,Copenhagen University | Sanchez-Ramirez D.C.,VU University Amsterdam | Sanchez-Ramirez D.C.,Amsterdam Rehabilitation Research Center Reade | Krasnik A.,Copenhagen University | Kildemoes H.W.,Copenhagen University
European Journal of Clinical Pharmacology

Purpose: To explore whether newly diagnosed type 2 diabetes patients without previous cardiovascular disease (CVD) initiate preventive statin therapy regardless of ethnic background. Methods: Using nationwide individual-level registers, we followed a cohort of Danish-born residents and immigrants from Turkey, Pakistan and Ex-Yugoslavia, all without previous diabetes or CVD, during the period 2000-2008 for first dispensing of oral glucose-lowering medication (GLM), first dispensing of statins and register-markers of CVD (N = 3,764,620). Logistic regression analyses were used to test whether the odds ratios (ORs) of early statin therapy initiation (within 180 days after first GLM dispensing) are the same regardless of ethnic background. While age and gender were included as confounders in the basic model, income was included in the second model as a potential mediating variable. Results: Compared to native Danes, the ORs for early statin therapy were 0.68 (95 % confidence interval 0.50-0.92], 0.67 (0.56-0.81) and 0.56 (0.44-0.71) for Ex-Yugoslavians, Turks and Pakistanis, respectively. The differences remained largely unchanged after adjusting for income and tended to be accentuated when the threshold period was extended. The ORs of women initiating therapy (compared to native Danes) were 0.56 (0.35-0.90), 0.60 (0.46-0.78) and 0.48 (0.32-0.72) for Ex-Yugoslavians, Turks and Pakistanis, respectively, and those for men were 0.78 (0.52-1.17), 0.74 (0.58-0.95) and 0.60 (0.44-0.83), respectively. Conclusions: Immigrants from Turkey, Pakistan and Ex-Yugoslavia with type 2 diabetes were less likely to initiate statin therapy than Danish-born residents - despite a similar or even higher risk of CVD. The treatment inequities associated with ethnicity were more pronounced in women than men. © 2012 Springer-Verlag. Source

Littooij E.,Amsterdam Rehabilitation Research Center Reade
Spinal Cord

Study design:Qualitative study.Objectives:To explore whether aspects of global meaning (that is, fundamental beliefs and life goals concerning core values, relationships, worldview, identity and inner posture) are associated with processes and outcomes in rehabilitation, as experienced by people with spinal cord injury (SCI).Setting:People living in the community receiving outpatient rehabilitation in a Dutch rehabilitation center.Methods:In-depth semi-structured interviews were conducted with 16 people with SCI. Interviews were analyzed using qualitative research methods: structural and provisional coding.Results:Core values, relationships, worldview, identity and inner posture (that is, the way in which people relate to the facts of life) were associated with various processes and outcomes of rehabilitation. Elements of the rehabilitation process included motivation, regulation of emotion, making decisions and handling stress. Elements of the outcome of rehabilitation included physical functioning, emotional functioning, social functioning and subjective sense of meaning. The influence was positive, with the exception of one case in which worldview and inner posture were negatively associated with motivation. Besides that, respondents emphasized the importance of rehabilitation professionals attuning to their global meaning.Conclusion:All aspects of global meaning were positively associated with various processes and outcomes of rehabilitation. It is recommended that rehabilitation professionals are aware of the importance of global meaning to people with SCI and that they take people’s fundamental beliefs and life goals into account.Spinal Cord advance online publication, 19 April 2016; doi:10.1038/sc.2016.48. © 2016 International Spinal Cord Society Source

Wheelchair users with spinal cord injury generally have a relatively inactive lifestyle. Several studies have shown that an inactive lifestyle is associated with a lower fitness level, poorer health, reduced social participation and a lower quality of life for wheelchair users. There are a number of ways in which wheelchair users can remain active in daily life, for instance, by using a wheelchair or handbike for mobility instead of taking the car, and by participating in sports or wheelchair sports. Some prerequisites should be met to enable wheelchair users to have a more active lifestyle: the wheelchair should be optimally adjusted and the everyday environment, including sport facilities, should be easily accessible. An active lifestyle often also requires a change in attitude or behaviour. General practitioners, other primary healthcare providers and rehabilitation professionals can help in this respect. Source

Oosterhof B.,Rehabilitation Center Heliomare | Dekker J.H.M.,Rehabilitation Center Heliomare | Sloots M.,Amsterdam Rehabilitation Research Center Reade | Bartels E.A.C.,VU University Amsterdam | Dekker J.,VU University Amsterdam
Disability and Rehabilitation

Aim: The aim of this study was to explore which factors are associated with a successful treatment outcome in chronic pain patients and professionals participating in a multidisciplinary rehabilitation program, with a specific focus on the patient-professional interaction. Methods: Patients (n = 16) and professionals (n = 10) were interviewed and/or observed. The transcribed interviews and observations were analyzed and themes were described. Results: Patients with a positive treatment outcome came to a shared understanding of their pain with their professional, demonstrated new learned behavior and were able to continue their learning process at home. Patients with a negative treatment outcome did not reach a shared understanding of their pain with their professional, were not able to change their behavior and wanted more help to achieve this. Both patient groups experienced organizational barriers within the treatment process. Factors associated with a high quality of patient-professional interaction included the patient experience of being taken seriously, the involvement of the professional with the patient, a clear explanation of the pain, and an open interaction between patient and professional. Conclusion: This study provides insight into factors which were related to a positively or negatively experienced outcome of pain rehabilitation. A good match within the patient-professional interaction seems essential. © 2014 Informa UK Ltd. Source

Sonenblum S.E.,Georgia Institute of Technology | Vonk T.E.,VU University Amsterdam | Janssen T.W.,VU University Amsterdam | Janssen T.W.,Amsterdam Rehabilitation Research Center Reade | Sprigle S.H.,Georgia Institute of Technology
Archives of Physical Medicine and Rehabilitation

Objective To investigate the effectiveness and interactions of 2 methods of pressure ulcer prevention, wheelchair cushions and pressure relief maneuvers, on interface pressure (IP) and blood flow of the buttocks. Design Within-subject repeated measures. Setting Rehabilitation center. Participants Wheelchair users with a spinal cord injury or disorder (N=17). Interventions Participants performed 3 forward leans and 2 sideward leans with different degrees of lean while seated on each of 3 different wheelchair cushions. Main Outcome Measures IP measured with a custom sensor and blood flow measured with laser Doppler flowmetry were collected at the ischial tuberosity. Results Pressure relief maneuvers had a significant main effect on the ischial IP (P<.001); all maneuvers except for the small frontward lean resulted in a significant reduction in IP compared with upright sitting. Blood flow significantly varied across postures (P<.001) with flow during upright sitting and small forward leans being significantly lower than during the full and intermediate leans in both the forward and sideward directions. Conclusions The results of the study highlight the importance of positioning wheelchair users in a manner that facilitates in-seat movement. Regardless of the cushion being used, the pressure relief maneuvers resulted in very large reductions in IPs and significant increases in buttock blood flow. Only the small frontward lean was shown to be ineffective in reducing pressure or increasing blood flow. Because these pressure relief maneuvers involved postural changes that can occur during functional activities, these pressure relief maneuvers can become a part of volitional pressure relief and functional weight shifts. Therefore, clinical instruction should cover both as a means to impart sitting behaviors that may lead to better tissue health. © 2014 by the American Congress of Rehabilitation Medicine. Source

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