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Nijmegen, Netherlands

Van Kempen J.A.L.,Radboud University Nijmegen | Melis R.J.F.,Radboud University Nijmegen | Perry M.,Radboud University Nijmegen | Schers H.J.,Radboud Institute for Health science | Olde Rikkert M.G.M.,Radboud University Nijmegen
Journal of the American Board of Family Medicine | Year: 2015

Background: To compare the outcomes of Comprehensive Geriatric Assessments by family physicians and geriatricians. Methods: An explorative observational study was conducted in six family practices (12 ambulatory family practitioners) and 1 geriatric department (4 hospital-based geriatricians) from a university medical center in Nijmegen (the Netherlands). As participants, we included 587 patients aged 70 years and older and registered in the six family practices. The main outcome measures were the judgment on the following: 1) absence or presence of frailty and 2) the state (good-fair-poor) on 8 underlying domains (physical, medication, cognition, sensory, instrumental activities of daily living scale, mobility, mental, and social) according to family practitioners and geriatricians based on a Comprehensive Geriatric Assessment. Results: Family physicians and geriatricians agreed on frailty absence/presence in 76% of cases. Geriatricians considered elderly more often frail than family physicians did (n = 294, 50% vs n = 213, 36%). Disagreement on frailty status was notably found in the patients who had less distinct, either poor or good, health states. Discordant frailty judgments, in which the geriatrician rated a person as frail and the family physicians did not, were related to geriatricians more often rating physical health as impaired. Further, geriatricians' judgments of frailty were more strongly related to impaired scores on the domains cognition, sensory, mobility, and mental compared with family physicians judgments: odds ratios 79.3 versus 9.3, 7.6 versus 2.0, 25.0 versus 3.0, and 18.0 versus 2.2, respectively. Impaired physical health and problematic medication use had equally strong associations with frailty in geriatricians and family physicians: odds ratios of 11.5 versus 10.4 and 2.4 versus 2.5, respectively. Conclusions: Geriatricians more often judge patients as frail compared with family physicians and seem to evaluate the available information differently. With increasing collaboration between primary and secondary care, understanding these differences becomes increasingly relevant. © 2015, American Board of Family Medicine. All rights reserved. Source


Atkinson C.L.,University of Western Australia | Lewis N.C.S.,University of British Columbia | Carter H.H.,University of Western Australia | Thijssen D.H.J.,Liverpool John Moores University | And 4 more authors.
Journal of Physiology | Year: 2015

Transient reduction in vascular function following systemic large muscle group exercise has previously been reported in humans. The mechanisms responsible are currently unknown. We hypothesised that sympathetic nervous system activation, induced by cycle ergometer exercise, would contribute to post-exercise reductions in flow-mediated dilatation (FMD). Ten healthy male subjects (28 ± 5 years) undertook two 30 min sessions of cycle exercise at 75% HRmax. Prior to exercise, individuals ingested either a placebo or an α1-adrenoreceptor blocker (prazosin; 0.05 mg kg-1). Central haemodynamics, brachial artery shear rate (SR) and blood flow profiles were assessed throughout each exercise bout and in response to brachial artery FMD, measured prior to, immediately after and 60 min after exercise. Cycle exercise increased both mean and antegrade SR (P < 0.001) with retrograde SR also elevated under both conditions (P < 0.001). Pre-exercise FMD was similar on both occasions, and was significantly reduced (27%) immediately following exercise in the placebo condition (t-test, P = 0.03). In contrast, FMD increased (37%) immediately following exercise in the prazosin condition (t-test, P = 0.004, interaction effect P = 0.01). Post-exercise FMD remained different between conditions after correction for baseline diameters preceding cuff deflation and also post-deflation SR. No differences in FMD or other variables were evident 60 min following recovery. Our results indicate that sympathetic vasoconstriction competes with endothelium-dependent dilator activity to determine post-exercise arterial function. These findings have implications for understanding the chronic impacts of interventions, such as exercise training, which affect both sympathetic activity and arterial shear stress. © 2015 The Physiological Society. Source


Van De Loo K.F.E.,Radboudumc Amalia Childrens Hospital | Van Gelder M.H.J.,Radboud Institute for Health science | Roukema J.,Radboudumc Amalia Childrens Hospital | Roeleveld N.,Radboud Institute for Health science | And 3 more authors.
European Respiratory Journal | Year: 2016

The aim of this study was to systematically review and meta-analyse observational studies on prenatal maternal psychological stress and the subsequent development of asthma and wheezing in early childhood. All available published literature from 1960 until November 2013 was systematically searched through electronic databases (PubMed, Embase, PsycInfo and Web of Science). All observational studies assessing associations between any form of prenatal maternal psychological stress and respiratory morbidity in the child were included. Data extraction, quality assessment and meta-analyses were performed. The overall meta-analysis included 10 studies and showed that the prevalence of wheezing, asthma and other respiratory symptoms is higher in children of mothers who were exposed to or experienced some form of psychological stress during pregnancy than in mothers who did not (pooled OR 1.56 (95% CI 1.36-1.80)). Comparable results were observed in subgroup analyses of stress exposure, perceived stress, asthma and wheezing. This study demonstrates that prenatal maternal psychological stress is associated with respiratory morbidity, including asthma and wheezing in the child. Future studies examining the early origins of asthma and wheezing need to account for the impact of prenatal maternal stress. © ERS 2016. Source


van Os N.J.H.,Donders Institute for Brain | Roeleveld N.,Radboud Institute for Health science | Weemaes C.M.R.,Radboudumc Amalia Childrens Hospital | Jongmans M.C.J.,Radboud University Nijmegen | And 4 more authors.
Clinical Genetics | Year: 2016

Ataxia-telangiectasia (AT) is an autosomal recessive neurodegenerative disorder with immunodeficiency and an increased risk of developing cancer, caused by mutations in the ataxia-telangiectasia mutated (ATM) gene. Logically, blood relatives may also carry a pathogenic ATM mutation. Female carriers of such a mutation have an increased risk of breast cancer. Other health risks for carriers are suspected but have never been studied systematically. Consequently, evidence-based guidelines for carriers are not available yet. We systematically analyzed all literature and found that ATM mutation carriers have a reduced life expectancy because of mortality from cancer and ischemic heart diseases (RR 1.7, 95% CI 1.2–2.4) and an increased risk of developing cancer (RR 1.5, 95% CI 0.9–2.4), in particular breast cancer (RRwomen 3.0, 95% CI 2.1–4.5), and cancers of the digestive tract. Associations between ATM heterozygosity and other health risks have been suggested, but clear evidence is lacking. Based on these results, we propose that all female carriers of 40–50 years of age and female ATM c.7271T>G mutation carriers from 25 years of age onwards be offered intensified surveillance programs for breast cancer. Furthermore, all carriers should be made aware of lifestyle factors that contribute to the development of cardiovascular diseases and diabetes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Source


Scheepers P.T.J.,Radboud Institute for Health science | Beckmann G.,Radboud Institute for Health science | van Hout S.,Radboud Institute for Health science | van der Kroon E.,Bradford Engineering | Leenders P.,Filtex
Environmental Technology and Innovation | Year: 2015

For fixation of biological specimen in the International Space Station (ISS) aqueous solutions of formaldehyde, glutaraldehyde and ethanol are used in a biological glove box (BGB) containment. The air circulated through the BGB unit is filtered over a bank of filters consisting of a packed bed of activated bituminous coal-based granular carbon impregnated with sodium bromate. A procedure was developed to determine the performance of these filters in the case an unexpected spill would occur. In a simulated spill scenario under earth gravity conditions finely dispersed aerosols of the aforementioned aqueous solutions were drawn through the filter unit at a flow of 75 L/min. To determine the filter capture efficiency, glass fiber membrane filters were impregnated with 2,4-dinitrophenylhydrazine (DNPH) to capture formaldehyde and glutaraldehyde by chemical binding. The filters were analyzed for the DNPH-aldehyde complex by HPLC-UV. Ethanol was collected by adsorption on activated coal and subsequently analyzed by gas chromatography flame ionization detection (GC-FID). A challenge with 10.0 mL of test solution resulted in downstream air concentrations of 0.295 ± 0.094 mg/m3 for a solution of 3% of formaldehyde in water and 0.018 ± 0.015 mg/m3 for a solution containing 3.5% of glutaraldehyde in water. For a filter load of 5.0 mL of 70% ethanol in water, the downstream concentration was 19.4 ± 7.8 mg/m3. This corresponds to filter capture efficiencies of 99.5% for formaldehyde, 99.9% for glutaraldehyde, and 97.5% for ethanol. The measured concentrations downstream of the filter unit all remained below the spacecraft maximum allowable concentrations (SMAC) for these substances. Breakthrough tests were performed at tenfold the volume of the simulated spill scenario. Complete breakthrough occurred at 35 ± 14 min for formaldehyde and at 15 ± 2 min for ethanol. For glutaraldehyde breakthrough was not observed within 75 min. © 2015 Elsevier B.V. Source

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