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Schuengel C, Cuypers M, Bakkum L, Leusink GL. Reproductive health of women with intellectual disability: antenatal care, pregnancies and outcomes in the Dutch population. J Intellect Disabil Res 2023; 67:1306-1316. [PMID: 36167410 DOI: 10.1111/jir.12982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Research in a handful of countries found that women with intellectual disability (ID) faced barriers and risks regarding antenatal care and reproductive health. This study tested disparities between women in the Netherlands with and without ID in antenatal care, pregnancy rates and pregnancy outcomes. METHODS Secondary analyses on the large representative panel of primary health patients in the Netherlands by the Netherlands Institute for Health Services Research (NIVEL) compared women in their reproductive age (18-49 years) with (n = 2397) and without (n = 228 608) indicators of ID. Bias due to underreporting and under-identification was reduced by linkage with an index of ID for the total Dutch population from Statistical Netherlands. RESULTS Women with ID were more likely to receive contraceptive care [95% confidence interval (CI) for odds ratio (OR) = 1.37-1.61] and became somewhat more often pregnant (95% CI OR = 1.06-2.30) than women from the general population, adjusting for age difference and follow-up time. No statistical differences were found in medical complications during pregnancy, delivery and immediately after birth, but women with indicators of ID had a higher risk of losing their pregnancy, including through induced abortion (95% CI OR = 1.26-1.99). CONCLUSIONS Women with ID have specific needs around contraceptive care and risks around their pregnancy that may require more awareness among practitioners and better understanding of the processes of care and decision-making.
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Affiliation(s)
- C Schuengel
- Department of Educational and Family Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Cuypers
- Radboud University Medical Center (Radboudumc), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - L Bakkum
- Department of Educational and Family Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G L Leusink
- Radboud University Medical Center (Radboudumc), Radboud University Nijmegen, Nijmegen, The Netherlands
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2
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Koks-Leensen M, Schalk B, Bakker-van Gijssel E, Cuypers M, van den Bemd M, Nägele M, Naaldenberg J, Leusink GL. COVID-19 registration in people with intellectual disabilities in Dutch long-term care facilities. Eur J Public Health 2021. [PMCID: PMC8574702 DOI: 10.1093/eurpub/ckab164.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aims to present a nationwide registration of COVID-19 in people with ID living in residential settings, in order to provide insight in COVID-19 epidemiology in this vulnerable group. In a health crisis as the current worldwide COVID-19 pandemic, it is crucial to gain knowledge about the new infectious disease and its effects on health. Identifying risk groups is important for adequate preventative measures and policy-making. People with ID generally have poorer health than others in the general population, with higher prevalence of co-morbidities, risk factors such as obesity, and higher excess mortality rates for infectious diseases. However, there is little reliable knowledge about specific risks and consequences of COVID-19 in the ID population as compared with the general population. To increase this knowledge a nationwide registration system for data on people with ID was set up in Dutch long term care facilities. The registration covered more than 6500 patients with (suspected) Covid-19 infection observed in 2020 and registration is still ongoing. Organizations registered data of their patients with either suspected or confirmed COVID-19 infection, regarding sociodemographics, medical history and COVID-19 infection characteristics. People with ID are vulnerable to COVID-19 at a younger age compared to people in the general population. Case fatality rate was 3-4 times higher among people with ID compared to the general population, and mortality was already higher in younger age groups (40 years and older). Their living circumstances matter: in group home living circumstances more infected people with ID were observed. The etiology of the ID, especially Down syndrome, is an unfavorable predictor. According to these findings, people with ID proved to be vulnerable for COVID-19. Policy makers and care providers should adequately account for this increased vulnerability of the ID population.
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Affiliation(s)
- M Koks-Leensen
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - B Schalk
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | | | - M Cuypers
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - M van den Bemd
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - M Nägele
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - J Naaldenberg
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - GL Leusink
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
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3
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van den Bemd M, Schalk B, Bischoff EWMA, Cuypers M, Leusink GL. Chronic disease prevalence and patterns of comorbidities in people with intellectual disabilities. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aims to examine chronic chronic disease prevalence in people with ID compared to those without ID in primary care settings and comorbidity patterns accompanying chronic diseases, by focusing on age and sex differences. With a focus on the four highest-impact chronic diseases worldwide and individually, ischemic heart disease, cerebrovascular disease, diabetes mellitus, and chronic obstructive pulmonary disease (COPD), it is assessed to what extent these diseases affect people with ID. Two databases are linked, that of Nivel Primary Care Database, a large representative sample of Dutch citizens registered in general practices, and non-public microdata from Statistics Netherlands, containing information on indication of long-term care or supportive services for people with ID. With prevalence rates and odds ratios chronic disease prevalence and comorbidity patterns were established by total groups of people with and without ID and by sex and age groups. Results displayed differences in chronic disease prevalence in people with and without ID: cardiovascular diseases were less prevalent, and diabetes mellitus more prevalent in people with ID. At relatively young age (<50 years), people with ID not only had more chronic diseases, but also more often had multiple comorbidities compared to those without ID. The most common comorbidity in all chronic diseases was hypertension, while diabetes mellitus as comorbidity also occurred often. This study is the first to present chronic disease prevalence and comorbidity patterns across the groups of people with and without ID and by sex and age groups. It can therefore be used as source of accurate information on the health prevalence and patterns of people with ID compared to the general populations, and provides a novel insight into differences in the group of people with ID.
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Affiliation(s)
- M van den Bemd
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - B Schalk
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - EWMA Bischoff
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - M Cuypers
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - GL Leusink
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
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4
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Pouls K, Cuypers M, Mastebroek M, Koks-Leensen M, Wieland J, Leusink GL, Assendelft P. Mental health care for adults with mild intellectual disabilities: A retrospective database study. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
People with mild ID suffer more mental health disorders (MHD) than people without ID. Practitioners working in mental health services (MHS) indicate limited knowledge and experience to provide the care needed. Besides diagnosing MHD, identification of the ID itself is a challenge and not all people with a ID are recorded in the MHS as such. These factors contribute to insufficient care and can result in chronic, more difficult to treat MHD. For this study, all adult users of Dutch MHS between 2015 and 2017 were enrolled in MHS databases of Statistics Netherlands. Presence of mild ID was established by linking MHS data with social services and chronic care databases. Characteristics of new cases of MHC were analyzed and compared between patients with and without mild ID. Linking databases identified 11,374 MHC patients with mild ID, and 525,162 patients without ID. A substantial proportion of patients with mild ID did not have this characteristic noted in their MHS records (60.6%). Preliminary results showed people with mild ID were younger, were more often man, had different diagnostic profiles, required more crisis interventions, and more psychiatric hospital admissions compared to people without ID. In addition, people with a mild ID and no ID record in MHS received less treatment compared to both people with mild ID and a ID record, and people with no ID. According to these findings, the prevalence of MHD and provided care between people with and without a mild ID, in MHS deviated. The Mild ID is potentially under recognized among MHS patients. The findings are a first step towards improving mental healthcare for patients with ID.
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Affiliation(s)
- K Pouls
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - M Cuypers
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - M Mastebroek
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - M Koks-Leensen
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - J Wieland
- Curium-LUMC, Leiden University Medical Center, Nijmegen, Netherlands
| | - GL Leusink
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - P Assendelft
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
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5
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Cuypers M, Tobi H, Naaldenberg J, Leusink GL. Linking Dutch national public services data to estimate the prevalence of intellectual disabilities. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
While people with ID depend on public (health) services more than others, they are difficult to identify within population data. This limits the opportunities to accurately estimate ID prevalence, monitor trends, or to tailor public health interventions according to the needs and characteristics of this groups. By linking relevant databases, this study estimated the prevalence of ID based on public service use, and explored methods to monitor other developments in the ID population. Starting point was the Dutch population register, containing all Dutch adults alive at January 1, 2015. From databases of public services (long-term care, and social benefits) we retrieved information of those individuals who accessed these services with an ID as primary reason. Through this method, 187,149 unique Dutch adults with an ID were identified within a population of almost 12.7 million Dutch adults, giving an ID prevalence estimate of 1.45%. Prevalence of ID was higher among males (1.7%) than among females (1.2%). Most individuals with ID were identified through use of residential care services (n = 91,064; 0.7%). Non-residential ID-related care was utilized by 27,007 individuals (0.2%). Social, employment, or income support due to a (mild) ID was received by 69,078 individuals (0.5%). Mean age in these ID-groups was between 8 and 10 years younger than in the general Dutch population. ID prevalence declined with increasing age across all ID-groups. The ID prevalence in The Netherlands as determined in this study aligned with international estimates. This suggests that national supportive services are well accessible for people with ID. Moreover, it demonstrated that databases from national supportive services can be a useful source to identify individuals with ID at the population level, and it enables structural monitoring of the ID population through linking national databases.
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Affiliation(s)
- M Cuypers
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - H Tobi
- Biometris, Wageningen University & Research, Wageningen, Netherlands
| | - J Naaldenberg
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - GL Leusink
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
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6
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Vlot-van Anrooij K, Naaldenberg J, Hilgenkamp TIM, Vaandrager L, van der Velden K, Leusink GL. Towards healthy settings for people with intellectual disabilities. Health Promot Int 2021; 35:661-670. [PMID: 31243433 PMCID: PMC7414853 DOI: 10.1093/heapro/daz054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
People with intellectual disabilities (ID) depend on their environment for support to live healthily. The characteristics of healthy settings for people with ID are unknown. This study aims to conceptualize healthy settings for people with ID by conducting an international and multidisciplinary concept mapping study. As theoretical framework the settings approach, an ecological model with a whole system focus toward health promotion, was used. The integrative mixed-methods approach of this study involved concept mapping with researchers specialized in healthcare for people with ID and researchers specialized in healthy settings. The 41 participants generated statements that were later sorted and rated. Findings encompass 13 clusters relating to the social environment, the physical environment and societal preconditions. Specific factors of healthy settings for people with ID include: (i) universal design of the physical environment, (ii) the role of care professionals in the social environment to empower people with ID, (iii) possibilities for care providers to contribute to a health-promoting setting and (iv) preconditions that allow people to engage in society. These factors can be used in strategies to apply the approach in practice and give directions to put in place policies on developing enabling environments and decreasing health inequities.
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Affiliation(s)
- Kristel Vlot-van Anrooij
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Corresponding author. E-mail:
| | - J Naaldenberg
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - T I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - L Vaandrager
- Department of Social Sciences, Health and Society, Wageningen University, PO Box 8130, 6706 KN Wageningen, The Netherlands
| | - K van der Velden
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - G L Leusink
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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7
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Schuengel C, Tummers J, Embregts PJCM, Leusink GL. Impact of the initial response to COVID-19 on long-term care for people with intellectual disability: an interrupted time series analysis of incident reports. J Intellect Disabil Res 2020; 64:817-824. [PMID: 32954592 PMCID: PMC7646647 DOI: 10.1111/jir.12778] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND The lockdown-measures in response to COVID-19 taken by long-term care organisations might have impacted problem behaviour and behavioural functioning of people with intellectual disability. This study tested changes in reported incidents, in particular regarding aggression, unexplained absence and, for contrast, medication errors. METHODS Metadata on weekly incident and near-incident reports from 2016 to June 2020 involving over 14 000 clients with mild to serious intellectual disability of 's Heeren Loo, a long-term care organisation for people with intellectual disability, were subjected to interrupted time series analysis, comparing the COVID-19 with the pre-COVID-19 period. RESULTS The imposition of lockdown-measures coincided with a significant drop in incidents (total, P < .001; aggression, P = .008; unexplained absences, P = .008; and medication errors, P < .001). Incidents in total (P = .001) and with aggression (P < .001) then climbed from this initial low level, while medication errors remained stably low (P = .94). CONCLUSION The rise in incidents involving aggression, against the background of generally lowered reporting, underlines the need for pandemic control measures that are suitable for people with intellectual disability in long-term care.
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Affiliation(s)
- C. Schuengel
- Department of Educational and Family Sciences, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - J. Tummers
- Department of Information TechnologyWageningen University & ResearchWageningenThe Netherlands
- Department of Primary and Community Care, Radboud Institute for Health SciencesRadboudumcNijmegenThe Netherlands
| | - P. J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - G. L. Leusink
- Department of Primary and Community Care, Radboud Institute for Health SciencesRadboudumcNijmegenThe Netherlands
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8
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Cuypers M, Schalk BWM, Koks‐Leensen MCJ, Nägele ME, Bakker‐van Gijssel EJ, Naaldenberg J, Leusink GL. Mortality of people with intellectual disabilities during the 2017/2018 influenza epidemic in the Netherlands: potential implications for the COVID-19 pandemic. J Intellect Disabil Res 2020; 64:482-488. [PMID: 32458565 PMCID: PMC7283786 DOI: 10.1111/jir.12739] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Data on the development of Covid-19 among people with intellectual disabilities (IDs) are scarce and it is uncertain to what extent general population data applies to people with ID. To give an indication of possible implications, this study investigated excess mortality patterns during a previous influenza epidemic. METHODS Using Dutch population and mortality registers, a historical cohort study was designed to compare mortality during the 2017-2018 influenza epidemic with mortality in the same period in the three previous years. People with ID were identified by entitlements to residential ID-care services as retrieved from a national database. RESULTS Data covered the entire adult Dutch population (12.6 million; GenPop), of which 91 064 individuals were identified with an ID. During the influenza epidemic, mortality among people with ID increased almost three times as much than in the GenPop (15.2% vs. 5.4%), and more among male individuals with ID (+19.5%) than among female individuals with ID (+10.6%), as compared with baseline. In both cohorts, comparable increases in mortality within older age groups and due to respiratory causes were seen. Particularly in the ID-cohort, excess deaths also occurred in younger age groups, due to endocrine diseases and ID-specific causes. CONCLUSIONS During the 2017-2018 influenza epidemic, excess mortality among people with ID was three times higher than in the general Dutch population, appeared more often at young age and with a broader range of underlying causes. These findings suggest that a pandemic may disproportionally affect people with ID while population data may not immediately raise warnings. Early detection of diverging patterns and faster implementation of tailored strategies therefore require collection of good quality data.
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Affiliation(s)
- M. Cuypers
- Radboud Institute for Health Sciences, Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - B. W. M. Schalk
- Radboud Institute for Health Sciences, Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - M. C. J. Koks‐Leensen
- Radboud Institute for Health Sciences, Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - M. E. Nägele
- Radboud Institute for Health Sciences, Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - E. J. Bakker‐van Gijssel
- Radboud Institute for Health Sciences, Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - J. Naaldenberg
- Radboud Institute for Health Sciences, Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - G. L. Leusink
- Radboud Institute for Health Sciences, Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
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9
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Koopmans B, Pouwer F, de Bie RA, Leusink GL, Denollet JKL, Pop VJM. Associations between vascular co-morbidities and depression in insulin-naive diabetes patients: the DIAZOB Primary Care Diabetes study. Diabetologia 2009; 52:2056-63. [PMID: 19669635 PMCID: PMC2744805 DOI: 10.1007/s00125-009-1460-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 06/16/2009] [Indexed: 12/02/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to determine the prevalence of depression in insulin-naive diabetes patients and to investigate the associations between different forms of vascular co-morbidity and depression. METHODS Cross-sectional data were used from a primary-care sample of 1,269 insulin-naive (i.e. not using insulin therapy) diabetes patients participating in the DIAZOB Primary Care Diabetes study. Demographics, vascular co-morbidities, clinical and lifestyle characteristics, and psychosocial factors were assessed. Depression symptoms were measured with the Edinburgh Depression Scale, with a score >11 defined as depression. The chi (2) and Student's t tests were used to compare groups with and without vascular co-morbidities. Rates and odds ratios of depression were calculated for each vascular co-morbidity, with diabetes only as the reference group, correcting for age and sex. Single and multiple logistic regression analyses were performed to test a more comprehensive model regarding the likelihood of depression in diabetes. RESULTS The prevalence of depression was 11% in the total sample with little difference between the groups with and without any vascular co-morbidity (11.2% vs 10.0%). Single vascular co-morbidities were not associated with increased rates of depression. The final model predicting depression included: having multiple vascular co-morbidities compared with none; having less social support; having experienced a recent stressful life event; female sex; and being a smoker. CONCLUSIONS/INTERPRETATION Rates of depression in those with one additional vascular co-morbidity did not differ from patients with diabetes only. Vascular co-morbidities were only associated with higher depression scores in case of multiple co-morbidities.
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Affiliation(s)
- B. Koopmans
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
| | - F. Pouwer
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
| | - R. A. de Bie
- CAPHRI School, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | | | - J. K. L. Denollet
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
| | - V. J. M. Pop
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
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10
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Abstract
BACKGROUND At the onset of the climacteric, healthy middle-aged women present with a variety of complaints, especially in general practice. In these first years of entering the menopause, vaginal blood loss alters from irregular periods to complete amenorrhoea. According to these different menstrual patterns, we can distinguish a pre-, peri- and postmenopausal phase. It could be useful to know whether specific climacteric complaints are related to these different phases. OBJECTIVE The aim of this study was to investigate the relationship between climacteric complaints and the menstrual pattern during the menopausal transition in a population-based cross-sectional survey of healthy middle-aged women. METHODS All women aged 47-54 years, living in the city of Eindhoven, were invited to participate in the Eindhoven Osteoporosis Study (EPOS); 6648 (78%) agreed to participate. All women completed a questionnaire concerning climacteric complaints. Climacteric status was defined by menstrual history. Odds ratios (ORs) were obtained for the relationship between climacteric status and climacteric complaints. Multiple logistic regression analysis was carried out, with climacteric status as the dependent variable. RESULTS Of the 27 items in the questionnaire concerning climacteric complaints, seven were significantly different between all three climacteric phases (P: < 0.1). After multiple logistic regression analysis, comparing peri- and premenopause, only flushing (OR 5.9) was significantly different. Between post- and perimenopause, seven symptoms appeared to be different: three urogenital complaints [vaginal dryness (OR 1.6), vaginal discharge (OR 0.4) and pain during intercourse (OR 1.9)], three vasomotor symptoms [daytime sweating (OR 1.4), night-time sweating (OR 0.7) and flushing (OR 1.9)] and, finally, insomnia (OR 1.3). When comparing post- and premenopause, flushing (OR 13.4), insomnia (OR 2.1) and depressed mood (OR 0.6) were significantly different, in addition to three urogenital symptoms: vaginal dryness (OR 2.6), vaginal discharge (OR 0.3) and pain during intercourse (OR 2.1). CONCLUSION The major findings of the study are that flushing is strongly associated with the transition from pre- to perimenopause, while urogenital complaints, daytime sweating and insomnia are more prominent in the transition from peri- to postmenopause.
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Affiliation(s)
- L W Maartens
- Diagnostic Centre Eindhoven, PO Box 6247, 5600 HG Eindhoven, Department of Family Medicine, University of Maastricht, The Netherlands
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11
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Abstract
OBJECTIVES It is suggested that during menopausal transition, women with vasomotor symptoms benefit from HRT, (hormone replacement therapy) whereas, the use of HRT for other cognitive-vegetative symptoms is questionable. METHODS The occurrence of menopausal complaints and depressive symptoms was assessed cross-sectionally in 5896 Dutch Caucasian women (47-54 years) of a large community sample in the city of Eindhoven, The Netherlands. Menopausal complaints were assessed using a 22 items self-rating scale (consisting of a vasomotor, uro-genital and a cognitive-vegetative subscale). Depressive symptoms were assessed using the Edinburgh depression scale (EDS). Differences in mean scores were analysed between groups using ANOVA. The independent relationship of depressive symptoms to the intensity of menopausal complaints was assessed, by multiple linear regression analysis. RESULTS Women using HRT showed the highest scores on all subscales. Oral contraceptive users had significantly lower scores on the vasomotor subscale compared to HRT users and to non users. Depressive symptoms contributed the most, to the explained variance on scores on the menopausal subscales. CONCLUSIONS Women during menopause presenting several complaints, other than vasomotor origin might be suffering from underlying depression which makes it questionable to prescribe HRT for the latter symptoms.
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12
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Leusink GL, Smeets-Goevaers CG, Breed SA, Keyzer JJ, van Pelt J. Carbohydrate-deficient transferrin in relation to the menopausal status of women. Alcohol Clin Exp Res 2000; 24:172-5. [PMID: 10698368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Carbohydrate-deficient transferrin (CDT) has been reported as an excellent marker for male alcohol abuse. Little is known about its validity among women, in whom rather conflicting data concerning the efficiency of the CDT marker and its biochemical mechanism have been reported. Moreover, it is not clear why the reference ranges are different for women (0 to 26 Units per liter) and men (0 to 20 Units per liter). METHODS In this population-based study, we examined the normal CDT values measured by CDTect in 331 healthy female teetotalers, randomly selected from a large cohort. They were divided into four groups: premenopausal women (n = 76), perimenopausal women (n = 86), postmenopausal women (n = 84), and users of estrogens/progestagens (n = 85). RESULTS The mean of the CDT value in the premenopausal group (15.2 Units per liter) was significantly higher than the mean in the postmenopausal group (13.6 Units per liter; p < 0.016). In pre- and perimenopausal women, higher CDT levels were associated with the last period of menstruation; for women menstruating less than 1 month ago versus longer ago, the mean serum CDT value was 15.4 vs. 13.0 Units per liter (p < 0.01). CONCLUSIONS The premenopausal state seems to increase serum levels of CDT, probably due to the amount and frequency of blood loss during the menstrual period, and should be considered when interpreting CDT values in women.
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Affiliation(s)
- G L Leusink
- Diagnostic Center Eindhoven, The Netherlands.
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van Pelt J, Leusink GL, van Nierop PW, Keyzer JJ. Test characteristics of carbohydrate-deficient transferrin and gamma-glutamyltransferase in alcohol-using perimenopausal women. Alcohol Clin Exp Res 2000; 24:176-9. [PMID: 10698369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND The application of biochemical markers to detect heavy alcohol use in women has shown disappointing results until now. We evaluated carbohydrate-deficient transferrin (CDT) by the CDTect method and gamma-glutamyltransferase (GGT) in a large cohort of alcohol-using perimenopausal women studied primarily for osteoporosis. METHODS CDT and GGT were measured in 431 women aged 46 to 54 years, who were selected from a large cohort (n = 8503) of pre-, peri-, and postmenopausal women. Their alcohol intake was known from questionnaires and face-to-face interviews. Three groups were constructed for statistical analysis: those drinking on average less than 7 alcoholic drinks per week (n = 103), those drinking 7 to 34 per week (n = 280), and those drinking at least 35 per week (n = 48). RESULTS The mean values of CDT and GGT of the three groups increased with an increasing alcohol intake, but there was a poor correlation between CDT and GGT in the complete study group (r = 0.3). The specificities of CDT and GGT were comparable, 83% and 78%, respectively. The sensitivities for CDT and GGT were 30% and 50%, respectively. A logistic regression model could assign, overall, 77% of the women correctly in relation to their alcohol intake: 43% of the women drinking at least 35 drinks per week and 92% of the women drinking less than 7 drinks per week. CONCLUSIONS The test characteristics of both GGT and CDT are not good enough to be used as biochemical markers for detecting heavy alcohol use in women. The use of a logistic regression model offers an advantage, because both numeric values of CDT and GGT are taken into account instead of arbitrary cutoff values.
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Affiliation(s)
- J van Pelt
- KCHL, Hospitals Noord-Limburg Venlo/Venray, The Netherlands.
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