Objective: To analyze the value of a single ultrasound biometry examination at the onset of the third trimester of pregnancy for the detection of small-for-gestational-age (SGA) and ...large-for-gestational-age (LGA) at birth in a low risk population. The aim of this study was to develop a simple and useful method for the detection of growth deviations during pregnancy in primary care (midwife or general practitioner) practices. Setting: A Dutch primary care midwifery practice. Study design: In an earlier study, we developed parity and sex specific fetal growth charts of abdominal circumference (AC) and head circumference (HC) on the basis of ultrasound data of a low-risk midwifery population in the Netherlands. In the present study, we calculated sensitivity, specificity and predictive values at different cut-off points of AC and HC for the prediction of growth deviations at birth. Patients booked for perinatal care between 1 January 1993 and 31 December 2003 (n=3449) were used for the identification of cut-off points (derivation cohort) and those admitted between 1 January 2004 and 31 December 2005 (n=725) were used to evaluate the performance of these cut-offs in an independent population (validation cohort). For the determination of SGA and macrosomia at birth, we used the recently published Dutch birth weight percentiles. Results: Most promising cut-offs were AC ≤25th percentile for the prediction of SGA (birth weight ≤10th percentile) and AC ≥75th percentile for the prediction of macrosomia (birth weight ≥90th percentile). Within the validation cohort these cut-offs performed slightly better than in the derivation cohort. For the prediction of SGA, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 53% (95% CI 49–58%), 81% (95% CI 80–83%), 26% (95% CI 23–29%), and 93% (95% CI 93–94%), respectively. The false positive rate was 74%. For the prediction of macrosomia, the values of these parameters were 64% (95% CI 59–69%), 80% (95% CI 78–81%), 23% (95% CI 20–26%), and 96% (95% CI 95–97%), respectively. Here, false positive rate was 77%. No cut-offs were found that predicted extreme birth weight deviations (≤2.3 percentile; ≥97.7 percentile) sufficiently well. Conclusions: In a low risk population, we could predict future growth deviations with a higher sensitivity and in a significant earlier stage (at the onset of the third trimester of pregnancy) than with the use of conventional screening methods (i.e., palpation of the uterus only and fundus-symphysis measurement). Sonographic measurement of fetal abdominal circumference enables to detect more than half of cases of SGA at birth and more than two-thirds of cases of macrosomia with acceptable false-positive rates. We suggest that fetuses with biometry results below the 25th percentile or above the 75th percentile at the onset of the third trimester of pregnancy should be more intensively investigated in order to distinguish between pathology (e.g., IUGR or macrosomia) and physiology and to decide about the appropriate level of further perinatal care.
In the Netherlands, absenteeism and reduced productivity due to work disability lead to high yearly costs reaching almost 5% of the gross national product. To reduce the economic burden of sick leave ...and reduced productivity, different employability interventions for work-disabled employees or employees at risk of work disability have been developed. Within this study, called 'CASE-study' (Cost-effectiveness Analysis of Sustainable Employability), five different employability interventions directed at work disabled employees with divergent health complaints will be analysed on their effectiveness and cost-effectiveness. This paper describes a consistent and transparent methodological design to do so.
Per employability intervention 142 participants are needed whereof approximately 66 participants receiving the intervention will be compared with 66 participants receiving usual care. Based on the intervention-specific characteristics, a randomized control trial or a quasi-experiment with match-criteria will be conducted. Notwithstanding the study design, eligible participants will be employees aged 18 to 63, working at least 12 h per week, and at risk of work disability, or already work-disabled due to medical restrictions. The primary outcome will be the duration of sick leave. Secondary outcomes are health status and quality of life. Outcomes will be assessed at baseline and then 6, 12 and 18 months later. Economic costs will consist of healthcare costs and cost of lost production due to work disability, and will be evaluated from a societal perspective.
The CASE-study is the first to conduct economic evaluations of multiple different employability interventions based on a similar methodological framework. The cost-effectiveness results for every employability intervention will be published in 2014, but the methods, strengths and weaknesses of the study protocol are discussed in this paper. To contribute to treatment options in occupational health practice and enable the development of guidelines on how to conduct economic evaluation better suited to this field; this paper provides an important first step.
Four trials involved in the CASE-study are registered with the Netherlands Trial Registry: Care for Work (NTR2886), Health and Motion (NTR3111), Guidance to Excel in Return to Work (NTR3151), Care for Companies/Second Care (NTR3136).
Worldwide, the employment rate of people with visual impairments (PVIs) is lower than that of the general working-age population. To improve the employment rate of this group, there is a need for ...knowledge about differences in modifiable factors between working and non-working PVIs.
To identify modifiable factors associated with participation on the competitive labour market of PVIs. Based on the findings, we aim to develop an individual assessment instrument for determining the odds of labour market success of PVIs.
Data were collected among 299 PVIs by means of a cross-sectional telephone survey based on existing (validated) and self-developed scales and items. Logistic regression analysis was used to find the strongest predictors of the dichotomous outcome of 'having paid work on the competitive labour market' (yes/no).
We found three personal non-modifiable factors (level of education, comorbidity, level of visual impairment) and three modifiable factors (mobility, acceptance and optimism) to be significantly (p < 0.05) associated with having paid work.
The factors of optimism, acceptance and mobility should be included in an individual assessment instrument which can provide PVIs and their job coaches with good starting points for improving the labour market situation of the PVIs.
Asthma is the most common chronic disease in childhood, characterized by chronic airway inflammation. There are problems with the diagnosis of asthma in young children since the majority of the ...children with recurrent asthma-like symptoms is symptom free at 6 years, and does not have asthma. With the conventional diagnostic tools it is not possible to differentiate between preschool children with transient symptoms and children with asthma. The analysis of biomarkers of airway inflammation in exhaled breath is a non-invasive and promising technique to diagnose asthma and monitor inflammation in young children. Moreover, relatively new lung function tests (airway resistance using the interrupter technique) have become available for young children. The primary objective of the ADEM study (Asthma DEtection and Monitoring study), is to develop a non-invasive instrument for an early asthma diagnosis in young children, using exhaled inflammatory markers and early lung function measurements. In addition, aetiological factors, including gene polymorphisms and gene expression profiles, in relation to the development of asthma are studied.
A prospective case-control study is started in 200 children with recurrent respiratory symptoms and 50 control subjects without respiratory symptoms. At 6 years, a definite diagnosis of asthma is made (primary outcome measure) on basis of lung function assessments and current respiratory symptoms ('golden standard'). From inclusion until the definite asthma diagnosis, repeated measurements of lung function tests and inflammatory markers in exhaled breath (condensate), blood and faeces are performed. The study is registered and ethically approved.
This article describes the study protocol of the ADEM study. The new diagnostic techniques applied in this study could make an early diagnosis of asthma possible. An early and reliable asthma diagnosis at 2-3 years will have consequences for the management of the large group of young children with asthma-like symptoms. It will avoid both over-treatment of children with transient wheeze and under-treatment of children with asthma. This might have a beneficial influence on the prognosis of asthma in these young children. Besides, insight into the pathophysiology and aetiology of asthma will be obtained.
This study is registered by (ClinicalTrials.gov) (NCT00422747).
The aim of this systematic review of the literature is to increase understanding of the factors that influence the labor force participation of persons who are visually impaired. Labor force ...participation was associated with many factors, such as communication training and education. Future research should focus on high-quality studies of labor force participation and underemployment in more countries.
Obesity is demonstrated to be associated with an enhanced inflammatory state, which is suggested to be a cause for the development of obesity-related morbidity. It was hypothesized that a decrease in ...body weight in morbid obese subjects would lead to a reduction of the inflammatory state in these subjects.
Weight loss was achieved by gastric restrictive surgery in 27 morbidly obese patients. Preoperative as well as 3-, 6-, 12-, and 24-month postoperative plasma concentrations of inflammatory mediators macrophage inhibitory factor, plasminogen activator inhibitor-1, lipopolysaccharide binding protein, α-1 acid glycoprotein, C-reactive protein, soluble TNFα receptors 55 and 75, and leptin were measured.
Macrophage inhibitory factor levels remained low normal for 6 months, during weight loss, after which they significantly increased to normal levels at 24 months postoperatively. The other inflammatory mediators remained elevated up to minimally 3 months postoperatively; thereafter they decreased significantly. Both TNFα receptors remained elevated up to at least 12 months postoperatively to decrease significantly at 2 yr postoperatively.
This study demonstrates that during weight loss, after gastric restrictive surgery, inflammatory mediators remain elevated for at least 3 months postoperatively, suggesting initially an ongoing inflammatory state. However, 2 yr after surgery, the inflammatory mediators reach near normal values.
These findings may be an explanation for the reduced comorbidity seen in morbidly obese patients after gastric restrictive surgery.
Objective: To establish a threshold value for fetal renal pelvis dilatation measured by automatic volume calculation (SonoAVC) in the third trimester of pregnancy to predict neonatal uropathies, and ...to compare these results with conventional antero-posterior (AP) measurement, fetal kidney 3D volume and renal parenchymal thickness.
Methods: In a prospective cohort study, 125 fetuses with renal pelvis AP diameter of ≥5 mm both at 20 weeks of gestation and in the third trimester, underwent an additional 3D volume measurement of the fetal kidney in the third trimester. Receiver operating characteristic (ROC) curves for establishing threshold values for fetal renal pelvis volume, AP measurement, fetal kidney volume and renal parenchymal thickness to predict neonatal uropathies were analyzed. Also, sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated.
Results: A cut-off point of 1.58 cm³ was identified in the third trimester of pregnancy (AUC 0.865 (95% CI 0.789-0.940), sensitivity 76.3%, specificity 87.4%, LR+ 6.06, LR− 0.27) for measurements with SonoAVC. A cut-off value of 11.5 mm was established in the third trimester of pregnancy (AUC 0.828 (95% CI 0.737-0.918), sensitivity 71.1%, specificity 85.1%, LR+ 4.77, LR− 0.34) for the conventional AP measurement. A cut-off point for fetal kidney volume was calculated at 13.29 cm³ (AUC 0.769 (95% CI 0.657-0.881), sensitivity 71%, specificity 66%, LR+ 2.09, LR− 0.44). For renal parenchymal thickness, a cut-off point of 8.4 mm was established (AUC 0.216 (95% CI 0.117-0.315), sensitivity 31.6%, specificity 32.6%, LR+ 0.47, LR− 2.10).
Conclusion: This study demonstrates that 3D fetal renal pelvis volume measurements and AP measurements both have a good and comparable diagnostic performance, fetal renal volume a fair accuracy and renal parenchymal thickness a poor accuracy in predicting postnatal renal outcome.
The purpose of this prospective cohort study was to determine whether planned vaginal delivery for the term singleton baby in breech position increases the risk of abnormal neurodevelopment at 2 ...years of age and to assess whether the effect is modified by birth weight.
At 2 years of age, all nonrandomized children born in breech position during our participation in the Term Breech Trial were screened for abnormal neurodevelopment with the Ages and Stages Questionnaire.
An Ages and Stages Questionnaire at 2 years of age was obtained in 183 of 203 children (90.1%). Twenty-eight percent of these children showed 1 or more abnormal Ages and Stages Questionnaire domains. There were no differences in the risk of having abnormal Ages and Stages Questionnaire domains between planned vaginal delivery and planned cesarean section (
P = .99). There was, however, evidence of interaction between mode of delivery and birth weight, with significantly higher risk in neurodevelopmental delay in children with birth weight greater than 3500 g with planned vaginal birth (adjusted odds ratio for interaction term 3.37; 95% confidence interval 1.14 to 9.95).
Based on the Ages and Stages Questionnaire results at 2 years of age, planned vaginal delivery is associated with an increased risk of neurodevelopmental delay at 2 years of age in term breech children with a birth weight greater than 3500 g.
Little is known about the natural course of fatigue among employees. An adequate understanding of its development and risk factors is important to prevent chronic health complaints and absenteeism. ...This longitudinal study investigated associations between positive changes in perceived work characterístics (ie, a decrease in job demands, an increase in decision latitude, and an increase in social support) and changes in fatigue by performing hierarchical regression analyses. The work characterístics of the demand-control-support model were selected as predictors. The outcome measures emotional exhaustion and psychologic distress were investigated as secondary outcomes. The results showed that, compared with a stable work situation, positive changes in perceived social support, decision latitude, and psychologic job demands went together with a decrease in fatigue. Similar results were found for the secondary outcomes emotional exhaustion and psychologic distress.
Objectives This study examined the effects of different worktime arrangements on work-home interference while taking into account other work-related factors, private situation and health status, ...explored gender differences in this relation, and examined reciprocal effects between workhours and work-home interference. Methods Data from the Maastricht cohort study on fatigue at work were used with 8 months of follow-up (N=6947 at baseline). Results Worktime arrangements were related to work-home interference among the men and women, even after control for confounding. As compared with day work, baseline shiftwork was associated with higher workhome interference over time. Within daywork, full-time work was prospectively related to higher work-home interference than part-time work was. For full-timers, baseline overtime work, hours of overtime work, change in number of workhours, and commuting time were related to higher work-home interference over time, whereas compensation for overtime work, familiarity with work roster, ability to take a day off, and a decrease in workhours at own request were associated with less work-home interference. For the part-timers, baseline overtime work and commuting time were related to higher work-home interference over time, whereas compensation for overtime, flexible workhours, and ability to take a day off were protective against work-home interference. Reciprocal relations between work-home interference and workhours were also found. Conclusions Worktime arrangements are clearly related to work-home interference. Because reciprocal effects exist as well, important selection processes may exist. Nevertheless, specific characteristics of worktime arrangements could constitute useful tools for reducing work-home interference.
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