Aims/hypothesis This systematic review examines the relationship between alcohol consumption and long-term complications of type 2 diabetes. Meta-analyses could only be performed for total mortality, ...mortality from CHD, and CHD incidence, because the availability of articles on other complications was too limited. Materials and methods A PubMed search through to September 2005 was performed and the reference lists of relevant articles examined. Among the relevant articles there were six cohort studies reporting on the risk of total mortality and/or fatal and/or incident CHD in alcohol non-consumers and in at least two groups of alcohol consumers. Results Statistical pooling showed lower risks in alcohol consumers than in non-consumers (the reference category). The relative risk (RR) of total mortality was 0.64 (95% CI 0.49-0.82) in the <6 g/day category. In the higher alcohol consumption categories (6 to <18, and >=18 g/day), the RRs of total mortality were not significant. Risks of fatal and total CHD were significantly lower in all three categories of alcohol consumers (<6, 6 to <18 and >=18 g/day) than in non-consumers, with RRs ranging from 0.34 to 0.75. Conclusions/interpretation This meta-analysis shows that, as with findings in the general population, moderate alcohol consumption is associated with a lower risk of mortality and CHD in type 2 diabetic populations.
Results of previous studies suggest that memory complaints may predict cognitive decline and dementia among elderly people in whom cognitive impairment is already apparent. However, cognitive decline ...is often a gradual process, and elderly people may notice that their memory deteriorates before mental status tests are able to detect any change in cognitive functioning. Therefore, the authors hypothesized that memory complaints would predict incident Alzheimer's disease in elderly subjects with no signs of cognitive impairment.
In the community-based Amsterdam Study of the Elderly, a sample of 3,778 nondemented persons, 65 to 84 years old, was selected and divided into two cognitive categories: normal (Mini-Mental State scores of 26-30) and borderline and impaired (Mini-Mental State scores less than 26). At baseline, the presence or absence of memory complaints was assessed. At follow-up, incident cases of Alzheimer's disease were diagnosed in a two-step procedure.
After an average of 3.2 years, 2,169 persons were reevaluated, of whom 77 had incident Alzheimer's disease. Multivariate logistic regression analyses showed that memory complaints were associated with incident Alzheimer's disease in subjects with normal baseline cognition but not in subjects with impaired baseline cognition.
The findings of this study suggest that memory complaints are a relatively strong predictor of incident Alzheimer's disease in older persons in whom cognitive impairment is not yet apparent. Furthermore, they suggest that older persons may be aware of a decline in cognition at a time when mental status tests are still unable to detect a decline from premorbid functioning.
The degree of glycaemia has been shown to be associated with all-cause and cardiovascular mortality in diabetic subjects. Whether this association also exists in the general population is still ...controversial. We studied the predictive value of fasting plasma glucose, 2-hour post-load glucose and HbA1c in a population-based cohort of 2363 older (50-75 years) subjects, without known diabetes.
Relative risks (RR) of all-cause and cardiovascular mortality were estimated by Cox proportional hazards model, adjusting for age and sex, and additionally for known cardiovascular risk factors.
During 8 years of follow-up, 185 subjects died; 98 of cardiovascular causes. Fasting plasma glucose was only predictive in the diabetic range, although the risks started to increase at about 6.1 mmol/l. Post-load glucose and HbA1c values were, even within the non-diabetic range, associated with an increased risk (p for linear trend < 0.05). These increased risks were mostly, but not completely, attributable to known cardiovascular risk factors. After exclusion of subjects with newly diagnosed diabetes or with pre-existent cardiovascular disease (n = 551), a 5.8 mmol/l increase of post-load glucose (corresponding to two standard deviations of the population distribution) was associated with a higher age-adjusted and sex-adjusted risk of all-cause (RR 2.24) and cardiovascular mortality (RR 3.40) (p < 0.05). After additional adjustment for known cardiovascular risk factors, these relative risks were still statistically significant, with values of 2.20 and 3.00 respectively (p < 0.05).
High glycaemic variables, especially 2-h post-load glucose concentrations and to a lesser extent HbA1c values, indicate a risk of all-cause and cardiovascular mortality in a general population without known diabetes.
The prevalence of neck pain in the general population ranges from 10 to 15%. The complaints can result in substantial medical consumption, absenteeism from work and disability. In this study we ...investigated the costs of neck pain in the Netherlands in 1996 to assess the financial burden to society. The study was based on prevalence data. Data sources included national registries, reports of research institutes and health care authorities. Direct health care costs were estimated for hospital care, general practice care and paramedical care. These costs were calculated using fees. Calculation of indirect costs (absenteeism and disability) was based on the Human Capital Method (HCM). As an alternative approach the Friction Cost Method (FCM) was used. The total cost of neck pain in The Netherlands in 1996 was estimated to be US $686 million. The share of these costs was about 1% of total health care expenditures and 0.1 % of the Gross Domestic Product (GDP) in 1996. Direct costs were $160 million (23%). Paramedical care accounted for largest proportion of direct costs (84%). When applying the HCM for calculating indirect costs, these costs amounted to $527 million (77%). The total number of sick days related to neck pain were estimated to be 1.4 million with a total cost of $185.4 million in 1996. Disability for neck pain accounted for the largest proportion (50%) of the total costs related to neck pain in 1996 ($341). When applying the FCM for calculating the indirect costs, these costs were reduced to $96 million. The costs related to neck pain in 1996 in The Netherlands were substantial. Some caution should be taken in interpretation, as a number of assumptions had to be made in order to estimate the total costs. The cost structure shown in this study, with high indirect costs, has also been found in other studies. From an economical point of view it seems to be important to prevent patients from having to take sick leave and disability. One way in achieving this goal is to develop and investigate more effective treatments for acute neck pain, in order to prevent patients developing chronic pain and disability. Another option is to protect chronic patients from sick leave and disability by careful management. Thus, also in the area of direct medical costs, there may be room for cost savings by stimulating and improving cost-efficiency and cost-effectiveness of the (para)medical care. In order to deal with the lack of specific disease information, more detailed information of medical consumption, sick leave and disability is required for future cost analysis.
Most systematic reviews rely substantially on the assessment of the methodological quality of the individual trials. The aim of this study was to obtain consensus among experts about a set of generic ...core items for quality assessment of randomized clinical trials (RCTs). The invited participants were experts in the field of quality assessment of RCTs. The initial item pool contained all items from existing criteria lists. Subsequently, we reduced the number of items by using the Delphi consensus technique. Each Delphi round comprised a questionnaire, an analysis, and a feedback report. The feedback report included staff team decisions made on the basis of the analysis and their justification. A total of 33 international experts agreed to participate, of whom 21 completed all questionnaires. The initial item pool of 206 items was reduced to 9 items in three Delphi rounds. The final criteria list (the Delphi list) was satisfactory to all participants. It is a starting point on the way to a minimum reference standard for RCTs on many different research topics. This list is not intended to replace, but rather to be used alongside, existing criteria lists.
This systematic review assessed aspects of physical load during work and leisure time as risk factors for back pain. Several reviews on this topic are available, but this one is based on a strict ...systematic approach to identify and summarize the evidence, comparable with that applied in the clinical literature on the efficacy of intervention for back pain. A computerized bibliographical search was made of several data bases for studies with a cohort or casereferent design. Cross-sectional studies were excluded. A rating system was used to assess the strength of the evidence, based on the methodological quality of 28 cohort and 3 case-referent studies and the consistency of the findings. Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain. The evidence was moderate for patient handling and heavy physical work, and no evidence was found for standing or walking, sitting, sports, and total leisure-time physical activity.
Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for ...stroke patients.
An extensive search in MEDLINE, CINAHL, EMBASE, AMED, and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Seven intervention categories were distinguished and separately analyzed. If a quantitative approach (meta-analysis) of data analysis was not appropriate, a qualitative approach (best-evidence synthesis), based on the type of design, methodological quality, and significant findings of outcome and/or process measures, was performed.
Thirty-two studies were included in this review, of which 18 were randomized controlled trials. Ten randomized controlled trials had a high methodological quality. For the comprehensive OT intervention, the pooled standardized mean difference for primary activities of daily living (ADL) (0.46; CI, 0.04 to 0.88), extended ADL (0.32; CI, 0.00 to 0.64), and social participation (0.33; CI, 0.03 to 0.62) favored treatment. For the training of skills intervention, some evidence for improvement in primary ADL was found. Insufficient evidence was found to indicate that the provision of splints is effective in decreasing muscle tone.
This review identified small but significant effect sizes for the efficacy of comprehensive OT on primary ADL, extended ADL, and social participation. These results correspond to the outcome of a systematic review of intensified rehabilitation for stroke patients. The amount of evidence with respect to specific interventions, however, is limited. More research is needed to enable evidence-based OT for stroke patients.
Persons with impaired glucose tolerance (IGT) are known to have an elevated risk of developing diabetes mellitus. Less is known about diabetes risk among persons with impaired fasting glucose (IFG) ...or with normal glucose levels.
To determine the incidence of diabetes in relation to baseline fasting and postload glucose levels and other risk factors.
Population-based cohort study conducted from October 1989 to February 1992 among 1342 nondiabetic white residents of Hoorn, the Netherlands, aged 50 to 75 years at baseline, in whom fasting plasma glucose (FPG) levels and glucose levels 2 hours after a 75-g oral glucose tolerance test were measured at baseline and at follow-up in 1996-1998.
Cumulative incidence of diabetes, defined according to the diagnostic criteria of the World Health Organization (WHO-1985 and WHO-1999) and the American Diabetes Association (ADA-1997), during a mean follow-up of 6.4 years, compared among participants with IFG, IGT, and normal glucose levels at baseline.
The cumulative incidence of diabetes was 6.1%, 8.3%, and 9.9% according to the WHO-1985, ADA, and WHO-1999 criteria, respectively. The cumulative incidence of diabetes (WHO-1999 criteria) for participants with both IFG and IGT was 64.5% compared with 4.5% for those with normal glucose levels at baseline. The odds ratios for diabetes (WHO-1999 criteria), adjusted for age, sex, and follow-up duration, were 10.0 (95% confidence interval CI, 6.1-16.5), 10.9 (95% CI, 6.0-19.9), and 39.5 (95% CI, 17.0-92.1), respectively, for those having isolated IFG, isolated IGT, and both IFG and IGT. In addition to FPG and 2-hour postload glucose levels (P<.001 for both), the waist-hip ratio also was an important risk factor for developing diabetes (P =.002).
In this study, the cumulative incidence of diabetes was strongly related to both IFG and IGT at baseline and, in particular, to the combined presence of IFG and IGT.
In this prospective study, the authors determined intrinsic risk factors for falls and recurrent falls and constructed a risk profile that indicated the relative contribution of each risk factor and ...also estimated the probabilities of falls and recurrent falls. In 1992, over a 28-week period, falls were recorded among 354 elderly subjects aged 70 years or over who were living in homes or apartments for the elderly in Amsterdam and the vicinity. During the study period, 251 falls were reported by 126 subjects (36%), and recurrent falls (≥2 falls) were reported by 57 subjects (16%). Associations of falls and recurrent falls with potential risk factors were identified in logistic regression models. Mobility impairment regarding one or more of the tested items (i.e., impairment of balance, leg-extension strength, and gait) was associated with falls (adjusted odds ratio (OR) = 2.6) and was strongly associated with recurrent falls (OR = 5.0). Dizziness upon standing was associated with falls (OR = 2.1) and recurrent falls (OR = 2.1). However, several risk factors were associated with recurrent falls only: history of stroke (OR = 3.4), poor mental state (OR = 2.4), and postural hypotension (OR = 2.0). The authors constructed a risk profile for recurrent falls that included the five risk factors mentioned above. Inclusion of all risk factors in the profile implied an 84% probability of recurrent falls over a period of 28 weeks, compared with 3% when no risk factor was present. The probability of recurrent falls ranged only from 11 % to 29% when predicted by number of falls occurring in the previous year. Physical activity, use of high-risk medication, and the use of vitamin D3, which was randomly allocated to the participants, were not strongly related to either falls or recurrent falls. In conclusion, a large range of probabilities of falls, especially of recurrent falls, was estimated by the risk profiles, in which mobility impairment was the major risk factor. Recurrent fallers may therefore be especially amenable to prevention based on mobilfty improvement. Am J Epidemiol 1996; 143: 1129–36.
ObjectiveTo investigate the biomedical scientist's perception of the prevailing publication culture.DesignQualitative focus group interview study.SettingFour university medical centres in the ...Netherlands.ParticipantsThree randomly selected groups of biomedical scientists (PhD, postdoctoral staff members and full professors).Main outcome measuresMain themes for discussion were selected by participants.ResultsFrequently perceived detrimental effects of contemporary publication culture were the strong focus on citation measures (like the Journal Impact Factor and the H-index), gift and ghost authorships and the order of authors, the peer review process, competition, the funding system and publication bias. These themes were generally associated with detrimental and undesirable effects on publication practices and on the validity of reported results. Furthermore, senior scientists tended to display a more cynical perception of the publication culture than their junior colleagues. However, even among the PhD students and the postdoctoral fellows, the sentiment was quite negative. Positive perceptions of specific features of contemporary scientific and publication culture were rare.ConclusionsOur findings suggest that the current publication culture leads to negative sentiments, counterproductive stress levels and, most importantly, to questionable research practices among junior and senior biomedical scientists.
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