Dimension-specific burden of caregiving among partners of rheumatoid arthritis patients.

Objectives: To assess subjective caregiver burden among partners of rheumatoid arthritis (RA) patients and to identify partner and patient variables and objective caregiver burden related to subjective caregiver burden.

Methods: In 2001, 134 patients diagnosed with RA and their caregiving partners participated in a postal questionnaire survey. Information was gathered on age, gender and health problems of patient and partner, disease duration of the patient, objective caregiver burden and subjective caregiver burden of the partner (using the multidimensional Caregiver Reaction Assessment).

The robustness of medical expertise: clinical case processing by medical experts and subexperts.

Medical specialists confronted with problems in their domain of expertise do not rely on intentional causal reasoning, using explicit principles or rules. Rather, reasoning is an automatic process, using knowledge in an encapsulated mode. Less clear is what happens when medical specialists encounter problems outside their specialties.

A Qualitative Analysis of the Transition from Theory to Practice in Undergraduate Training in a PBL-Medical School.

In spite of numerous curricular innovations, the problems medical students encounter in making the transition from theoretical training to clinical training remain unresolved and the problem has received scant attention in the literature. We performed a qualitative study to explore students' perceptions and attitudes regarding this transition in undergraduate medical training. Twenty fifth-year students of the Maastricht Medical School participated in focus group discussions about the transition from the preclinical phase to the clinical phase of the curriculum.

Selection bias due to non-response in a health survey among patients with rheumatoid arthritis.

Background: Non-response may lead to bias in health(care) outcomes.

Methods: We compared respondents (n = 334) to a questionnaire survey among patients with rheumatoid arthritis with non-respondents (n = 68) and determined predictors of (non-)response. The bias in prevalence estimates of health characteristics and health care use was quantified.

The association between noise exposure and blood pressure and ischemic heart disease: a meta-analysis.

It has been suggested that noise exposure is associated with blood pressure changes and ischemic heart disease risk, but epidemiologic evidence is still limited. Furthermore, most reviews investigating these relations were not carried out in a systematic way, which makes them more prone to bias. We conducted a meta-analysis of 43 epidemiologic studies published between 1970 and 1999 that investigate the relation between noise exposure (both occupational and community) and blood pressure and/or ischemic heart disease (International Classification of Diseases, Ninth Revision, codes 410-414).

Predicting cardiovascular risk in the elderly in different European countries.

Aims: The objective of this study was to develop risk functions for coronary heart disease and cardiovascular disease mortality for elderly men in different European countries.

Methods And Results: The FINE Study is a prospective follow-up study of 2170 elderly men aged 65-84 years in Finland, Italy and The Netherlands. During 10 years of follow-up 289 men died from coronary heart disease and 545 men from cardiovascular disease.

A large outbreak of Legionnaires' disease at a flower show, the Netherlands, 1999.

In 1999, an outbreak of Legionnaires' disease affected many visitors to a flower show in the Netherlands. To identify the source of the outbreak, we performed an environmental investigation, as well as a case-control study among visitors and a serologic cohort study among exhibitors to measure exposure to possible sources. Of 77,061 visitors, 188 became ill (133 confirmed and 55 probable cases), for an attack rate of 0.

Long-term retention of a theatrical script by repertory actors: the role of context.

Four actors were requested to perform Sartre's No Exit after a retention interval of more than 5 months. Their recall of the play was studied either with the spatial and visual contextual cues normally available during a performance or without such cues. Total recall was still considerable, equalling 85%.

Costs of different strategies for neonatal hearing screening: a modelling approach.

Objective: To compare the cost effectiveness of various strategies for neonatal hearing screening by estimating the cost per hearing impaired child detected.

Design: Cost analyses with a simulation model, including a multivariate sensitivity analysis. Comparisons of the cost per child detected were made for: screening method (automated auditory brainstem response or otoacoustic emissions); number of stages in the screening process (two or three); target disorder (bilateral hearing loss or both unilateral and bilateral loss); location (at home or at a child health clinic).

Subclinical Legionella infection in workers near the source of a large outbreak of Legionnaires disease.

A survey was conducted of exhibitors at a 1999 floral trade show, where a whirlpool spa on display caused a large outbreak of legionnaires disease (LD). In total, 742 exhibitors without LD returned a questionnaire on their whereabouts during the fair and their health afterward and supplied blood samples for the detection of IgM and IgG antibodies against Legionella pneumophila. The exhibitors had higher average antibody levels than did the general population.

Medical informatics and problem-based learning.

Problem-based learning (PBL) is an educational method that can be considered as an alternative to the traditional, discipline-based, approach to teaching. In this paper the characteristics of both approaches are discussed and compared. Some background knowledge concerning the principles that determine the success of instructional methods is presented.

Do short cases elicit different thinking processes than factual knowledge questions do?

Purpose: To assess whether case-based questions elicit different thinking processes from factual knowledge-based questions.

Method: 20 general practitioners (GPs) and 20 students solved case-based questions and matched factual knowledge-based questions while thinking aloud. Verbatim protocols were analysed.

Knowledge Encapsulation and the Intermediate Effect.

The present study explored the role of so-called encapsulated knowledge in diagnosing clinical cases outside the expert physicians' domain of expertise. Neurologists and 2nd-year and 6th-year medical students were required to diagnose, recall, and explain the signs and symptoms of two cardiological and two pulmonological clinical case descriptions. Our experiment showed that neurologists diagnosed these clinical cases faster and more accurately than 2nd-year and 6th-year medical students.

Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research.

Medical diagnosis is a categorization task that allows physicians to make predictions about features of clinical situations and to determine appropriate course of action. The script concept, which first arose in cognitive psychology, provides a theoretical framework to explain how medical diagnostic knowledge can be structured for diagnostic problem solving. The main characteristics of the script concept are pre-stored knowledge, values acceptable or not acceptable for each illness attribute, and default values.

Multiple imputation of missing blood pressure covariates in survival analysis.

This paper studies a non-response problem in survival analysis where the occurrence of missing data in the risk factor is related to mortality. In a study to determine the influence of blood pressure on survival in the very old (85+ years), blood pressure measurements are missing in about 12.5 per cent of the sample.

A failure to reproduce the intermediate effect in clinical case recall.

Purpose: To investigate the differences between experts, intermediates, and novices in diagnosing and representing clinical cases under various time constraints.

Method: Second-, fourth-, and sixth-year medical students, and internists studied, diagnosed, and recalled four clinical cases from internal medicine. Participants were allowed to study each case for either 3 minutes, 1 minute 15 seconds, or 30 seconds.

Blood pressure and mortality in elderly people aged 85 and older: community based study.

Objective: To determine whether the inverse relation between blood pressure and all cause mortality in elderly people over 85 years of age can be explained by adjusting for health status, and to determine whether high blood pressure is a risk factor for mortality when the effects of poor health are accounted for.

Design: 5 to 7 year follow up of community residents aged 85 years and older.

Setting: Leiden, the Netherlands.

Maternal smoking during lactation: relation to growth during the first year of life in a Dutch birth cohort.

A recent article by Little et al. (Am J Epidemiol 1994;140:544-54) reported that infants in Seattle, Washington, who were breastfed by mothers who smoked gained more weight than either infants who were breastfed by mothers who did not smoke or infants who were bottle-fed by mothers who smoked. In this study, the authors aimed to verify this result with the use of data from the Social Medical Survey of Children Attending Child Health Clinics (SMOCC) cohort, a nationally representative cohort of 2,151 children born in the Netherlands in 1988-1989.

Average age at first occurrence as an alternative occurrence parameter in epidemiology.

Background: Current epidemiological methods focus mostly on incidence rates and their ratios as measures of occurrence and effect. Incidence rates and rate ratios can be hard to interpret when the outcome disease is common.

Methods: The possibilities of using an alternative measure, average age at first occurrence of the disease, are discussed.

Measuring knowledge and clinical reasoning skills in a problem-based curriculum.

The purpose of this study was to investigate the validity of the Progress Test that was specially designed for measuring the growth of knowledge and clinical reasoning skills in a problem-based medical curriculum. Scores and subscores of students from the different categories of the Progress Test were compared with their scores on a Clinical Reasoning Tests. Both the Progress Test and the Clinical Reasoning Test revealed the same pattern of increasing scores over the years, and had a high intercorrelation.

Health expectancy calculations: a novel approach to studying population health in Bulgaria.

The measurement of life expectancy in terms of either good or poor health is a novel approach to studying the health of the population in Bulgaria. The pilot study reported here-carried out among people aged > or = 60 years in a middle-sized Bulgarian town-was designed to obtain information on the years of functional restrictions expected among the elderly. In accordance with the answers to a series of questions (recommended by WHO), subjects were categorized as disabled, handicapped, or having different states of perceived health.

Dementia-free life expectancy (DemFLE) in The Netherlands.

To gain an insight into the burden of dementia in an aging society, life expectancy with dementia and its counterpart dementia-free life expectancy (DemFLE) in The Netherlands are presented. Sullivan's method was used to calculate DemFLE. For elderly living either independently or in homes for the elderly prevalence figures on dementia were obtained from the Rotterdam Elderly Study (RES; n = 7528); for elderly in nursing homes the SIG Nursing home Information System was used.

Occupational handicap-free life expectancy in Bulgaria 1976-1992 based on the data of the medical expert commissions.

This article presents health expectancy calculations from Bulgaria for 1976-1992. The calculations are based on mortality statistics and data from a national information system from the Expert Medical Commissions on Working Capacity about loss of working capacity. Following internationally accepted terminology, the most appropriate term for the health expectancies presented here is "occupational handicap-free life expectancy' (OHFLE).