Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke: Determinants and prediction.

Objectives: (a) To determine levels of and factors explaining partners' burden, anxiety and depressive symptoms at two months post-stroke, (b) to predict partners' burden, anxiety and depressive symptoms at one year post-stroke based on patient and partner characteristics available at two months post-stroke.

Methods: Prospective cohort study. Partners of stroke patients (N=183) were included.

Course of social support and relationships between social support and patients' depressive symptoms in the first 3 years post-stroke.

Objective: To describe the course of social support (everyday support, support in problem situations and esteem support) from initial inpatient rehabilitation until 3 years post-stroke and to examine the cross-sectional and longitudinal relationships of social support with depressive symptoms.

Design: Prospective cohort study.

Subjects: A total of 249 stroke patients.

Quality of life of adult men with Duchenne muscular dystrophy in the Netherlands: implications for care.

Objective: To assess quality of life of adults with Duchenne muscular dystrophy in the Netherlands and to identify domains and major problems influencing quality of life.

Design: Cross-sectional.

Subjects: Seventy-nine men aged ≥ 20 years with Duchenne muscular dystrophy.

Subjective caregiver burden of parents of adults with Duchenne muscular dystrophy.

Purpose: To describe subjective caregiver burden of parents of adults with Duchenne muscular dystrophy (DMD) and to identify factors associated with the level of subjective burden.

Methods: In a cross-sectional study in 80 parents of 57 adult, severely disabled DMD patients' level of subjective caregiver burden was measured with the Caregiver Strain Index (CSI) and the Self Rated Burden Scale. A visual analogue scale was used to measure happiness.

Course of social support and relationships between social support and life satisfaction in spouses of patients with stroke in the chronic phase.

Objective: To describe the course of social support in spouses of patients with stroke, and to examine direct and indirect relationships between social support and life satisfaction over time.

Methods: Prospective cohort study (N=180) with measurements at 2 months after discharge from inpatient rehabilitation, 1 year, and 3 years after stroke. Social support was assessed using the Social Support List-12, Life satisfaction with the Life Satisfaction Questionnaire (LiSat-9) and Caregiver strain with the Caregiver Strain Index.

Is there equity in long-term healthcare utilization after traumatic brain injury?

Objective: To quantify the long-term use of various types of healthcare services in patients with traumatic brain injury and to estimate the relative contribution of predisposing characteristics, enabling factors and health-related needs to determine whether there is equity in healthcare utilization.

Design: Cross-sectional study.

Patients: Seventy-nine non-institutionalized moderate to severe patients with traumatic brain injury (age range 16-67 years).

Impact of preexisting depression on length of stay and discharge destination among patients hospitalized for acute stroke: linked register-based study.

Background And Purpose: There exists limited knowledge regarding the relation between depression and healthcare utilization in stroke patients. The objective of this register-based study was to examine the impact of having preexisting depression at the time of hospital admission for acute stroke on length of hospital stay and discharge destination.

Methods: Data from a general-practice database were linked to those of a hospital database to identify patients hospitalized for stroke and were used to categorize these patients into 3 groups based on preexisting mental health (MH) status at admission, ie, those with preexisting depression, those with another preexisting MH condition, and those without any preexisting MH condition.

Comorbidity was associated with neurologic and psychiatric diseases: a general practice-based controlled study.

Background And Objective: To comprehensively examine comorbidity in unselected cohorts of patients with depression, stroke, multiple sclerosis (MS), Parkinson's disease/parkinsonism (PD/PKM), dementia, migraine, and epilepsy.

Methods: This cross-sectional study used morbidity data recorded by Dutch general practitioners. Index disease cohort sizes ranged from 241 patients with MS to 6,641 patients with lifetime depression.

Cerebrovascular risk factors and subsequent depression in older general practice patients.

Background: This general practice-based case-control study tested the association between cerebrovascular risk factors (CVRFs) and the development of later-life depression by focusing on the impact of exposure duration to CVRFs and the modifying influence of age at depression onset.

Methods: Cases were 286 patients aged > or = 50 years with a first diagnosis of depression at age > or = 50 years. Nondepressed controls (N=832) were individually matched for age, gender and practice.

Future costs of stroke in the Netherlands: the impact of stroke services.

Objectives: In the next decades, the number of stroke patients is expected to increase. Furthermore, organizational changes, such as stroke services, are expected to be implemented on a large scale. The purpose of this study is to estimate the future healthcare costs by taking into account the expected increase of stroke patients and a nationwide implementation of stroke services.

Comorbidity in patients with diabetes mellitus: impact on medical health care utilization.

Background: Comorbidity has been shown to intensify health care utilization and to increase medical care costs for patients with diabetes. However, most studies have been focused on one health care service, mainly hospital care, or limited their analyses to one additional comorbid disease, or the data were based on self-reported questionnaires instead of health care registration data. The purpose of this study is to estimate the effects a broad spectrum of of comorbidities on the type and volume of medical health care utilization of patients with diabetes.

Hierarchy levels, sum score, and worsening of disability are related to depressive symptoms in elderly men from three European countries.

Objectives: The objectives were to investigate the predictive value of hierarchy levels and sum score of disability and change in disability on depressive symptoms.

Method: Longitudinal data of 723 men age 70 and older from the Finland, Italy, and the Netherlands Elderly Study were collected in 1990 and 1995. Self-reported disability was based on three disability domains (instrumental activities, mobility, and basic activities) and depressive symptoms on the Zung questionnaire.

The contribution of self-rated health and depressive symptoms to disability severity as a predictor of 10-year mortality in European elderly men.

Objectives: To investigate the effect of disability severity and the contribution of self-rated health and depressive symptoms to 10-year mortality.

Methods: Longitudinal data were collected from 1141 men aged 70 to 89 years from the Finland, Italy, and the Netherlands Elderly Study from 1990 to 2000. Disability severity was classified into 4 categories: no disability, instrumental activities, mobility, and basic activities of daily living.

Economic valuation of informal care: lessons from the application of the opportunity costs and proxy good methods.

This paper reports the results of the application of the opportunity costs and proxy good methods to determine a monetary value of informal care. We developed a survey in which we asked informal caregivers in The Netherlands to indicate the different types of time forgone (paid work, unpaid work and leisure) in order to be able to provide care. Moreover, we asked informal caregivers how much time they spent on a list of 16 informal care tasks during the week before the interview.

Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity.

Background: Depression is highly co-morbid with both psychiatric and chronic somatic disease. These types of co-morbidity have been shown to exert opposite effects on underdiagnosis of depression by general practitioners (GPs). However, past research has not addressed their combined effect on underdiagnosis of depression.

Duration and intensity of physical activity and disability among European elderly men.

Purpose: To investigate the relationship between duration and intensity of physical activity and disability 10 years later, and to investigate the possible effect of selective mortality.

Method: Longitudinal data of 560 men aged 70?-?89 years, without disability at baseline from the Finland, Italy and The Netherlands Elderly (FINE) Study was used. Physical activity in 1990 was based on activities like walking, bicycling and gardening.

Modeling the future burden of stroke in The Netherlands: impact of aging, smoking, and hypertension.

Background And Purpose: In the near future, the number of stroke patients and their related healthcare costs are expected to rise. The purpose of this study was to estimate this expected increase in stroke patients in the Netherlands. We sought to determine what the future developments in the number of stroke patients due to demographic changes and trends in the prevalence of smoking and hypertension in terms of the prevalence, incidence, and potential years of life lost might be.

Psychological distress in couples dealing with colorectal cancer: gender and role differences and intracouple correspondence.

Objectives: This longitudinal study examined patterns of psychological distress in couples facing colorectal cancer within 6 months after surgery. In addition, correspondence in psychological distress was investigated between patients and their spouses, taking into account the gender of the patient.

Method: The study had a longitudinal design, involving three assessment points; (T1) within 2 weeks after surgery, (T2) 3 months after baseline and (T3) 6 months after baseline.

Impact of fatigue on health-related quality of life in rheumatoid arthritis.

Objective: To multidimensionally assess fatigue in rheumatoid arthritis (RA) and to evaluate the impact of fatigue on health-related quality of life (HRQOL).

Methods: The study was conducted in 1999 among 490 RA patients with varying disease duration. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) and HRQOL with a validated Dutch version of the RAND 36-Item Health Survey.

Burden of caregiving: evidence of objective burden, subjective burden, and quality of life impacts on informal caregivers of patients with rheumatoid arthritis.

Objective: To improve understanding of the nature and magnitude of the burden of informal care and also to indicate important areas for improving the current ways in which informal care is investigated.

Methods: Information on objective burden (such as care tasks performed and time investment), subjective burden (using the Caregiver Reaction Assessment instrument and a self-rated burden score), and quality of life (using the EuroQoL instrument) were collected in a postal questionnaire of 153 informal caregivers who provide care for rheumatoid arthritis (RA) patients.

Results: Caregivers had been caring for the RA patients on average for >11 years, reflecting the chronic nature of RA.

Unmet demands for health care among patients with rheumatoid arthritis: indications for underuse?

Objective: To assess the prevalence of unmet health care demands among rheumatoid arthritis (RA) patients, and to determine if these unmet demands indicate underuse.

Methods: A total of 679 patients with RA participated in a questionnaire survey and clinical examination. Unmet health care demands and health care use were assessed for orthopedic care, allied health care, home care, and psychosocial care.

International comparison of stroke cost studies.

Purpose: With the rapid international spread of interventions, there is a need to understand the economic implications of these changes and to interpret these economic implications on the international level. The purpose of this study is to systematically compare total health care expenditures on stroke, the costs of stroke per capita, and the distribution of stroke costs within different countries, with special attention to the allocation of resources among different health care facilities.

Methods: Studies for this literature review were selected by conducting a literature search from January 1966 to July 2003.

Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden.

Objective: To compare the feasibility, convergent and clinical validity of three commonly used burden scales: Caregiver Strain Index (CSI), Caregiver Reaction Assessment (CRA) and Sense of Competence Questionnaire (SCQ), with a self-developed single question on self-rated burden (SRB).

Subjects: Stroke patients receiving support from an informal caregiver (n = 148) and their caregivers were followed up to six months after stroke.

Intervention: Feasibility was assessed with several measures of missing values.

Quality of rheumatoid arthritis care: the patient's perspective.

Objective: To identify health care aspects of inadequate quality in rheumatoid arthritis (RA) care from the perspective of patients, and to study to what extent patients' perspectives on quality of care are associated with patient characteristics.

Design: Cross-sectional questionnaire survey performed in 1999.

Setting: Secondary and tertiary rheumatology outpatient clinics.

Effect of widowhood on disability onset in elderly men from three European countries.

Objectives: To investigate in different countries the effects of becoming widowed, duration of widowhood, and household composition of widowed men on disability onset in different disability domains.

Design: Longitudinal data from a cohort study collected around 1990, 1995, and 2000.

Setting: Three cohorts from Finland, The Netherlands, and Italy.