RESUMEN
BACKGROUND: Metabolic health in people with obesity is determined by body composition. In this study, we examined the influence of a combined strength exercise and motivational programme -embedded in the school curriculum- on adolescents body composition and daily physical activity. METHODS: A total of 695 adolescents (11-15y) from nine Dutch secondary schools participated in a one year cluster randomised controlled trial (RCT). In the intervention schools, physical education teachers were instructed to spend 15-30 min of all physical education lessons (2× per week) on strength exercises. Monthly motivational lessons were given to stimulate students to be more physically active. Control schools followed their usual curriculum. The primary outcome measure was body composition assessed by the deuterium dilution technique. Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome. RESULTS: After 1 year, a 1.6% fat mass difference was found in favour of the intervention group (p = .007). This reflected a 0.9 kg difference in fat free mass (intervention>control; p = .041) and 0.7 kg difference in fat mass (interventionAsunto(s)
Composición Corporal
, Fuerza Muscular
, Obesidad/prevención & control
, Educación y Entrenamiento Físico/métodos
, Evaluación de Programas y Proyectos de Salud/métodos
, Servicios de Salud Escolar
, Adolescente
, Conducta del Adolescente
, Niño
, Análisis por Conglomerados
, Curriculum
, Femenino
, Humanos
, Masculino
, Motivación
, Países Bajos
, Estudios Retrospectivos
, Instituciones Académicas
, Estudiantes
RESUMEN
BACKGROUND: Laparoscopic left lateral sectionectomy (LLLS) has been associated with shorter hospital stay and reduced overall morbidity compared with open left lateral sectionectomy (OLLS). Strong evidence has not, however, been provided. METHODS: In this multicentre double-blind RCT, patients (aged 18-80 years with a BMI of 18-35 kg/m2 and ASA fitness grade of III or below) requiring left lateral sectionectomy (LLS) were assigned randomly to OLLS or LLLS within an enhanced recovery after surgery (ERAS) programme. All randomized patients, ward physicians and nurses were blinded to the procedure undertaken. A parallel prospective registry (open non-randomized (ONR) versus laparoscopic non-randomized (LNR)) was used to monitor patients who were not enrolled for randomization because of doctor or patient preference. The primary endpoint was time to functional recovery. Secondary endpoints were length of hospital stay (LOS), readmission rate, overall morbidity, composite endpoint of liver surgery-specific morbidity, mortality, and reasons for delay in discharge after functional recovery. RESULTS: Between January 2010 and July 2014, patients were recruited at ten centres. Of these, 24 patients were randomized at eight centres, and 67 patients from eight centres were included in the prospective registry. Owing to slow accrual, the trial was stopped on the advice of an independent Data and Safety Monitoring Board in the Netherlands. No significant difference in median (i.q.r.) time to functional recovery was observed between laparoscopic and open surgery in the randomized or non-randomized groups: 3 (3-5) days for OLLS versus 3 (3-3) days for LLLS; and 3 (3-3) days for ONR versus 3 (3-4) days for LNR. There were no significant differences with regard to LOS, morbidity, reoperation, readmission and mortality rates. CONCLUSION: This RCT comparing open and laparoscopic LLS in an ERAS setting was not able to reach a conclusion on time to functional recovery, because it was stopped prematurely owing to slow accrual. Registration number: NCT00874224 ( https://www.clinicaltrials.gov).
Asunto(s)
Hepatectomía/métodos , Laparoscopía/métodos , Hígado/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Hepatectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Goals and objectives as mentioned in Individual Support Plans (ISPs) were analysed to explore what domains of quality of life they are associated with, what support resources are referenced for achieving the goals, and how domains and resources are related to clients age, gender and intellectual disability (ID) level. METHOD: A total of 209 ISPs for persons with ID from eight residential Dutch service provider organisations were analysed. Mixed linear regression analyses were conducted to examine the relations between client characteristics and the content of goals and support resources. RESULTS: Results showed that ISPs of people with mild and moderate ID had significantly more goals related to independence and social participation as compared to the ISPs of people with severe and profound ID. ISPs of clients with profound ID addressed quality of life factors related to 'well-being' more than ISPs of all other clients. ISPs of people aged 20-34 years had significantly more goals on independence than the two other age groups. ISPs of people under the age of 50 had significantly fewer goals with respect to well-being than found in ISPs of older people. Regarding the use of resources, 42.6% of the ISP goals were associated with resources from specialised services, 31.5% associated with natural resources and 25.9% associated with a combination of both natural and specialised services. In ISPs of people with mild ID, natural resources are more often mentioned, and specialised service-based resources are less often mentioned than for other people. CONCLUSIONS: This study offers empirical feedback on ISP practices in the field of ID in the Netherlands. In light of current ISP practices, results suggest that attention should be paid to: (1) distinguishing between a 'service contract' and an ISP; (2) keeping a focus on the whole person in all age groups and levels of functioning and (3) involving the service recipient in ISP development and implementation.
Asunto(s)
Objetivos , Necesidades y Demandas de Servicios de Salud , Discapacidad Intelectual/psicología , Discapacidad Intelectual/rehabilitación , Planificación de Atención al Paciente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Países Bajos , Instituciones Residenciales , Adulto JovenRESUMEN
BACKGROUND: The feasibility of randomized controlled trials (RCTs) in liver surgery using a single-component clinical endpoint is low as such endpoints require large sample sizes owing to their low incidence. A liver surgery-specific composite endpoint (CEP) could solve this problem. The aim of this study was to develop a liver surgery-specific CEP with well-defined components. METHODS: Components of a liver surgery-specific CEP were selected based on a systematic literature search and consensus among 28 international hepatopancreatobiliary (HPB) surgeons. As an example, two prospective cohorts of patients who had undergone liver surgery in high-volume HPB centres were used to assess the event rate and effect of implementing a liver surgery-specific CEP. RESULTS: Components selected for the liver surgery-specific CEP were ascites, postresectional liver failure, bile leakage, intra-abdominal haemorrhage, intra-abdominal abscess and operative mortality, all with a Clavien-Dindo grade of at least 3 and occurring within 90 days after initial surgery. The incidence of this liver surgery-specific CEP was 19.2 per cent in one cohort and 10.7 per cent in the other. These rates led to an approximately twofold reduction in the theoretical sample size required for an adequately powered RCT in liver surgery using the CEP as primary endpoint. CONCLUSION: The proposed liver surgery-specific CEP consists of ascites, postresectional liver failure, bile leakage, intra-abdominal haemorrhage, intra-abdominal abscess and operative mortality. It has a considerably higher event rate than any of its components. Its use as the primary endpoint will increase the feasibility and comparability of RCTs in liver surgery.
Asunto(s)
Determinación de Punto Final , Hepatopatías/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Anciano , Consenso , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnósticoRESUMEN
BACKGROUND: There is a shortage of randomized controlled trials (RCTs) on which to base guidelines in liver surgery. The feasibility of conducting an adequately powered RCT in liver surgery using the dichotomous endpoints surgery-related mortality or morbidity was examined. METHODS: Articles published between January 2002 and November 2007 with mortality or morbidity after liver surgery as primary endpoint were retrieved. Sample size calculations for a RCT aiming to show a relative reduction of these endpoints by 33, 50 or 66 per cent were performed. RESULTS: The mean operative mortality rate was 1.0 per cent and the total morbidity rate 28.9 per cent; mean rates of bile leakage and postresectional liver failure were 4.4 and 2.6 per cent respectively. The smallest numbers of patients needed in each arm of a RCT aiming to show a 33 per cent relative reduction were 15 614 for operative mortality, 412 for total morbidity, 3446 for bile leakage and 5924 for postresectional liver failure. CONCLUSION: The feasibility of conducting an adequately powered RCT in liver surgery using outcomes such as mortality or specific complications seems low. Conclusions of underpowered RCTs should be interpreted with caution. A liver surgery-specific composite endpoint may be a useful and clinically relevant solution to pursue.
Asunto(s)
Neoplasias Hepáticas/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto/mortalidad , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Factibilidad , Femenino , Hepatectomía/mortalidad , Hepatectomía/estadística & datos numéricos , Humanos , Lactante , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Adulto JovenRESUMEN
In medical research the responses of patients to a number of items are often combined into a summary measure or total score for a more general patient characteristic, such as mobility. Clinical and statistical criteria exist for determining the weight of each question in the total score. The choice of weights may affect the differences between patients. The total score is often analysed statistically as if it had interval level of measurement, thereby allowing conclusions about the size of differences between patients, but it has merely an ordinal level. The incorrectness of the interval assumption may also affect differences between patients or patient groups. Finally, differences between patients are less dependent on the weighting of the items and on the assumption of an interval scale as the total score is based on more homogeneous items. Standard statistical software contains statistical methods for determining the homogeneity as well as the weights.
Asunto(s)
Intervalos de Confianza , Interpretación Estadística de Datos , Proyectos de Investigación , Encuestas y Cuestionarios , HumanosRESUMEN
Life-span retention of street names was studied in a sample of former students of a Dutch elementary school. Participants were requested to recall the street names of their childhood neighbourhood and indicate their position on a map. In addition, information was gathered concerning (a) the extensiveness of the original learning experience, (b) its elaborateness, and (c) the amount of interference from similar materials occurring between original learning experience and time of recall. Retention intervals varied from 0 to 71 years. Amount of exposure, elaborateness of learning, and retroactive interference all contributed to the memorability of names. In addition, the forgetting curve showed a permastore effect (Bahrick, 1984), suggesting that memory for non-schematic, incidentally learned material is subject to processes of forgetting similar to those that affect intentionally learned material, such as subject-matter acquired in school.
Asunto(s)
Ambiente , Recuerdo Mental , Nombres , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Memoria , Persona de Mediana Edad , Análisis de Regresión , Refuerzo en Psicología , Factores de TiempoRESUMEN
The purpose of this study was to investigate the psychometric properties of a Dutch translation of the Multidimensional Pain Inventory, MPI-DLV. Data was available on 733 chronic pain patients. There were three issues of special interest. The first one related to the comparability between the MPI-DLV and the American and German MPI versions with regard to the psychometric aspects. The second dealt with the construct validity of the MPI-DLV scale 'general activity'. It was predicted that patients with high scores on this scale would be in better physical condition, as measured on a working-to-tolerance bicycle ergometer test. In relation to the third issue, attention was given to the factor-invariance between fibromyalgia patients and back pain patients. From the results obtained it was concluded that (1) the factorial structure of the three MPI parts is replicated and the reliability estimates and validity indicators are similar to those from the American and German versions; (2) patients with high scores on the 'general activity' scale are in better physical condition and (3) MPI-DLVs of fibromyalgia and back pain patients do have similar factorial structures. Evidence was also obtained that the MPI-DLV is sensitive to treatment changes. Applications of the MPI-DLV are discussed.
Asunto(s)
Comparación Transcultural , Lenguaje , Dimensión del Dolor/estadística & datos numéricos , Dolor/psicología , Adulto , Enfermedad Crónica , Terapia Cognitivo-Conductual , Prueba de Esfuerzo , Femenino , Fibromialgia/psicología , Fibromialgia/rehabilitación , Humanos , Dolor de la Región Lumbar/psicología , Dolor de la Región Lumbar/rehabilitación , Masculino , Persona de Mediana Edad , Países Bajos , Dolor/rehabilitaciónRESUMEN
A randomized trial was conducted to study the impact of individualized computer-generated nutrition information and additional effects of iterative feedback on changes in intake of fat, fruits, and vegetables. Respondents in the experimental group received computer-generated feedback letters tailored to their dietary intake, intentions, attitudes, self-efficacy expectations, and self-rated behavior. After the first feedback letter, half of the experimental group received additional iterative feedback tailored to changes in behavior and intentions. The control group received a single general nutrition information letter in a format similar to the tailored letters. Computer-tailored feedback had a significantly greater impact on fat reduction and fruit and vegetable intake than did general information. Iterative computer-tailored feedback had an additional impact on fat intake. The results confirm that computer-generated individualized feedback can be effective in inducing recommended dietary changes and that iterative feedback can increase the longer term impact of computer-tailored nutrition education on fat reduction.
Asunto(s)
Grasas de la Dieta/administración & dosificación , Retroalimentación , Conducta Alimentaria , Frutas , Programas Informáticos , Verduras , Adulto , Conducta Alimentaria/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Necesidades Nutricionales , Ciencias de la Nutrición/educación , Autoeficacia , Encuestas y CuestionariosRESUMEN
Based upon classical hypotheses about accumulating mental fatigue and distraction and its effect on response times, put forward in late 19th and early 20th century papers, a mathematical model is proposed for response times on tests of speed and concentration. The model assumes the random occurrence of very short distractions during information processing. It explains fluctuation and the increasing trend in response times on successive equivalent task units and leads to some simple diagnostic RT measures of speed and concentration as alternatives to the mean RT. A review is given of several experimental applications of the model, with subjects with and without concentration problems, using cancellation and digit addition tasks. The results demonstrate the potential usefulness of the model and the diagnostic measures derived from it. As predicted by the model, prolonged task performance yields an increasing trend in RT mean and variance that can be strongly reduced by giving very short resting periods very frequently, and to a lesser extent also by task alternation, but not by simply motivating the subjects to concentrate. Some practical implications for the administration and scoring of tests of speed and concentration are discussed, as well as limitations of the present results and the complementary relation of our approach to popular ones such as "stage analysis."