Sexual precocity: sex incidence and aetiology

The aetiology of 197 girls and 16 boys presenting with sexual precocity was reviewed. Ninety one girls and four boys had central precocious puberty (M:F 23:1); a cause was identified in all the boys but in only six girls. All boys with precocious puberty need detailed investigation; in girls investigation should be based on clinical findings, particularly the consonance of puberty.     

Outcome of psychiatric consultation in a Dutch university hospital

Concordance by treating physicians with the recommendations of consultation psychiatrists was examined in this retrospective study, using specific outcome criteria. Recommendations for use of psychotropics were accepted in 80% (72 of 90) of the consultations involving prescribing advice. Diagnosis and other nondrug advice presented by the psychiatrist were embodied in the treating physician's discharge summary 49% of the time (114 of 233 summaries). Similarities and differences with related recent American studies are discussed.     

Comparison of generic and disease-specific questionnaires for the assessment of quality of life in patients with peripheral arterial disease

OBJECTIVE: This study compared the ability of generic and disease-specific questionnaires to assess quality of life (QOL) at baseline and to detect change in QOL after treatment in patients with peripheral arterial disease (PAD). METHODS: This prospective multicenter trial recruited 514 patients with PAD who needed an imaging workup and had an ankle brachial pressure index of less than 0.90. Patients with severe comorbidity were excluded, leaving a study population of 450 patients. Patients completed two generic questionnaires, the Short Form 36 (SF-36) and the European Quality of Life 5D (EuroQol-5D), and one disease-specific questionnaire, the Vascular Quality of Life (VascuQol) at baseline and after 6 months of follow-up. Rutherford classification and treadmill walking distance were determined at baseline and after 6 months of follow-up and were considered indicators of disease severity. Receiver operating characteristic (ROC) curves and areas under the curves (AUCs) were used to evaluate each of the three questionnaires for its ability to discriminate between severe and mild disease at baseline and to discriminate between a large and small change in disease severity after follow-up. The underlying assumption was that disease severity is a major determinant of QOL. This implies that the validity of a QOL questionnaire is reflected by its ability to discriminate between mildly and severely diseased patients. RESULTS: At baseline, 443 patients and after follow-up, 386 patients completed questionnaires. At baseline, no significant ( P >.05) differences were observed among AUCs for the total scores of the three questionnaires, indicating that all three questionnaires assessed the disease severity equally well. After follow-up, the AUCs for the VascuQol were significantly higher than the AUCs for the SF-36 and EuroQol-5D with respect to detection of improvement in Rutherford classification ( P < .05), indicating that change in disease severity after follow-up was best detected by the VascuQol. CONCLUSION: The VascuQol is the preferred questionnaire as outcome measure for QOL in future trials and clinical follow-up of patients with PAD.     

Resolving controversies regarding hemodiafiltration versus hemodialysis: the Dutch Convective Transport Study

Hemodialysis patients suffer from a high incidence of cardiovascular disease. Among the many predisposing factors, such as high blood pressure, dyslipidemia, and fluid overload, the accumulation of high molecular weight uremic toxins, the so-called middle molecules, may play an important role. Since convective therapies such as online hemodiafiltration have a better clearance profile for these compounds than standard hemodialysis, it has been suggested that these dialysis strategies may reduce cardiovascular morbidity and mortality. As reliable data on these issues are not available, the Dutch Convective Transport Study (CONTRAST) was recently initiated. This prospective randomized trial was designed to compare online hemodiafiltration with low-flux hemodialysis with respect to cardiovascular morbidity and mortality.     

Disentangling the causal relationships between work-home interference and employee health

OBJECTIVES: The present study was designed to investigate the causal relationships between (time- and strain-based) work-home interference and employee health. The effort-recovery theory provided the theoretical basis for this study. METHODS: Two-phase longitudinal data (with a 1-year time lag) were gathered from 730 Dutch police officers to test the following hypotheses with structural equation modeling: (i) work-home interference predicts health deterioration, (ii) health complaints precede increased levels of such interference, and (iii) both processes operate. The relationship between stable and changed levels of work-home interference across time and their relationships with the course of health were tested with a group-by-time analysis of variance. Four subgroups were created that differed in starting point and the development of work-home interference across time. RESULTS: The normal causal model, in which strain-based (but not time-based) work-home interference was longitudinally related to increased health complaints 1 year later, fit the data well and significantly better than the reversed causal model. Although the reciprocal model also provided a good fit, it was less parsimonious than the normal causal model. In addition, both an increment in (strain-based) work-home interference across time and a long-lasting experience of high (strain-based) work-home interference were associated with a deterioration in health. CONCLUSIONS: It was concluded that (strain-based) work-home interference acts as a precursor of health impairment and that different patterns of (strain-based) work-home interference across time are related to different health courses. Particularly long-term experience of (strain-based) work-home interference seems responsible for an accumulation of health complaints.     

Influence of sediment quality on the responses of benthic invertebrates after treatment with the fungicide triphenyltin acetate

After decades of pollution, benthic communities in floodplain lake ecosystems are likely to be exposed to a diverse assortment of sediment-bound historical toxicants and nutrients as well as pulses of newly discharged or deposited toxicants. The aim of this study was therefore to analyze the effects of background sediment pollution on the responses of benthic invertebrates to an experimental toxic shock in a laboratory setting. Sediment from a relatively clean and a historically polluted floodplain lake located along the River Waal, a branch of the River Rhine, The Netherlands, was selected, and the fungicide triphenyltin acetate (TPT) was used as the acute stressor. Juvenile stages of the mayfly Ephoron virgo and the midge Chironomus riparius were chosen as test organisms because of their different response to sediment-bound toxicants and food quantity and quality. Our results demonstrated that the type of sediment had no effect on survival and growth of C. riparius when exposed to sediment-associated TPT and that E. virgo was more affected by sediment-associated TPT on clean sediment than on polluted sediment. For the mayfly, no cumulative response of the historical pollution and the recent toxic shock was observed. This observation is discussed in view of the variable content of organic matter, acting both as food and as sorbent, and leads to the hypothesis that a very strong sequestering of TPT in historically polluted sediment prevents expression of toxic effects.     

Changes in maternal characteristics in Nova Scotia, Canada from 1988 to 2001

BACKGROUND: Maternal characteristics such as age, parity, smoking status, pre-pregnancy weight and pregnancy weight gain have changed in many industrialized countries in recent years. Many of these changes have not been adequately described at a population level. The purpose of this study was to describe recent trends in selected maternal characteristics in Nova Scotia. METHODS: Data from a population-based perinatal database were used to examine changes in maternal age, parity, smoking, pre-pregnancy weight, delivery weight and pregnancy weight gain among all deliveries between 1988 and 2001. RESULTS: The proportion of deliveries to women > or = 35 years increased by 84% over the study period from 7.0% in 1988-1991 to 12.9% in 1998-2000, while deliveries to women > or = 40 years increased by more than 100%. The number of nulliparous women > or = 35 years also increased significantly. The overall prevalence of smoking decreased from 32.7% in 1988-1991 to 25.1% in 1998-2001, however the prevalence of smoking among women <20 years did not change over the study period and was almost 50%. The proportion of women with a pre-pregnancy weight of > or = 90 kilograms (kg) increased by 165% from 4.1% in 1988-1991 to 10.7% in 1998-2001. The proportion of women with pregnancy weight gain of < 7 kg and > or =18 kg increased by 37% and 13%, respectively. CONCLUSION: Dramatic changes have occurred in several important maternal characteristics and there is evidence of ongoing change. Continuation of these trends is likely to impact on future obstetric practice and perinatal health.