H.M. van der Ploeg

Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas : a comparative study

BACKGROUND Because survival benefits of treatment with radiotherapy are questionable and such treatment can cause substantial damage to the brain over time, the optimum management strategy for low-grade gliomas remains controversial. We aimed to identify the specific effects of radiotherapy on objective and self-reported cognitive function, and on cognitive deterioration over time, in patients with low-grade gliomas treated with early radiotherapy. METHODS 195 patients with low-grade glioma (of whom 104 had received radiotherapy 1-22 years previously) were compared with 100 low-grade haematological patients and 195 healthy controls. Our analyses aimed to differentiate between the effects of the tumour (eg, disease duration, lateralisation) and treatment effects (neurosurgery, radiotherapy, antiepileptic drugs) on cognitive function and on relative risk of cognitive disability. FINDINGS Low-grade glioma patients had lower ability in all cognitive domains than did low-grade haematological patients, and did even less well by comparison with healthy controls. Use of radiotherapy was associated with poorer cognitive function; however, cognitive disability in the memory domain was found only in radiotherapy patients who received fraction doses exceeding 2 Gy. Antiepileptic drug use was strongly associated with disability in attentional and executive function. INTERPRETATION Our findings suggest that the tumour itself has the most deleterious effect on cognitive function and that radiotherapy mainly results in additional long-term cognitive disability when high fraction doses are used. Additionally, the effects of other medical factors, especially antiepileptic drug use, on cognitive function in glioma patients deserve attention.

Insulin-treated diabetes patients with fear of self-injecting or fear of self-testing: Psychological comorbidity and general well-being

OBJECTIVE To examine psychological functioning and self-management behaviours of Dutch adult patients with insulin-requiring diabetes mellitus suffering from extreme fear of self-injecting (FSI) and/or fear of self-testing (FST). METHODS A cross-sectional survey was performed in a sample of insulin-treated diabetes patients (n=1275; 51.1% male; age 49.7+/-15.8 years; 58.0% Type 1 diabetes), assessing FSI and FST. Patients completed the questionnaires concerning trait/state anxiety, depression, fear of hypoglycemia, diabetes-related distress, diabetes self-care activities, and general well-being. Comparisons were made on these measures between patients with extremely high scores on FSI and/or FST (> or = 95th percentile) and the other patients. Patients with extreme scores on FSI and/or FST were invited to take part in a second survey to assess the prevalence of major depression, common fears/phobias, and psychoneuroticism. RESULTS People with extreme FSI/ FST scores, as compared to the other patients, reported higher levels of trait/state anxiety and depression. This group also reported more fear of hypoglycaemia and diabetes-related distress, had lower levels of general well-being, and reported less frequent self-monitoring of blood glucose. The second survey showed 11.1% of patients with extreme FSI/FST reporting scores indicating major depression. Prevalence of scores greater than or equal to the high scores on phobias (38.0-63.3%) and psychoneuroticism (27.8%) were consistently higher than norm group prevalences. DISCUSSION Extreme levels of FSI and/or FST are associated with high diabetes-related distress, poor general well-being, and psychological comorbidity, as well as poorer adherence to the diabetes treatment regimen. It is concluded that patients with extreme FSI/FST are often burdened with more than this specific phobia.

A comparison of the standard and the computerized versions of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ)

In the present study, the equivalence of paper and pencil assessment versus computer assessment of two self-administered questionnaires was investigated by means of a randomized cross-over design. Therefore, 105 out-patients with diabetes were invited to participate; 76 patients completed both the computer and the paper and pencil version of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) in a randomized order, with a mean interval of 7 days. The scales showed high test-retest correlations and the means, dispersions, kurtosis and skewness were found to be approximately the same in both versions. In both modes of assessment, the depression and the energy scale proved to be sensitive for carry-over effects, resulting in better well-being scores at the second measurement. Almost all subjects reported that using the personal computer in the realization of a questionnaire was easy. It is concluded that the paper and pencil and the computerized versions of the WBQ and DTSQ can be considered equivalent. Therefore, the norms and cut-off scores obtained from paper and pencil assessments can be used in computerized versions of the WBQ and DTSQ and vice versa.

Exploring differences between subgroups of multiple sclerosis patients in health-related quality of life

Abstract Health-related quality of life (HRQoL) questionnaires finding increasing use in medicine, but still only few publications have reported on HRQoL in patients with multiple sclerosis (MS). Because of its progressive and disabling nature, the disease has a considerable effect on HRQoL. To facilitate the interpretation of scores for the heterogeneous MS population, we explored differences between subgroups of MS outpatients (n = 90) on two HRQoL instruments: the Medical Outcome Study Short Form-36 and the Disability and Impact Profile. Three disease-related characteristics were studied: severity of MS, time since diagnosis, and MS progression in the past 6 months. The results show that each of these have an effect on one or more aspects of HRQoL. Thus, the longer the disease duration and the more severe and progressive the MS, the lower is the patient’s experienced HRQoL.

Phobia of self-injecting and self-testing in insulin-treated diabetes patients: opportunities for screening.

Aims  To define clinically relevant cut‐off points for severe fear of self‐injecting (FSI) and self‐testing (FST) (phobia) in insulin‐treated patients with diabetes, and to estimate the magnitude of these phobias in our research population.

Fifty years later: the long-term psychological adjustment of ageing World War II survivors

Most studies of the long‐term after‐effects of war have focused on survivors seeking treatment or financial compensation. The present study examined the current psychological adjustment of a community sample of ageing World War II (WWII) survivors, including survivors of bombardments, persecution, resistance, combat and other violence.

Cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients: long-term effects on HbA moderated by depression. A randomized controlled trial.

Objective  To test the effectiveness at 6 and 12 months’ follow‐up of group cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients and to explore the moderating effect of baseline depression.

Perceived risk for Type 2 diabetes in participants in a stepwise population-screening programme.

Aims To determine the risk perception of Type 2 diabetes in participants in a stepwise population‐screening programme.

Participation in preconceptional carrier couple screening: characteristics, attitudes, and knowledge of both partners

Editor—Couples in which both partners are carriers for a particular autosomal recessive disease, such as cystic fibrosis, Tay-Sachs disease, or thalassaemia, have a 1 in 4 risk for each child to have this disorder. Population carrier screening programmes aimed at the identification of carrier couples make it possible to inform these couples about their risk and about the reproductive options that are available. Before beginning any genetic screening programme, it is important to assess community interest in screening.1 It is well known that the way in which carrier screening is offered and the timing, for example, during or outside pregnancy, determine participation in screening and the reasons for participation. Screening offered face to face with the possibility of immediate testing gives high uptake rates, whereas offers made by mailed invitation or poster announcements attract little interest.2-6 Most of the data on motives for participation have been obtained from programmes offering carrier screening during pregnancy.7-15 In these studies, a high interest in screening was reported, although it has been argued that testing during pregnancy is often accepted just because it is offered.16The decision to participate was mostly made by women, who were often initially tested without discussing it with their partner. Anxiety has been reported among those who are tested positive, while waiting for their partners results.10 17 18 It can also cause distress when the partner is not available or does not want to be tested.19 Furthermore, prenatal screening leaves limited reproductive options for a carrier couple and might impose time constraints when decisions about a prenatal diagnosis have to be made.20 Offering carrier screening outside pregnancy shows low participation rates when no pregnancy is planned, but interest is higher when there are plans for having children (preconceptional).4 7 …

A health-related quality of life questionnaire for multiple sclerosis patients

Objective ‐ The construction of a brief, valid and reliable HRQoL questionnaire for use in multiple sclerosis patients based on generic and disease‐specific HRQoL measures. Material and methods ‐ The Medical Outcomes Study 36‐item Short Form Health Survey (SF‐36), COOP/WONCA Charts, and Disability & Impact Profile (DIP) were used in a longitudinal study in 162 patients with multiple sclerosis. Results ‐ Factor analyses identified 2 underlying dimensions of HRQoL, relating to “physical functioning” and “psychological functioning”. Selection of the 3 highest loading reliable scales on each factor resulted in a final questionnaire consisting of 3 scales of the SF‐36 and 3 scales of the DIP. In total 40 items were selected; completion time is about 10 min. Conclusion ‐ The final questionnaire adequately measured 2 dimensions of HRQoL. The length of the questionnaire is acceptable for patients with MS in view of respondent burden.