Mariken Stegmann

Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode

BACKGROUND The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor. METHODS Data was analyzed from a subsample (N=8796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression. RESULTS All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease. LIMITATIONS Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation cannot simply be interpreted as the amount of mediation. CONCLUSIONS Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions.

Correspondence between primary and secondary care about patients with cancer: A qualitative mixed-methods analysis

Abstract Cancer care is complex and involves many different healthcare providers, especially during diagnosis and initial treatment, and it has been reported that both general practitioners and oncology specialists experience difficulties with interdisciplinary communication. The aim of this qualitative study was to explore information sharing between primary and secondary care for patients with lung, breast or colorectal cancer. A qualitative content analysis of 50 medical files (419 documents) was performed, which identified 70 correspondence‐related items. Six main topics were identified in most referral letters from primary to secondary care, but it was particularly notable that highly relevant information regarding the past medical history was often mixed with less relevant information. To lesser extents, the same held true for the medication list and presenting history. In the letters from specialists, nine topics were identified in most letters. Although information about actual treatment was always present, only limited detail, if any, was given about the intent of the treatment (curative or palliative) or the treatment alternatives. Interviews with nine healthcare providers confirmed these issues. These findings indicate that neither the initial referral nor the specialist correspondence is tailored to the needs of the recipient.

Venapunctie mag na lymfeklierdissectie bij mammacarcinoom

SamenvattingVraagstelling Patiënten die een axillaire lymfeklierdissectie ondergaan, krijgen het advies geen bloed af te laten nemen uit dezelfde arm uit angst voor het optreden van lymfeoedeem. Is dit advies juist? De NHG-Standaarden geven hier geen antwoord op en daarom formuleerden wij de vraag: hebben vrouwen die een axillaire lymfeklierdissectie ondergingen vanwege borstkanker een hogere kans op lymfeoedeem in de ipsilaterale arm wanneer venapuncties zijn verricht dan zonder venapuncties?

Echografie bij kinderen met buikpijn

SamenvattingHoltman GA, Stegmann ME, Berger MY. Echografie bij kinderen met buikpijn. Huisarts Wet 2017;60(10):523-5. Echografie is in de tweede lijn een waardevol diagnostisch hulpmiddel bij allerlei aandoeningen en wordt ook in de eerste lijn steeds vaker toegepast. Onduidelijk is nog of dat ook geldt voor kinderen. Bij een kind met buikpijn is een echo door de huisarts niet nuttig; bij zeldzame ernstige aandoeningen heeft snelle verwijzing prioriteit boven een echo. Bij een mogelijke , stomp buiktrauma of obstipatie kan een echo de onzekerheid over de diagnose verkleinen en onnodige verwijzing voorkomen, maar er is nog te weinig bekend over de testkarakteristieken in de eerste lijn om dit te kunnen aanraden.

A systematic review of the psychological impact of false-positive colorectal cancer screening: What is the role of the general practitioner?

Screening for colorectal cancer (CRC) has both advantages (e.g. reduction in morbidity and mortality) and disadvantages (e.g. false positives and distress). A systematic review was therefore performed to improve our understanding of how false-positive CRC screening results affect patients psychologically (and to make recommendations for primary care). The PubMed, Embase, PsychINFO, CINAHL and Cochrane databases were searched in October 2014 and supplemented in December 2016 to identify studies on the psychological impact of false-positive CRC screening. Original studies were eligible when they assessed psychological impact in a screening setting, provided they also included false-positive CRC screening results. Two authors independently assessed 2,367 available manuscripts and included seven. Heterogeneity in their outcome measures meant that data could not be pooled. Two studies showed that a false-positive CRC screening result caused some moderate psychological distress shortly before and after colonoscopy. The remaining five studies illustrated that the psychological distress of patients with true-positive and false-positive CRC screening results was comparable. We conclude that a false-positive CRC screening result may cause some moderate psychological distress, especially just before or after colonoscopy. We recommend that general practitioners mention this when discussing CRC screening with patients and monitor those with a false-positive outcome for psychological distress.

Lung cancer stigma and patient-provider communication: a complex association

Dear Editor: We would like to congratulate Shen et al. on their recent article titled BAssociation between patient-provider communication and lung cancer stigma^ as published in Supportive Care in Cancer [1]. In this article, the authors elaborate on these two variables, their association, and suggest future interventions to diminish lung cancer stigma. The authors write that lung cancer stigma is common in both smokers and non-smokers and has several detrimental effects as detailed in previous studies [2]. It is therefore of interest to investigate whether patientprovider communication might have an effect on perceived lung cancer stigma [3]. In the current study, patient-provider communication, as measured by the Provider Communication Subscale of the Consumer Assessment of Health Care Providers and System Program (CAHPS), was associated with lung cancer stigma as reported by patients, assessed with the Cataldo Lung Cancer Stigma Scale (CLCSS). The authors state that better patient-provider communication was associated with lower levels of lung cancer stigma. In their conclusion the authors imply a causal relationship by which improved patient-provider communication may reduce levels of lung cancer stigma. We argue that this study adds insufficient evidence for this conclusion. To evaluate the association between patient-provider communication and lung cancer stigma, the authors assessed the correlation between these two variables. Although they find a statistically significant correlation, the magnitude of the correlation is very small (r-value =−0.18). It is common knowledge that this score is not very relevant as the correlation score ranges from −1 to +1 (0 = no correlation) and significance only means that the null-hypothesis (correlation = 0) is to be rejected. In addition, the consecutive multivariable linear regression analysis shows a statistically significant independent association between patient-provider communication and lung cancer stigma. The predictors included (patient-provider communication, age and marital status) are all weakly correlated with lung cancer stigma (rvalues between −0.2 and +0.2). It is therefore not surprising that only six percent (Adjusted R= 0.06) of the total predictability of the level of lung cancer stigma is explained by this model. Although we welcome all interventions aimed at improving patient-provider communication, we believe that this intervention will hardly reduce the level of lung cancer stigma. Several reasons might explain the finding of a weak association between patient-provider communication and levels of lung cancer stigma. First, as the authors point out, stigma is a broad concept which can be divided into external stigma and internalized stigma [4]. Therefore, patient-provider communication may be only one of the many explanatory variables. Second, the selected study population is heterogeneous possibly affecting the association: more women than men were included, patients with newly diagnosed as well as recurrent lung cancer were eligible, and a broad interval between diagnosis and study inclusion (0–12 months) was used. Third, as * O. P. Geerse o.p.geerse@umcg.nl

Welke behandeling willen ouderen met kanker

SamenvattingMeneer Pieters is een 79-jarige boer die zijn land heeft verkocht maar in de boerderij is blijven wonen. Hij is gesteld op zijn zelfstandigheid en is het liefst de hele dag buiten. Hij belandt via zijn huisarts in het ziekenhuis met een longontsteking en op de röntgenfoto worden afwijkingen gezien die mogelijk maligne zijn. Nadere diagnostiek bevestigt de diagnose stadium-IV longkanker. Er wordt chemotherapie gestart en hoewel de patiënt hier aanvankelijk baat bij lijkt te hebben, krijgt hij na de tweede kuur koorts. Hij neemt direct contact op met het ziekenhuis, wordt opgenomen en overlijdt binnen enkele dagen. Alles is gegaan volgens de richtlijnen en de familie is niet ontevreden. Toch knaagt er iets bij de huisarts: wilde de patiënt deze chemotherapie wel echt?