In dit document is het logopedisch onderzoek bij broddelen beschreven waarover internationaal consensus bestaat. Dit document is gepresenteerd op de website van de International Cluttering Association
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Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Background: The diagnosis of sarcopenia is essential for early treatment of sarcopenia in older adults, for which assessment of appendicular lean mass (ALM) is needed. Multi-frequency bio-electrical impedance analysis (MF-BIA) may be a valid assessment tool to assess ALM in older adults, but the evidences are limited. Therefore, we validated the BIA to diagnose low ALM in older adults.Methods: ALM was assessed by a standing-posture 8 electrode MF-BIA (Tanita MC-780) in 202 community-dwelling older adults (age ≥ 55 years), and compared with dual-energy X-ray absorptiometry (DXA) (Hologic Inc., Marlborough, MA, United States; DXA). The validity for assessing the absolute values of ALM was evaluated by: (1) bias (mean difference), (2) percentage of accurate predictions (within 5% of DXA values), (3) the mean absolute error (MAE), and (4) limits of agreement (Bland-Altman analysis). The lowest quintile of ALM by DXA was used as proxy for low ALM (< 22.8 kg for men, < 16.1 kg for women). Sensitivity and specificity of diagnosing low ALM by BIA were assessed.Results: The mean age of the subjects was 72.1 ± 6.4 years, with a BMI of 25.4 ± 3.6 kg/m2, and 71% were women. BIA slightly underestimated ALM compared to DXA with a mean bias of -0.6 ± 1.2 kg. The percentage of accurate predictions was 54% with a MAE of 1.1 kg, and limits of agreement were -3.0 to + 1.8 kg. The sensitivity for ALM was 80%, indicating that 80% of subjects who were diagnosed as low ALM according to DXA were also diagnosed low ALM by BIA. The specificity was 90%, indicating that 90% of subjects who were diagnosed as normal ALM by DXA were also diagnosed as normal ALM by the BIA.Conclusion: This comparison showed a poor validity of MF-BIA to assess the absolute values of ALM, but a reasonable sensitivity and specificity to recognize the community-dwelling older adults with the lowest muscle mass.
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Voor veel risicovolle beroepen ontbreken duidelijke definities of onderbouwingen van veilige grenswaarden voor het visueel functioneren, zoals bijvoorbeeld contrastgevoeligheid of kleurenzien. Afhankelijk van de functie is naast visus (gezichtsscherpte), kleurenzien ook een belangrijk onderdeel van de keuringscriteria. Kleurenzien is bij de luchtmacht voor piloten en luchtverkeersleiders onder andere essentieel bij het gebruik van cockpitinstrumenten en elektronische displays met kleur coderingen, navigatiesystemen, signaallampen, radarschermen en weerkaarten. Kleurenzienstoornissen kunnen worden onderverdeeld in verworven (als gevolg van oogheelkundige pathologie) en aangeboren (congenitale) stoornissen. Potentiële kandidaten met een congenitale kleurenzienstoornis komen niet in aanmerking voor een functie als piloot of luchtverkeersleider. Hierdoor vallen geschikte kandidaten af op basis van het kleurenzien, waarbij onvoldoende duidelijk is of dit terecht is. Uit onderzoek is duidelijk dat congenitale kleurenzienstoornissen in verschillende mate aanwezig kunnen zijn. Voorbeelden van kleurenzientesten die ook een waarde aan de mate van kleurenzien geven zijn de Colour Assessment and Diagnosis (CAD) test, en de ColorDx CCTHD test. De CAD test wordt vooral gebruikt binnen keuringen voor de civiele luchtvaart, terwijl de ColorDx CCTHD test vooral wordt ingezet bij de keuringen voor de luchtmacht. In dit project wordt een verkennend onderzoek uitgevoerd om veilige grenswaarden voor kleurenzien vast te stellen, en te onderzoeken hoe deze gemeten kunnen worden met bestaande of nieuwe technologieën. Het uiteindelijke doel is het ontwikkelen van een testmethodiek die specifieke grenswaarden voor kleurenzien bepaalt, gericht op de luchtmacht. Deze grenswaarden zullen worden gebruikt om te beoordelen of kandidaten geschikt zijn voor kritieke functies zoals piloot of luchtverkeersleider. Medische adviseurs binnen de luchtmacht zullen hiermee beschikken over duidelijke, betrouwbare criteria voor de beoordeling van kleurenzien bij kandidaten. Daarnaast wordt onderzocht of, en op welke wijze, deze methodiek en technologie ook bij andere (risicovolle) beroepen, zoals andere defensieonderdelen, politie, brandweer en gezondheidszorg, toegepast kunnen worden.