Groeneveld, F.P.M.J.

Erectile Dysfunction in the Community: Trends over Time in Incidence, Prevalence, GP Consultation and Medication Use - the Krimpen Study: Trends in ED (Article)

2010-07-01T00:00:00Z

Introduction: In the general population, erectile dysfunction (ED) is surrounded by a " taboo." Epidemiologists studying this problem have to be aware of the phenomenon of the " tip-of-the-iceberg." Aims: Our aim is to describe the iceberg phenomenon for ED and their help-seeking behavior in the general population during a period when public interest in ED heightened and waned after the introduction of the drug sildenafil. Methods: The data were obtained as part of a large longitudinal community-based study, i.e., the Krimpen study. With four rounds of data collection with an approximate 2.1 years interval, the local pharmacists provided data on medication use, whereas abstracts from the medical record and history were provided by the local general practitioners (GPs). The data from the questionnaires were entered into the Krimpen study database but were not communicated to the GPs. Main Outcome Measures: ED: according to the ICS-questionnaire, GP consultation: search of electronic medical dossier for ED or reports from any specialist, use of ED medication as delivered by the pharmacy. Results: The age-standardized prevalence of ED is stable, i.e., around 40%. During the period 1995 to 2000, the incidence increased from 5% to 6.5%, then it stabilizes around 5% per year. The first-time use of ED medication increases exponentially between 1995 and 2000, then it stabilizes at about 3.5% per year. The number of GP consultations by men with ED increases up to 1999, after which it stabilizes at about 1.8% per year. Conclusion: We suggest that the availability and awareness of a new pharmacological option induced a change of behavior among GPs and their patients.

No clear association between female hormonal aspects and osteoarthritis of the hand, hip and knee: a systematic review (Article)

2009-09-01T00:00:00Z

OBJECTIVE: Incidence of OA rises steeply in women of age >50 years; the climacteric period for women. The simultaneous occurrence of these events suggests an association between OA and changes in female hormonal aspects. This systematic review studies the assumed association between OA and aspects concerning the fertile period (duration, endogenous hormones, age at menarche/menopause) and the menopause [menopausal status, years since menopause (YSM) and surgical menopause]. METHODS: Medline and EMBASE were searched for articles assessing associations between hand/hip/knee OA and female hormonal aspects. Methodological quality was assessed systematically, and results were summarized in a best-evidence synthesis. RESULTS: Sixteen studies were included in the present study. For most hormonal aspects no association was found. Conflicting evidence was found for an association of age at menarche with Herberden's nodes (HNs) and hand ROA, YSM with knee ROA and ovariectomy with hip OA. An increased risk was seen for low estradiol serum levels in the early follicular phase with incident knee ROA, age at menarche being < or =11 years old with total hip replacement, being post-menopausal and YSM with the presence of HN. A protective effect was seen for age at menopause being > or =52 years with total knee replacement. Evidence level was limited for all. CONCLUSIONS: The assumed relationship between the female hormonal aspects and OA was not clearly observed in this review. The relationship is perhaps too complex, or other aspects, yet to be determined, play a role in the increased incidence in women aged >50 years.

Risk factors for deterioration of erectile function: The Krimpen study (Article)

2009-04-01T00:00:00Z

This report from the Krimpen study explored the relationship between the determinants for worsening of erectile function in the open population. In Krimpen aan den IJssel (a municipality near Rotterdam), all men aged 50-75 years, without cancer of the prostate or the bladder and without a history of radical prostatectomy or neurogenic bladder disease, were invited to participate in June 1995. The response rate was 50%. The follow-up was until June 2004. At baseline a visit to a health centre for the measurement of urinalysis, height, weight and blood pressure was part of the ongoing study. During baseline and at the first follow-up, second follow-up and third follow-up, a self-administered booklet consisting of a compilation of validated questionnaires including the International Continence Society male sex questionnaire was completed. At the urology outpatient clinic, a urological workup was measured. All participants were asked to keep a frequency-volume chart for 3 days. A multivariate Cox-proportional hazard model was constructed to find the determinants of worsening of erectile function, correcting for age. Total follow-up time was 4948 person years consisting of 975 men. During follow-up, 441 events of worsening of erectile function occurred. Multivariate Cox-proportional hazard ratio analyses showed that body mass index (BMI), irritative lower urinary tract symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and sexual inactivity were determinants with significant hazard ratios. In addition to age, determinants for a deterioration of erectile function based on multivariate longitudinal analyses are BMI, diabetes mellitus, COPD, sexual inactivity and irritative IPSS. The mechanism of various determinants is discussed.

Limited evidence for a protective effect of unopposed oestrogen therapy for osteoarthritis of the hip: a systematic review (Article)

2009-02-01T00:00:00Z

Above the age of 50 yrs, the incidence of OA rises steeply in women but less in men, suggesting an association with changes in female hormone levels in the menopause. This systematic review summarizes the evidence on the assumed association between exogenous hormone use and OA. Medline was searched up to March 2008 for articles assessing associations between OA of hand, hip or knee and menopause-related aspects. Methodological quality of the studies was assessed systematically. The results were summarized in a best-evidence synthesis. Nineteen studies on exogenous hormone use are included. Limited evidence was seen for a protective effect of unopposed oestrogen use for incidence of hip replacement/joint replacement, and a protective trend for incident radiological OA (ROA) of the knee. In prevalence studies, conflicting evidence was observed for hormone replacement therapy (HRT) use with DIP ROA and 'any joint OA', and oestrogen use with clinical knee OA. We found limited evidence for a significantly increased risk by using HRT for clinical hip OA and a significant protective effect of long-term unopposed oestrogen use for hip ROA. For all other relations studied no associations were found. Heterogeneity between the hormones used and outcome measurements made statistical data pooling impossible. The assumed relationship between the exogenous hormone use and OA was not clearly observed in this review. The relationship is perhaps too complex, or other aspects, yet to be determined, play a role in the increased incidence in women aged over 50 yrs. However, there is some evidence of a protective effect of unopposed oestrogen use for hip OA.

No clear association between female hormonal aspects and osteoarthritis of the hand, hip and knee: a systematic review. (Article)

2009-01-01T00:00:00Z

No clear association between female hormonal aspects and osteoarthritis of the hand, hip and knee: a systematic review. (Article)

2009-01-01T00:00:00Z

The Long-Term Relationship between a Real Change in Prostate Volume and a Significant Change in Lower Urinary Tract Symptom Severity in Population-Based Men: The Krimpen Study (Article)

2008-04-01T00:00:00Z

Objective: We used the database of a longitudinal community-based study to investigate whether real changes in prostate volume (PV) (ie, changes greater than the combination of intra- and interobserver variation of volume measurement) corresponded with significant changes in symptom severity. Methods: In a community-based study of men aged 50-78 yr, the International Prostate Symptom Score (IPSS) and PV were measured at baseline and at 4.2-yr follow-up. Of 1417 men, 864 completed both rounds. A significant change in IPSS was defined as a change of ≥ 4 points. A real change in PV was defined as a percent change of ≥ 26%, or an absolute change of ≥ 10 cc. Results: After 4.2 yr, about 20% of the men had experienced a significant increase in IPSS and 16-23% had a real increase in PV. The age-adjusted odds ratio for a significant increase in symptom severity, which contrasts men who have a real increase in PV and men who do not show such an increase, is 1.38 (95%CI, 1.05-1.85]. The age-adjusted odds ratio for a significant decrease in symptom severity, which contrasts men with a real increase in PV and those without such an increase, is 1.50 (95%CI, 1.11-2.85). Conclusions: Benign prostatic hyperplasia can be characterised as a progressive disease in a certain proportion of men older than 50 yr. Men with growing prostates are at a greater risk of symptomatic deterioration. Men who have prostates that do not grow significantly are more likely to improve symptomatically.

Influence of coping styles on quality of life in men with new and increasing lower urinary tract symptoms: The Krimpen study in community-dwelling men (Article)

2007-10-01T00:00:00Z

Objective: The present study aims to determine the influence of coping on quality of life (QOL) in elderly men developing lower urinary tract symptoms (LUTS). Materials and Methods: Longitudinal population-based study with a follow-up period of 6.5 years on 1,688 men aged 50-78 years. Data were collected through self-administered questionnaires, including the Sickness Impact Profile (SIP, three domains), Inventory of Subjective Health (ISH), International Prostate Symptom Score (IPSS), and the Utrecht Coping List (UCL). Various physical and urological measurements were completed. Multiple linear regressions were used to determine the change in QOL in men with incident LUTS in relation to coping behavior. Results: Overall no significant association is found between changes in LUTS with a change in QOL. However, a positive change in QOL is significantly associated with a change in LUTS when men use the coping style active problem solving and a negative relation exists with coping style reassuring thoughts. Conclusion: Different coping styles have a different impact on the relation between a change in LUTS and a change in generic QOL in community-dwelling elderly men. This makes a future exploration of the clinical treatment possibilities warranted. Copyright

Serum Prostate-Specific Antigen as a Predictor of Prostate Volume in the Community: The Krimpen Study (Article)

2007-06-01T00:00:00Z

Objectives: Serum prostate-specific antigen (PSA) is considered a proxy for prostate volume (PV). This study investigates which range of PSA values has the best utility in the determination of PV (<30 cc, at 30, 40, and 50 cc), and whether PSA performs better than digital rectal examination (DRE) when estimating PV. Methods: In a population-based follow-up study of 1688 men in Krimpen aan den IJssel, The Netherlands, at baseline we estimated PV by DRE and by transrectal planimetric ultrasound (TRUS), in addition to measuring PSA. Men who tested positive for prostate cancer (PCa) at baseline and at 2 and 4 yr of follow-up were excluded from the analyses (n = 142). Of the men without PCa, PSA and PV data were available in 1524 participants. Results: Of all 1524 men analysed, 76.7% had a PSA of 0-2.0, 15.0% had a PSA of 2.1-4.0, and 8.3% a PSA > 4. Low PSA ranges (0-2 and 2.1-4.0) discriminate better for a PV of 30 cc (eg, in men with a PSA range of 2.1-2.5 ng/ml there was a 72% chance of having a PV > 30 cc). Higher ranges of PSA (>4.0) discriminate better for a PV > 40 or 50 cc. (eg, in men with a PSA in the range of 4.1-7.0 ng/ml there was a 69% chance of having a PV > 40 cc and in men with a PSA > 10 ng/ml there was a 75% chance of a PV > 50 cc). The receiver operating curve (ROC) for the performance of PSA in estimating a PV > 30 cc shows an area under the curve (AUC) of 0.79, denoting reasonable discrimination, and AUCs of 0.86 and 0.92, denoting good discrimination of PVs > 40 cc and >50 cc, respectively. PSA performed significantly better than DRE at estimating PV. Multiple regression analysis shows that both DRE and an interaction term for age and PSA provided minimal additional information beyond PSA in the prediction of PV; however, their contribution is numerically minimal/not clinically meaningful. Conclusions: In men for whom a diagnosis of PCa has been ruled out, PSA can be used to detect an enlarged prostate (>30 cc and with more accuracy PV > 40 or 50 cc). More precision in estimating PV can be obtained when using a formula that contains PSA, age, DRE, and an interaction term between age and PSA; however, the clinical advantage of the formula over PSA alone is only modest as shown by the ROC curves. Thus, for clinicians looking for an easy and fast way to identify patients with an enlarged prostate, PSA is a good approximation for men without PCa.

Health status and its correlates among Dutch community-dwelling older men with and without lower urogenital tract dysfunction (Article)

2002-06-01T00:00:00Z

Objective: To study health status and its correlates in older men with and without lower urogenital tract dysfunction. Methods: Cross-sectional population-based study on 1688 men aged 50-78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction or a negative advice from their general practitioner. Data were collected through self-administered questionnaires, including Sickness Impact Profile (SIP, three domains), Inventory of Subjective Health (ISH), International Prostate Symptom Score (IPSS) and International Continence Society (ICS) Male Sex questionnaire, medication use, socio-economic and lifestyle factors. Additional information was collected by measurement of blood pressure, transrectal ultrasonography of the prostate and uroflowmetry. Four health status domains were analyzed using the ISH and three domains of the SIP. Lower urinary tract symptoms (LUTS) were categorised using IPSS, erectile and ejaculatory dysfunction were defined using the ICS questionnaire. Results: All urogenital characteristics and parameters were related to at least two of the health status domains. Multivariate regression analyses yielded that LUTS and cardiac symptoms were associated with suboptimal scores of all four domains. Chronic obstructive pulmonary disease and drugs for abdominal symptoms were related to three domains; erectile and ejaculatory dysfunction, muskuloskeletal or psycho(ana)leptic drugs and marital status to two domains. Conclusions: The impact of LUTS on health status was equally important as the impact of cardiac symptoms. The impact of sexual dysfunction was smaller than expected. Longitudinal studies are needed to determine how health status and illnesses interact.

The climacteric: blood, sweat and tears? : population based studies of well-being, attitudes and hormone replacement therapy among 1947 women aged 45-60 years (Doctoral Thesis)

1994-06-29T00:00:00Z

During the premenopausal years the cyclical events gradually decrease until postmenopausal amenorrhea is established. The primary process takes place in the ovaries as a gradual decline and final cessation of the generative and endocrine functions, although a certain non-cyclical endocrine activity of the ovaries is maintained until advanced age. Alexander found that the absence of ovarian steroids does not influence the hypothalamic secretion of gonadotropin releasing hormone (GnRH): the mean level of GnRH does not change with advanCing age. The lack of response of postmenopausal ovaries to endogenous gonadotropin stimulation is a result of primary age-related changes in the ovaries, not in the hypothalamus. As a result ofthe decrease in estrogens, the feed-back of ovarian estrogens on the hypothalamus diminishes, resulting in high FSH levels. A high serum FSH level is the only constant laboratory finding in the postmenopausal years. Apart from hormonal changes other effects of the aging do occur. No study so far has pointed out that in the climacteric years there is an acceleration of aging.