Prevalence of sexual dysfunctions and other sexual disorders in adults with attention-deficit/hyperactivity disorder compared to the general population.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by symptoms of inattention and/or hyperactivity and impulsivity that lead to dysfunctioning in daily life. One of the affected areas of life that has so far not been studied in ADHD is sexual functioning. The goal of this study was to assess prevalence of sexual dysfunctions and other sexual disorders among adults with ADHD. A total of n = 136 adult patients treated in a Dutch outpatient ADHD clinic filled out two questionnaires to screen for sexual dysfunctions and other sexual disorders. We compared the prevalence of sexual dysfunctions and other sexual disorders in our ADHD patient population to results from two large surveys among the general Dutch population. We found that 39% of the male and 43% of the female ADHD patients had symptoms of a sexual dysfunction, and 17% of the male and 5% of the female ADHD patients had symptoms of any other sexual disorder. Only one male patient had received a diagnosis of a sexual disorder at this clinic prior to study participation. In conclusion, sexual dysfunctions and other sexual disorders are highly prevalent in adults with ADHD. Screening for sexual disorders should be therefore standard procedure during diagnostic assessment.

No association between posture and musculoskeletal complaints in a professional bassist sample.

BACKGROUND: Professional musicians receive little attention in pain medicine despite reports of high prevalence of musculoskeletal complaints. This study aims to investigate the association between work-related postures and musculoskeletal complaints of professional bass players. METHOD: Participants were 141 professional and professional student double bassists and bass guitarists. Data about self-reported functioning, general and mental health status, location and intensity of musculoskeletal complaints and psychosocial distress were collected online with self constructed and existing questionnaires. Logistic regression analyses were performed to analyse associations between work-related postural stress (including type of instrument and accompanying specific exposures) and physical complains, adjusted for potential confounders. RESULTS: Logistic regression analyses revealed no association between complaints and the playing position of the left shoulder area in double bassists (p = 0.30), the right wrist area in the bass guitarists (p = 0.70), the right wrist area for the German versus French bowing style (p = 0.59). CONCLUSION: All three hypotheses were rejected. This study shows that in this sample of professional bass players' long-lasting exposures to postural stress were not associated with musculoskeletal complaints. This challenges a dominant model in pain medicine to focus on ergonomic postures.

Psychometric qualities of the Short Form of the Self-efficacy for Parenting Tasks Index-Toddler Scale.

Parental self-efficacy (PSE; parental self-perceived competence in parenting) is known to have considerable impact on parenting quality. Although PSE is particularly under pressure during the turbulent period of toddlerhood, most studies so far have focused on PSE in parents of older children. The current study presents the psychometric qualities of the Short Form of the Self-Efficacy for Parenting Tasks Index-Toddler Scale (SEPTI-TS). Parents from a normal (n = 282) and clinical sample (n = 27) of children filled in the SEPTI-TS, and other questionnaires concerning PSE, general self-evaluation, and psychological problems. Factor analysis resulted in a 26-item instrument, representing four domains of PSE with a strong factor structure and high reliability: nurturance, discipline, play, and routine. For this new Short Form of the SEPTI-TS, good face, discriminative, concurrent, and divergent validity were found. Cut-offs for normal PSE were provided. The Short Form SEPTI-TS enables identifying problematic PSE in specific domains of parenting during toddlerhood.

Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain.

Cross sectional study, performed in an outpatient university based pain rehabilitation setting. To analyze the relationship between psychological factors (psychosocial distress, depression, self efficacy, self-esteem, fear of movement, pain cognitions and coping reactions) and performance-based and self-reported disability, as measured with a Functional Capacity Evaluation (FCE) and the Roland Morris Disability Questionnaire (RMDQ), in patients with chronic low back pain (CLBP). It has been suggested that a strong relationship exists between psychological factors and disability in patients with CLBP. In former research disability was often measured by self-report and seldom performance-based. Study sample consisted of 92 patients with CLBP admitted for multidisciplinary rehabilitation. Prior to treatment, all patients completed questionnaires to measure psychological factors and self-reported disability, and performed an FCE to measure performance-based disability. Correlation coefficients between psychological variables and FCE and self-reported disability were calculated. Multivariate linear regression analyses were performed with self-reported or performance based disability measures as outcome variables, and psychological measures as predictor variables. Out of 42 relations analyzed, 5 were statistically significant. This concerned one significant correlation between kinesiophobia and a subtest of FCE, and four correlations between psychological factors and RMDQ. No correlation was significant after the Bonferroni correction was applied (P < 0.001). The strength of significant correlations ranged from r = -0.33 to r = 0.25. The multivariate analysis revealed that psychological variables measured in this study could explain 19% of the variance of self-reported disability, with kinesiophobia being the only psychological variable that contributed significantly. The suggested strong relationship between psychological factors and performance-based and self-reported disability could not be confirmed in this study. This may implicate that the relationship between psychological factors and disability in patients with CLBP is not as unambiguous as suggested.

A family-specific use of the Measure of Processes of Care for Service Providers (MPOC-SP).

OBJECTIVE: To examine the validity and utility of the Dutch Measure of Processes of Care for Service Providers (MPOC-SP) as a family-specific measure. DESIGN: A validation study. SETTING: Five paediatric rehabilitation settings in the Netherlands. MAIN MEASURES: The MPOC-SP was utilized in a general (reflecting on services provided for all clients and clients' families) and family-specific way (filled out in reference to a particular child and his or her family). SUBJECTS: Professionals providing rehabilitation and educational services to children with cerebral palsy. METHODS: For construct validity, Pearson's product-moment correlation coefficients (r ) between the scales were calculated. The ability of service providers to discriminate between general and family-specific ratings was examined by exploration of absolute difference scores. RESULTS: One hundred and sixteen service professionals filled out 240 family-specific MPOC-SPs. In addition, a subgroup of 81 professionals filled out a general MPOC-SP. For each professional, family-specific and general scores were paired, resulting in 151 general-family-specific MPOC-SP pairs. The construct validity analyses confirmed the scale structure: 21 items (77.8%) loaded highest in the original MPOC-SP factors, and all items correlated best and significantly with their own scale score (r 0.565 to 0.897; P<0.001). Intercorrelations between the scales ranged from r = 0.159 to r = 0.522. In total, 94.4% of the mean absolute difference scores between general and family-specific scale scores were larger than the expected difference. CONCLUSION: Service providers were able to discriminate between general and family-specific MPOC-SP item ratings. The family-specific MPOC-SP is a valid measure that can be used for individual evaluation of family-centred services and can be the impetus for family-related quality improvement.

Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial.

BACKGROUND: Data on the efficacy and safety of methylphenidate in adults with attention deficit/ hyperactivity disorder (ADHD) are lacking in Europe. This study was undertaken to report on the efficacy and safety of methylphenidate in an adult out-patient population with ADHD, and to compare results with US data. METHOD: A double-blind randomized cross-over trial comparing methylphenidate and placebo in 45 adults with ADHD with childhood onset was performed in a dose-titration design. Methylphenidate was titrated from 0.5 mg/kg per day in week 1 up to 1.0 mg/kg per day in week 3. RESULTS: Response rates using methylphenidate varied between 38 and 51%, and using placebo between 7 and 18% (p<0.05), depending on outcome measure used. Although the overall percentage of subjects having any side effect on both methylphenidate and placebo was rather high, side effects on methylphenidate over and above those on placebo were few and mild. CONCLUSIONS: Methylphenidate proves to be an effective and well tolerated treatment for symptoms of ADHD in adults in the short term. Future research should study the long-term response and clarify the impact of gender, co-morbidity, socio-economic status and IQ on response rates in adults with ADHD.

Health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders.

This exploratory study attempted to estimate the severity of health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders in the Netherlands. Information on the severity and the distribution of the complaints in these patients is important to acquire insight in the problems which these patients experience, and moreover is essential for further research, especially for evaluating effects of patients undergoing foot orthosis treatment. Patients with degenerative foot disorders aged 18 years and over were recruited from nine orthopaedic workshops over a period of three months in 2000. One hundred and twenty-two (122) patients were included in the study. Two approaches were used to obtain data. Firstly, shoe technicians and orthotists inspected patients' feet and legs and interviewed them at their initial visit. Data on gender, age, height, weight, existing and prescribed orthotic devices were recorded on a report form. Secondly, patients were asked to fill in a questionnaire assessing type, location, frequency, intensity and duration of health complaints, and disability. Data indicate that females with degenerative foot disorders and foot orthoses are twice as common as men. Patients supplied with foot orthoses are twice as often overweight compared to subjects in the general population. Besides frequent and protracted pain there are also fatigue complaints, particularly in the feet and lower leg. Duration and frequency of the complaints suggest that these patients suffer from a chronic pain syndrome. In addition, the results indicate that the functional level of these patients is below that of the general population, in particular regarding physical activities.

Lower limb deficient children in The Netherlands: epidemiological aspects.

Information on the characteristics of children with limb deficiencies and amputations in The Netherlands is largely lacking. The present study aimed to collect data about the prevalence of congenital deficiencies, the ratio of congenital to acquired limb deficiencies, types of lower leg deficiency or amputation and male/female ratios. Data were obtained from a regional birth defects registry for the northern part of The Netherlands (EUROCAT-NNL) and from a national survey. Inclusion criteria for the selection of the EUROCAT data were: children/foetuses with lower leg deficiencies born in 1981-1986. Inclusion criteria for the survey data were: children aged 1-18 years with congenital deficiencies or acquired amputations of the leg, excluding toe deficiencies/amputations. Both the regional birth defects registry and the national survey only yielded small numbers of children, which limits the validity of the authors' findings. The Eurocat data show a prevalence of lower leg deficiencies at birth of 2.07/10,000. Fifty-five (55) children/foetuses were included in the present study. The male/female ratio was 1:1. Of the live-born children, 30% also had defects of the upper limbs, while 38% had bilateral lower limb deficiencies. The national survey included 89 children, of whom 73% had congenital deficiencies, while the others had undergone amputations: of which 37% were due to malignancies, 29% to traumata, 13% to infections and 21% to other pathology. The male/female ratio was 7:3 for the children with congenital deficiencies versus 6:4 for the children with acquired amputations. In the group of congenital deficiencies, fibula deficiency was most frequently seen (36%), while in the group with acquired amputations trans-femoral amputation, knee disarticulation and trans-tibial amputation were seen with equal frequency (21%). In 40% of the children with congenital deficiency and in 8% of the children with acquired amputations the arm was also affected. Both legs were affected in 37% of the children with congenital deficiencies and in 8% of the children with acquired amputations.

Children with congenital deficiencies or acquired amputations of the lower limbs: functional aspects.

The aim of the study was to evaluate the use of prostheses, some secondary complications and functional aspects among children who had a congenital leg deficiency or an acquired leg amputation. Rehabilitation physicians were asked to refer children, aged 1-18 years, with a leg deficiency or amputation. Mentally retarded children, children who had only had a toe amputated and children within one year after amputation were excluded. A total of 88 children were included; 64 with a congenital deficiency and 24 with an acquired amputation. In 25 of these 88, both legs were affected; 28 children also had an arm deficiency or amputation. A structured interview was held and the Child-HAQ assessed. Five (5) questions from the Child-HAQ, all relating to leg functions, were analysed. All but 7 children had had a prosthesis fitted, most (89%) using it for almost the entire day. In the children with congenital deficiencies, the first prosthesis had been fitted at an average age of approximately 18 months. Four (4) of the 7 children without prostheses used orthopaedic footwear. The 10 children with congenital deficiencies necessitating prostheses with articulated knees had the first knee of this type fitted at an average age of approximately 37 months. Forty-seven (47) of the 88 children had needed one or more (secondary) operations. In the children with congenital deficiencies, this was usually a conversion procedure, while the children with an acquired amputation had usually been operated on for osseous overgrowth. Twenty (20) of the 88 children experienced or had previously experienced phantom sensations, 5 children phantom pain. Skin problems were common. Most children (95%) were able to walk, most of them (93%) more than 100 m and 93% of the children aged 4 years or over were able to cycle. Most children (94%) aged 6 years or over were able to don and doff their prostheses independently. Some 90% of the children aged 4 years or over attended a normal primary or secondary school. Most (93%) of the children were able to take part in the physical education programme at school, although frequently (47%) with some degree of difficulty. The functional abilities of 88 Dutch children with congenital leg deficiencies or leg amputations were found to be generally satisfactory. Most of the children used prostheses in their daily activities. Secondary complications were, however, frequent.

Gait analysis of transfemoral amputee patients using prostheses with two different knee joints.

OBJECTIVE: To evaluate the gait of transfemoral amputee patients using a prosthesis with a 4-bar linkage knee joint with either a mechanical swing phase control (Otto Bock 3R20) or a pneumatic swing phase control (Tehlin knee). DESIGN: Randomized cross-over trial. SETTING: Rehabilitation Department of a university hospital in The Netherlands. PATIENTS: Twenty-eight subjects with unilateral transfemoral amputation for reasons other than chronic vascular disease; ages between 16 and 65 years and familiar with the use of the Otto Bock 3R20 knee. SELECTION PROCEDURE: a consecutive sample. INTERVENTION: The Otto Bock 3R20 was used by the subjects before they entered the study. The patients changed to the Tehlin knee at random either after 1 or 2 assessments with the Otto Bock 3R20. MAIN OUTCOME MEASURES: Temporal and kinematic variables in gait analysis (speed recordings were taken before and after the equipment for the measurements of the other parameters was placed on the patients). Subjective scores for comfortable and fast ambulation were obtained by means of 2 questionnaires. Questionnaire A consisted of multiple choice questions (maximum score: 5) and questions using an 8-point rating scale (maximum score: 7). In questionnaire B, the patient was asked to compare the present prosthesis with the previous one. RESULTS: Fast walking speed in gait analysis was higher with the Tehlin knee than with the 3R20 (without equipment 95% confidence interval (CI) .02-.09 m/sec, with equipment CI .04-.11), while comfortable walking speed was not higher with the Tehlin knee (without equipment CI -.20-.20 m/sec, with equipment CI .00-.05). Symmetry of walking as regards swing phase duration was closer to 100% with the Tehlin knee than with the 3R20 (comf. walking CI 4% to 19%, fast walking CI 7% to 17%). Knee joint range of motion during swing phase was smaller with the Tehlin knee than with the 3R20 (comf. walking CI 1.8 degrees-8.7 degrees, fast walking CI 2.0 degrees-9.5 degrees). Knee flexion duration during swing phase was shorter for the Tehlin knee than for the 3R20 at fast walking speed (CI 6-46msec), while knee flexion duration from and to 10 degrees flexion was shorter for the Tehlin knee at comfortable speed (CI 18-67msec) and fast speed (CI 20-64msec). In questionnaire A the amputees reported the Tehlin knee to be better for fast walking (part A1 CI .01-.52, part A2 CI .13-.98) and in questionnaire B for both comfortable and fast walking.

Energy cost during ambulation in transfemoral amputees: a knee joint with a mechanical swing phase control vs a knee joint with a pneumatic swing phase control.

The aim of the study was (i) to evaluate the preference of transfemoral amputees for a 4-bar linked knee joint with either a mechanical swing phase control or a pneumatic swing phase control, and (ii) to compare the energy expenditure in transfemoral amputees using a prosthesis with a mechanical swing phase control with that of the same amputees using a prosthesis with a pneumatic swing phase control. The study included 28 unilateral transfemoral amputees amputated for reasons other than chronic vascular disease. All patients had a prosthesis with a knee joint with mechanical swing phase control (the Otto Bock 3R20) before entering the study. The amputees changed their knee joint to one with pneumatic swing phase control (the Tehlin knee joint) at random either after the first or second assessment. The amputees were asked for their preference at the second and third assessments. The energy expenditure while walking at speeds of 2 and 3 km/h was measured at each assessment. After having tried both knee joints, 19 patients preferred the Tehlin knee, 6 patients preferred the Otto Bock 3R20, and 3 patients had no preference. The energy expenditure measurement showed that walking with the Tehlin knee required more energy than walking with Otto Bock 3R20. Because of the limited number of patients included in the study and the fact that a double-blind design was impossible to achieve, conclusions should be drawn with caution.

The gait of unilateral transfemoral amputees.

The aim of this study was to describe the gait of persons with a unilateral transfemoral amputation by means of a questionnaire, gait analysis and measurement of energy expenditure, and to find correlations among the variables studied. The study included 29 transfemoral amputees amputated for other reasons than a chronic vascular disease. The patients were assessed using the following methods: 1) A questionnaire rating the walking distance and walking difficulty in different circumstances. 2) Gait analysis measuring temporal variables and goniometry of hips and knees. 3) Measurement of energy expenditure during sitting and walking. Scores on the questionnaire showed a correlation with socket design, a negative correlation with age and energy expenditure, and a positive correlation with fast speed. The gait of transfemoral amputees was asymmetrical as far as temporal variables were concerned, and for most amputees also for the range of motion of hip and knee. The walking speed of the amputees was lower than that of non-amputees and showed a positive correlation with hip extension-flexion range of motion and a negative correlation with age and stride time. The energy expenditure of the amputees during ambulation was higher than that of non-amputees, and seemed to correlate with residual limb length and the hip abduction-adduction range of motion.

Functional outcome of rehabilitated bilateral lower limb amputees.

The functional outcome of rehabilitated bilateral lower limb amputees was studied. The study included 31 amputees who were admitted during 1980-1990 to a rehabilitation centre in the north of the Netherlands. The clinical notes made during the patients' admission were studied to obtain information about their characteristics, while mobility and prosthetic use were studied at discharge. The patients who were alive and willing to participate in the study were interviewed by a physician at their residence in November 1992, using among other things, the Sickness Impact Profile (SIP) and the Life Satisfaction questionnaire. Some 25 of the 31 patients were amputated for vascular reasons, 1 patient primarily for traumatic reasons and secondarily for vascular reasons, 5 patients for traumatic reasons. Eight patients had a bilateral trans-femoral amputation, 18 patients a bilateral trans-tibial amputation, 2 patients a combination of trans-tibial and knee-disarticulation amputation, 3 patients a trans-femoral/trans-tibial amputation. Mean age at second amputation was 66.3 years. Of the 31 amputees 21 were men and 10 women, 25 amputees were prosthetically rehabilitated during admission, 3 of them died during admission and 5 did not achieve mobility at discharge. In their activities of daily life 22 of the 28 patients alive at discharge were almost independent. At the time of the follow-up evaluation 17 of the 31 patients had died. For several reasons only 8 patients could be included in the follow-up, 6 vascular amputees and 2 traumatic amputees.(ABSTRACT TRUNCATED AT 250 WORDS)

Walking speed of normal subjects and amputees: aspects of validity of gait analysis.

This study investigated some aspects of the validity of walking speed recording in 15 normal subjects, 16 trans-femoral amputees and 8 knee disarticulation amputees. The variability and test-retest reliability of walking speed and the influence of simultaneous recording of EMG and goniometry on comfortable and fast walking speeds were studied. The variability between sessions was mainly determined by the variance within each session. The variance of speed within sessions while walking with fast speed, was higher when walking without equipment than when walking with equipment. The variances of speed within sessions of the normal subjects were higher than those for both amputee groups. The test-retest reliability, expressed by the intra-class correlation coefficient, was good: between 0.83 and 0.98. The speed when walking without equipment was significantly higher both in normal subjects and amputees than the speed when walking with equipment.

Comparison of gait using a Multiflex foot versus a Quantum foot in knee disarticulation amputees.

The subjective responses and gait patterns of unilateral knee disarticulation amputees wearing prostheses fitted first with the Multiflex foot and then with the Quantum foot were studied. Nine amputees were included in the trial. A questionnaire asked the amputees about their preference for one of the feet. Gait analysis was performed measuring temporal parameters and goniometry of hips, knees and ankles in the sagittal and frontal planes. There was a slight preference for the Quantum foot. Preference seemed not to be related to physical characteristics of the amputees nor to gait parameters. There were no differences in gait as far as the temporal factors were concerned. The main differences in the range of motion of the joints were in the frontal plane: the eversion-inversion movement of the ankle and the adduction-abduction movement of the hip. During walking at comfortable speed with the Multiflex foot the ankle and hip range of motion averaged 2.1 and 3.1 degrees respectively, less than during walking with the Quantum foot.

Ultrasonography of the peroneal nerve muscle group in normal subjects and patients with peroneal paresis.

A method for measuring the cross-sectional area (CS area) of the peroneal nerve muscle groups (PNMG) by ultrasonography is presented. The method has a good reliability and can be performed easily. The mean value of the ratio (x 100) of the right-sided PNMG CS area to the left-sided PNMG CS area in right-handed normal subjects was 98%, with a standard deviation of 8.5%. The normal range for this value was 81%-115% (mean +/- 2 SD). Examples of these measurements in patients with peroneal pareses during denervation and reinnervation are given.

The effect of low-frequency electrical stimulation on denervation atrophy in man.

The effect of low frequency electrical stimulation (LES) on denervation atrophy and recovery of the muscles was examined in a group of 73 patients with a single or a combined total lesion of the median, ulnar or peroneal nerves. The differences between the patients were evaluated by means of clinical muscle force testing, EMG, dynamometry (ulnar and median nerve lesions), computer tomography (ulnar nerve lesions) and ultrasonography (median and peroneal nerve lesions). A beneficial effect of LES could not be shown.