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Objectives The aim of this study was to investigate the influence of rate control on quality of life (QOL). Background The RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) trial showed that lenient rate control is not inferior to strict rate control in terms of cardiovascular morbidity and mortality. The influence of stringency of rate control on QOL is unknown. Methods In RACE II, a total of 614 patients with permanent atrial fibrillation (AF) were randomized to lenient (resting heart rate [HR] Results Median follow-up was 3 years. Mean age was 68 +/- 8 years, and 66% were males. At the end of follow-up, all SF-36 subscales were comparable between both groups. The AF severity scale was similar at baseline and end of study. At baseline and at end of study there were no differences in the MFI-20 subscales between the 2 groups. Symptoms at baseline, younger age, and less severe underlying disease, rather than assigned therapy or heart rate, were associated with QOL improvements. Female sex and cardiovascular endpoints during the study were associated with worsening of QOL. Conclusions Stringency of heart rate control does not influence QOL. Instead, symptoms, sex, age, and severity of the underlying disease influence QOL. (Rate Control Efficacy in Permanent Atrial Fibrillation; NCT00392613) (J Am Coll Cardiol 2011;58:1795-803) (C) 2011 by the American College of Cardiology Foundation

Background and aims: Volunteer bias in intervention studies on successful aging has been poorly explored. This paper investigated differences between participants and non-participants of the Groningen Intervention Study on Successful Aging (GISSA) over a wide range of demographic, physical, psychological and social subject characteristics. Methods: Subjects were recruited among a longitudinal cohort study (Groningen Longitudinal Aging Study) and included 558 men and 711 women, aged 65-96 years, who were invited to participate in the GISSA. Measures were obtained by questionnaires at the moment of invitation and eight years before invitation. Participants were compared with three groups of non-participants: persons who refused to participate, those who did not respond after a reminder, and those who intended to participate but withdrew before pre-test. Results: At the moment of invitation, participants were younger, better educated, and functionally and physically more active than the three groups of non-participants. They also had better scores on the physical functioning subscale of the medical outcome scale, better ADL, iADL and vigorous ADL functions and fewer depressive symptoms, and perceived less social support in everyday and problem situations. Participants reported a less strong rate of decline in physical and psychological functioning in the eight years prior to the invitation than did the other groups. Conclusion: Due to volunteer bias, results of intervention studies on successful aging may have limited generalizability.

BACKGROUND. The present study examined the structure and reliability of the Dutch version of the Patient Satisfaction Questionnaire III (PSQ 111). The PSQ III was designed to measure technical competence, interpersonal manner, communication, time spent with doctor, financial aspects, and access to care. In the Dutch version, the financial items were left aside because these are not appropriate for the Dutch socialized system. OBJECTIVES. The main objectives were to assess response bias, the number of dimensions needed to describe the PSQ III items, and the reliability of the scales. In addition, distribution characteristics were examined and norm scores to interpret satisfaction scores in an oncological setting were presented. RESEARCH DESIGN. A cross-sectional survey study. SUBJECTS. The study was comprised of 1594 cancer patients from eight hospitals. MEASURES. The Dutch version of the PSQ III. RESULTS. Approximately 14% of the respondents were found to demonstrate considerable response bias. Confirmative factor analyses were performed to test three theoretical models with a varying number of dimensions among those participants who did not demonstrate response bias. The original structure did not fit the data well, but support was found for a three-factor model (with interpersonal manner, communication, and time spent with doctor loading on one factor instead of separate factors) and a one-dimensional model. CONCLUSIONS. The PSQ III seems to be an appropriate measure of cancer patients' satisfaction, with the note that the number of dimensions may vary for different patient groups and/or care settings and that it is important to be aware of response bias.

AIMS: To provide one of the diagnostic categories for distal diabetic polyneuro-pathy,several symptom scoring systems are available, which are often extensive andlack in validation. We validated a new four-item Diabetic Neuropathy Symptom (DNS) scorefor diagnosing distal diabetic polyneuropathy. METHODS: We compared score characteristics of the generally accepted NeuropathySymptom Score (NSS) with the DNS score, and tested construct validity,predictive value and reproducibility with the Diabetic Neuropathy Examinationscore, Semmes-Weinstein monofilaments and Vibration Perception Threshold(clinical standards) in 73 patients with diabetes (24 Type 1, 49 Type 2;43 male/30 female; mean age 57 years (19-90);mean diabetes duration 15 years (1-43)). RESULTS: Correlation between NSS and DNS score was high (Spearman r= 0.88). Patient scoreswere more differentiated on the DNS score. The relation of the NSS andDNS scores, respectively, with clinical standards was good (Spearman r= 0.21-0.60). Reproducibility ofthe DNS score was high (Cohen weighted kappa 0.78-0.95). The DNSscore was easier to perform in clinical practice. CONCLUSIONS: The DNS is validated, fast and easy to perform, with a high predictive valuewhen screening for diabetic polyneuropathy. Diabet. Med. 19, 962-965 (2002)

The impact of attrition was studied in a two-wave panel study on the associations between psychological attributes (mastery, self-efficacy expectancies) and disability increase among low-functioning older persons (n=753, 76.4% participated at the follow-up 2 years later). The results showed that: (1) attrition at follow-up was clearly associated with age and level of disability at baseline. Older persons and those with higher levels of disability did not participate in the follow-up and (2) the strength of the association between the selected psychological attributes and the increase in disability did not substantially alter when (a) missing follow-up scores of disability were replaced by several values (e.g., lower, equal or higher compared to those who actually participated at the follow-up), or (b) associations were Computed excluding those participants at follow-up with highest increase in disability. We conclude that attrition may affect the descriptive outcomes of aging studies, particularly when such studies focus on health and function, but that attrition not always seems to be a serious problem when associations between variables are the focus of study. (C) 2002 Elsevier Science Inc. All rights reserved.

OBJECTIVES We sought to study the influence of frequency of exercise training during cardiac rehabilitation on functional capacity (i.e., peak oxygen consumption [VO2] and ventilatory anaerobic threshold [VAT]) and quality of life (QoL). BACKGROUND Although the value of cardiac rehabilitation is now well established, the influence of the different program characteristics on outcome has received little attention, and the effect of frequency of exercise training is unclear. Functional capacity is regularly evaluated by peak VO2 but parameters of submaximal exercise capacity such as VAT should also be considered because submaximal exercise capacity is especially important in daily living. METHODS Patients with coronary artery disease (n = 130, 114 men; mean age 52 +/- 9 years) were randomized to either a high- or low-frequency program of six weeks (10 or 2 exercise sessions per week of 2 h, respectively). Functional capacity and QoL were assessed before and after cardiac rehabilitation. Global costs were also compared. RESULTS Compared with baseline, mean exercise capacity increased in both programs: for high- and low-frequency, respectively: peak VO2 = 15% and 12%, Wmax = 18% and 12%, VAT = 35% and 12% (all p

This paper examines the moderating effects of three-psychological attributes (neuroticism, self-efficacy expectancies and mastery) on the association between functional limitations (motor:and cognitive limitation, vision and hearing loss) and disability ((instrumental) activities of daily living, role function and social:function) in a sample of 624 community-dwelling older persons. In contrast to our hypothesis, we did not find any evidence for interaction effects. This means that low levels of psychological resources do not exacerbate the effect of functional limitation on disability in community-dwelling older persons. We found significant unique contributions of the psychological attributes to disability. Even when all three psychological attributes were taken into account, neuroticism and mastery had unique effects on social and role function, and self-efficacy expectancies had unique effects on (instrumental) activities of daily living. We conclude that the effects of functional limitation and psychological attributes;on disability can be considered as additive. Older persons with less psychological resources are particularly at risk in developing disability. (C) 1999 Elsevier Science Ltd. All rights reserved.

Background: In this study, a complex theoretical model regarding the stress-distress relationship was evaluated. The various components in the model included experienced stress (daily hassles), psychological distress, neuroticism, problem-focused coping, avoidant coping, satisfaction with received social support and unassertiveness. On the basis of various previous findings, experienced stress was assumed to have a direct effect on psychological distress. In addition, neuroticism was assumed to have a direct effect on psychological distress as well as an indirect effect through its association with experienced stress, problem-focused coping, avoidant coping, satisfaction with social support and unassertiveness. Further, both problem-focused and avoidant coping were assumed to affect the revel of psychological distress directly as well as indirectly through their influence on experienced stress. Similarly, satisfaction with social support was assumed to have a direct beneficial effect on psychological distress in addition to an indirect effect through its association with coping and experienced stress. Finally, unassertiveness was assumed to have a direct effect on psychological distress as well as an indirect effect through its influence on experienced stress and coping. Methods: A covariance path analysis technique (LISREL) was used. Results: A considerable predictive power of the model could be demonstrated. Experienced stress and neuroticism turned out to be most predictive of psychological distress. The effects of social support, coping and unassertiveness on psychological distress were seriously attenuated by their common association with neuroticism. Conclusion: Above all, the present findings underscore the need to investigate all variables that are expected to play a role simultaneously so as to be able to take their interdependency into account. It is argued that although such comprehensive models may be more difficult to interpret as of yet, they are likely to more closely resemble reality. Copyright (C) 1999 S. Karger AG, Basel.

Aims Most studies in chronic heart failure have only included patients with marked left ventricular systolic dysfunction (i.e. ejection fraction less than or equal to 0.35), and patients with mild left ventricular dysfunction are usually excluded. Further, exercise capacity strongly depends on age, but age-adjustment is usually not applied in these studies. Therefore, this study sought to establish whether (age-adjusted) peak Vo(2) was impaired in patients with mild left ventricular dysfunction. Methods Peak Vo(2) and ventilatory anaerobic threshold were measured in 56 male patients with mild left ventricular dysfunction (ejection fraction 0.35-0.55; study population) and in 17 male patients with a normal left ventricular function (ejection fraction >0.55; control population). All patients had an old (>4 weeks) myocardial infarction. By using age-adjusted peak Vo(2) values, a 'decreased' exercise capacity was defined as less than or equal to predicted peak Vo(2) - 1 x SD (0.81 of predicted peak Vo(2)), and a severely decreased exercise capacity as less than or equal to predicted peak Vo(2) - 2 x SD (0.62 of predicted peak Vo(2)). Results Patients in the study population (age 52 +/- 9 years; ejection fraction 0.46 +/- 0.06) were mostly asymptomatic (NYHA class I; n=40, 76%), while 16 patients (24%) had mild symptoms, i.e. NYHA class II. All 17 controls (age 57 +/- 8 years) were asymptomatic. Mean peak Vo(2) was lower in patients with mild left ventricular dysfunction (23.6 +/- 5.7 vs 27.1 +/- 4.6 ml.min(-1).kg(-1) in controls, P Conclusion In patients with mild left ventricular dysfunction, who have either no or only mild symptoms of chronic heart failure, a substantial proportion has an impaired exercise capacity. By using age-adjustment, impairment of exercise capacity becomes more evident in younger patients. Patients with mild left ventricular dysfunction are probably under-diagnosed, and this finding has clinical and therapeutic implications.

When handling missing data, a researcher should be aware of the mechanism underlying the missingness. In the presence of non-randomly missing data, a model of the missing data mechanism should be included in the analyses to prevent the analyses based on the data from becoming biased. Modeling the missing data mechanism, however, is a difficult task. One way in which knowledge about the missing data mechanism may be obtained is by collecting additional data from non-respondents. In this paper the method of re-approaching respondents who did not answer all questions of a questionnaire is described. New answers were obtained from a sample of these non-respondents and the reason(s) for skipping questions was (were) probed for. The additional data resulted in a larger sample and was used to investigate the differences between respondents and non-respondents, whereas probing for the causes of missingness resulted in more knowledge about the nature of the missing data patterns.

This article presents results from a follow-up study in the Netherlands among 292 patients with early rheumatoid arthritis (RA). The main focus of this paper is on (changes in) personality characteristics, coping strategies and psychological status between the first and second wave (T1 and T2). On personality characteristics and psychological status RA patients are compared with a reference group (N=173) from the general community. The levels of self-esteem, neuroticism and social desirability of RA patients were significantly different when compared to those of control subjects. As far as the coping strategies 'emotional expression' and 'confrontation' were concerned, RA patients presented less favourable scores than subjects from the reference group. Along the same line, psychological status was also found to be significantly different in the groups. The results on personality characteristics and psychological status remained stable after 12 months (T2). The patients' functional status appeared to be rather strongly associated only with level of self-esteem. In addition, depression on TI could be explained mainly by personality-related aspects rather than functional status and tenderness. This pattern was also present in explaining the variance of T2 depression. However, in this latter regression analysis functional status did not contribute to depression. From the results it can be concluded that factors related to the disease process such as activity restrictions and tenderness, are not or only slightly related to the psychological status of RA patients. In addition, personality characteristics, especially the level of self-esteem, appeared to be an important determinant of depressive mood in patients with RA. These findings may contribute to the treatment of RA patients by explicitly paying attention to the relevance of personality-related aspects in (self-) management programmes.