Falls in Parkinson__s (PD) and Huntington__s disease (HD) are common. 50 % of moderately affected PD patients sustained two or more falls during a prospective follow-up of 6 months. During a 3... Show moreFalls in Parkinson__s (PD) and Huntington__s disease (HD) are common. 50 % of moderately affected PD patients sustained two or more falls during a prospective follow-up of 6 months. During a 3 month period 40 % of HD patients reported one or more fall. Many falls resulted in minor injuries and 42 % of PD patients reported a fear of future falls. A different study on quality of life in PD showed that quality of life scores were significantly related to fear of falling in PD. In order to predict future falls several clinical tests and risk factors were studied. However, it proved difficult to identify future fallers and asking for prior falls was the best predictor of falls in the near future in PD. Analysis with quantative measurements in HD patients showed that an increased medio lateral trunk sway and a decreased stride length were associated with an increased fall risk. Based on the findings in these studies and on a literature study, the thesis concludes with a proposal for a multidisciplinary intervention program to prevent falls in Parkinson__s disease. Show less
Chronic kidney disease (CKD) is a progressive disease associated with increased morbidity and mortality. Different therapeutic interventions in the course of CKD are shown to be effective in... Show moreChronic kidney disease (CKD) is a progressive disease associated with increased morbidity and mortality. Different therapeutic interventions in the course of CKD are shown to be effective in slowing or preventing disease progression. This thesis focused on the progression of CKD from pre-dialysis to dialysis. The main conclusions of this thesis are: A positive first-degree family medical history of diabetes mellitus and cardiovascular disease is associated with increased mortality in the first year of pre-dialysis care, but not with decline of kidney function. Second, increased serum phosphorus levels, but not serum calcium levels, are associated with a shorter dialysis-free survival in the first two years of pre-dialysis care. Furthermore, increased phosphorus levels at start of pre-dialysis care are associated with the rate of decline of kidney function. Third, late referral to pre-dialysis care is associated with increased mortality in the first year of dialysis. Fourth, the decline of kidney function is constant in the period of one year before dialysis initiation until two to four months of dialysis therapy. After that period, the rate of decline of kidney function decreases. Finally, in contrast to common believe, in dialysis patients, cardiovascular and noncardiovascular mortality are equally increased. Show less
Meer, J. van der; Rood, Y.R. van; Wee, N.J. van der; Hollander-Gijsman, M. den; Noorden, M.S. van; Giltay, E.J.; Zitman, F.G. 2012
Pulmonary embolism is traditionally, since autopsy studies by Virchow in the mid 1800s, thought to originate from embolization of a deep-vein thrombosis, resulting in two clinical manifestations of... Show morePulmonary embolism is traditionally, since autopsy studies by Virchow in the mid 1800s, thought to originate from embolization of a deep-vein thrombosis, resulting in two clinical manifestations of one disease: venous thrombosis. The incidence of deep-vein thrombosis in the population is twice as high as the incidence of pulmonary embolism, i.e. 1 per 1000 and 0.5 per 1000 person-years respectively. The aim of this thesis was to assess whether pulmonary embolism and deep-vein thrombosis are always the same disease or not, and to answer this question with regard to etiology (genetic and acquired risk factors) and anatomical distribution of thrombi in the veins. We studied this question in two populations: the PEDLAR study and the MEGA case-control study. In the PEDLAR study we assessed the origin of pulmonary embolism using a total body Magnetic Resonance Direct Thrombus Imaging technique. We proposed several mecha nisms for the absence of deep-vein thrombi in more than half of the patients with pulmonary embolism. In addition, we investigated the effect of aging on venous valve thickness. This was performed in an ultrasonography study, with participants from 20 to 80 years old (the aging venous valves study). We hypothesized that part of the increasing incidence in venous thrombosis with age can be explained by increasing valve thickness. Show less
Noorden, M.S. van; Fenema, E.M. van; Wee, N.J.A. van der; Zitman, F.G.; Giltay, E.J. 2012
In this thesis we describe, combine and compare results of a series of meta-analyses on the prevalence of child sexual, physical, and emotional abuse and of physical and emotional neglect,... Show moreIn this thesis we describe, combine and compare results of a series of meta-analyses on the prevalence of child sexual, physical, and emotional abuse and of physical and emotional neglect, including 244 publications and 577 prevalence rates for the various types of maltreatment. Child maltreatment research seems to be dominated by research on sexual abuse, by studies in developed parts of the world, and by research using self-report measures. The overall estimated prevalence rates for self-report studies were 127/1,000 for sexual abuse (76/1,000 among boys and 180/1,000 among girls), 226/1,000 for physical abuse, 363/1,000 for emotional abuse, 163/1,000 for physical neglect, and 184/1,000 for emotional neglect. The overall estimated prevalence rates for studies using informants were 4/1,000 for sexual abuse and 3/1,000 for physical and for emotional abuse. Design and sample characteristics partly explained variation of self-reported prevalence rates. We conclude that child maltreatment is a widespread, global phenomenon affecting the lives of millions of children all over the world, which is in sharp contrast with the United Nation’s Convention on the Rights of the Child. Show less
