The aim of this thesis was to study the link between hearing loss, language skills, and social functioning in deaf and hard of hearing (DHH) children. Sufficient language skills are an... Show moreThe aim of this thesis was to study the link between hearing loss, language skills, and social functioning in deaf and hard of hearing (DHH) children. Sufficient language skills are an essential prerequisite to develop appropriate communication skills, in order to join in conversations with others. Both their hearing loss and their diminished communication skills prevent DHH children from learning by observing their surroundings (incidental learning). As a result, DHH children showed more difficulty in understanding others’ thoughts and wishes (Theory of Mind or ToM). DHH teenagers reported to have difficulties with understanding others’ emotions and showed lower levels of prosocial behavior. Higher communication skills, but not language skills, were related to better ToM development and higher empathic abilities. Second, the role of early identification and intervention of hearing loss on the social-emotional development of DHH children was studied. This was illustrated in a longitudinal study showing that early cochlear implantation resulted in higher language and communication skills. In turn, these improved skills prevented the development of early signs of psychopathology. To conclude, this thesis shows that in order to stimulate the social-emotional development of DHH children, their opportunities for incidental learning have to be increased. Show less
Palen, R.L.F. van der; Barker, A.J.; Bollache, E.; Garcia, J.; Rose, M.J.; Ooij, P. van; ... ; Rigsby, C.K. 2017
In haar proefschrift heeft Katinka Beker onderzoek gedaan naar de fundamentele leesprocessen die ten grondslag liggen aan leren van (meerdere) teksten. Uit een combinatie van literatuur- en... Show moreIn haar proefschrift heeft Katinka Beker onderzoek gedaan naar de fundamentele leesprocessen die ten grondslag liggen aan leren van (meerdere) teksten. Uit een combinatie van literatuur- en experimenteel onderzoek is gebleken dat het activeren van eerder gelezen informatie en achtergrondkennis tijdens het lezen belangrijk is bij het leren van teksten. Door een nieuw onderzoeksparadigma te gebruiken kon op een subtiele manier onderzocht worden of informatie uit eerder gelezen teksten of achtergrondkennis actief was tijdens het lezen van nieuwe teksten. Het paradigma kan in toekomstig onderzoek gebruikt worden om te onderzoeken onder welke omstandigheden informatie uit eerder gelezen teksten of achtergrondkennis geactiveerd wordt tijdens het lezen van nieuwe teksten. Het onderzoek is vooral fundamenteel van aard, maar bevat ook een aantal aanknopingspunten waarmee in toekomstig praktijkgericht onderzoek mogelijk een vertaalslag gemaakt kan worden voor de onderwijspraktijk. Zo lijken consolidatie- en verrijkingsprocessen belangrijk te zijn bij het leren van teksten. Show less
Westra, D.; Volokhina, E.B.; Molen, R.G. van der; Velden, T.J.A.M. van der; Jeronimus-Klaasen, A.; Goertz, J.; ... ; Kar, N.C.A.J. van de 2017
Prevalence of childhood obesity is increasing. Insulin resistance is a consequence of childhood obesity, and it has a keyrole in the development of cardiometabolic complications, such as... Show more Prevalence of childhood obesity is increasing. Insulin resistance is a consequence of childhood obesity, and it has a keyrole in the development of cardiometabolic complications, such as diabetes mellitus. In the first part of this thesis, the epidemiology of insulin resistance has been described. Since there is no clear definition for insulin resistance, the prevalence of IR remains unclear. In addition, the use of IR in the screening for diabetes mellitus in obese children was evaluated. In the second part of the thesis, treatment of obese children with insulin resistance is discussed. In a randomized controlled trial of 18 months, children were treated with either metformin or placebo in addition to lifestyle intervention. Body mass index in children treated with metformin remained stable during the 18 months, whereas placebo-treated children had an increase in body mass index. Finally, the treatment with metformin under the strict circumstances of the clinical trial was compared to treatment with metformin in daily practice during 18 months. Both groups showed similar results regarding body mass index during metformin treatment. Show less
Coeliac disease (CD) is an immune-mediated systemic disorder elicited by gluten in genetically susceptible individuals. The aim of this thesis was to investigate the influence of infant feeding on... Show moreCoeliac disease (CD) is an immune-mediated systemic disorder elicited by gluten in genetically susceptible individuals. The aim of this thesis was to investigate the influence of infant feeding on prevention and development of childhood CD (part 1) and to explore new strategies for improvement of care for CD children and young adults (part 2). In part 1, the European multi-centre randomized double-blind placebo-controlled dietary intervention-study in high-risk children (www.preventcd.com) is presented. Based on retrospective studies suggesting a ‘window of opportunity’ for primary prevention of CD, parents were advised to introduce gluten between 4–6 months of age. Our results show that this did not reduce the risk of CD by 3 years of age and contributed to a new European guideline stating that gluten may be introduced between age 4-12 months. Part 2 shows that physicians overestimate the CD specific health-related quality-of-life (HRQOL) of CD patients, supporting implementation of self-reported CD-specific HRQOL measurements during follow-up. Compared to traditional hospital visits for treated CD, E-health was cost-saving, satisfactory, and significantly improved the CD-specific HRQOL. As E-health requires a point-of-care test suitable for follow-up of treated CD, three different tests were compared with conventional ELISA and one was found to be suitable. Show less
Increasingly, pleas are made for extending the involvement of minors in decision-making about participation in pediatric research. However, a number of issues arise from this desired... Show more Increasingly, pleas are made for extending the involvement of minors in decision-making about participation in pediatric research. However, a number of issues arise from this desired participation of minors. First, involvement in decision-making requires children and adolescents to be adequately informed about what participation in research entails. Second, the plea for increased involvement in decision-making requires further investigation whether children indeed can, should and want to play a role in the decision about research participation. This thesis addresses these issues and thereby contributes to insights in how to empower minors in the context of informed consent for research participation. New informed consent material was developed in close cooperation with children and other end-users, the process of which is described and evaluated. Also, insights in the role that minors can, should and want to play in the informed consent procedure are described. These insights were obtained by reviewing multidisciplinary scientific evidence on the competence of minors, by an ethical reflection on the view on children that we should adopt, and by consulting minors themselves about the perspectives on their role in decision-making. Finally, based on this research, recommendations are provided on how to empower minors in decision-making about research participation. Show less
When trying to understand texts, readers engage in various cognitive processes. If all goes well, the engagement in these cognitive processes during reading results in the construction of a... Show moreWhen trying to understand texts, readers engage in various cognitive processes. If all goes well, the engagement in these cognitive processes during reading results in the construction of a coherent mental representation of the text, the essence of successful reading comprehension. To construct such a representation, readers need to monitor the coherence of the text and of their emerging mental representation of what the text is about. The central aim of the empirical studies described is to examine coherence-monitoring processes across development by measuring reader’s ability to detect coherence breaks during reading of narratives. The first part of this dissertation consists of three empirical studies (chapter 2-4). The first study examined whether good and poor comprehenders at age 8-9 and 10-11 detected coherence-breaks during and/or after reading. The second study builds on the first study by examining the protracted development of coherence monitoring in an adolescent population (ages 10-22) using the same task under more challenging circumstances. The third study explored the neural correlates of coherence-break detection in young adults in an fMRI study. The second part of this dissertation consists of two conceptual chapters in which the results are summarized and discussed in a broader theoretical perspective (chapter 5-6). Show less
Special populations are groups of patients that may respond differently to drug treatment due to a variety of factors, such as age or disease. Therefore, in drug development dedicated clinical... Show moreSpecial populations are groups of patients that may respond differently to drug treatment due to a variety of factors, such as age or disease. Therefore, in drug development dedicated clinical studies are often required to determine the optimal dose for these (vulnerable) patient groups. Such studies are complicated by ethical and practical barriers that can hinder the objective of the study when not well designed. To optimise the design of such studies, the application of model-based approaches is essential. In this thesis, we aimed to develop a semi-physiological framework that constitutes a scientific basis for optimisation of study designs in special populations. First, we examined the accuracy of existing approaches in paediatric patients. For the "allometric scaling plus maturation function" approach, the accuracy was shown low especially in young children. An alternative approach was found in the physiological well-stirred-model of hepatic clearance. On this basis, the semi-physiological PK models were developed by interfacing descriptive compartmental pharmacokinetic models with the well-stirred-model of hepatic clearance, and a mechanistic description of plasma-protein binding. The performance of these models was evaluated using two paradigm-drugs (solifenacin and tamsulosin) and was shown successful for the prediction of the pharmacokinetics in paediatric, hepatic-impaired and renal-impaired patients. Show less
