Childhood obesity is an increasing health issue. In the first part of this thesis comorbidities in children with obesity were studied, concerning the diagnostic process and dosing regimens. In... Show moreChildhood obesity is an increasing health issue. In the first part of this thesis comorbidities in children with obesity were studied, concerning the diagnostic process and dosing regimens. In children with obesity and respiratory symptoms the diagnosis of asthma was studied and in children with ADHD dosing regimens. Overtreatment as a consequence of overdiagnosis was frequently observed in children with obesity and asthma and undertreatment due to relative underdosing in the ADHD population with obesity. This highlights the necessity for accurate diagnostic processes alongside dosing regimens based on pharmacokinetic changes caused by obesity. The focus in the second part of this thesis was on screening for complications of obesity namely insulin resistance and cardiovascular diseases. Given the high prevalence of insulin resistance and the observed changes of cardiovascular parameters, screening on cardiometabolic complications is warranted in all children with obesity. Pharmacological treatment with metformin in addition to lifestyle intervention was studied in the last part of this thesis. Given the favorable effect on BMI in children and adults and the maintenance of weight loss and reduction in progression towards T2DM in adults, metformin can be considered in children with obesity and insulin resistance in addition to lifestyle intervention. Show less
Backer, J.A.; M. van boven; Hoek, W. van der; Wallinga, J. 2019
De overheid mag kinderen onder voorwaarden van hun vrijheid beroven met als doel ze op te voeden en te beschermen. In de Nederlandse context wordt deze vorm van vrijheidsberoving ‘gesloten... Show moreDe overheid mag kinderen onder voorwaarden van hun vrijheid beroven met als doel ze op te voeden en te beschermen. In de Nederlandse context wordt deze vorm van vrijheidsberoving ‘gesloten jeugdhulp’ genoemd, geregeld in de Jeugdwet. Met dit onderzoek is beoogd om een kinder- en mensenrechtentoetsingskader op te stellen, waaraan de Nederlandse wet en de toepassing getoetst wordt. Tevens biedt het onderzoek inzicht in 200 jaar historie.Verder zijn 586 rechterlijke uitspraken over een periode van 10 jaar (2008-2017) geanalyseerd. Hieruit blijkt dat een plaatsing vaak gebaseerd is op het inzetten van acute hulp in een situatie waar in niets anders mogelijk lijkt te zijn. Doorgaans wordt daarbij onvoldoende gekeken naar het doel van deze plaatsing en de vrijheidsbeperkingen die dit met zich meebrengt.In dit onderzoek komen ten slotte 23 kinderen aan het woord die te maken kregen met een gesloten uithuisplaatsing. Uit het onderzoek blijkt dat de legitimiteit van het op grote schaal toepassen van deze maatregel onder druk staat, met name omdat het nogal eens ontbreekt aan passende zorg. Verschillende aanbevelingen worden gedaan om de legitimiteit te verbeteren, onder meer door middel van verdieping van het juridische toetsingskader, verkorting van de maximale duur van een plaatsing. Show less
International Commercial Surrogacy (ICS) has emerged over the past decade as a modern method of family formation. ICS is unregulated internationally and domestic laws are struggling to keep pace... Show moreInternational Commercial Surrogacy (ICS) has emerged over the past decade as a modern method of family formation. ICS is unregulated internationally and domestic laws are struggling to keep pace with ICS. However, a child is at the centre of every ICS arrangement, and children conceived and born through ICS are at a heightened risk of their rights being infringed.Written over the course of time when ICS has rapidly developed, this book explores why and how the child's rights are at risk in ICS, and seeks to apply the standards and norms of the United Nations Convention on the Rights of the Child to the ICS context. This book proposes approaches for balancing the competing rights and interests of the child and other parties in ICS. It presents a framework for protecting the rights of children born through ICS, illustrating that this is achievable in practice, in the absence of international consensus on ICS as a phenomenon.This book is relevant for child rights practitioners and academics, and useful for policy-makers, legislators and national and international decision-makers grappling with the children’s and human rights issues presented by this 21st century human rights challenge. Show less
Objective: To evaluate the clinically relevant abnormalities as visualized on CT and MR imaging in children with symmetric and asymmetric bilateral sensorineural hearing loss (SNHL), in relation to... Show moreObjective: To evaluate the clinically relevant abnormalities as visualized on CT and MR imaging in children with symmetric and asymmetric bilateral sensorineural hearing loss (SNHL), in relation to age and the severity of hearing loss.Study design: Retrospective cohort study.Setting: Tertiary referral otology and audiology center.Patients and diagnostic interventions: From January 2006 until January 2016, a total of 207 children diagnosed with symmetric and asymmetric bilateral SNHL were included. They underwent CT and/or MR imaging for the evaluation of the etiology of their hearing loss.Main outcome measures: Radiologic abnormalities associated with SNHL.Results: 302 scans were performed in 207 children (median age of 0.8 years old) with bilateral SNHL. The most frequently identified cause of bilateral SNHL was a malformation of the labyrinth. The combined diagnostic yield of CT and MR imaging was 32%. The diagnostic yield of MR (34%) was considerably higher than that of CT (20%). We found a higher rate of abnormalities in children with profound hearing loss (41%) compared to milder hearing loss (8-29%), and in asymmetric SNHL (52%) compared to symmetric SNHL (30%).Conclusion: Imaging is essential in the etiologic evaluation of children with bilateral SNHL. The highest diagnostic yield is found in children with bilateral asymmetric SNHL or profound SNHL. Based on our findings, MR is the primary imaging modality of choice in the etiological evaluation of children with bilateral SNHL because of its high diagnostic yield. Show less
Sleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep... Show moreSleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep problems are directed at underlying mechanisms. We evaluated the association of sleep problems and sleep patterns with sleep hygiene (behavioral/environmental practices that influence sleep quality, e.g. caffeine use), access to electronic media, chronotype, and anxiety/depression in children aged 6–12 years with ADHD, ASD, or typical development (TD) using parental questionnaires. ANOVA and linear regression analyses were adjusted for age and sex. Children with ADHD and ASD showed more sleep problems (63.6 and 64.7%, vs 25.1% in TD) and shorter sleep duration than controls, while differences between ADHD and ASD were not significant. Sleep hygiene was worse in ADHD and ASD compared to TD, however, the association of worse sleep hygiene with more sleep problems was only significant in ASD and TD. There was a significant association of access to electronic media with sleep problems only in typically developing controls. Chronotype did not differ significantly between groups, but evening types were associated with sleep problems in ADHD and TD. Associations of greater anxiety/depression with more sleep problems were shown in ADHD and TD; however, anxiety/depression did not moderate the effects of chronotype and sleep hygiene. We conclude that sleep problems are highly prevalent in ADHD and ASD, but are differentially related to chronotype and sleep hygiene. In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in TD both factors are important. Clinical implications are discussed. Show less
We studied a novel triage approach to the organisation of routine assessments by Preventive Child Health care (PCH), including task-shifting among professionals. In the triage approach, access to... Show moreWe studied a novel triage approach to the organisation of routine assessments by Preventive Child Health care (PCH), including task-shifting among professionals. In the triage approach, access to PCH, and the detection of the health problems studied, were comparable with the usual approach. The efficient deployment of PCH professionals using triage and task-shifting reduced the costs and involvement of PCH physicians and nurses in routine assessments, particularly in the youngest age group (5 to 6 years). The associated release of workforce and budgets may create more opportunities for the delivery of care to children and their families with specific health-care needs. In our study, in the triage approach PCH physicians and nurses provided more demand-driven care at the request of parents and others such as school professionals. We have emphasised the importance of making the PCH programme more flexible to create time for PCH professionals to collaborate with professionals from the school system, and from the youth care and primary care systems, with the aim of improving joint commitment to early detection, and the delivery of more coordinated care. More research is needed into the outcomes of referral to extra care and into the cost benefits of the triage approach. Show less
