Research questionAre age at last childbirth and number of children, as facets of female reproductive health, related to individual lifespan or familial longevity?DesignThis observational study... Show moreResearch questionAre age at last childbirth and number of children, as facets of female reproductive health, related to individual lifespan or familial longevity?DesignThis observational study included 10,255 female participants from a multigenerational historical cohort, the LINKing System for historical family reconstruction (LINKS), and 1258 female participants from 651 long-lived families in the Leiden Longevity Study (LLS). Age at last childbirth and number of children, as outcomes of reproductive success, were compared with individual and familial longevity using the LINKS dataset. In addition, the genetic predisposition in the form of a polygenic risk score (PRS) for age at menopause was studied in relation to familial longevity using the LLS dataset.ResultsFor each year increase in the age of the birth of the last child, a woman's lifespan increased by 0.06 years (22 days; P = 0.002). The yearly risk for having a last child was 9% lower in women who survived to the oldest 10% of their birth cohort (hazard ratio 0.91, 95% CI 0.86–0.95). Women who came from long-living families did not have a higher mean age of last childbirth. There was no significant association between familial longevity and genetic predisposition to age at menopause.ConclusionsFemale reproductive health associates with a longer lifespan. Familial longevity does not associate to extended reproductive health. Other factors in somatic maintenance that support a longer lifespan are likely to have an impact on reproductive health. Show less
Transgender care, especially regarding the care of children and adolescents, is a relatively new field, in which developments are rapid, in which there is still relatively little empirical data... Show moreTransgender care, especially regarding the care of children and adolescents, is a relatively new field, in which developments are rapid, in which there is still relatively little empirical data available on long-term outcomes of providing or refraining from early medical treatment, and which is a subject of polarized debate. This thesis describes the themes that lead to controversies surrounding the use of early medical treatment for transgender children and adolescents. For each theme, it describes how the considerations, ideas and newly obtained scientific data, when applicable, have changed and developed over the recent years. It shows that care for transgender children and adolescents inherently involves ethical dilemmas, even if more clinical research data will be provided to underpin the evidence-base. Evidence alone will likely not be able to provide answers to all raised uncertainties concerning adolescent gender-affirming medical care. Ethical dilemmas will therefore probably remain part of this sensitive field of care. Besides illumination of some of these ethical dilemmas, this thesis gives suggestions for future studies and proposes ways of dealing with them in clinical practice. Show less
Background Anti-cancer drugs commonly adversely affect fertility and sexual function. Despite this, patients report a lack of counselling of these potential adverse effects. The aim was to... Show moreBackground Anti-cancer drugs commonly adversely affect fertility and sexual function. Despite this, patients report a lack of counselling of these potential adverse effects. The aim was to determine Dutch oncologists' knowledge about the adverse effects of various cancer drugs on fertility and sexual function. Methods A cross-sectional survey was sent to members of the Dutch Society for Medical Oncology (n = 433). The survey questions included various cancer drugs' adverse effects on fertility, ovulation, spermatogenesis, and sexual function. Results One hundred and five of 392 oncologists responded (26.8%). Oncologists were more aware of the adverse effects on fertility compared to sexual function. Drugs that were mostly believed to negatively affect fertility were cisplatin (n = 81, 80.2%), epirubicin (n = 78, 78.0%) and cyclophosphamide (n = 80, 77.7%). Regarding sexual function, most mentioned drugs were tamoxifen (n = 67, 65.7%), GnRH-agonists (n = 64, 63.4%) and cisplatin (n = 58, 57.4%). Oncologists with expertise in urology possessed more awareness regarding sexuality-related adverse effects (cisplatin p = 0.038, etoposide p = 0.025, ifosfamide p = 0.06, vinblastine p = 0.000). Conclusion Results revealed that oncologists have different beliefs about possible sexual and fertility-related adverse effects concerning medication resources and literature. Based on our results, oncologists do not possess sufficient knowledge to inform patients about sexual and fertility-related adverse effects. Show less
Cancer diagnosis and treatment may influence reproductive planning and impact fertility in patients of reproductive age. Although guidelines have been established in the past decade, education,... Show moreCancer diagnosis and treatment may influence reproductive planning and impact fertility in patients of reproductive age. Although guidelines have been established in the past decade, education, practice, and attitudes of medical oncologists regarding fertility preservation remain undecided. A nationwide survey was performed among members of the Dutch Society for Medical Oncology. Demographics, practice, knowledge, and barriers were measured regarding information provision of fertility preservation towards cancer patients of childbearing age. From 392 members, 120 oncologists completed the questionnaire (30.6%). Majority of oncologists was convinced it is their responsibility to discuss impact of cancer treatment to fertility (93.2%), yet 68.3% discussed the subject often or always (n = 82). Oncologists employed in district general hospitals were less likely to discuss fertility (p = 0.033). On average, 44.6% of reproductive men and 28.9% of reproductive women is referred to fertility specialists. Half of the respondents declared to possess sufficient knowledge regarding fertility preservation (n = 57, 47.5%). Poor prognosis (53%), unlikely survival (43.1%), and high chances on fertility recovery (28.7%) were identified as barriers to discussing fertility preservation. Among oncologists, impact of cancer treatment on fertility is a well-accepted responsibility to counsel. Despite, self-reported knowledge regarding fertility preservation is strongly varying. In practice, fertility is discussed to some extent, influenced by several barriers and depending on prognosis and type of hospital. Patients benefit from knowledge improvement among oncology care providers concerning fertility effects of cancer treatment. Education during medical school, residency, and among practicing oncologists may raise awareness, together with enhancement of referral possibilities. Show less
Sexual health and fertility does not come naturally for men and women suffering chronic kidney disease (CKD); sexual dysfunction and fertility issues are common throughout all stages of disease,... Show moreSexual health and fertility does not come naturally for men and women suffering chronic kidney disease (CKD); sexual dysfunction and fertility issues are common throughout all stages of disease, including dialysis and transplantation. These issues, alongside with other side-effects of CKD, affect patients social and relation life as well. Besides, their partners often fulfill an important and supportive role during intensive treatments or a lingering sickbed. As a result, the disease and the accompanying burdens affect also their partners’ well-being on several levels.Since CKD patients and their partners face multiple challenges in the area of sexuality, fertility, and relationships one could assume awareness about these difficulties exist among their care providers. Unfortunately, this thesis shows that renal care providers do not routinely discuss sexuality with their patients, underlying reasons varied between the different renal care providers. Whereas the results imply that providing an opportunity to discuss sexuality during is preferred by patients and their partners, especially after renal transplantations.As for fertility, most nephrologists include this subject in their consultation. However nurses of the nephrology department could also play an important role in addressing this part of renal care, however, insufficient knowledge is a retaining factor for them. Show less
Cauda equina syndrome (CES) is most commonly caused by lumbar herniated disc; emergency decompressive surgery is essential to increase chances of recovery. Even though micturition, defecation and... Show moreCauda equina syndrome (CES) is most commonly caused by lumbar herniated disc; emergency decompressive surgery is essential to increase chances of recovery. Even though micturition, defecation and/or sexual function are by definition affected in CES patients, little is known about the outcome of these functions after surgical intervention. This thesis provides a comprehensive overview on presentation and on short- and long term outcome of CES after surgical intervention focused on micturition, defecation and sexual function, demonstrating high prevalences of dysfunction even at long term follow up. In addition, this thesis provides insight into attitude and practice patterns of neurosurgeons regarding discussing sexual health and fertility with spinal patients and explores the relationship between presenting MRI features and clinical features (both at outcome and at presentation). Show less
Neyer, G.; Thévenon, O.; Digoix, M.; Cortina, C.; Festy, P.; Waaldijk, C.; ... ; Hellgren, Z. 2017
This document summarizes the main findings from the research carried out in Workpackage 9, Policies and Diversity over the Life Course, within the FamiliesAndSocieties project. We present key... Show moreThis document summarizes the main findings from the research carried out in Workpackage 9, Policies and Diversity over the Life Course, within the FamiliesAndSocieties project. We present key results from our studies (1) on policies directed to young people at the transition to adulthood and self-sufficient living, (2) on preferences, usage, and consequences of parental-leave and fathers’ leave policies on family dynamics; (3) on the legal family formats for same-sex and/or different-sex couples in European countries, (4) on the emergence of private markets and issues of migration and care, and (5) on European Union family-policy initiatives. In our summary, we focus on policy-relevant findings and in particular on those of broader implications for policies, policy directions, and policy design in Europe at large. In concluding we summarize some of the core policy implications of our studies.See also www.familiesandsocieties.eu and www.lawsandfamilies.eu. Show less
Background Many African countries experience a protracted epidemiologic transition, different from the classical transition in western societies. The factors driving this protracted transition are... Show moreBackground Many African countries experience a protracted epidemiologic transition, different from the classical transition in western societies. The factors driving this protracted transition are largely unknown. In northeast Ghana, we studied an ongoing epidemiologic transition and investigated the effects of socioeconomic status and drinking water source on the transition. Methods During a 9-year period, we followed a cohort of almost 30 000 individuals and collected information on mortality and fertility rates. In addition, using the standards set out by the WHO, we obtained the causes of death by verbal autopsy. Individuals were stratified according to their socioeconomic status and the households' use of an improved or unimproved drinking water source. Results Mortality rates decreased by −5.0% annually (p<0.001) and the main cause of death shifted from infectious to non-infectious diseases (p=0.014). General fertility rates and child-women ratios decreased annually by −12.7% (p<0.001) and −11.9% (p<0.001), respectively. There was no difference in the decline of mortality and fertility depending on socioeconomic status or drinking water source. Show less
Op de lijst van potentiële 'hot topics' voor de komende EU-verkiezingen vinden we vergrijzing, economische malaise en de vraag met welke maatregelen Europa's lage geboortecijfers opgekrikt kunnen... Show moreOp de lijst van potentiële 'hot topics' voor de komende EU-verkiezingen vinden we vergrijzing, economische malaise en de vraag met welke maatregelen Europa's lage geboortecijfers opgekrikt kunnen worden. De problematiek van de nog verse 21ste eeuw. Maar die is niet zonder precedenten volgens oud-historici gespecialiseerd in de sociaal-economische en demografische geschiedenis van Romeins Italië. De laatste twee eeuwen voor Christus, toen Rome van een stadstaatje tot een wereldrijk werd, waren roerige tijden voor de burgers van Italië. Zij werden betrokken in oorlogen, waren getuige van grootscheepse politieke veranderingen en leefden met snel groeiende immigranten en slaven in een nog sneller verstedelijkende samenlevering, volop dynamiek, dus. Lang werd gedacht dat het bestaan van de 'oude kern' van Romeinen temidden van deze hectiek van meerdere kanten af werd uitgehold. Met, inderdaad, economische maliase en vergrijzing en ontvolking als gevolg. Deze dissertatie betoogt echter dat het allemaal wel meeviel. Terwijl burgers met in name de landbouwsector in de regio rond Rome getroffen werd, groeiden de kansen in andere sectoren van de Romeinse economie. Gunstige klimaatomstandigheden en de voordelen van imperialise verzachten de problematiek. De economische schade bleef, met andere woorden, beperkt. En die baby's dan? Hier speelden specifieke culturele en sociale omstandigheden een rol. Een 'mamacultuur'en het dorpsleven met familie en buren nabij, ondervingen een goed deel van de potentieel nagatieve gevolgen van armoede voor het Romeinse geboortecijfer. Deze en andere factoren doen vermoeden dat de periode zelfs, in tegenstelling tot wat eerder gedacht werd, ruimte liet voor bevolkingsgroei. Een gedachte die aansluiting vindtin een nieuwe interpretatie van de met raadsels omgeven volkstellingscijfers van Rome's eerste keizer, Augustus. Doemdenkers en pessimisten onder oudere generaties oud-historici lijken daarmee door de geschiedenis te worden ingehaald. Een geruststellend lichtpuntje anno 2009 Show less
A central paradigm in life-history theory is the trade-off between offspring number and quality. Several studies have investigated this trade-off in humans, but data are inconclusive, perhaps... Show moreA central paradigm in life-history theory is the trade-off between offspring number and quality. Several studies have investigated this trade-off in humans, but data are inconclusive, perhaps because prosperous socio-cultural factors mask the trade-off. Therefore, we studied 2461 offspring groups in an area under adverse conditions in northern Ghana with high fertility and mortality rates. In a linear mixed model controlling for differences in age and tribe of the mother and socioeconomic status, each additional child in the offspring group resulted in a 2.3% (95% CI 1.9–2.6%, P < 0.001) lower proportional survival of the offspring. Furthermore, we made use of the polygamous population structure and compared offspring of co-wives in 388 households, thus controlling for variation in resources between compounds. Here, offspring survival decreased 2.8% (95% CI 2.3–4.0%, P < 0.001) for each increase in offspring number. We interpret these data as an apparent quality–quantity trade-off in human offspring. Show less
There is accumulating evidence that the evolutionary trade-off between body maintenance and fertility is also present in humans. Several studies have shown this trade-off in historic data sets.... Show moreThere is accumulating evidence that the evolutionary trade-off between body maintenance and fertility is also present in humans. Several studies have shown this trade-off in historic data sets. Other studies found no evidence for the trade-off. This could, in part, be explained by the fact that the populations under study resided in a modern affluent environment characterized by low mortality and fertility rates, i.e. having past the epidemiologic transition. Lycett et al for instance demonstrated that the trade-off was stronger under conditions of poverty. Accordingly, it has been shown, that the trade-off disappeared in the British aristocracy when environmental conditions markedly improved after 1700 and initiated a demographic transition. Similar trends over time were found in other studies. The objective of this thesis was to test the hypothesis that fertility trades off with early survival in a contemporary population that is still exposed to adverse environmental conditions. Therefore all the studies were performed in the upper east region of Ghana, Africa. The results can be divided into two parts. Part A, Chapters 2, 3 and 4, describes the research population analyzes whether or not the epidemiologic transition has taken place. Part B, Chapters 5, 6 and 7, describes the actual testing of the hypothesis. Show less
Genetic factors play an important role in the regulation of human life span but the exact pathways remain to be elucidated, however they may be interrelated with the regulation of human... Show moreGenetic factors play an important role in the regulation of human life span but the exact pathways remain to be elucidated, however they may be interrelated with the regulation of human reproduction. It is argued that an innate cytokine profile supportive of Th1-type T cells favors survival of infectious diseases (with longevity as the ultimate), but women with this profile are found less likely to have successful pregnancies (progeny). The probability of a normal fertility was found to increase more than 10-fold when the innate cytokine profile was characterized by high IL-10 (Th-2 cytokine) and low TNF- (Th-1 cytokine) responsiveness. The IL10 –2849 AA genotype was found to be associated with a decreased fertility and fecundity (time to pregnancy) in females, possibly due to the lower expected IL10 responsiveness. Rheumatoid arthritis (RA) is an example of a Th-1 mediated disease. It was found that the phenotype of joint destruction in RA was associated with the phenotype of reported miscarriages, suggesting common genetic risk factors for each of these two traits, possibly through the innate Th-1/Th-2 phenotype. Factor V Leiden (FVL) is a point mutation in the factor V gene generating a 7-fold increase in incidence of deep vein thrombosis. Specific advantages of the FVL mutation in early pregnancy (implantation) might balance its potentially harmful effects later in life and explain the remarkably high prevalence of this mutation in the general population. Show less
This thesis contains the results of several studies on the long-term consequences of the myeloablative conditioning for haematopoietic stem cell transplantation (SCT) during infancy and childhood,... Show moreThis thesis contains the results of several studies on the long-term consequences of the myeloablative conditioning for haematopoietic stem cell transplantation (SCT) during infancy and childhood, with the emphasis on late effects on endocrine functions. After a general introduction, effects of total-body irradiation (TBI) on pituitary and thyroid glands in rhesus monkeys and effects of irradiation on growth plates in growing rats are discussed. After these experimental animal data, effects of different conditioning regimens for SCT in children on growth, pubertal development, thyroid function and quality of life are discussed in subsequent chapters, and results of growth hormone therapy in these patients are presented. All study results presented in the thesis and relevant data from the literature are integrated into a general discussion at the end of the thesis. Show less
