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Physical exercise has many health benefits, equally so for people with diabetes mellitus. The glycaemic responses to the various types of exercise differ and include an increased risk of late (nocturnal) hypoglycaemia, making physical exercise a challenge for some people with diabetes who are treated with insulin. Insulin treatment interferes with normal physiologic responses to exercise, which are necessary to maintain the blood glucose level within the normal range. During aerobic exercise, the blood glucose concentration usually drops, whereas anaerobic exercise generally causes a rise in glycaemia in people with diabetes using insulin. In people with insulin treated diabetes, a combination of frequent (continuous) blood glucose monitoring, adjustments in insulin dose and ingestion of carbohydrates ensures a safe management of glycaemia during and after physical activity.

In deze bijdrage staat het civiel effect van de Taxonomie- en Transparantieverordening (SFDR) centraal. Na een weergave van de opkomende trend van duurzaam beleggen en de risico’s daarvan bespreken wij de relevante Europese duurzaamheidsregelgeving. Vervolgens gaan wij in op de kernvraag of een gedupeerde belegger een vordering tot schadevergoeding kan instellen bij het door een financiële instelling schenden van de Taxonomie- en/of Transparantieverordening. Wij bespreken in dit verband de verhouding tussen het Europees financieel toezichtrecht en het nationaal privaatrecht aan de hand van twee modellen van zorgplichten, het subordination model en het complementarity model. Wij sluiten onze bijdrage af met een toepassing van deze modellen op de Taxonomie- en Transparantieverordening.

BACKGROUND Checkpoint inhibitors are relatively new anti-cancer medicines that activate tumour cell immunity. CASE DESCRIPTION We describe two patients who presented to the emergency department due to severe ketoacidosis, this being the first symptom of diabetes in said patients. A few weeks prior to this, they each commenced treatment with the checkpoint inhibitor pembrolizumab. HbA1c level, assessed in one of the patients, was not elevated upon presentation. CONCLUSION Type 1 diabetes mellitus is a rare, but potentially life-threatening, complication of treatment with checkpoint inhibitors. However, routine measurement of glucose or HbA1c levels is not useful in patients who are treated with checkpoint inhibitors. Both patients and healthcare professionals should be (made) aware of the symptoms of hyperglycaemia, thereby ensuring immediate treatment with insulin in order to prevent severe ketoacidosis.

The number of patients with diabetes who are receiving insulin therapy is increasing, and as a consequence the burden of insulin-related hypoglycaemia is increasing proportionally. In a recent paper, it was calculated that almost 100,000 patients visit the emergency department (ED) of American hospitals each year for insulin-related hypoglycaemia. Patients aged ≥ 80 years were twice as likely to visit the ED as younger patients. There are a number of possible reasons for this high risk, including: greater risk of direct or indirect injury arising from hypoglycaemia; higher prevalence of cognitive dysfunction; and age-induced loss of appetite, also referred to as anorexia of aging. The author proposes a de-escalating treatment strategy away from basal-bolus insulin regimens in frail elderly patients, combined with specific patient education focused on prevention of hypoglycaemia. Finally, all healthcare providers should be made aware of frequently occurring precipitating factors for hypoglycaemia, so that they can take timely precautionary action.

Hormoonverstoorders of Endocrine Disrupting Compounds (EDCs) zijn lichaamsvreemde stoffen die in staat zijn het endocrien systeem van mensen of dieren te ontregelen. Lage dosissen van deze stoffen kunnen op termijn zorgen voor een grotere kans op obesitas, diabetes, verminderde vruchtbaarheid, prostaat- en borstkanker. Kinderen vormen de meest kwetsbare groep voor hormoonverstoring en onderzoek toonde reeds aan dat voor deze doelgroep het binnenhuisstof één van de belangrijkste bronnen vormt van EDCs. Kleuterklassen hebben veel in kunststof vervaardigd speelgoed, dat hormoonverstoorders zoals weekmakers en vlamvertragers bevat. Deze niet chemisch gebonden moleculen kunnen na verloop van tijd vrijkomen en verzamelen in het binnenhuisstof. De hormoonverstoorders omvatten zeer veel moleculen die, indien men ze elk apart zou willen bepalen, veel tijd en geld voor analyse vragen. Daarnaast zijn er nog veel hormoonverstoorders niet gekend, die men bijgevolg ook niet kan bepalen en opnemen in een risicoanalyse. Er is dus duidelijk nood aan een andere aanpak. De receptor-gebaseerde techniek, gebruikt in deze studie, is een bio-analytische methode die een globaal beeld geeft van de hormoonverstorende activiteit van een staal. Zo kan men onbekende EDCs meenemen in de analyse en rekening houden met het effect dat EDCs op elkaar kunnen hebben wanneer ze samen aanwezig zijn. De stofstalen uit kleuterklassen worden onderling vergeleken, waarbij men de hormoonverstorende activiteit probeert te koppelen aan het interieur van de klas. Mogelijke aanbevelingen ter preventie van deze hormoonverstoorders en voorstellen voor toekomstig onderzoek sluiten dit project af.

Good glycaemic control of diabetes mellitus is still hampered by the fear of insulin injections. Particularly in patients with type 2 diabetes, inhaled insulin as a novel therapeutic option for glycaemic control could be an alternative to subcutaneous insulin. Phase III clinical studies have shown glycaemic equivalence between inhaled insulin and conventional subcutaneous insulin. However, no study comparing inhaled insulin with short-acting insulin analogues has yet been published. Thus, methodological problems preclude conclusive remarks concerning quality-of-life issues. Inhaled insulin should be reserved for selected patient groups only. Lengthier studies to evaluate the long-term (pulmonary) safety of inhaled insulin and a cost-effectiveness study are needed.

To establish the distribution of perinatal mortality over the various levels of obstetrical care, taking into account the various causes of perinatal mortality.Prospective, descriptive.Data were collected on all parturitions of women living in the region Delft-Westland-Oostland (DWO), the Netherlands, during the period 1983-1992, regardless of the ultimate setting of the parturition. A prospective regional registration system for perinatal mortality in the region was matched with the registration by the Central Statistics Office (CBS). With anonymous linking, duplicatures could be excluded. The causes of death were assessed by a gynaecologist, a paediatrician and a child pathologist. It was determined for all cases of perinatal mortality whether the antenatal care had been under the final responsibility of a midwife or a general practitioner (primary care), either at home or in the outpatient clinic, or under the final responsibility of a gynaecologist (secondary care).In the decade studied, 28,983 children were born in the DWO region; 51% under primary care management. The actual perinatal mortality of the region was calculated as amounting to at least 247 cases (0.85%). In 26% (n = 64) of these, the childbirth was managed under primary care responsibility, in 43% (n = 106) after risk selection from primary to secondary care, in 14% (n = 34) under the exclusive responsibility of secondary care and in 17% (n = 43) after risk selection from secondary to tertiary care. The most frequent causes of death were progressive placental insufficiency and lethal congenital anomalies.The results show that further decrease of perinatal mortality may be achieved by risk selection (in primary care) with regard to lethal congenital anomalies and acute or progressive placental abnormalities. The perinatal mortality is so low (0.85%) that further medicalization of childbirth may be expected to contribute only little to a further decrease of the perinatal mortality figures.

To determine the reliability of the Dutch registration of causes of perinatal death by the Centraal Bureau voor de Statistiek (CBS, Central Statistics Office).Prospective, descriptive.Region Delft-Westland-Oostland, the Netherlands.The registration was based on data concerning all deliveries of women domiciled in the region, irrespective of the ultimate place of delivery, during 1983-1992. By linking, in retrospect, a prospective regional registration system for perinatal mortality within the region anonymously to the CBS registration, the reliability of the latter registration with regard to the causes of death was determined. To establish the causes of death, all available data were judged by a team consisting of a gynaecologist, a paediatrician and a paediatric pathologist. The diagnoses were classified with the aid of the International Classification of Diseases 9 (ICD-9).In 10 years, 28983 children were born in the region. Over this period, the CBS recorded 227 cases of perinatal mortality. The actual perinatal mortality was calculated as at least 247 cases. In 32% of the cases of stillbirth, the cause of death was not known at the CBS. Of the 82 cases in which the CBS had recorded a diagnosis, the causes of death were in agreement with those found in the regional study in 46%. Of the first-week mortality, the diagnosis was unknown at the CBS in one case and of the remaining 76 cases, the registration of the cause of death was the same in 68% of the cases.Registration of the causes of death regarding perinatal mortality and particularly stillbirth by the CBS shows gaps, mostly due to incorrect reporting of the cause of death by the treating physician or autopsist, due to the fact that at the time of notification the morbid-anatomical diagnosis and/or laboratory data were not complete. For the study of the backgrounds of perinatal mortality the current CBS registration of causes of death appears unsuitable.

Al spoedig na de start van streekverbeteringswerk in de Zak van Zuid-Beveland in 1957 bleek de medewerking van de bevolking niet aan de verwachtingen te beantwoorden. Het vermoeden ontstond dat een aantal sociale factoren in het gebied en wellicht in het algemeen de mentaliteit van zijn bevolking, het bereiken van de doelstellingen van de streekverbetering in de weg stonden. Bovendien ontbrak het aan inzicht omtrent de taken en de methode van de agrarisch-sociale voorlichting en aan een aantal gegevens op huishoudelijk gebied. Ter oplossing van deze moeilijkheden werd aan de afdeling Streekonderzoek van het Landbouw-Economisch Instituut gevraagd naar de genoemde punten een onderzoek in te stellen. Met dit onderzoek werd ultimo 1957 een aanvang gemaakt; het rapport, dat de resultaten van het onderzoek weergeeft, kwam in mei 1959 gereed. In het rapport is een uitvoerige beschrijving gegeven van het betrokken streekverbeteringsgebied en de samenleving daarbinnen; een min of meer hypothetische analyse wordt gegeven van de oorzaken van het aanvankelijk geringe succes van de streekverbetering; ten slotte is een uitgebreide lijst van richtlijnen, met name voor de agrarisch- sociale voorlichting, opgenomen. Mede omdat het een eerste onderzoek in zijn soort betreft, leek het gewenst aan de resultaten ervan wat ruimere bekendheid te geven. Dat gebeurt in deze artikelen.

The study consists of three parts. The first two chart developments in economic analysis of individual labour supply and that of fertility respectively. This is intended in the first place to lay the foundations for an adequate theoretical and empirical analysis in the areas concerned. In the second place the intention is to obtain more insight into the way in which the development of theories takes place within the neo-classical research progranme. The third and final part reports on the results of three empirical analyses carried out on data obtained in the Netherlands. ... Zie: Summary