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In hoeverre kampen slachtoffers van recent seksueel geweld vaker met psychische, lichamelijke, sociale, financiële, juridische en religieuze problemen, dan een vergelijkbare groep volwassenen die niet recent zijn getroffen door seksueel geweld? In hoeverre zijn zij vaker getroffen door andere ingrijpende gebeurtenissen, zoals ernstige bedreigingen, diefstal, ongevallen en het verlies van dierbaren? In deze studie worden deze vragen beantwoord op basis van vier surveys van de Victims in Modern Society (VICTIMS)-studie, uitgevoerd met het Longitudinal Internet studies for the Social Sciences (LISS) panel. Dit panel is gebaseerd op een omvangrijke steekproef onder de Nederlandse bevolking door het Centraal Bureau voor de Statistiek (CBS). De groep niet-slachtoffers is gematcht op basis van 64 unieke demografische profielen. De resultaten tonen dat volwassenen die in de afgelopen 12 maanden slachtoffer zijn geworden van seksueel geweld significant vaker dan niet-slachtoffers kampen met 1) algemene psychische klachten, matig en ernstige angst- en depressieve klachten, 2) lichamelijke problemen, 3) een gebrek aan emotionele steun en luisterend oor, 4) financiële problemen, 5) juridische problemen en 6) religieuze problemen. Slachtoffers zijn in de afgelopen 12 maanden ook vaker getroffen door een of meerdere andere ingrijpende gebeurtenissen, zoals een serieuze bedreiging, diefstal, een ongeval of het verlies van dierbaren. Wanneer rekening wordt gehouden met de negatieve effecten van deze andere ingrijpende gebeurtenissen, blijken slachtoffers van recent seksueel geweld nog altijd vaker met de eerdergenoemde problemen te kampen. Wanneer slachtoffers professionele hulp nodig hebben, is het daarom van groot belang de diversiteit aan mogelijke problemen te inventariseren en niet alleen te focussen op alleen de mentale of lichamelijke gezondheid.

There have been concerns about the negative effects of general anaesthesia in elderly hip fracture patients. For full informed consent, data from carefully designed clinical trials with functional outcome measures in older patients are essential. The development and implementation of such knowledge can be improved by using standardized functional outcomes in perioperative research.

Vrouwen werden in het verleden vaak uitgesloten van deelname aan klinische geneesmiddelenstudies. Gaandeweg is de aandacht voor vrouwen in deze studies toegenomen. Dit heeft geleid tot veranderingen in beleid. Tegenwoordig wordt in richtlijnen aangegeven dat een onderzoekspopulatie representatief moet zijn voor de beoogde gebruiker van het geneesmiddel, wat betreft leeftijd, geslacht en andere belangrijke kenmerken. Ook moeten subgroepanalyses naar onder andere geslacht uitgevoerd worden. Uit recent onderzoek blijkt dan ook dat er aandacht is voor vrouwen in geneesmiddelenstudies; zo is geslachtsspecifieke informatie beschikbaar over farmacokinetiek, effectiviteit en veiligheid van de onderzochte geneesmiddelen. Toch is er ruimte voor verbetering, onder andere op het gebied van de vertegenwoordiging van vrouwen in bepaalde ziektegebieden. Bij de beoordeling van geneesmiddelen wordt gekeken naar mogelijke effectverschillen tussen mannen en vrouwen. Meestal worden er geen klinisch relevante verschillen gevonden. Wanneer dit wel zo is, worden geslachtsspecifieke behandeladviezen opgesteld. Het is belangrijk dergelijke geslachtsverschillen in behandeladviezen in de praktijk op te volgen en waar mogelijk nog niet bekende verschillen te signaleren om te komen tot een optimale behandeling van elke individuele patiënt.

To systematically collect clinical data from patients with a proven COVID-19 infection in the Netherlands.Data from 2579 patients with COVID-19 admitted to 10 Dutch centers in the period February to July 2020 are described. The clinical data are based on the WHO COVID case record form (CRF) and supplemented with patient characteristics of which recently an association disease severity has been reported.Survival analyses were performed as primary statistical analysis. These Kaplan-Meier curves for time to (early) death (3 weeks) have been determined for pre-morbid patient characteristics and clinical, radiological and laboratory data at hospital admission.Total in-hospital mortality after 3 weeks was 22.2% (95% CI: 20.7% - 23.9%), hospital mortality within 21 days was significantly higher for elderly patients (70 years; 35, 0% (95% CI: 32.4% - 37.8%) and patients who died during the 21 days and were admitted to the intensive care (36.5% (95% CI: 32.1% - 41.3%)). Apart from that, in this Dutch population we also see a risk of early death in patients with co-morbidities (such as chronic neurological, nephrological and cardiac disorders and hypertension), and in patients with more home medication and / or with increased urea and creatinine levels.Early death due to a COVID-19 infection in the Netherlands appears to be associated with demographic variables (e.g. age), comorbidity (e.g. cardiovascular disease) but also disease char-acteristics at admission.

OBJECTIVE: To systematically collect clinical data from patients with a proven COVID-19 infection in the Netherlands. DESIGN: Data from 2579 patients with COVID-19 admitted to 10 Dutch centers in the period February to July 2020 are described. The clinical data are based on the WHO COVID case record form (CRF) and supplemented with patient characteristics of which recently an association disease severity has been reported. METHODS: Survival analyses were performed as primary statistical analysis. These Kaplan-Meier curves for time to (early) death (3 weeks) have been determined for pre-morbid patient characteristics and clinical, radiological and laboratory data at hospital admission. RESULTS: Total in-hospital mortality after 3 weeks was 22.2% (95% CI: 20.7% - 23.9%), hospital mortality within 21 days was significantly higher for elderly patients (> 70 years; 35, 0% (95% CI: 32.4% - 37.8%) and patients who died during the 21 days and were admitted to the intensive care (36.5% (95% CI: 32.1% - 41.3%)). Apart from that, in this Dutch population we also see a risk of early death in patients with co-morbidities (such as chronic neurological, nephrological and cardiac disorders and hypertension), and in patients with more home medication and / or with increased urea and creatinine levels. CONCLUSION: Early death due to a COVID-19 infection in the Netherlands appears to be associated with demographic variables (e.g. age), comorbidity (e.g. cardiovascular disease) but also disease char-acteristics at admission.

It is important for healthcare professionals and pregnant women to have knowledge of the risks of using medicines during pregnancy and lactation. This not only concerns the influence of the medicinal product on the pregnant woman and the pregnancy, but also its impact on the growth and development of the (unborn) child, neonatal adaptation, possible precautions regarding child-birth, drug excretion in breast milk, and the short-term and long-term consequences for the newborn child. At present, information and advices are often fragmentary, sometimes contradictory, not easily accessible, or even not available at all. It is high time for one independent source to provide unambiguous, scientifically substantiated information and advice, accessible to both healthcare professionals and pregnant women - preferably in a digital format.

De recent geregistreerde PCSK9-remmers evolocumab en alirocumab behoren tot een nieuwe klasse van cholesterolverlagers. Ze zijn geregistreerd voor de behandeling van familiaire en niet-familiaire hypercholesterolemie en van gemengde dyslipidemie, maar ze zijn nu – in afwachting van cardiovasculaire uitkomststudies – vooral geschikt voor hoogrisicopatiënten.

BACKGROUND: Barbiturate intoxication is potentially lethal. With the availability of the newer anticonvulsants the use of barbiturates in treating epilepsy has decreased significantly, with a concurrent decrease in the incidence of overdose with these medications. There have, however, been recent alarm signals from governmental sources concerning the increase in the Internet purchase of illegal medications, including barbiturates, for use in attempted suicide. CASE DESCRIPTION: Here we describe two patient cases involving barbiturate intoxication with amobarbital and thiopental, respectively. They had both obtained the barbiturates via the Internet. Both patients were comatose and showed signs of respiratory depression; one of them was also haemodynamically unstable. Both patients recovered fully following intensive supportive therapy. CONCLUSION: In patients with coma, respiratory depression, absence of brainstem reflexes and shock with no evident cause one should be aware of the possibility of barbiturate intoxication, even when there is no indication that these have been prescribed or that the patient has direct or indirect access to barbiturates. Prompt, optimal supportive therapy will give a good chance of full somatic recovery.

To examine the effects of the mass shooting in the city of Alphen aan den Rijn, the Netherlands, on 9 April 2011 on the health and healthcare utilisation of those affected, compared with a reference group of neighbouring residents.Observational longitudinal study.Those affected by the shooting incident and a reference group of neighbouring residents were identified using patient and health care data from various care providers (Dutch Victim Support (SHN), Dutch Association of Mental Health and Addiction Care, social work), in which the request for assistance was documented. The health and healthcare process of 161 affected persons and 115 local residents in the year before and the year after the mass shooting could be followed with data extracted from the electronic medical records of general practices. The effects of the mass shooting on health and healthcare utilisation were analysed with logistic and Poisson multilevel regression analyses for repeated measurements.After the mass shooting, the prevalence of psychological and social problems presented to the GP increased for affected persons (OR: 2.99; 95% CI: 1.75-5.12) compared with the year before the shooting incident, and differed from the reference group (OR: 2.68; 95% CI: 0.93-7.72). In particular, there was a sharp increase in the prevalence of anxiety and stress reactions (OR: 4.07; 95% CI: 1.86-8.92) and the prescription of hypnotics and sedatives (OR: 2.32; 95% CI: 1.08-4.98) and benzodiazepines (OR: 187; 95% CI: 1.07-3.26). However, these problems declined significantly after the first quarter. A small group of people was treated by mental health care for a post-traumatic stress disorder while half of those affected had registered with SHN.For a limited period of time, the mass shooting had a negative impact on the psychological well-being and healthcare utilisation of those affected.

Recent European legislation has provided new tools to enhance the overseeing of medicinal products in the postmarketing phase. Package leaflets of newly approved medicines contain a black inverted triangle as a signal for enhanced monitoring. The leaflets also have clear instructions on how to report possible adverse drug reactions. Databases of drug reactions are accessible by the public. The most important change is the establishment of the Pharmacovigilance Risk Assessment Committee (PRAC) within the European Medicines Agency (EMA). This Committee will review safety signals of medicinal products arising in the member states of the European Union. The Committee could recommend adaptation of the package leaflet, or suspension or revocation of the marketing authorisation. The PRAC is also involved in the assessment of risk management plans for medicinal products and post-authorisation efficacy and safety studies.

In deze studie wordt het stadsdeel Oost van Amsterdam onderzocht op de stand van zaken en mogelijkheden van waardecreatie en de wijze waarop dat wordt gefaciliteerd door de fysiek ruimtelijke kenmerken van dat stadsdeel in relatie tot andere delen. Amsterdam Oost is een stadsdeel van de stad Amsterdam dat vanaf 1875 stukje bij beetje is ontstaan en een stadsdeel van Amsterdam is geworden. Het begon in eerste instantie met de Oosterparkbuurt en de Dapperbuurt. Vanaf 1900 zijn de Transvaalbuurt en de Indische Buurt geplant en ontstaan. Watergraafsmeer is er later 1920) bijgekomen. In 2002 is IJburg begonnen met de aanleg en bouw. IJburg wordt ook wel aangeduid als "Nieuw Oost".

Recent European legislation has provided new tools to enhance the overseeing of medicinal products in the postmarketing phase. Package leaflets of newly approved medicines contain a black inverted triangle as a signal for enhanced monitoring. The leaflets also have clear instructions on how to report possible adverse drug reactions. Databases of drug reactions are accessible by the public. The most important change is the establishment of the Pharmacovigilance Risk Assessment Committee (PRAC) within the European Medicines Agency (EMA). This Committee will review safety signals of medicinal products arising in the member states of the European Union. The Committee could recommend adaptation of the package leaflet, or suspension or revocation of the marketing authorisation. The PRAC is also involved in the assessment of risk management plans for medicinal products and post-authorisation efficacy and safety studies.

Een handelsvergunning is nodig voordat een geneesmiddel op de markt kan worden gebracht. Het geneesmiddel is dan geregistreerd, maar daarmee is nog niet besloten om het geneesmiddel in het verzekeringspakket op te nemen en te vergoeden (zie H. 7).

Weight-loss products, which are freely available in some other countries and on the Internet, may be contaminated with ingredients not mentioned on the label.We describe a 43-year-old woman who presented to the emergency ward of our hospital after stabbing herself in the stomach with a knife, because of severe psychosis. A few days after admission her symptoms were completely gone and there were no longer signs of psychosis. The most likely explanation for the psychosis was the use of sibutramine-contaminated weight-loss coffee (Brazil Potent Slimming Coffee).Brazil Potent Slimming Coffee and possibly also other weight-loss products may be contaminated with sibutramine and as a result cause severe adverse reactions. It is always important to consider intoxication due to the use of herbal supplements and other OTC products in the differential diagnosis.

In a 34-year-old woman with a dichorionic twin pregnancy, a velamentous insertion of the umbilical cord of the second twin was diagnosed with ultrasound. During caesarean section the second child was born within the membranes; the velamentous insertion was clearly visible.

OBJECTIVE: To analyse the prevalence of preventable adverse drug events (pADEs) and non-preventable adverse drug reactions (ADRs) as well as the determinants of both pADEs and ADRs. METHODS: Adverse events experienced by patients admitted to two Dutch hospitals with functioning computerized physician order entry (CPOE) systems were prospectively identifed through chart review. For both pADEs and non-preventable ADRs a causal relationship between adverse events and patients' drugs was established using the simplifed Yale algorithm. RESULTS: pADEs and non-preventable ADRs were experienced by 349 (58%) patients, of whom 307 (88%) had non-preventable ADRs. Multi-morbidity (adjusted odds ratio [ORadj] 1.90 and 1.28 respec tively), length of stay (ORadj1.13 and 1.11), admission to the geriatric ward (ORadj7.78 and 3.82) and number of medication orders (ORadj1.25 and 1.13) were signifcantly associated with pADEs and ADRs. Admission to the gastroenterology/rheumatology ward (ORadj0.22 and 0.40) was inversely related to both pADEs and ADRs. Other determinants for ADRs only were female sex (ORadj1.77) and use of drugs affecting the nervous system (ORadj1.83). Age was a signifcant determinant for pADEs only (ORadj1.07). CONCLUSIONS: More than half of the patients admitted to the hospitals are harmed by drugs, of which most are non-serious, non-preventable ADRs. Determinants of both pADEs and ADRs overlap to a large extent. Our results imply the need for signalling early potential adverse events during the normal use of drugs in multimorbid patients or those in geriatric wards. Subsequent therapeutic interventions may improve their well-being more than focusing on errors in the medication process only.

Osteogenesis imperfecta is a hereditary connective tissue disorder characterized primarily by fractures with no or small causal antecedent; in most patients this is a consequence of diminished or abnormal production of collagen type I. It is a clinically heterogeneous disorder: it has been proposed recently to classify osteogenesis imperfecta in types I-V on the basis of the clinical picture and radiology. It is also a genetically heterogeneous disorder; 90% of cases are due to autosomal dominant mutations, while the remaining 10% are due to autosomal recessive mutations or of unknown cause. Osteogenesis imperfecta type I and to a lesser extent type IV are important differential diagnostic considerations in case of suspicion of non-accidental injury (NAI). When osteogenesis imperfecta is suspected, DNA analysis of the dominant COL1A1 and COL1A2 genes is currently the starting point for laboratory diagnosis unless there are strong indications for a recessive cause. Protein analysis based on skin biopsy remains indicated in specific cases.

Een aantal wijken binnen Haarlem Oost vallen onder de 40+ wijken, ook wel de Vogelaarwijken van Nederland genoemd. Uit de leefbarometer en de meer specifieke cijfers rond inkomensontwikkeling en arbeidsparticipatie blijkt dat wijken in Haarlem Oost langzaam maar zeker verder op achterstand raken ten opzichte van het Haarlemse gemiddelde. In het licht van deze ontwikkelingen is het van essentiële betekenis dat bewoners en ondernemers weer perspectief kunnen zien voor hun omgeving en voor zichzelf. Sociaaleconomische problematiek vraagt om een gerichte aanpak, een aanpak op strategisch niveau. Investeren in fysiekruimtelijke interventies wordt in deze studie gezien als voorwaarde voor de aanpak van die sociaaleconomische problematiek. Op basis van het verbeteren van de fysiek ruimtelijke condities en kwaliteit kan een belangrijke bijlage geleverd worden aan de versterking van het woon- en leefklimaat in de wijken. In deze studie wordt ten eerste een inventarisatie gemaakt van de reeds bestaande stedenbouwkundige kwaliteiten van Haarlem Oost en wordt aangegeven waar fysiek ruimtelijke conditie slecht zijn en interventies nodig zijn ten behoeve van nieuwe ontwikkelingen. Nieuwe ontwikkelingen die nodig zijn om weer perspectief te kunnen bieden aan de mensen die reeds in Haarlem Oost wonen en graag willen blijven wonen. Nieuwe ontwikkelingen voor mensen die hun onderneming een nieuwe impuls willen geven maar ook voor nieuwe bewoners en ondernemers die nodig zijn om nieuwe energie te bieden aan de omgeving. Nieuwe bewoners die kleur zullen geven aan de monocultuur van het naoorlogse gezinsleven dat niet meer past bij de gemêleerde en geïndividualiseerde maatschappij van vandaag de dag.

The drug interaction between proton pump inhibitors and clopidogrel has been the subject of much study in recent years. Contradictory results regarding the effect of proton pump inhibitors on platelet reactivity and on clinical outcome in clopidogrel-treated patients have been reported in literature. Concomitant use of omeprazole and clopidogrel was found to decrease the exposure (AUC) to clopidogrel's active metabolite by 50% and to sharply increase platelet reactivity, as a result of inhibition by omeprazole of CYP2C19, a cytochrome P450 (CYP) enzyme. Pantoprazole has a much weaker effect on clopidogrel's pharmacokinetics and on platelet reactivity during concomitant use. The influence of the other proton pump inhibitors when used simultaneously with clopidogrel has not yet been investigated in adequately randomized studies. Regulatory agencies state that the combination of clopidogrel and the CYP2C19 inhibitors omeprazole and esomeprazole should be avoided. To date, there is no conclusive evidence of a clinically-relevant interaction between any of the proton pump inhibitors and clopidogrel.

To gain an insight into perinatal mortality and morbidity in full-term infants without congenital abnormalities admitted to a neonatal intensive care unit (NICU).Retrospective analysis.In this study, all full-term infants, who were born in the period 1997-2003 without congenital disorders and admitted to the NICU at the Wilhelmina Children's Hospital in Utrecht, the Netherlands were included. Information about the delivery, NICU-admission and follow-up until the age of 18 months was obtained from the hospital charts.In total 597 full-term neonates were admitted to the NICU during the study period; this is equivalent to 3-4 per 1,000 full-term neonates in the Utrecht region. Of these, 47% were admitted on account of asphyxia, 17% with respiratory problems and 12% with infections. In 79% of all NICU admissions the delivery had taken place under secondary care; in 29% labour had started under exclusive care of a primary level midwife, because the pregnancy had been defined as low-risk. 21% of the neonates were admitted to the NICU following delivery under exclusive primary care. Almost 15% of the infants died in the NICU, in 89% due to asphyxia. Of the surviving infants following perinatal asphyxia, 15% had a permanent disability at the age of 18 months.Post-partum admission of a fundamentally healthy full-term neonate to the NICU is a serious adverse perinatal outcome, and warrants further investigation. The various factors that influence these admissions should be analysed in more detail, for instance by means of perinatal audits.

Wat is stedelijke vitaliteit? Er zijn vele invalshoeken en definities in de markt, maar gaat het wel om de definiëring van dat begrip, of gaat het er meer om wat we eronder kunnen verstaan en welk belang het dient? Want hoe wordt het begrip door professionals, instituten en bewoners gebruikt, welke inhoud geven zij eraan en welke parameters zijn daarbij voor hen van belang? In dit boek wordt het begrip stedelijke vitaliteit verkend zonder daar meteen een allesomvattende, eensluidende definitie aan te verbinden.