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1 maart 2012, Item does not contain fulltext, BACKGROUND: Chemotherapy for the treatment of maternal cancers during pregnancy has become more acceptable in the past decade; however, the effect of prenatal exposure to chemotherapy on cardiac and neurodevelopmental outcomes of the offspring is still uncertain. We aimed to record the general health, cardiac function, and neurodevelopmental outcomes of children who were prenatally exposed to chemotherapy. METHODS: We did an interim analysis of a multicentre observational cohort study assessing children who were prenatally exposed to maternal cancer staging and treatment, including chemotherapy. We assessed children at birth, at age 18 months, and at age 5-6, 8-9, 11-12, 14-15, or 18 years. We did clinical neurological examinations, tests of the general level of cognitive functioning (Bayley or intelligence quotient [IQ] test), electrocardiography and echocardiography, and administered a questionnaire on general health and development. From age 5 years, we also did audiometry, the Auditory Verbal Learning Test, and subtasks of the Children's Memory Scale, and the Test of Everyday Attention for Children, and we also completed the Child Behavior Checklist. This study is registered with ClinicalTrials.gov, number NCT00330447. FINDINGS: 236 cycles of chemotherapy were administered in 68 pregnancies. We assessed 70 children, born at a median gestational age of 35.7 weeks (range 28.3-41.0; IQR 3.3; 47 women at <37 weeks), with a median follow-up period of 22.3 months (range 16.8-211.6; IQR 54.9). Although neurocognitive outcomes were within normal ranges, cognitive development scores were lower for children who were born preterm than for those born at full term. When controlling for age, sex, and country, the score for IQ increased by an average 11.6 points (95% CI 6.0-17.1) for each additional month of gestation (p<0.0001). Our measurements of the children's behaviour, general health, hearing, and growth corresponded with those of the general population. Cardiac dimensio

Contains fulltext : 88224.pdf (publisher's version ) (Open Access), PURPOSE: The aim of this study was to assess the management and the obstetrical and neonatal outcomes of pregnancies complicated by cancer. PATIENTS AND METHODS: In an international collaborative setting, patients with invasive cancer diagnosed during pregnancy between 1998 and 2008 were identified. Clinical data regarding the cancer diagnosis and treatment and the obstetric and neonatal outcomes were collected and analyzed. RESULTS: Of 215 patients, five (2.3%) had a pregnancy that ended in a spontaneous miscarriage and 30 (14.0%) pregnancies were interrupted. Treatment was initiated during pregnancy in 122 (56.7%) patients and postpartum in 58 (27.0%) patients. The most frequently encountered cancer types were breast cancer (46%), hematologic malignancies (18%), and dermatologic malignancies (10%). The mean gestational age at delivery was 36.3 +/- 2.9 weeks. Delivery was induced in 71.7% of pregnancies, and 54.2% of children were born preterm. In the group of patients prenatally exposed to cytotoxic treatment, the prevalence of preterm labor was increased (11.8%; P = .012). Furthermore, in this group a higher proportion of small-for-gestational-age children (birth weight below 10th percentile) was observed (24.2%; P = .001). Of all neonates, 51.2% were admitted to a neonatal intensive care unit, mainly (85.2%) because of prematurity. There was no increased incidence of congenital malformations. CONCLUSION: Pregnant cancer patients should be treated in a multidisciplinary setting with access to maternal and neonatal intensive care units. Prevention of iatrogenic prematurity appears to be an important part of the treatment strategy.

1 oktober 2010, Contains fulltext : 89768.pdf (publisher's version ) (Closed access), OBJECTIVE: To determine the impact of physiologic changes of pregnancy on pharmacokinetics of chemotherapeutic agents. DESIGN: A preclinical and a clinical case-control trial. SETTING: Institute of Primate Research Nairobi and collaborating hospitals in Belgium, the Netherlands and Czech Republic. POPULATION: Pregnant and nonpregnant women and baboons receiving chemotherapy. METHODS: Chemotherapy pharmacokinetics was compared between the pregnant and nonpregnant state. Standard-dosed chemotherapy regimens were administered in pregnant and nonpregnant baboons/women, followed by serial blood samplings. Drug plasma levels were determined using high performance liquid chromatography and atomic absorption spectrometry. MAIN OUTCOME MEASURES: Area under the curve (AUC), maximal plasma concentration, terminal elimination half-life, clearance and distribution volume of each drug in pregnant and nonpregnant state. RESULTS: Intraindividual comparative pharmacokinetic data were obtained for doxorubicin and paclitaxel/platinum in three and two baboons, respectively. In the clinical trial, two patients were exposed to doxorubicin and one patient was exposed to paclitaxel/platinum during and after pregnancy. Furthermore, a pooled analysis was performed based on 16 cycles of pregnant and 11 cycles of nonpregnant women. Numbers of pregnant/nonpregnant patients were 5/2, 7/5, 4/4 and 2/2 for paclitaxel, doxorubicin, epirubicin and platinum, respectively. For all drugs tested in the preclinical and clinical study, a decreased AUC and maximal plasma concentration and an increased distribution volume and clearance were observed in pregnancy. CONCLUSIONS: Although numbers were too small for statistical significance, pregnancy-associated physiologic alterations appear to lead to a decrease in plasma exposure of chemotherapeutic drugs. The importance of long-term follow-up of women treated with chemotherapy during pregnancy is underscored.

Contains fulltext : 80545.pdf (publisher's version ) (Closed access)

Evangelisasiewerk het in die Hervormde Kerk nog nooit regtig van die grand af gekom nie. Jaar na jaar word daar op vergaderings verslag gedoen dat daar in die meeste gemeentes op hierdie gebied nie·veel gebeur nie. Hierdie studie het gevra na die werklike stand van sake tans in die Kerk; die paradigmaverskuiwing wat besig is om plaas te vind; en na 'n moontlike nuwe teorie om die huidige praxis mee te probeer wysig. Die resultate van die ondersoek het die volgende opgelewer: - Tans is daar ongeveer 15% van die gemeentes wat hoegenaamd op 'n georganiseerde wyse by evangelisasiewerk betrokke is; - 0,38% van die totale lidmaattal van die Kerk is toegerus vir evangelisasiewerk, en gebruik hulle opleiding; - Die Kerk het egter reeds die regte besluite in sy vergaderings geneem, soos bv dat die gemeente die evangelis is en dat elke lidmaat betrokke moet wees. Hierdie besluite moet geimplementeer word. Myns insiens kan dit alleen gebeur wanneer daar op gemeentevlak met harde teologiese arbeid deelgeneem word aan die huidige gesprek random 'n prakties-teologiese ekklesiologie., When the annual reports of the Hervormde Kerk are being studied, it becomes clear that the church finds itself in a crisis. The essence of this crisis manifests itself in the fact that the church is not evangelising the world as it is suppose to do. This study was undertaken to ask what is really going on in the field of evangelisation in the church; to look at the paradigm shift that is taken place at the moment; and, to ask for a new theory to try to alter the current praxis. The results of this study are: - Only 15% of the congregations of the church are involved in organised evangelisation activities; - 0,38% of churchmembers are trained and are using their training to do evangelisation; - The church has already realised that the congregation is suppose to be the evangelist and that every member must be involved in this ministry. But it has not yet come from the ground. This can only happen, I believe, when the congregation starts to participate in finding an ecclesiology for the time and context that we are living in.

Apartheid is verby. Die nuwe Suid-Afrika het gekom. Maar met die koms van die nuwe Suid-Afrika het die oue nie verdwyn nie. Die oue van die apartheidsverlede is nog met ons. Ons is die erfgename van apartheid en dra die letsels van apartheid nog saam met ons. Armoede, werkloosheid, behuisingsnood en geweld en misdaad is deel van die post-apartheid samelewing en kan nie weggewens word nie. Die kerk is geroep om die evangelie in die samelewing aan alle mense te kommunikeer. In hierdie kommunikasie moet die evangelie in 'n post-apartheid samelewing gesien en ervaar kan word in dade van diens. Daarom staan dade van diens in hierdie studie sentraal. Hierdie studie handel dus oor die diens van gelowiges wat 'n kommunikasievoertuig is van die evangelie in 'n post-apartheid samelewing. Vanuit die nood en behoeftes van mense in die post-apartheid samelewing is twee dade van diens geidentifiseer wat sentraal staan in die kommunikasie van die evangelie. Dit is bemagtiging en versoening. Omdat 'n groot dee! van die samelewing in die verlede geen mag op ekonomiese en politieke terreine gehad het nie, is dade van diens wat mense bemagtig noodsaaklik. In hierdie bemagtiging speel ekonomiese-, sosiale- en psigologiese bemagtiging 'n groot rol. En omdat mense deur die verlede van apartheid op grond van velkleur van mekaar geskei en geisoleer is, vra dit dat mense met mekaar versoen word. In die proses om versoening tussen mense te bewerkstellig speel verantwoordelikheid, erkenning van apartheidskuld, restitusie, regstellende aksie, die luister na mense se stories en vergifnis 'n baie belangrike rol. Vanuit 'n geloofsperspektief is die

Talle Christelike kerke in Suid- Afrika, onder meer die Nederduitsch Hervormde Kerk van Afrika, verkeer tans in 'n krisis. Die lidmaattalle toon 'n drasties dalende tendens, minder kinders word gedoop en minder Iidmate le belydenis van geloof af Hierdie krisis, asook die invloed van die postmodernisme op die hedendaagse mens, word aan die hand van die handelingswetenskaplike benadering ondersoek. Die gemeenteboumodel van Kenon L Callahan word gebruik, en daar word gevra tot watter mate hierdie model op die Nederduitsch Hervormde Kerk van Afrika toegepas kan word. Wat sal die prakties- teologiese implikasies daarvan op die gemeenskap van gelowiges in die Nederduitsch Hervormde Kerk van Afrika wees? Die resultaat van die studie is dat die Nederduitsch Hervormde Kerk van Afrika wel met vrug gebruik kan maak van Callahan se model, met inagneming van die kerk se bestaande struktuur, tradisie en geskiedenis. In die toepassing van die model sal daar nuwe, ongekende eise aan die kerk gestel word., Numerous christian churches in South Africa, including the Dutch Reformed Church of Africa is currently experiencing a crisis. Membership is declining, less children are baptised While new and unknown demands will be made on the church, new and exciting opportunities will also be met each year, and less members are confirmed. This crisis, together with the influence of the post- modernism, is explored using an operational science approach, and a possible solution to this problem is sought. The church growth model ofK.L. Callahan is used to facilitate this research. The applicability of this model to the Dutch Reformed Church of Africa is explored, together with the practical theological implications thereof on the holy community. The result of the study is that the Dutch Reformed Church of Africa can apply Callahan' s model to great affect, while cognisance should be taken of the church's own structure, tradition and history.

Gemeentebou funksioneer binne die raamwerk van die koninkryk van God en nie slegs binne 'n gemeente nie. Om hierdie rede word die ondersoekvraag gestel naamlik wanneer staan gemeentebou in diens van die koninkryk van God. Dit is 'n tersaaklike vraag in die lig van die feit dat gemeentebouliteratuur die opbou en by geleentheid ook die uitbou van die gemeente beskryf maar opbou met die oog op die samelewing geniet nie die nodige aandag nie. Die koninkryk van God staan sentraal in die kosmos. Om Sy koningsheerskappy op aarde te vestig gebruik God die gemeente. Daarom vind die gemeente sy oorsprong in God; dit beskik oor 'n koninkryksbepaalde identiteit; dit bestaan met 'n koninkryksdienstige doel; sy funksionering realiseer die gemeente se koninkryksdiens en dit bestaan binne 'n bepaalde konteks om tekens van die Koninkryk daar op te rig. Die koninkryk van God bepaal alle gemeentehandelinge en dit dien as korrektief daarop. Gemeentebou vestig en bevorder hierdie koninkryksperspektief binne elke handeling van die gemeente. Binne die raamwerk van die koninkryk word aspekte vir die aandag van verruimde gemeentebou in hierdie studie geidentifiseer (antropologie; ekonomie; ekologie; strukture). 'n Positiewe verband tussen gemeentebou en volle werklikheid van die koninkryk van God bou gemeentesentriese bouwerk uit tot effektiewe en omvattende kommunikatiewe handelinge in diens van die Koninkryk binne die gemeentekonteks. Hierdie verhouding tussen die koninkryk, die gemeente en die samelewing word deur Christus bepaal. Om dit op die mees effektiewe wyse te realiseer, is drie dimensies in hierdie studie geidentifiseer wat deel van gemeentebou behoort uit te maak (basisteorie). Gemeentebou dien die koninkryk wanneer dit lidmate se verstaan van die gemeente verruim om dit in toto in koninkryksdiens te stel; wanneer dit die gemeente se vermoe om in diens van die koninkryk te staan realiseer, en wanneer die gemeente opgebou word om met sy konteks rekening te hou. Gemeentebou staan, The building up of the congregation functions within the framework of the Kingdom of God and not only within the congregation. For this reason the question is raised i.e. when does the building up of the congregation serves the Kingdom of God. It is relevant in view of the fact that the literature about the building up of the congregation covers the building up of the congregation, but the emphasis on the community does not enjoy the necessary attention it deserves. Centrally within the cosmos the Kingdom of God exists. To establish His Kingdom on earth, God uses the congregation. Thus "the origins of the congregation is found in God; its identity is determined by the Kingdom; it exists for Kindompurposes; its functioning is aimed at serving the Kingdom, and it exists within a certain context where it should erect signs of the kingdom of God. The kingdom of God determines all congregational activities. The building up of the congregation establishes and promotes this kingdomperspective within every aspect of its actions. In this study certain aspects have been identified to broaden the scope of the building up of the congregation within the framework of the kingdom (i.e. anthropology; economy; ecology; structures). When the building up of the congregation is understood from a kingdomperspective, congregation-centered upbuilding developes into effective and comprehensive communicative actions in the service of the kingdom. The relationship between the kingdom, the congregation and the community is determined by Christ. In this study three dimensions are identified which ought to constitute the building up of the congregation for this to be realised most effectively. It serves the kingdom as it increases the congregations' understanding of its total service of the kingdom; as it realizes the church's service of the.kingdom through continuing change, and as it takes the context of the congregation sufficiently into consideration. An empirical research into the views of

Geloof wat in die kategese as deel van 'n to tale geloofsvormingsproses op die tafel kom, moet holisties-ekosistemies verstaan word met die 'hic et nunc'- relevansie daarvan as 'n kwalifiserende maatstaf. Geloof so gesien, behoort in die kategesemateriaal van die Nederduitse Gereformeerde Kerk na vore te kom. Die grootste deel van die studie is gewy aan die bree teoretisering in holisties-ekosistemiese perspektief. Vanuit 'n wetenskapsteoretiese vertrekpunt is 'n eie prakties-teologiese teorie oor geloof ontwerp wat geloof enersyds sien as die dinamiese interaksie van gawe, inhoud en respons, en andersyds as 'n aantal perspektiewe daarop. Hierdie teorie het as vertrekpunt gedien om sekere van die kontekste waarbinne geloof funksioneer, te beskryf, naamlik die koninkryk van God, die samelewing, die gemeente, die kategese, die adolessent, die jeugsubkultuur en die skool. In hierdie beskrywing is 'n omvattende teorie oor die kategese daargestel wat dit holisties-ekosistemies sien. Deur middel van inhoudsanalise is fasette van die teoriee getoets aan die lesse in die handboeke van die kategete wat met die adolessente in standerd 5 tot 8 werk. Daar is bevind dat die geloofsbeeld wat na vore kom steriel kognitief-vertikaal is. Oor 'n tydperk van meer as twintig jaar is weinig samelewingsrelevante kwessies aangeraak. Die belangwekkende dokumente Ras, Volk en Nasie en Kerk en Samelewing het nie gefunksioneer nie. In terme van die teorie oor geloof fasiliteer die kategesemateriaal nie relevante geloof midde-in die wereld waarin die adolessente moet glo nie. Dit het ook geblyk dat die inhoudsanalise as werkwyse en die meetinstrument wat ontwerp is, bruikbaar was. Die studie formuleer vanuit die teoriee en die empiriese ondersoek 'n aantal perspektiewe van waaruit die kategese en die lesmateriaal daarvan die kritiese hantering van die verhouding kognitief-affektief-konatief en die gerigtheid individueel-vertikaal, horisontaal-ekklesiaal en horisontaal-sosiaal kan hanteer met d, Faith which is handled in catechesis as part of the total process of the formation of faith should be understood in a holistic-ecosystemic way with its 'hic et nunc' relevance as a qualifying criterion. It should also appear in this form in the material for catechesis in the Nederduitse Gereformeerde Kerk. The greater part of the study focuses on broad theorising from a holistic-ecosystemic perspective. An independent practical-theological theory on faith is developed from a scientific-theoretical basis. This theory sees faith as a dynamic interaction of gift, content and response on the one hand and a number of different perspectives on the other. It serves as the point of departure for describing some of the contexts in which faith functions, namely the kingdom of God, society, the community, catechesis, the adolescent, the youth subculture and the school. In the process a comprehensive theory about catechesis is developed which sees it holistically ecosystemically. Content analysis is used to test aspects of the theories against the lessons in the manuals for catechists working with adolescents in standards 5 to 8. The resultant image of faith is found to be cognitively-vertically sterile. Over a period of more than twenty years few socially relevant issues were touched on. The important documents Ras, Volk en Nasie and Kerk en Samelewing did not function. In terms of the theory of faith this material for catechesis does not facilitate relevant faith in the world in which the adolescent has to have faith. It is also apparent that content analysis as a method and the measuring instrument used were suitable. Using the theories and the empirical investigation the study formulates a number of perspectives from which catechesis and the lesson material can deal with the critical handling of the relationship cognitively-affectively-conatively and the directedness individually-vertically, horizontally-ecclesially and horizontally-socially so that the church does not impr