Temporal changes in the epidemiology, treatment and outcome of inflammatory bowel disease in South Limburg

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic inflammatory diseases of the gastrointestinal tract. This thesis presents the results of a large cohort in South Limburg of 2837 IBD patients. We showed that 4186 patients in the region suffer from Crohn's or colitis and that this number is increasing by 6% and 4% per year, respectively. An extrapolation to the national situation shows that 80,627 patients in the Netherlands suffer from IBD, significantly more than the earlier estimate of 55,000. Furthermore, we show that there have been some improvements in the course of the disease in the last 20 years. For example, the risk of bowel surgery has fallen by 59% (Crohn) and 45% (colitis). The total use of prednisone, a substance with relevant side effects, has also decreased. The latter is mainly due to new treatments and treatment strategies

Liquidness: Conceptualising water within boating tourism

This paper discusses the elemental materialities of water mobilities, bringing the agentive qualities of water to the centre of theoretical discussion of tourism. Analysing data collected through qualitative interviews with, and participant observation of, British boating tourists, the analysis of watery materialities and the corresponding tourist assemblages are presented across water bodies: on inland waterways and in coastal areas. Examining the mobilities of the water materialities and the cooperation between water, boat and the tourist, we propose the concept of water-boat-human assemblage for examining boating tourism in terms of liquid relationships. The paper also introduces the notion of liquidness: the relational conglomerate between mobilities, materialities and practices as an analytical category for theorising water tourism

Generic Conversions of Abstract Syntax Representations

In this paper we present a datatype-generic approach to syntax with variable binding. A universe specifies the binding and scoping structure of object languages, including binders that bind multiple variables as well as sequential and recursive scoping. Two interpretations of the universe are given: one based on parametric higher-order abstract syntax and one on well-typed de Bruijn indices. The former provides convenient interfaces to embedded domain-specific languages, but is awkward to analyse and manipulate directly, while the latter is a convenient representation in implementations, but is unusable as a surface language. We show how to generically convert from the parametric HOAS interpretation to the de Bruijn interpretation thereby taking the pain from DSL developer to write the conversion themselves

Classic drugs in the time of new drugs:Real-world, long-term outcomes of thiopurine monotherapy in 1016 patients with inflammatory bowel disease

BACKGROUND: Thiopurines remain recommended as maintenance therapy in patients with inflammatory bowel disease (IBD). Despite their widespread use, long‐term effectiveness data are sparse and safety is an increasingly debated topic which thwarts proper delineation in the current IBD treatment algorithm. AIMS: To document effectiveness and safety of thiopurine monotherapy in patients with IBD, using the population‐based IBD South‐Limburg (IBDSL) cohort METHODS: All patients starting thiopurine monotherapy as maintenance between 1991 and 2014 were included. Therapy was defined as effective if there was no escalation to biologicals, no course of corticosteroids, no surgery and no hospitalisation for active disease during treatment. Long‐term effectiveness was assessed by adjusting for differences in follow‐up using Kaplan–Meier analyses. Mid‐ to long‐term safety regarding cancer incidence and clinically relevant liver disease was documented. RESULTS: In total, 1016 patients (643 Crohn's disease [CD]; 373 ulcerative colitis [UC]) received thiopurine monotherapy at a median of 15.2 (Q1‐Q3 4.2–48.5) months after diagnosis. During follow‐up, effectiveness rates at 1, 5 and 10 years were 64%, 45%, 32%, respectively, in CD and and 66%, 41%, 36%, respectively in UC. No statistically significant differences in effectiveness were observed after stratification for era of initiation (pre‐biological vs biological, CD: p = 0.56; UC: p = 0.43). Sixteen non‐melanoma skin cancers (incidence rate [IR] 3.33/1000 PY), five lymphomas (IR 1.04/1000 PY) and one urinary tract cancer (IR 0.21/1000 PY) were recorded. Two cases of portal hypertension were identified. CONCLUSION: In real‐world practice, thiopurine monotherapy remains effective, safe and durable for patients with CD or UC, including in the era of biologics

Classic drugs in the time of new drugs: Real-world, long-term outcomes of thiopurine monotherapy in 1016 patients with inflammatory bowel disease

BACKGROUND: Thiopurines remain recommended as maintenance therapy in patients with inflammatory bowel disease (IBD). Despite their widespread use, long-term effectiveness data are sparse and safety is an increasingly debated topic which thwarts proper delineation in the current IBD treatment algorithm. AIMS: To document effectiveness and safety of thiopurine monotherapy in patients with IBD, using the population-based IBD South-Limburg (IBDSL) cohort METHODS: All patients starting thiopurine monotherapy as maintenance between 1991 and 2014 were included. Therapy was defined as effective if there was no escalation to biologicals, no course of corticosteroids, no surgery and no hospitalisation for active disease during treatment. Long-term effectiveness was assessed by adjusting for differences in follow-up using Kaplan-Meier analyses. Mid- to long-term safety regarding cancer incidence and clinically relevant liver disease was documented. RESULTS: In total, 1016 patients (643 Crohn's disease [CD]; 373 ulcerative colitis [UC]) received thiopurine monotherapy at a median of 15.2 (Q1-Q3 4.2-48.5) months after diagnosis. During follow-up, effectiveness rates were 64%, 45%, 32% and 66%, 41%, 36% at 1, 5 and 10 years in CD and UC, respectively. No statistically significant differences in effectiveness were observed after stratification for era of initiation (pre-biological vs biological, CD: p = 0.56; UC: p = 0.43). Sixteen non-melanoma skin cancers (incidence rate [IR] 3.33/1000 PY), five lymphomas (IR 1.04/1000 PY) and one urinary tract cancer (IR 0.21/1000 PY) were recorded. Two cases of portal hypertension were identified. CONCLUSION: In real-world practice, thiopurine monotherapy remains an effective, safe and durable treatment option for patients with CD or UC, including in the era of biologics