Screening for congenital heart malformations in child health centres

The objective of this thesis is to clarify the effectiveness and the efficiency of screening for congenital heart malformations in Dutch child health centres and the possibilities to optimise this prevention programme. To this end the following main questions will be addressed. 1. Does screening for congenital heart malformations, as actually performed in Dutch child health centres, prevent adverse outcomes of these disorders in the short and long run? What would be the answer to this question, if all children were optimally screened? 2. Will screening for congenital heart malformations as actually performed in Dutch child health centres, considering its .test properties and the proportions of false positive and false negative test results, lead to unfavourable effects? What would be the answer to this question, if all children were optimally screened? 3. What costs and savings are involved in the management, including screening in child health centres, of relevant congenital heart malformations? 4. What costs are made per child benefiting from the screening progrannne as actually performed? What would be these costs, if all children were optimally screened? 5. What measures will have to be taken to optiInise the effect of screening for congenital heart malformations in Dutch child health centres

Renale osteodystrofie : pathofysiologie en behandeling met 1α-hydroxy-derivaten van vitamine D

Renale osteodystrofie omvat de botafwijkingen die ontstaan ten gevolge van veranderingen in de Ca- en P-stofwisse!ing, die optreden bij patiënten met een chronische nierinsufficiëntie. Met de chronische nierziekten zijn bedoeld g!omerulaire/parenchymateuze aandoeningen en niet specifieke tubu!aire defecten zoals bij renale tubulaire acidose en het Fanconi-syndroom. Het is onwaarschijnlijk dat de aetiologie van de g!omerulaire/parenchymateuze nierafwijkingen in het algemeen van invloed is op het soort botafwijkingen, dat onstaat. Wel worden niet altijd dezelfde afwijkingen in dezelfde mate bij alle patiënten met vergelijkbaar nierfunctieverlies gevonden. In wisselende mate worden tekenen van hyperparathyreoidie, osteomalacie en osteosclerose in het histologisch beeld aangetroffe

De conservatieve behandeling van de fractura cruris met vroege belasting

"De behandeling van de fractura cruris is gericht op het voorkómen van complicaties". Een bewering, die uiteraard geen stand kan houden, want de behandeling is vanzelfsprekend gericht op een zo spoedig mogelijk functioneel en anatomisch herstel van het getroffen been. Toch zijn het bijna altijd complicaties, die het bereiken van dit doel in de weg staan en verantwoordelijk zijn voor een geprotraheerd ziektebeloop en een onbevredigend eindresultaat. De voornaamste complicaties, die een patiënt met een crurisfractuur bedreigen, zijn: 1. infectie. 2. pseudarthrosevorming. 3. een combinatie van 1 en 2, een geïnfecteerde pseudarthrose. Hier tegenover staat, dat bij een fractura cruris die in een redelijke tijd in een acceptabele stand consolideert, bijna altijd een goed functioneel herstel optreedt. Het accent van de behandeling lijkt dus te moeten liggen op het scheppen van een zo gunstig mogelijk klimaat voor fractuurconsolidatie. Dit proefschrift gaat over de wijze waarop in de heelkundige kliniek van het Academisch Ziekenhuis "Dijkzigt" te Rotterdam getracht wordt dit laatste te bewerkstelligen

Factors that determine the effectiveness of screening for congenital heart malformations at child health centres

BACKGROUND: The actual yield from current screening for clinically significant congenital heart malformations in Dutch child health care is far from optimal. In this study factors that determine the effectiveness of this screening are identified and recommendations for the optimization of the screening programme are formulated. METHODS: Eighty-two patients with a clinically significant congenital heart malformation were consecutively included in this study. Parents and child health centre physicians were interviewed in order to establish the screening, detection and referral history. Paediatric cardiologists established whether these patients were diagnosed 'in time' or 'too late'. RESULTS: Incomplete performance of the screening examination has more influence on the occurrence of delayed diagnoses than failure by parents to adhere to the complete visit schedule. Adequate screening advances detection of congenital heart malformations. Severity, however, is the most predominant determinant of the age at referral and diagnosis, as well as of the risk of complications. In only 7 out of 39 patients diagnosed 'too late', could no avoidable cause for an adverse outcome be found. In 10 cases (25%) there was a prolonged interval between first referral and diagnosis. CONCLUSION: To optimize the yield of the screening programme, improvement in the performance of the child health centre physicians and the co-operation of other physicians involved in reducing the interval between referral and diagnosis are required. Thus a considerable improvement in the prevention of complications of congenital heart malformations can be obtained

Maternal and Paternal Risk Factors for Cryptorchidism and Hypospadias: A Case–Control Study in Newborn Boys

Little is known on environmental risk factors for cryptorchidism and hypospadias, which are among the most frequent congenital abnormalities. The aim of our study was to identify risk factors for cryptorchidism and hypospadias, with a focus on potential endocrine disruptors in parental diet and occupation. In a case–control study nested within a cohort of 8,698 male births, we compared 78 cryptorchidism cases and 56 hypospadias cases with 313 controls. The participation rate was 85% for cases and 68% for controls. Through interviews, information was collected on pregnancy aspects and personal characteristics, lifestyle, occupation, and dietary phytoestrogen intake of both parents. Occupational exposure to potential endocrine disruptors was classified based on self-reported exposure and ratings of occupational hygienists based on job descriptions. Our findings indicate that paternal pesticide exposure was associated with cryptorchidism [odds ratio (OR) = 3.8; 95% confidence interval (95% CI), 1.1–13.4]. Smoking of the father was associated with hypospadias (OR = 3.8; 95% CI, 1.8–8.2). Maternal occupational, dietary, and lifestyle exposures were not associated with either abnormality. Both abnormalities were associated with suboptimal maternal health, a lower maternal education, and a Turkish origin of the parents. Being small for gestational age was a risk factor for hypospadias, and preterm birth was a risk factor for cryptorchidism. Because paternal pesticide exposure was significantly associated with cryptorchidism and paternal smoking was associated with hypospadias in male offspring, paternal exposure should be included in further studies on cryptorchidism and hypospadias risk factors

Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures: results from VERTOS II

Background and purpose: Pv is increasingly used as treatment for osteoporotic vcfs. However, controversy exists as to whether pv increases the risk for new vcfs during follow-up. The purpose of our research was to assess the incidence of new vcfs in patients with acute vcfs randomized to pv and conservative therapy. Materials and methods: Vertos ii is a prospective multicenter randomized controlled trial comparing pv with conservative therapy in 202 patients. Incidence, distribution, and timing of new vcfs during follow-up were assessed from spine radiographs. In addition, further height loss during follow-up of treated vcfs was measured. Results: After a mean follow-up of 11.4 Months (Median, 12.0; Range, 1-24 months), 18 New vcfs occurred in 15 of 91 patients after pv and 30 new vcfs in 21 of 85 patients after conservative therapy. This difference was not significant (P = .44). There was no higher fracture risk for adjacent-versus-distant vertebrae. Mean time to new vcf was 16.2 Months after pv and 17.8 Months after conservative treatment (Logrank, p = .45). The baseline number of vcfs was the only risk factor for occurrence (Or, 1.43; 95% Ci, 1.05-1.95) And number (P = .01) Of new vcfs. After conservative therapy, further height loss of treated vertebrae occurred more frequently (35 Of 85 versus 11 of 91 patients, p < .001) And was more severe (P < .001) Than after pv. Conclusions: Incidence of new vcfs was not different after pv compared with conservative therapy after a mean of 11.4 Months' follow-up. The only risk factor for new vcfs was the number of vcfs at baseline. Pv contributed to preservation of stature by decreasing both the incidence and severity of further height loss in treated vertebrae

Screening for congenital heart malformation in child health centres

BACKGROUND: Although screening for congenital heart malformations is part of the child health care programme in several countries, there are very few published evaluations of these activities. This report is concerned with the evaluation of this screening at the Dutch Child Health Centres (CHC). METHODS: All consecutive patients, aged between 32 days and 4 years, presented at the Sophia Children's Hospital Rotterdam throughout a period of 2 years, with a congenital heart malformation were included in this study. Paediatric cardiologists established whether or not these patients were diagnosed after haemodynamic complications had already developed (diagnosed 'too late'). Parents and CHC-physicians were interviewed in order to establish the screening and detection history. Test properties were established for all patients with a congenital heart malformation (n = 290), intended effects of screening were established in patients with clinically significant malformations (n = 82). RESULTS: The sensitivity of the actual screening programme was 0.57 (95% CI : 0.51-0.62), the specificity 0.985 (95% CI : 0.981-0.990) and the predictive value of a positive test result 0.13 (95% CI: 0.10-0.19). Sensitivity in a subpopulation of patients adequately screened was 0.89 (95% CI: 0.74-0.96). Adequately screened patients were less likely to be diagnosed 'too late' than inadequately screened patients (odds ratio [OR] = 0.20, 95% CI: 0.04-1.05). The actual risk of being diagnosed 'too late' in the study-population (48%) was only slightly less than the estimated risk for patients not exposed to CHC-screening (58%, 95% CI: 43%-72%). Adequately screened patients however were at considerably less risk (17%, 95% CI: 4%-48%). CONCLUSION: Screening for congenital heart malformations in CHC contributes to the timely detection of these disorders. The actual yield, however, is far from optimal, and the screening programme should be improved