Brain structure and function in primary adrenal insufficiency

Individuals with primary adrenal insufficiency (PAI), i.e., congenital adrenal hyperplasia (CAH) and autoimmune Addison’s disease (AAD), suffer from impaired production of the adrenal gland hormones cortisol and aldosterone, and in the case of AAD, also androgens. Replacement medication for these hormones is sub-optimal due to the difficulties in replicating the natural rhythms of cortisol secretion. The hormones are known to affect brain function via many mechanisms, and both pre- and postnatal hormone dysregulation may affect cognitive functioning, brain structure and brain function. Therefore, studying brain health in PAI is of interest and is needed to optimise treatment and patient wellbeing. The present thesis investigated brain structure related to cognitive functioning in individuals with CAH, and cognitive functioning, brain structure and resting-state functional connectivity in individuals with AAD. We found that individuals with CAH have impairments in white matter microstructure, as well as cortical thinning of the frontoparietal network that was related to weaker performance on a visuospatial working memory task. On the other hand, individuals with AAD performed equally to control subjects on most measures of cognitive functions assessed with standardized tests during the lab-visit, but they self-reported executive function problems in daily life, which were related to experienced mental fatigue. As opposed to individuals with CAH, those with AAD did not have profound differences in the structure of the brain, apart from smaller total brain volumes. However, they displayed increased resting-state functional connectivity, particularly in primary visual regions and the orbitofrontal cortex. Our results suggest that the effects of adrenal hormone insufficiency affect individuals with CAH and AAD differently. This difference may be related to the onset of the disease, which is from conception for those with CAH and in adolescence or adulthood for those with AAD. Long-term follow-up studies are needed to assess whether the observed differences contribute to increased cognitive decline later in life and how to optimise replacement medication to sustain brain health

Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial

BACKGROUND There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers. METHODS A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants. RESULTS Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 personyears in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9. CONCLUSIONS In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.)

Restorative principles in the criminal justice system: alternatives for satisfying justice?

The subject of this thesis is criminal justice policy. It focusses on diversion, that is, alternatives to the court system. I argue that the current criminal justice system, which is rooted in retributive principles, has shortfalls which are of such a degree that it makes sense to consider alternatives. A new movement in criminal justice policy, restorative justice, reflects a theory that may provide a framework for new programs. Restorative justice is based on principles that are fundamentally different from retributive ideology and the translation of these ideas results in dramatically different programs. In my thesis I delineate the differences between restorative and retributive principles. The retributive system leads to dissatisfaction among the stakeholders in the criminal process. The purpose of the thesis is to investigate whether implementation of restorative justice principles could lead to more satisfaction and a higher quality of justice. The restorative justice theory has a strong rhetoric, as will be made clear. The implementation of restorative programs, however, does not develop quickly. There are several reasons for the slowness, including the reluctance of criminal justice officials to give new initiatives a chance to develop and to co-operate in their development. I describe three restorative programs that divert criminal cases from the court system, they are: mediation, dading, and family group conferences. On the basis of these programs I make clear which are the strengths and the possible weaknesses of restorative justice. The comparison of different programs from different countries, provides a useful insight in the dynamics of restorative justice in practice. International research and comparison will lead to understanding in how to design a suitable and valuable process. My conclusion is that a truly restorative system is neither a realistic, nor a wished situation. For a variety of cases, though, restorative programs provide a better locus for resolving the problems involved in crime, than the court process does. I therefore advise that the development of restorative programs must go on.Law, Peter A. Allard School ofGraduat

Social Cognition in Autism and Other Neurodevelopmental Disorders : A Co-twin Control Study

Alterations in social cognition (SC) are hypothesized to underlie social communication and interaction challenges in autism spectrum disorder (ASD). The aetiological underpinnings driving this association remain unclear. We examined SC in 196 twins with ASD, other neurodevelopmental disorders or typical development using the naturalistic Movie for the Assessment of Social Cognition. Autism and its severity were assessed with the Autism Diagnostic Observation Schedule-2, and autistic traits with the Social Responsiveness Scale-2. Using within twin-pair regression models, controlling for age, sex, IQ, and unmeasured familial confounders such as genetic background and shared-environment, SC correlated with ASD diagnosis, autism severity, and autistic traits. Our findings highlight the importance of SC alterations in autism and suggest a non-shared environmental impact on the association