Obesity: exploring neural pathophysiological pathways and improving diagnostic strategies

This thesis describes investigations in the neural pathophysiological mechanisms leading to obesity with a specific focus on the relation of brainstructure and function with behaviour and genetics. Furthermore, it describes investigations in the diagnostic strategy in overweight and obese children. Nutricia Early Life NutritionLUMC / Geneeskunde Repositoriu

Responding to future regime shifts with agrobiodiversity: A multi-level perspective on small-scale farming in Uganda

We analyse the impact of two large-scale regime shifts caused by disease incidence or climate change, and associated crop productivity and price changes, on banana-based smallholders in Uganda. We evaluate these farmers' vulnerability and assess the potential of using increased crop diversity to improve their resilience. We further explore trade-offs and synergies between environmental, economic and nutritional outcomes faced by the farmers in their decision making when a regime shift occurs. We simulate the large-scale scenarios with the IMPACT model and use the results obtained to assess their effect at the local level using the bio-economic farm-household model, FarmDESIGN. Our results indicate that climate change can lead to a regime shift that expands revenue variance, increases soil erosion and reduces vitamin A yield for farmers. Banana disease can negatively impact income levels and species diversity. We show that under both scenarios farmers have scope to reconfigure their farms and recover farm performance. Specifically, we discuss the benefits of species diversity; increasing agrobiodiversity by adding new crops increases the farm's adaptive capacity and resilience, allowing for much higher revenues, on-farm crop diversity and vitamin A production. The conceptual approach and the method we developed can be applied to assess the local synergies and trade-offs between crop diversity conservation, nutrition, environmental protection and human nutrition that farmers face as a result of global drivers. Our results offer a further understanding of how biodiverse systems respond to regime shifts, which can inform effective policy design. Our method can be also useful to help farmers manage their farms in a way to better meet their complex needs.</p

Cardiovascular mortality in women in their forties after hypertensive disorders of pregnancy in the Netherlands : a national cohort study

Peer reviewedPublisher PD

Development of a practical guideline for person centred goal setting in geriatric rehabilitation:A participatory action research

PurposeTo improve goal setting in Geriatric Rehabilitation (GR), by developing an evidence-based practical guideline for patient-centred goal setting.MethodsParticipatory action research (PAR) in a cyclical process, with GR professionals as co-researchers. Each cycle consisted of five phases: problem analysis, literature review, development, practical experience, feedback &amp; evaluation. The evaluation was based on video recordings of goal setting conversations, and on oral and written feedback of the GR professionals who tested the guideline.ResultsIn two PAR-cycles the guideline was developed, consisting of eight recommendations for setting and using goals, and of practical advices elaborating three of the recommendations, concerning conversational skills specific for goal setting conversations. After the second cycle the research team concluded that the guideline was feasible in daily practice and effective when used consciously.ConclusionIn this study, a practical guideline for setting and using goals in GR was developed. GR teams can improve their patient centred working with goals by discussing the recommendations in their team and choosing the recommendations to work on. This can be supported by the development of an interdisciplinary training. The effect on quality of care should be subject to further investigation

Determinants of Advanced Bone Age in Childhood Obesity

Background: Childhood obesity is associated with advanced bone age (BA). Previous studies suggest that androgens, oestrogens, sex hormone-binding globulin, and insulin are responsible for this phenomenon, but results are contradictory and might be biased by confounders. We aim to elucidate this matter by applying a multivariate approach. Method: We performed a correlation analysis of BA standard deviation score (SDS) with age- and sex-specific SDS for androgens, oestrogens, and with indicators of insulin secretion derived from oral glucose tolerance testing, in a group of obese children. A multivariate analysis was performed to investigate which parameters were independently predictive of BA SDS. Results: In this cohort (n = 101; mean age 10.9 years; mean BA 11.8 years; mean BMI SDS 3.3), BMI SDS was significantly correlated to BA SDS (r = 0.55, p < 0.001). In a regression analysis in the total cohort (B = 0.27, p < 0.001) as well as in females (B = 0.34, p = 0.042), males (B = 0.31, p = 0.006), and pubertal children (B = 0.32, p = 0.046), dehydroepiandrosterone sulphate (DHEAS) showed a positive, independent association with BA SD