Sociale Psychiatrie in de 21e eeuw

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Epidemiology of osteoporosis and prediction of fractures : a 9-year population based follow-up study

The investigation that is the subject of this thesis intended to evaluate the clinical value of risk factors of osteoporosis for prediction of fractures. Osteoporosis and related fractures constitute a frequently occurring and expanding medical problem in the elderly population. The occuiTence of skeletal fractures is approximately five times more frequent in women aged 85 years as compared to women aged 45 years. 1 Osteoporosis. a condition characterised by a reduced amount of bone tissue in the skeleton. may be a major cause of the age related increase in fracture risk. Although osteoporosis is by no means a new disease. it has become a significant public health problem only recently. In the past decade, the absolute number of elderly fracture patients has grown considerably. In I 972 approximately 6000 subjects aged 65 years and over were admitted to Dutch hospitals for treatment of a limb fracture. Ten years later, in 1982 the number of hospital treated fracture patients of this age had increased by 65 per cent. to more than 10.000 patients.2 These figures represent only a small fraction of all fracture patients. since the majority of fractures will have been treated in outpatient facilities. The rise in the absolute number of fractures may be explained from two factors. Firstly. there has been some increase in the age specific incidence of (hip) fractures.3 Secondly. the size of the population with a high risk of fractures. has grown considerably. Between I 972 and 1982. the size of the Dutch population of subjects aged 65 years and over increased by 20 per cent: the population aged 75 years and over increased by 35 per cent: and the female population aged 75 years and over increased by more than 45 per cent. In the latter group the risk of fractures is particularly high.4 ·5 For the future it is expected that the absolute number of elderly subjects will continue to increase. 6 As a consequence the "epidemic" of fractures among the elderly will fwiher expand. The financial consequences of the large number of fractures may be considerable. For the USA. the financial costs of osteoporosis has been estimated at 6. I billion dollar in 1983.7 In the past few years osteoporosis has become a major health issue for the general public. The condition has been frequently discussed: both m the professional and in the lay press. News papers and popular magazines have regularly devoted their pages to inform the public about the disease. For the same reason several popular books have been published. some of which had provoking titles such as: "Osteoporosis: your head start on the prevention and treatment of brittle bones". 8 All this publicity may add to the impression of an epidemic disease threatening the integrity of our bones

The impact of study design on schizophrenia incidence estimates: a systematic review of Northern European studies 2008-2019

The best estimates of the incidence of schizophrenia range more than 25-fold from 3 to 80 per 100,000 person years. To what extent do differences in study design explain this wide variation? We selected all studies published between 2008-2019 reporting the incidence of schizophrenia in general populations of Northern Europe. We identified 17 estimates covering 85 million person-years and more than 15,000 individual cases. The estimates ranged from 4-72 per 100,000 person-years (median 30; interquartile range 13-41). We classified the estimates in terms of three study design factors (coverage of services, time frame, and diagnostic quality) and two population factors (urbanicity and age). A meta-regression model of the three design factors, using the two population factors as covariates, explained 91% of between-study variation. Studies performed in general psychiatric services reported similar estimates [incidence rate ratio 1.12 (95% confidence interval 0.88 to 1.43)] to those performed in specialized services. But studies applying a cumulative time frame to diagnosis reported fourfold higher estimates [4.04 (3.14 to 5.2)] than those applying a first-contact time frame. And studies based on clinical diagnoses reported lower estimates [0.55 (0.43 to 0.72)] than those based on standardized research diagnoses. The three study design factors by themselves explained 67% of between-study variation. When comparing incidence rates from different populations, distorsions arising from differences in study design can eclipse differences caused by schizophrenia risk factors, such as gender, age or migrant status. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).Stress-related psychiatric disorders across the life spa

Strain characterization of FinFETs using Raman spectroscopy

Metal induced strain in the channel region of silicon (Si) fin-field effect transistor (FinFET) devices has been characterized using Raman spectroscopy. The strain originates from the difference in thermal expansion coefficient of Si and titanium-nitride. The Raman map of the device region is used to determine strain in the channel after preparing the device with the focused ion beam milling. Using the Raman peak shift relative to that of relaxed Si, compressive strain values up to – 0.88% have been obtained for a 5 nm wide silicon fin. The strain is found to increase with reducing fin width though it scales less than previously reported results from holographic interferometry. In addition, finite-element method (FEM) simulations have been utilized to analyze the amount of strain generated after thermal processing. It is shown that obtained FEM simulated strain values are in good agreement with the calculated strain values obtained from Raman spectroscop

Excess mortality in general hospital patients with delirium: A 5-year follow-up of 519 patients seen in psychiatric consultation

Mortality was determined in 519 patients with delirium who were seen in psychiatric consultation in two general hospitals. Among 419 patients with simple delirium (DSM-III: 293.00) in-hospital mortality was 26%. As compared to average hospital patients the age adjusted in-hospital excess mortality ratio varied from 6.2 for patients with malignancies to 2.1 for patients with motor system disease. After hospital discharge the 5-yr cumulative mortality was 51%. As compared to the general population excess mortality was noted in most, but not in all diagnostic subgroups. The age and sex adjusted excess mortality ratio varied from 14.1 for malignancies to 1.3 for motor system disease. The figures underline a general notion that delirium may be an indicator of disorders of grave prognosis, but mortality appears to depend more on the medical condition than on the presence of delirium

The clinical and cost-effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners/caregivers: study protocol of a multicenter pragmatic randomized controlled trial

Background: After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options, these patients often receive long-term, non-protocolized care as usual (CAU) that does not involve the partner/caregiver of the patient. Although the revised depression treatment guidelines suggest focusing on psychiatric rehabilitation and self-management as the next treatment step for PDD, an evidence-based cost-effective self-management protocol for PDD is lacking. This study investigates the "Patient and Partner Education Program for All Chronic Illnesses" (PPEP4All) as a brief self-management protocol that could lead to lower costs, higher quality of life, and less disease burden in PDD patients and their partners/caregivers.Methods: Presented is the rationale and methods of a multicenter pragmatic randomized controlled trial to evaluate the clinical efficacy and cost-effectiveness of PPEP4All for patients with PDD and their partners/caregivers. In accordance with current recommendations, a mixed methods research approach is used with both quantitative and qualitative data. A total of 178 eligible outpatients with PDD and their partners/caregivers are recruited and randomized to either PPEP4All or CAU. Those assigned to PPEP4All receive nine weekly self-management sessions with a trained PPEP4All therapist. Primary and secondary outcome measurements are at 0, 3, 6, and 12 months.Discussion: This project will result in the implementation of a self-management intervention for patients with PDD, meeting an urgent need in mental healthcare. Using PPEP4All can optimize the quality and efficiency of care for both patients with PDD and their partners/caregivers.Stress-related psychiatric disorders across the life spa

Self-association of the spindle pole body-related intermediate filament protein Fin 1p and its phosphorylation-dependent interaction with 14-3-3 proteins in yeast

Moleculaire ontwikkelingsgenetic

Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study

offerosclerosis and osteoporosis are major causes of morbidity and mortality in postmenopausal women and have been suggested to be associated. No study has examined whether progression of atherosclerotic calcification is associated with bone loss. In the present study, we examined progression of aortic calcification, diagnosed by radiographic detection of calcified deposits in the abdominal aorta, in relation to metacarpal bone loss, as assessed by metacarpal radiogrammetry, during menopause. Initially premenopausal women (n=236), aged 45 to 57 years at baseline, were followed for 9 years. We additionally assessed the cross-sectional association between the extent of aortic calcification and metacarpal bone mass and density in 720 postmenopausal women. Twenty-five percent of women going through menopause showed progression of aortic calcification. The average loss of metacarpal bone mass among women with progression of aortic calcification was 3.2 mm(2), and their loss of metacarpal bone density was 7.2 mm(2) %, whereas in women without progression of aortic calcification, these losses were 2.0 mm(2) and 5.6 mm(2) %, respectively, adjusted for age and years of follow-up (P<0.05). Additional adjustment for age at menopause, body mass index, blood pressure, smoking, diabetes mellitus, and use of hormone replacement therapy, thiazide, and loop diuretics did not influence these results. In postmenopausal women, a graded inverse cross-sectional association between the extent of aortic calcification and metacarpal bone mass and density was found. In conclusion, our results indicate that progression of atherosclerotic calcification is associated with increased bone loss in women during menopause

The cumulation of ill health and low agency in socially excluded city dwellers in the Netherlands: how to better identify high-risk/high-need population segments with public health survey data

Background: Population segmentation and risk stratification are important strategies for allocating resources in public health, health care and social care. Social exclusion, which is defined as the cumulation of disadvantages in social, economic, cultural and political domains, is associated with an increased risk of health problems, low agency, and as a consequence, a higher need for health and social care. The aim of this study is to test social exclusion against traditional social stratifiers to identify high-risk/high-need population segments.Methods: We used data from 33,285 adults from the 2016 Public Health Monitor of four major cities in the Netherlands. To identify at-risk populations for cardiovascular risk, cancer, low self-rated health, anxiety and depression symptoms, and low personal control, we compared relative risks (RR) and population attributable fractions (PAF) for social exclusion, which was measured with the Social Exclusion Index for Health Surveys (SEI-HS), and four traditional social stratifiers, namely, education, income, labour market position and migration background.Results: The analyses showed significant associations of social exclusion with all the health indicators and personal control. Particular strong RRs were found for anxiety and depression symptoms (7.95) and low personal control (6.36), with corresponding PAFs of 42 and 35%, respectively. Social exclusion was significantly better at identifying population segments with high anxiety and depression symptoms and low personal control than were the four traditional stratifiers, while the two approaches were similar at identifying other health problems. The combination of social exclusion with a low labour market position (19.5% of the adult population) captured 67% of the prevalence of anxiety and depression symptoms and 60% of the prevalence of low personal control, as well as substantial proportions of the other health indicators.Conclusions: This study shows that the SEI-HS is a powerful tool for identifying high-risk/high-need population segments in which not only ill health is concentrated, as is the case with traditional social stratifiers, but also a high prevalence of anxiety and depression symptoms and low personal control are present, in addition to an accumulation of social problems. These findings have implications for health care practice, public health and social interventions in large cities.Stress-related psychiatric disorders across the life spa