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Carotid artery intima-media thickness (CIMT) is widely used in observational and intervention studies. Despite the long history and its frequent use there is little uniformity in the measurement of CIMT. This diversity may have substantial effects on published results of studies and on the interpretation thereof. In this thesis we aimed to study several methodological aspects of CIMT measurements to facilitate an evidence-based decision making with respect to CIMT measurements. In chapter 2, two online techniques to measure CIMT, an automated RF approach and a manual B-mode approach, were compared. CIMT measured with B-mode showed stronger relations with established risk factors and was more strongly associated with risk of future cardiovascular events whereas in individuals with a thin CIMT (< 0.9 mm) automated RF provided stronger re...
Atherosclerotic cardiovascular disease (CVD), which involves the heart, brain, and peripheral circulation, is a major health problem world-wide. The development of atherosclerosis is a complex process, and several established risk factors are involved. Nevertheless, these established risk factors do not fully explain the occurrence of CVD and further insight is required in factors such as genetic determinants that may identify individuals at risk. In this thesis we worked on the genetic basis of CVD in three parts. Part one focuses on genes in lipid metabolism pathway and association with CVD. In chapters 2 and 3 we studied the association of the T64A polymorphism in the β3–adrenergic receptor gene (ADRB3) and the peroxisome proliferator-activated receptor gamma-2 (PPARG2) gene polymorphism (P12A), respectively, with coronary heart d...
The studies in this thesis demonstrate that linked data from the Hospital Discharge Register (HDR), Population Register (PR) and National Cause of Death Register are a valuable, inexpensive and easily accessible source of information that can be used for cardiovascular disease research. Based on nationwide register data we determined nationwide incidence of stroke, stroke subtypes and sudden death in the young (<40 years). In addition, we examined trends in age-specific coronary heart disease (CHD) mortality rates in the Netherlands as these trends may change as a result of changes in the pattern for major cardiovascular risk factor trends. We reported slowing or flattening of CHD mortality rates in young adults (35-54 years) between 1993 and 1999 in men and between1989 and 2000 in women. Slowing or flattening of CHD mortality rates in...
Gastro-oesophageal reflux disease (GORD), characterized by heartburn and acid regurgitation, is one of the most common gastrointestinal diseases general practitioners encounter. GORD is effectively treated with acid suppressive medication (ASM), of which proton pump inhibitors (PPIs) are most commonly used. Due to high therapy satisfaction and minor side-effects, initial short-term treatment with PPIs often evolves in long-term treatment, resulting in many GORD patients chronically using ASM without evidence-based indication. Dosage reduction is promoted for budgetary reasons and to prevent unnecessary use and adverse side-effects of long-term acid suppression. Since 2000, ‘on-demand’ treatment with PPIs has been shown to be effective and safe for GORD treatment; patients only take medication when they experience symptoms, and terminat...
Over 95% of children with congenital heart defects now reach adulthood and the number of adults with congenital heart disease is estimated to be at least 1.2 million in Europe alone. Despite major developments in diagnostic methods and treatment of congenital heart disease, cure is rarely achieved. In this thesis, the long-term prognosis of adult patients with congenital heart disease is assessed using the Dutch nationwide CONCOR registry that momentarily comprises more than 11,000 patients. Review of current literature confirmed the paucity in studies on long-term prognosis in adults with congenital heart defects. Reports on survival existed mainly up until 40 years of age and showed a decrease in survival compared to their healthy counterparts, which was most pronounced in complex defects. Data on morbidity were sparse; based on the ...
Carla Zomer behandelt de noodzaak van chirurgie en andere interventies bij volwassenen met een aangeboren hartaandoening. Zomer zag dat mannen vaker chirurgie ondergaan en lagere overlevingskansen hebben na heroperaties dan vrouwen. Ze keek ook naar het sociaal functioneren van volwassenen met een aangeboren hartaandoening. Deze patiëntengroep is minder hoog opgeleid, heeft minder vaak werk en minder vaak een relatie dan de referentiegroep. Het laatste onderdeel van het onderzoek betreft mortaliteit bij volwassenen met een aangeboren hartaandoening. De meest voorkomende doodsoorzaak is hartfalen en aritmie (plotse dood). Volwassenen met een aangeboren hartaandoening overlijden meestal in rust, bij slechts twee procent is sprake van plotse dood tijdens inspanning.
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