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Biomedical subjects

R A Hirasing

Publications and source records attributed to R A Hirasing.

At least 19 recordsLinked to original sources
PubMed1999

[Increase of reported HIV-1 infections in children in Netherlands, 1982-1997: more vertical transmission and a greater proportion of other than Dutch children].

OBJECTIVE: To document the trend of the yearly number of newly diagnosed paediatric HIV-1 infections in the Netherlands. DESIGN: Retrospective registration regarding the period January 1st 1982-December 31st 1994 and prospective registration regarding January 1st 1995-December 31st 1997. METHOD: Based on reports to the Dutch Paediatric Surveillance Unit (Nederlands Signaleringscentrum Kindergeneeskunde) numbers of paediatric HIV-1 diagnoses (0-18 years) in the Netherlands were determined prospectively. Retrospective figures were determined by asking the paediatricians also to report the HIV-1 infected children diagnosed before the first of January 1995. A comparison was made with data from the Inspectorate for Health Care (Inspectie voor de Gezondheidszorg). All reports were followed up with standard questionnaires. RESULTS: In both periods an increase in the number of newly diagnosed paediatric HIV-1 infections per year in the Netherlands was seen (1982-1994: 74 children; 1995-1997: 43 children). The majority of the parents of the HIV-1 infected children originated from outside the Netherlands (1982-1994: 57%; 1995-1997: 91%), often from HIV-endemic countries (1982-1994: 41%; 1995-1997: 77%). The main mode of infection was vertical transmission (1982-1994: 62%; 1995-1997: 84%); diagnosis in allochtonous children was made relatively late. CONCLUSION: The current rise in the absolute number of newly detected paediatric HIV-1 infections in the Netherlands is predominantly due to the growing group of children born to parents who originate from HIV-endemic countries.

Africa↗
PubMed1999

[Hemolytic disease of the newborn and irregular blood group antibodies in the Netherlands: prevalence and morbidity].

OBJECTIVE: To inventory prevalence and morbidity of haemolytic disease of newborn caused by irregular anti-erythrocyte antibodies other than antirhesus-D. DESIGN: Prospective registration study. METHOD: All paediatricians (n = 380) in general hospitals and contact persons (n = 79) in university hospitals were asked for monthly reports of clinical cases of haemolytic disease of newborn during 2 years (1996-1997). RESULTS: Response was 97%. A total of 130 reports were received in two study years, 49 of which could not be confirmed as non-RhD-non-AB0 antagonism. In the group of which the transfusion history was known (n = 60), 29 pregnant women (48%) had received transfused blood at some time. Of the antibodies found, anti-c, anti-E and anti-K were the most frequent. The direct antiglobulin test was positive in 61 of the 81 cases, negative in 10 cases, while in 10 cases it was unknown or false-negative due to earlier intrauterine transfusions (in three neonates). The highest bilirubin levels recorded were 572, 559 and 520 mumol/l (all three with maternal anti-c antagonism). Therapeutic data were known concerning 80 of the 81 newborn: 21 (16%) received no treatment, 24 (29%) only phototherapy and the others--in addition to phototherapy if any--also blood transfusion, exchange transfusion or intrauterine transfusion, or a combination of these. CONCLUSION: It was calculated that the actual prevalence of irregular anti-erythrocyte antibodies in Dutch pregnant women probably amounts to approximately 0.25%. This finding may possibly be confirmed since starting 1 July 1998 all pregnant women in the country are screened for the presence of these antibodies. It is recommended that girls and women in the reproductive age group should receive primary prevention of development of irregular anti-erythrocyte antibodies by application of a selective blood transfusion policy, taking into account the occurrence of the antigens c, E and K.

Blood Group Incompatibility↗
PubMed1999

Endocrine features of polycystic ovary syndrome in a random population sample of 14-16 year old adolescents.

Hospital based studies have shown that oligomenorrhoeic adolescents have high luteinizing hormone (LH) and androgen concentrations, endocrine signs of polycystic ovary syndrome (PCOS). The prevalence of these abnormalities in an unselected population of adolescents is not known. We determined LH, follicle stimulating hormone (FSH), androstenedione, testosterone, dehydroepiandrosterone sulphate (DHEAS), oestradiol and prolactin concentrations in unselected population samples of adolescents with oligomenorrhoea, secondary amenorrhoea and regular menstrual cycles. A total of 2248 white, west European adolescents, aged 15.3 +/- 0.6 (mean +/- SD) years, participated. Blood was taken from 107 adolescents with regular menstrual cycles, 52 with oligomenorrhoea and four with secondary amenorrhoea. Oligomenorrhoeic adolescents had higher mean LH, androstenedione, testosterone, DHEAS and oestradiol concentrations compared with girls with regular menstrual cycles; 57% of the oligomenorrhoeic girls had LH or androgen concentrations above the 95th centile of adolescents with regular menstrual cycles. None of the 52 oligomenorrhoeic girls and only one of four girls with secondary amenorrhoea had a hypogonadotrophic endocrine pattern. The present study and available literature support the view that oligomenorrhoea in adolescents is not a stage in the physiological maturation of the hypothalamic pituitary-ovarian axis but an early sign of PCOS associated with subfertility. Physicians should consider endocrine evaluation before reassuring oligomenorrhoeic girls or prescribing oral contraceptives to these girls.

Adolescent↗
PubMed1998

[Alarm training also successful in 5 to 7 year olds with nocturnal enuresis].

OBJECTIVE: To determine how many bed-wetting children aged 5-7 years unlearn the habit using the alarm treatment. DESIGN: Descriptive. SETTING: TNO Prevention and Health, Leiden, the Netherlands. METHODS: The population consisted of all children aged 5 to 7 with nocturnal enuresis (defined as > or = 2 wettings per week) who ordered an Elther alarm set (Elther BV, Tilburg) in May or June 1996 (n = III). The parents and the child were asked to keep notes during the treatment of whether the child had remained dry and of whether the alarm had sounded. When at the time of cessation of the alarm training the results were insufficient, the parents were asked about the reason to stop. When the child had remained dry for 14 nights in succession (the definition of 'success'), a questionnaire was sent 6 months later to inquire if the child was still dry or had relapsed. RESULTS: The totals of success for children aged 5, 6 and 7 years were 70% (n = 7/10), 73% (n = 29/40) and 90% (n = 55/61), respectively. Seven-year-olds were significantly more successful than the children aged 5 or 6 (p = 0.02). No significant correlations were found between results of treatment and sex, the nature of the enuresis (purely functional or not), familial occurrence and frequency of bed-wetting at the start of the treatment. The average times until success were 53 days for the 5-year-olds (range: 31-78), 65 days for the 6-year-olds (26-154) and 59 for the 7-year-olds (17-141). The proportions of relapse after 6 months were 0%, 14% and 9%, respectively. CONCLUSION: Alarm training with pad and buzzer appears to be a suitable method of treatment even for children younger than 8 years.

Age Factors↗
PubMed1998

[Twenty years of childhood coeliac disease in the Netherlands: more diagnoses and a changed clinical picture].

OBJECTIVE: To assess the incidence of childhood coeliac disease in the Netherlands and to study the clinical features. DESIGN: Prospective. SETTING: Leiden University Medical Centre, Leiden, the Netherlands. METHOD: Cases of childhood coeliac disease in the Netherlands in 1993-1995 were identified by means of the Dutch Paediatric Surveillance Unit. Inclusion criteria were: birth in the Netherlands, diagnosis with at least one small bowel biopsy in 1993-1995 and age at diagnosis 0-14 years. The data were cross checked with the Dutch Network and National Database of Pathology and compared with data from a previous study on childhood coeliac disease, 1975-1990. RESULTS: 297 Coeliac patients were identified by means of the Surveillance Unit, another 32 through the National Database of Pathology. The mean crude incidence rate of diagnosed childhood coeliac disease was 0.51/1000 live births, which was in the range of rates found in other West European countries and significantly higher than the mean crude incidence rate of 0.18/1000 live births found in the Netherlands in 1975-1990. The clinical presentation was classic up to 1990: chronic diarrhoea, abdominal distention and growth failure. From 1993 onward, however, the number of children with chronic diarrhoea and abdominal distention decreased significantly and the number with weight loss, anaemia and abdominal pain increased. Associated disorders were present in 13.7% of the cases. CONCLUSIONS: The incidence of diagnosed childhood coeliac disease in the Netherlands showed a tendency to increase significantly during the past decade. In a period of 20 years a significant trend toward change in the clinical presentation of coeliac disease in Dutch children was observed.

Adolescent↗
PubMed1998

Childhood nocturnal enuresis in The Netherlands.

OBJECTIVES: To assess the prevalence of nocturnal enuresis in school children aged 5 to 15 years, and to investigate the association of bedwetting with ethnicity, the educational level of the parents, and the type of education (mainstream or special) received by the child. METHODS: Data were obtained for 5360 children in mainstream education and 2571 children in special education. The data were weighted to calculate estimates representative of the Dutch population. Nocturnal enuresis was examined in children 5 or 6 years of age who wet their bed at least twice in the 4 weeks previous to questioning, and in children 7 years of age and older who did so at least once in the previous 4 weeks. RESULTS: The prevalence of nocturnal enuresis was 6%; 15% in the 5 to 6-year-age group and 1% in the 13 to 15-year age group. Marked enuresis (at least twice a week) was reported in 4%. Nocturnal enuresis was more common in Turkish/Moroccan (14%) than in Dutch children (6%). The educational level of the parents was not significantly related to nocturnal enuresis. Children in special education more frequently reported nocturnal enuresis than children in mainstream education (14% and 6%, respectively). This was especially true for children in schools for the mentally retarded as compared to children in mainstream education ¿odds ratio [OR] in boys 3.21 (99% confidence interval [CI] 2.26 to 4.55) and OR in girls 4.25 [99% CI 2.61 to 6.92]¿. CONCLUSIONS: Nocturnal enuresis occurs most frequently among mentally retarded children. Children attending special education schools for reasons other than mental retardation are also at a higher risk of experiencing nocturnal enuresis than children attending mainstream education schools. Nocturnal enuresis is more prevalent in Turkish/Moroccan children than in Dutch children.

Adolescent↗
PubMed1998

Psychological responses to the needle-free Medi-Jector or the multidose Disetronic injection pen in human growth hormone therapy.

The aim of the study was to test the hypothesis that daily administration of growth hormone using the Medi-Jector results in fewer adverse psychological responses than needle injection with a multidose injection pen. The Medi-Jector is a needle-free injection device that can deliver growth hormone subcutaneously through jet injection. The group studied consisted of 18 children aged 10 y or over who were participating in a study of the bioequivalence and bioequipotence of the administration of growth hormone through jet injection or needle injection. Previously, all subjects had received growth hormone therapy with commercially available multidose injection pens. The study was designed as a prospective, randomized, two-period cross-over trial. A questionnaire was used to assess psychological responses such as non-compliance, opinion on ease of preparation, affective responses to administration and local side-effects, as well as overall preference. In addition, the subjects kept a diary during the study. The subjects found the Medi-Jector less offputting (p < 0.01), less painful with respect to both frequency (p < 0.04) and intensity (p < 0.01) and less unpleasant (p < 0.05) than a multidose injection pen with a 28G needle (p < 0.01). No difference in compliance was detected. Most subjects preferred the Medi-Jector for future use (p < 0.05). The mean score on a 1-10 point scale (10 is excellent) was 7.9 (SD 1.4) for the Medi-Jector and 6.8 (SD 2.3) for the multidose injection pen (p < 0.08). The prevalence of visible bruises each day was higher (p < 0.01) with the Medi-Jector (2.5, SD 2.1) than with the multidose injection pen (0.7, SD 1.1), but children showed indifferent affective responses to bruising. Thirteen out of 18 subjects decided to continue therapy with the Medi-Jector (p < 0.06). It is concluded that use of the Medi-Jector in growth hormone therapy tends to lead to fewer adverse psychological responses than a multidose injection pen with 28G needles.

Adolescent↗
PubMed1998

Relationship of the menstrual cycle pattern in 14-17 year old old adolescents with gynaecological age, body mass index and historical parameters.

In a cross-sectional population-based study the association between the menstrual pattern in ninth grade schoolgirls and calendar age, gynaecological age, body mass index (BMI) and historical parameters was investigated. The survey was held in a combined urban and rural region, south of Amsterdam. A total of 2480 adolescents, mean age 15.3 +/- 0.6 (SD) years, answered a questionnaire: response 92%. The menstrual cycle patterns were categorized to regular menstrual cycles (RMC), irregular menstrual cycles (IMC), oligomenorrhoea, polymenorrhoea, pre-menarche, <6 months after menarche, and oral contraceptive use. Gynaecological age was strongly associated with the prevalence of IMC but only weakly with the prevalence of oligomenorrhoea. In a logistic regression analysis gynaecological age, subjective acne and intellectual performance were independently associated with oligomenorrhoea. Gynaecological age, low BMI, chronic non-specific lung disease (CNSLD) or allergic disease, stress and strain, weight loss of >5 kg were independently associated with IMC. More than 8 h sports per week was associated with not having experienced menarche in the ninth grade but not with menstrual cycle disturbances. The association between CNSLD or allergic disease and IMC has not previously been described. The associations between weight loss, low body weight, stress, physical exercise or signs of hyperandrogenism and menstrual cycle patterns in adolescents are weak when studied on a population basis. The value of these parameters to explain abnormal menstrual cycle patterns is limited.

Adolescent↗
PubMed1998

Surveillance of acute flaccid paralysis in The Netherlands, 1992-94.

Detection and investigation of all cases of acute flaccid paralysis (AFP) in children below 15 years of age are among the criteria for poliomyelitis-free certification. In the absence of poliomyelitis the incidence of AFP is around 1 per 100,000 children aged < 15 years. In the Netherlands, surveillance of AFP began in October 1992 under the supervision of the Dutch Paediatric Surveillance System (NSCK). Over 90% of clinically active paediatricians participated in the monthly reporting of new cases of AFP. From October 1992 to December 1994 (27 months), 52 cases of AFP were reported. The incidence was 0.7 per 100,000 over the period, and reported cases were evenly distributed throughout the country. The main cause of AFP was Guillain-Barré syndrome. The average time between onset of symptoms and visiting a doctor was less than 3 days. The median reporting delay was 29 days, although the system was not intended as surveillance for action. Virological examination of faeces was carried out for only 40.4% of AFP patients. The start of the NSCK surveillance system coincided with the 1992-93 outbreak of poliomyelitis in the Netherlands, but only 7 of the 18 children with paralytic poliomyelitis were reported through the AFP surveillance system. For certification purposes, the present AFP surveillance system in the Netherlands needs to be improved with respect to coverage by including neurologists, rapidity of reporting, and completeness of laboratory investigations.

Adolescent↗
PubMed1998

The use of oral contraceptives by adolescents for contraception, menstrual cycle problems or acne.

BACKGROUND: Oral contraceptives are prescribed as contraception but also as therapy for menstrual cycle disturbances and acne. We studied the prevalence of oral contraceptive (OC) use and the indications to start OC use among adolescents. METHODS: A cohort consisting of ninth grade secondary school girls (mean age 15.3+/-0.6 (s.d.) years) answered a questionnaire on their menstrual cycle. OC users were asked about duration and reasons for OC-use and the name of the preparation they used. The influence of calendar age, gynecological age and level of education on the prevalence of OC was studied by multiple logistic regression analysis. RESULTS: The response on the questionnaire was 92%. Of 2248 responders 248 (11%) used oral contraceptives: 74% used low dose 'sub 50' preparations, 3% pills with 50 microg estrogen, 3% tri-phase preparations and 17% pills with antiandrogens. Of girls aged 14, 15 and 16 years 4%, 12% and 28% respectively, used OC. Of the 15-year-olds 31% mentioned contraception as most important reason for OC use, 18% menstrual cycle irregularity, 26% dysmenorrhea, 10% acne and 5% other reasons. Calendar age, gynecological age and level of education were independent variables for OC use in general and for OC use for contraception or dysmenorrhea, but less so for OC use for menstrual cycle irregularity or acne. CONCLUSIONS: During adolescence low dose OC's were frequently used. In The Netherlands OC use among girls aged 15 and 16 years doubled in comparison with 1982. One third of the adolescent OC-users mentioned contraception as most important reason to start OC. Gynecological age (a determinant of biological maturation), calendar age (a determinant of biological maturation and lifestyle in peer groups), and level of education (a determinant of lifestyle in peer groups) were associated with OC use.

Acne Vulgaris↗
PubMed1997

[Current developments in preventive health care].

On the occasion of the publication of the second revised edition of the Preventiegids (Prevention guide), some recent developments in preventive health care can be analysed and priorities for the near future can be formulated. Some controversies have been resolved (e.g. periconceptional use of folic acid, influenza vaccination of all elderly), a number of others still exist (e.g. postmenopausal oestrogen substitution, screening for hypertension and hypercholesterolaemia). Further health benefit can be obtained by preventive activities, albeit to a limited extent. The focus should be on correct implementation (standardisation) of existing prevention programmes plus evaluation, with improvements where possible. There will also be opportunities for new prevention programmes (e.g. use of the triple test in screening for Down syndrome). It will be possible to discontinue existing inefficient programmes (e.g. routine pregnancy ultrasonography, routine administration of iron to pregnant women.

Adolescent↗
PubMed1997

Confirmation of high incidence of type 1 (insulin-dependent) diabetes mellitus in Moroccan children in The Netherlands.

The incidence of Type 1 (insulin-dependent) diabetes mellitus among Moroccan children aged (0-19 years) in The Netherlands was determined. Point of reference was the data derived from the second nationwide incidence study on Type 1 diabetes among children under 20 years of age. In that study the incidence among Dutch children was 13.2 100000(-1) year(-1). To scrutinize the data and to obtain more information a questionnaire was sent in 1993 to all specialists who had reported that they had diagnosed a patient with Type 1 diabetes during the years 1988-1990 whose parents originated from Morocco, Turkey or other foreign countries. The questionnaire requested information on origin and migration of child and parents. The response to the questionnaire was 86% for the Moroccan children, 75% for the Turkish children and 100% for the children from other countries. In only one case a wrong country had been recorded. None of the patients had been in The Netherlands for less than 6 months before the diagnosis. The incidence for Moroccan children was 20.0 (95% CI 14.6-26.9) and for Turkish children 4.5 (95% CI 2.2-8.0) 100,000(-1) year(-1). It is concluded that the incidence of Type 1 diabetes in Moroccan children (0-19 years) is 1.5 times higher than in Dutch children and 4.5 times higher than in Turkish children.

Adolescent↗
PubMed1997

Food intolerance (food hypersensitivity) and chronic complaints in children: the parents' perception.

UNLABELLED: The aim of the study was to assess the prevalence of food intolerance (FI) in Dutch 5- and 6-year-old children and its association with chronic ailments with a survey among parents by questionnaire. Based on parents' perception the prevalence of "probable" FI was 3.8%. FI was associated with asthma, wheezing, eczema, hay fever, chronic rhinitis, hives, chronic diarrhoea and hyperactive behaviour. The Dutch research results are commensurate with the findings of a study carried out in the U.K. Parents frequently associate FI with eczema, hives, chronic diarrhoea and hyperactivity. The association with FI remains for asthma, wheezing, chronic rhinitis, hay fever, chronic diarrhoea and hyperactive behaviour even after adjustment for this information bias. CONCLUSION: Many parents are not aware that chronic ailments in their child may be caused by FI. The associations of FI and chronic complaints are strong enough to justify the discussion with parents during the client contacts by school physicians, in order to assess the advantages of consulting a paediatrician or allergologist.

Adult↗
PubMed1997

Bedwetting and behavioural and/or emotional problems.

OBJECTIVE: To assess the link between enuresis nocturna and the severity of behavioural and/or emotional problems in Dutch children and the course of these problems. SETTING: West-Mine Region in the Netherlands. SUBJECTS AND METHODS: Prospective cohort study involving 66 of the 80 bedwetting children from all 1652 children born in 1983 in this region. After 1 y, contact was still possible with 64 of the enuretics. We used the Dutch version of the Child Behaviour Checklist (CBCL) and a questionnaire about bedwetting. RESULTS: The mean T-score for Total Problems (CBCL score) in 1992 (M1; mean age 8.6) was 52.1, and 1 y later was 49.2 (M2). There was no significant difference in the CBCL scores for M1, M2 and a matching group from the Dutch CBCL norm population, either in the group who remained wet or in the group who became dry. There were no differences between the sexes. There was no link between the severity of behavioural and emotional problems and the frequency of bedwetting. However, more children with bedwetting than expected were in the clinical range. CONCLUSION: There was no difference in behavioural and/or emotional problems between the first and the second measurement and the matching group from the CBCL norm group. There were no differences in behavioural and/or emotional problems between primary and secondary bedwetters, nor were there any consequences related to the frequency of bedwetting.

Affective Symptoms↗
PubMed1997

Twenty years of childhood coeliac disease in The Netherlands: a rapidly increasing incidence?

BACKGROUND: The incidence of coeliac disease varies internationally. AIMS: To assess the incidence of childhood coeliac disease in The Netherlands and to study the clinical features and the presence of associated disorders. SUBJECTS: Identified cases of childhood coeliac disease in The Netherlands in 1993-4 by means of the Dutch Paediatric Surveillance Unit. METHODS: Inclusion criteria were born in The Netherlands, diagnosed with at least one biopsy of the small bowel in 1993-4 and age at diagnosis 0-14 years. The data were cross checked by the Dutch Network and National Database of Pathology and compared with data from a previous study on childhood coeliac disease, 1975-90. RESULTS: A total of 193 coeliac patients were identified by means of the Surveillance Unit, another 20 through the National Database of Pathology. The mean crude incidence rate of diagnosed childhood coeliac disease was 0.54/1000 live births, which is in the range of rates found in other western European countries and significantly higher than the mean crude incidence rate of 0.18/1000 live births found in The Netherlands in 1975-90. The clinical presentation was classic: chronic diarrhoea, abdominal distension, and growth failure. Associated disorders were present in 11.7% of the cases. CONCLUSIONS: The incidence of diagnosed childhood coeliac disease in The Netherlands seems to have increased significantly during the past few years. In a period of 20 years no significant changes could be found in the clinical picture at preentation of coeliac disease in Dutch children.

Adolescent↗
PubMed1997

Enuresis nocturna in adults.

To assess the prevalence and characteristics of enuresis nocturna in adults, the treatment they received and the perceived impact, a random sample of 13081 non-institutionalized adults (18-64 years old) were asked to participate in the study in January-March 1996. The response rate was 87%. A personal computer questionnaire included 23 questions on frequency of bedwetting, daytime wetting, treatment and perceived impact. Any respondent reporting bedwetting at least once during the previous 4 weeks was considered to have enuresis nocturna. The overall prevalence of enuresis nocturna was 0.5%. Differences between age groups and sexes were not significant. Fifty percent of men and 19% of women reporting enuresis nocturna had primary enuresis nocturna, of those with enuresis nocturna, 12% of men and 29% of women had always daytime incontinence. Fifty percent of the men and 35% of the women had never consulted a care provider for their bedwetting and 38% of the men and 26% of the women had done nothing to become dry. Only 30% believed that bedwetting was treatable. Bedwetting was associated with several psychosocial problems. Enuresis nocturna in adults is common and may lead to embarrassment and discomfort. It may affect careers, social life and personal relationships. Adults should be more aware that bedwetting is a treatable problem. More information should be given on this issue.

Adolescent↗