Reproductive health of women with intellectual disability: antenatal care, pregnancies and outcomes in the Dutch population.

BACKGROUND: Research in a handful of countries found that women with intellectual disability (ID) faced barriers and risks regarding antenatal care and reproductive health. This study tested disparities between women in the Netherlands with and without ID in antenatal care, pregnancy rates and pregnancy outcomes. METHODS: Secondary analyses on the large representative panel of primary health patients in the Netherlands by the Netherlands Institute for Health Services Research (NIVEL) compared women in their reproductive age (18-49 years) with (n = 2397) and without (n = 228 608) indicators of ID. Bias due to underreporting and under-identification was reduced by linkage with an index of ID for the total Dutch population from Statistical Netherlands. RESULTS: Women with ID were more likely to receive contraceptive care [95% confidence interval (CI) for odds ratio (OR) = 1.37-1.61] and became somewhat more often pregnant (95% CI OR = 1.06-2.30) than women from the general population, adjusting for age difference and follow-up time. No statistical differences were found in medical complications during pregnancy, delivery and immediately after birth, but women with indicators of ID had a higher risk of losing their pregnancy, including through induced abortion (95% CI OR = 1.26-1.99). CONCLUSIONS: Women with ID have specific needs around contraceptive care and risks around their pregnancy that may require more awareness among practitioners and better understanding of the processes of care and decision-making.

Mortality of people with intellectual disabilities during the 2017/2018 influenza epidemic in the Netherlands: potential implications for the COVID-19 pandemic.

BACKGROUND: Data on the development of Covid-19 among people with intellectual disabilities (IDs) are scarce and it is uncertain to what extent general population data applies to people with ID. To give an indication of possible implications, this study investigated excess mortality patterns during a previous influenza epidemic. METHODS: Using Dutch population and mortality registers, a historical cohort study was designed to compare mortality during the 2017-2018 influenza epidemic with mortality in the same period in the three previous years. People with ID were identified by entitlements to residential ID-care services as retrieved from a national database. RESULTS: Data covered the entire adult Dutch population (12.6 million; GenPop), of which 91 064 individuals were identified with an ID. During the influenza epidemic, mortality among people with ID increased almost three times as much than in the GenPop (15.2% vs. 5.4%), and more among male individuals with ID (+19.5%) than among female individuals with ID (+10.6%), as compared with baseline. In both cohorts, comparable increases in mortality within older age groups and due to respiratory causes were seen. Particularly in the ID-cohort, excess deaths also occurred in younger age groups, due to endocrine diseases and ID-specific causes. CONCLUSIONS: During the 2017-2018 influenza epidemic, excess mortality among people with ID was three times higher than in the general Dutch population, appeared more often at young age and with a broader range of underlying causes. These findings suggest that a pandemic may disproportionally affect people with ID while population data may not immediately raise warnings. Early detection of diverging patterns and faster implementation of tailored strategies therefore require collection of good quality data.

Comparative Fe and Zn K-edge X-ray absorption spectroscopic study of the ferroxidase centres of human H-chain ferritin and bacterioferritin from Desulfovibrio desulfuricans.

Iron uptake by the ubiquitous iron-storage protein ferritin involves the oxidation of two Fe(II) ions located at the highly conserved dinuclear "ferroxidase centre" in individual subunits. We have measured X-ray absorption spectra of four mutants (K86Q, K86Q/E27D, K86Q/E107D, and K86Q/E27D/E107D, involving variations of Glu to Asp on either or both sides of the dinuclear ferroxidase site) of recombinant human H-chain ferritin (rHuHF) in their complexes with reactive Fe(II) and redox-inactive Zn(II). The results for Fe-rHuHf are compared with those for recombinant Desulfovibrio desulfuricans bacterioferritin (DdBfr) in three states: oxidised, reduced, and oxidised/Chelex-treated. The X-ray absorption near-edge region of the spectrum allows the oxidation state of the iron ions to be assessed. Extended X-ray absorption fine structure simulations have yielded accurate geometric information that represents an important refinement of the crystal structure of DdBfr; most metal-ligand bonds are shortened and there is a decrease in ionic radius going from the Fe(II) to the Fe(III) state. The Chelex-treated sample is found to be partly mineralised, giving an indication of the state of iron in the cycled-oxidised (reduced, then oxidised) form of DdBfr, where the crystal structure shows the dinuclear site to be only half occupied. In the case of rHuHF the complexes with Zn(II) reveal a surprising similarity between the variants, indicating that the rHuHf dinuclear site is rigid. In spite of this, the rHuHf complexes with Fe(II) show a variation in reactivity that is reflected in the iron oxidation states and coordination geometries.

The crystal structure of the Dps2 from Deinococcus radiodurans reveals an unusual pore profile with a non-specific metal binding site.

The crystal structure of recombinant Dps2 (DRB0092, DNA protecting protein under starved conditions) from the Gram-positive, radiation-resistant bacterium Deinococcus radiodurans has been determined in its apo and iron loaded states. Like other members of the Dps family, the bacterial DrDps2 assembles as a spherical dodecamer with an outer shell diameter of 90 A and an interior diameter of 40 A. A total of five iron sites were located in the iron loaded structure, representing the first stages of iron biomineralisation. Each subunit contains a mononuclear iron ferroxidase centre coordinated by residues highly conserved amongst the Dps family of proteins. In the structures presented, a distinct iron site is observed 6.1 A from the ferroxidase centre with a unique ligand configuration of mono coordination by the protein and no bridging ligand to the ferroxidase centre. A non-specific metallic binding site, suspected to play a regulative role in iron uptake/release from the cage, was found in a pocket located near to the external edge of the C-terminal 3-fold channel.

Pattern-reversal visual evoked potentials in patients with epiretinal membrane.

PURPOSE: To determine the extent of pattern-reversal visual evoked potential parameter alteration by epiretinal membranes and to investigate the use of pattern-reversal visual evoked potential in the estimation of macular function in eyes with epiretinal membrane and in the fellow eyes. METHODS: In both eyes of 162 patients with epiretinal membrane, 92 of primary and 70 of secondary origin, pattern-reversal visual evoked potentials were recorded. Check sizes of 17', 10', and 7' (minutes of arc) were used. Parameters investigated were N80 and P100 latencies and P100 amplitude. RESULTS: No significant difference was detected between eyes with epiretinal membrane of primary and secondary origin regarding visual acuity and the pattern-reversal visual evoked potential parameters for the different check sizes. Compared with the fellow eyes, the eyes with epiretinal membrane had a significantly reduced visual acuity, prolonged N80 and P100 latencies, and a reduced P100 amplitude for the different check sizes. Compared with a separate control group (N = 20) with patients 50 to 59 years old, eyes with epiretinal membrane (N = 9) showed the same features as in the total group, but only for the 17' and 10' check sizes. The fellow eyes (N = 9) showed a significant reduction of the P100 amplitude (P < .05) for the pattern sizes of 17' and 10', but no difference in visual acuity or pattern-reversal visual evoked potential latency was found. CONCLUSIONS: In eyes with epiretinal membrane, pattern-reversal visual evoked potential latencies are prolonged, and amplitude is reduced. Relationships between clinical parameters and pattern-reversal visual evoked potential parameters require further study.

The EOG in Best's disease and dominant cystoid macular dystrophy (DCMD).

The electro-oculogram (EOG) was studied in 156 normal patients, 103 patients with Best's disease, and 52 patients with dominant cystoid macular dystrophy (DCMD). Statistical analysis was performed by comparing the distribution of Lp/Dt ratios of the groups. Strength of association between Lp/Dt ratio and age was studied with correlation and regression analysis. In normal patients and in those with Best's disease, there was no significant correlation between age and Lp/Dt ratio. Obviously, the gene defect in Best's disease causes an altered light-sensitive slow oscillation that remains stable throughout life. In DCMD patients, there was a significant negative correlation between age and Lp/Dt ratio for the total sample and for the female subgroup. Likely, the gene defect in DCMD interferes with capillary permeability, that becomes susceptible to changes of the female hormones.

Treatment of hyperopia with contact Ho:YAG laser thermal keratoplasty.

PURPOSE: To evaluate the effectiveness, safety, and stability of contact Ho:YAG laser thermal keratoplasty for low to moderate hyperopia. METHODS: Fifty-five hyperopic eyes of 39 patients were treated with a Technomed contact Ho:YAG laser; 23 eyes were treated a second time. Treatment parameters were 1 octagonal ring of 8 spots with a treatment diameter of 6 mm, 7 mm, or 8 mm. Efficacy of the Ho:YAG laser treatment was evaluated after 6 months, comparing 3 treatment zone diameters. Stability and efficacy after 12 months was evaluated comparing 7-mm and 8-mm treatment zone diameters. RESULTS: Mean reduction of spherical equivalent refraction after 6 months was not statistically significantly different between the 6-mm or 7-mm diameter zones: 1.42 (+/- 1.30) D versus 2.22 (+/- 0.44) D. An 8-mm diameter treatment zone was significantly less effective, 1.12 (+/- 0.47) D. Longer follow-up did not show stability: mean reduction of spherical equivalent manifest refraction was 1.58 (+/- 0.45) D for the 7-mm diameter treatment zone and 0.82 (+/- 0.61) D for the 8-mm diameter treatment zone after approximately 12 months. Retreatment had a limited additive effect. No clinically significant loss of spectacle-corrected visual acuity was reported. No eyes lost more than 1 line of visual acuity. CONCLUSION: Contact Ho:YAG laser thermal keratoplasty corrected hyperopia up to 2.50 D, but predictability was poor and a regression of initial effect occurred. Instability of refraction persisted to 1 year after surgery.

Comparison of optic disc image assessment methods when examining serial photographs for glaucomatous progression.

AIM: To assess serial, simultaneous stereo optic disc images by four methods for glaucomatous progression. METHODS: Using varying techniques, two ophthalmologists assessed serial optic disc images of 52 eyes from 27 patients with a mean duration between images of 18 months. The neuroretinal rim width was qualitatively assessed by four assessment methods and compared with quantitative rim measurements made using PC based software. RESULTS: The highest sensitivity of 83% was achieved using computerised stereo chronoscopy. CONCLUSION: Stereo chronoscopy improved the detection of subtle optic disc changes when compared with simpler assessment techniques.

Assessment of myocardial velocities in healthy children using tissue Doppler imaging.

The objective was to determine the normal range of tissue velocities in paediatric hearts as measured by tissue Doppler imaging. A prospective study was carried out involving 160 healthy children (mean age 10.8 y, range 4.0-17.9 y). Using tissue Doppler imaging (TDI) from parasternal long axis and apical views, peak velocities and peak myocardial velocity differences across the right ventricular anterior wall, interventricular septum and left ventricular posterior wall were assessed during systole, early and late diastole. The existence of transmyocardial velocity differences between the left and right side of the interventricular septum, as well as between the endocardium and epicardium of the left ventricular posterior wall was observed throughout the heart cycle. With range-gated TDI from apical four-chamber view, peak velocities were measured within the basal, mid and apical parts of the interventricular septum, and the left and right free ventricular walls. The highest peak systolic, early and late diastolic velocities were measured within the basal parts of all myocardial walls. The ranges of the calculated velocity ratios (early-to-late diastolic velocity and early diastolic-to-systolic velocity) for the various wall parts appeared to be overlapping. The correlations of peak myocardial tissue velocities and their ratios with age and weight were weak and practically irrelevant. These normal values of peak myocardial velocities, transmyocardial velocity differences and the ratios of peak wall velocities can be used as reference values in future investigations of ventricular dysfunction in this age group.

Influence of histochemical preparation on acoustic parameters of liver tissue: a 5-MHz study.

In this study the influence of various histological techniques on the acoustic parameters of liver tissue was investigated. Radiofrequency (RF) echographic data were obtained in vitro from 21 liver samples taken from 8 white New Zealander rabbits. The samples were measured in four different subsequent histological tissue processing conditions (freshly excised, 4% buffered formalin fixed, after it went through a paraffin cycle and after staining with hematoxylin and eosin). The acoustic parameters that were obtained from the rf data were velocity of sound, slope of the attenuation coefficient versus frequency between 1.9 and 6.9 MHz, attenuation coefficient at 4.4 MHz, slope of the backscattering spectrum between 1.9 and 6.9 MHz, and intercept of the backscattering spectrum. It was found that fixation by formalin preserves the acoustic properties of the tissue to a reasonable extent. Embedding in paraffin and deparaffinizing induces large changes in the acoustic properties of the tissue. As an alternative, freezing prior to cutting, rather than the paraffin cycle, was investigated also in 10 liver samples obtained from 4 New Zealander rabbits. This method produced no significant changes of the acoustic parameters and should therefore be preferred in acoustic microscopy.

The inverse problem in electroretinography: a study based on skin potentials and a realistic geometry model.

The problem of obtaining the retinal source distribution that generates the electroretinogram (ERG) from measured skin potentials is addressed. A realistic three-dimensional (3-D) volume conductor model of the head is constructed from magnetic resonance image (MRI) data sets. The skin potential distribution generated in this model by a dipole layer source at the retina is computed by using the boundary element method (BEM). The influence of the various compartments of the complete model on the results was investigated, and a simplified model was defined. An inverse procedure for estimating the source distribution at the retina from ERG's obtained from skin electrodes was developed. The procedure was tested on simulated potentials. A fair correspondence between the original and estimated source distribution was found. Furthermore, the ERG's measured at seven skin electrodes were used to estimate the source distribution at the retina. The ERG potential waveform at an additional skin electrode was computed from this source distribution and compared to the measured potential at this electrode. Again a fair correspondence was obtained. It is concluded that the methods may become a useful tool for clinical applications, i.e., for the assessment of localized defects in retinal function.

Polymers of 1-vinyl-2-pyrrolidinone as potential vitreous substitutes: physical selection.

More than 300 polymers of 1-vinyl-2-pyrrolidinone (VP) were synthesized, subjected to hydration, and characterized with the aim to select the most suitable materials as potential artificial substitutes for the vitreous body of the eye. The materials include cross-linked homopolymers, uncross-linked copolymers of VP with 2-hydroxyethyl methacrylate (HEMA), and cross-linked copolymers VP/HEMA. Five different cross-linking agents, both hydrophobic and hydrophilic, were used in this study. The resulting hydrogels, with equilibrium water contents ranging between 66.5 and 99.1%, were first subjected to a selection based on their physical behavior during manipulation, after which only the transparent, viscoelastic gels were further considered. Subsequent injectability and visual acuity tests, as well as the evaluation of light transmission characteristics, reduced further the number of potential candidates for vitreous substitution to only thirteen hydrogels. An eliminatory strategy based on physical properties of the potential vitreous substitutes is essential in order to avoid unnecessary sacrifice of experimental animals for in vivo assessment.

IDEA: a large-scale project on electronic identification of livestock.

The aim of the IDEA (Identification électronique des animaux) project is to collect information on the feasibility of the introduction into the European Union (EU) of an animal electronic identification system, as referred to in Directive 92/102 and Regulation 1760/2000. The project will run for a period of four years (1998-2001) and will include one million animals in six countries (France, Germany, Italy, The Netherlands, Portugal and Spain). The Joint Research Centre, as technical co-ordinator of the project, provides technical support in terms of testing and certification of electronic identification devices, establishment of the central database, transmission and recording of data and evaluation of results. Identification has been undertaken in cattle, sheep, goats and buffalo using three types of electronic tags (ruminal bolus, ear tag and injectable transponder). The performance of these tags is checked at defined intervals until recovery in the slaughterhouse. The evaluation of the results in terms of the performance of the device and the necessary organisational support structures will lead to recommendations for a system to trace animals from birth to slaughterhouse, including the appropriate technology to be applied in any generalised system for the livestock sector in the EU.

Tele-ophthalmology screening for retinal and anterior segment diseases.

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera used as gold standards. Images (390 x 300 pixels x 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup-disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.

Improving the ensemble average of visual evoked potentials. I. Theory of correction by spectral phase difference methods.

The considered causes of variability of visual evoked potentials (VEPs) are additive noise and time variability. The time variability can be modelled in three different ways: 1. time invariant VEP waveform and delay-time "jitter"; 2. time variant VEP waveform, due to 2a. jitter of individual components or 2b. constant VEP waveform and "wow", i.e. expansion or compression of the time scale. The wow model has not been considered so far in the literature. Correction of jitter and/or wow is based on a frequency domain method: the "spectral phase difference" method (SPD). When jitter is present the SPD method is applied in the frequency domain on the single responses, or on a subensemble of a small number of responses. For the wow a new method is proposed where the time scale is logarithmically compressed prior to the calculation of the spectrum. It is shown that the SPD method can also be applied then to estimate the compression factor yielding the wow. The single responses, or the averaged sub-ensembles, can subsequently be corrected by this factor and finally be averaged. Improvement of the precision and accuracy of estimates of both the peak latencies and the peak amplitudes, as well as a comparison between the results of the jitter and wow models, have been reported in a companion paper.

Improving the ensemble average of visual evoked potentials. II. Simulations and experiments.

Ensemble averaging is generally used for the estimation of Evoked Potentials. This paper deals with the assessment of correction procedures for the time variability of the ensemble components, this time variability reduces the improvement of the signal-to-noise ratio (SNR) by averaging. Evoked potentials were estimated by ensemble averaging, synchronized to a periodic stimulus. It is assumed that VEP-instability is partly caused by time-variability of the evoked potentials. Two time-variate models were used, from which procedures were derived to correct the single VEP-responses prior to ensemble averaging. The models are: (1) variation in response delay (jitter), (2) variable compression/expansion of the time scale of the response (wow). The Spectral Phase Difference method was applied to estimate both the delay time jitter and the wow factor of single responses with respect to a template (conventional ensemble average). The effects of the devised correction on the average VEP waveform and on the SNR of the ensemble were investigated by using data from realistic simulations and from experiments (n = 23) with a number of healthy human volunteers (n = 17). Jitter- and wow-corrections were effective on simulations with time variability due to delay time jitter and time scale distortion (wow), respectively. Both wow- and jitter correction of the single responses improved the SNR of the VEP measurements significantly and to the same amount. A combined wow-jitter approach resulted in significantly better results than the exclusive application of jitter- or wow correction.

A new magnifying indirect stereo ophthalmoscope.

A new magnifying indirect stereo ophthalmoscope had been designed, built, and tested. Magnification is achieved by means of Keplerian telescopic systems mounted in each eyepiece. Schmidt or Pechan prisms are incorporated to shorten the length of the telescopic systems. Using a +20 diopter condensing lens, the total retinal magnification achieved with this system varies from 5.6x at a 40-cm observation distance to the aerial image to 9.4x at a 25-cm observation distance. When the fundus is viewed through a dilated pupil extraordinary stereopsis is obtained. When combined with the magnification, this stereopsis greatly enhances the view of the posterior segment of the eye.

Retinal blood flow changes in diabetic retinopathy measured with the Heidelberg scanning laser Doppler flowmeter.

BACKGROUND: Investigation of retinal blood flow in patients with and without diabetic retinopathy (DR). Retinal blood flow is measured with the non-invasive Heidelberg Retinal Flowmeter (HRF). The clinical suitability of the HRF in patients with diabetes mellitus is investigated, and measured blood flow is compared with blood flow in a group of non-diabetic persons. METHODS: Cross-sectional study of retinal capillary perfusion in eighty diabetic patients and forty-nine control persons, non-invasively measured with the Heidelberg scanning laser Doppler flowmeter. RESULTS: In the control group, HRF measurements could be performed in all subjects. In the diabetes group some patients had media opacities or were not able to maintain stable fixation. Therefore HRF measurement was only possible in 79%, 75% and 60% of the subjects for the nasal, papillo-macular and foveal areas respectively. Retinal blood flow as measured in the perifoveal and nasal areas was associated with the level of diabetic retinopathy. In patients with proliferative DR (levels 4 and 5) the blood flow was reduced, in comparison with that of the patients with exudative or non-proliferative DR (levels 1 and 2) and preproliferative DR (level 3). Blood flow was not correlated with age, systemic blood pressure, intra-ocular pressure and perfusion pressure in either group. A significant negative correlation with the actual blood glucose level was found in the perifoveal area (R = -0.585, P = 0.0001). CONCLUSIONS: The HRF offers an interesting non-invasive method for measurement of retinal blood flow. In this cross-sectional study variations in retinal blood flow could be detected in various stages of DR in relation to clinically visible funduscopic changes.