Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar e... more Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar en werkt parttime als secretaresse op een advocatenkantoor. Zij is recent opgenomen geweest wegens een beperkt voorwandinfarct waarvoor zij een PCI met plaatsing van een stent heeft ondergaan. Haar voorgeschiedenis is verder blanco op een appen dec - tomie in haar jeugd na. Als risicofactoren voor hart- en vaatziekten springt haar excessieve roken naar voren (30 sigaretten per dag gedurende bijna 40 jaar), daarnaast is er sprake van matig overgewicht: lengte 1,70 m bij een gewicht van 82 kg. Hoewel zij op dit moment lichamelijk vrijwel klachtenvrij is, voelt zij zich psychisch ‘een wrak’.
Als de sigaret nu zou worden uitgevonden, zou hij nooit op de markt worden gebracht. Geen enkele ... more Als de sigaret nu zou worden uitgevonden, zou hij nooit op de markt worden gebracht. Geen enkele autoriteit zou een staafje goedkeuren dat zoveel schade veroorzaakt als het precies zo wordt gebruikt als de fabrikant op het oog heeft. Het gevolg is dat twee op de drie gebruikers op termijn overlijden, een kwart van hen voor hun pensioen.
In the Netherlands, every day some 100 adolescents become addicted to cigarettes. These new smoke... more In the Netherlands, every day some 100 adolescents become addicted to cigarettes. These new smokers fill the gap left by the 25% of smokers who die before reaching retirement age. The State Secretary for Health, Welfare and Sport in the Netherlands, the Royal Dutch Medical Association (KNMG), and the Dutch Cancer Society, Lung Foundation and Heart Foundation all support the concept of a tobacco-free generation. The concept is that, by applying public health interventions and restriction of tobacco accessibility through price hikes, in the near future none of the children in the Netherlands born in 2017 and beyond will take up smoking. This appealing plan can be phased in gradually, reaching full implementation by 2035. That gives politicians time to take evidence-based measures. The roadmap for this 'tobacco endgame' starts today with tobacco-free conception and pregnancy, and will follow the life of a child from then on. In this comment, I discuss the concept of a tobacco-free generation and focus on the responsibility of the government to take effective measures.
Anti-cancer treatments for various subtypes of cancer have significantly improved. As a result, t... more Anti-cancer treatments for various subtypes of cancer have significantly improved. As a result, the number of cancer patients who cannot be completely cured but may live for a considerable period of time is growing. A 72-year-old woman was diagnosed with metastatic EGFR-mutated non-small-cell lung cancer. She received anti-tumour treatment with gefitinib for almost two years and experienced only limited side effects. She was anxious about not knowing her prognosis but after visiting a psychologist she feels as if she can continue life. A 46-year-old woman started to experience symptoms of depression two years after treatment for metastatic breast cancer. A visit to a psycho-oncologist proved to be very helpful. She does not want to know her prognosis and is particularly happy that everything is going well at present. These two cases illustrate that patients living longer with incurable cancer may experience specific dilemmas. We make several recommendations for the care of this group of patients.
SamenvattingTussen de vaststelling ‘niet meer te genezen’ en ‘terminale fase’ zit een steeds grot... more SamenvattingTussen de vaststelling ‘niet meer te genezen’ en ‘terminale fase’ zit een steeds groter gebied. Over dit gebied is maar weinig bekend. Reden voor een pilot van het Antoni van Leeuwenhoek, die zich richt op deze lacune in de zorg. In dit artikel aandacht voor die pilot en een reflectie op die onbekende tussenfase aan de hand van een patiëntenervaring.1
Any publicity campaigns by companies bringing psychoactive substances onto the market should be v... more Any publicity campaigns by companies bringing psychoactive substances onto the market should be viewed with great caution. It would become our withdrawing government if it did not leave this aspect of promotion of health and lifestyle changes to local authorities, and certainly not to the industry itself.
Tobacco use disorder is a major contributor to morbidity and mortality worldwide. Yet, in contras... more Tobacco use disorder is a major contributor to morbidity and mortality worldwide. Yet, in contrast to other substance use disorders, tobacco use disorder is often considered as an unhealthy lifestyle. In this article we argue that tobacco use disorder should be considered similar to other addictive disorders, and summarize supporting arguments from genetics, neuroscience, as well as treatment perspective. Considering Tobacco Use Disorder as an addictive disorder will facilitate awareness among health professionals that patients with this condition should receive proper treatment that should be reimbursed by health insurance. This will reduce the health burden of tobacco use disorder, improve quality of life of individual patients and reduce societal health care costs.
ABSTRACT Any publicity campaigns by companies bringing psychoactive substances onto the market sh... more ABSTRACT Any publicity campaigns by companies bringing psychoactive substances onto the market should be viewed with great caution. It would become our withdrawing government if it did not leave this aspect of promotion of health and lifestyle changes to local authorities, and certainly not to the industry itself.
Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar e... more Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar en werkt parttime als secretaresse op een advocatenkantoor. Zij is recent opgenomen geweest wegens een beperkt voorwandinfarct waarvoor zij een PCI met plaatsing van een stent heeft ondergaan. Haar voorgeschiedenis is verder blanco op een appen dec - tomie in haar jeugd na. Als risicofactoren voor hart- en vaatziekten springt haar excessieve roken naar voren (30 sigaretten per dag gedurende bijna 40 jaar), daarnaast is er sprake van matig overgewicht: lengte 1,70 m bij een gewicht van 82 kg. Hoewel zij op dit moment lichamelijk vrijwel klachtenvrij is, voelt zij zich psychisch ‘een wrak’.
Background/Objective: The prevalence of sleep-related complaints (SRC) and the frequency of sleep... more Background/Objective: The prevalence of sleep-related complaints (SRC) and the frequency of sleep-disordered breathing (SDB) in obese patients has not been studied extensively. We investigated SRC and SDB in a group of obese persons as part of a preoperative workup for weight reduction (bariatric) surgery. Methods: All consecutive patients attending a weight-loss clinic for evaluation for bariatric surgery were asked to complete a questionnaire. The questionnaire consisted of a section on SRC and a validated general sleep questionnaire (Sleep Wake Experience List). The patients underwent sleep studies in which an Edentrace recorder registered heart rate, chest wall movements by impedance, airflow and oxygen saturation. Results: Fifty-one patients (14 men, 37 women) were evaluated. Mean body mass index (BMI) was 45 kg/m2 (range 33–61). Eighteen patients (35%) demonstrated SDB, defined as (a) an apnea/hypopnea index ≥5, and/or (b) more than 2% of registration time with an oxygen satur...
Recently a systemic review and meta-analysis of studies on preoperative smoking and postoperative... more Recently a systemic review and meta-analysis of studies on preoperative smoking and postoperative complications was published. The meta-analysis showed that wound healing is better if patients do not smoke before surgery. Also, in major surgery there were fewer postoperative pulmonary complications, wound healing was better and patients who did not smoke stayed fewer days on Intensive Care. In bone surgery the consolidation process was better in non-smoking patients. We suggest that every surgeon should give well-founded and motivational advice on stopping smoking before every operation. If there is time to postpone the operation, as is the case in gastric bypass surgery for obesity, stopping smoking should generally be a conditio sine quanon for surgery. We require surgeons to be fit to operate. Likewise, for improvement of short term and long term results we should require patients to be as fit as possible to be operated on.
Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar e... more Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar en werkt parttime als secretaresse op een advocatenkantoor. Zij is recent opgenomen geweest wegens een beperkt voorwandinfarct waarvoor zij een PCI met plaatsing van een stent heeft ondergaan. Haar voorgeschiedenis is verder blanco op een appen dec - tomie in haar jeugd na. Als risicofactoren voor hart- en vaatziekten springt haar excessieve roken naar voren (30 sigaretten per dag gedurende bijna 40 jaar), daarnaast is er sprake van matig overgewicht: lengte 1,70 m bij een gewicht van 82 kg. Hoewel zij op dit moment lichamelijk vrijwel klachtenvrij is, voelt zij zich psychisch ‘een wrak’.
Als de sigaret nu zou worden uitgevonden, zou hij nooit op de markt worden gebracht. Geen enkele ... more Als de sigaret nu zou worden uitgevonden, zou hij nooit op de markt worden gebracht. Geen enkele autoriteit zou een staafje goedkeuren dat zoveel schade veroorzaakt als het precies zo wordt gebruikt als de fabrikant op het oog heeft. Het gevolg is dat twee op de drie gebruikers op termijn overlijden, een kwart van hen voor hun pensioen.
In the Netherlands, every day some 100 adolescents become addicted to cigarettes. These new smoke... more In the Netherlands, every day some 100 adolescents become addicted to cigarettes. These new smokers fill the gap left by the 25% of smokers who die before reaching retirement age. The State Secretary for Health, Welfare and Sport in the Netherlands, the Royal Dutch Medical Association (KNMG), and the Dutch Cancer Society, Lung Foundation and Heart Foundation all support the concept of a tobacco-free generation. The concept is that, by applying public health interventions and restriction of tobacco accessibility through price hikes, in the near future none of the children in the Netherlands born in 2017 and beyond will take up smoking. This appealing plan can be phased in gradually, reaching full implementation by 2035. That gives politicians time to take evidence-based measures. The roadmap for this 'tobacco endgame' starts today with tobacco-free conception and pregnancy, and will follow the life of a child from then on. In this comment, I discuss the concept of a tobacco-free generation and focus on the responsibility of the government to take effective measures.
Anti-cancer treatments for various subtypes of cancer have significantly improved. As a result, t... more Anti-cancer treatments for various subtypes of cancer have significantly improved. As a result, the number of cancer patients who cannot be completely cured but may live for a considerable period of time is growing. A 72-year-old woman was diagnosed with metastatic EGFR-mutated non-small-cell lung cancer. She received anti-tumour treatment with gefitinib for almost two years and experienced only limited side effects. She was anxious about not knowing her prognosis but after visiting a psychologist she feels as if she can continue life. A 46-year-old woman started to experience symptoms of depression two years after treatment for metastatic breast cancer. A visit to a psycho-oncologist proved to be very helpful. She does not want to know her prognosis and is particularly happy that everything is going well at present. These two cases illustrate that patients living longer with incurable cancer may experience specific dilemmas. We make several recommendations for the care of this group of patients.
SamenvattingTussen de vaststelling ‘niet meer te genezen’ en ‘terminale fase’ zit een steeds grot... more SamenvattingTussen de vaststelling ‘niet meer te genezen’ en ‘terminale fase’ zit een steeds groter gebied. Over dit gebied is maar weinig bekend. Reden voor een pilot van het Antoni van Leeuwenhoek, die zich richt op deze lacune in de zorg. In dit artikel aandacht voor die pilot en een reflectie op die onbekende tussenfase aan de hand van een patiëntenervaring.1
Any publicity campaigns by companies bringing psychoactive substances onto the market should be v... more Any publicity campaigns by companies bringing psychoactive substances onto the market should be viewed with great caution. It would become our withdrawing government if it did not leave this aspect of promotion of health and lifestyle changes to local authorities, and certainly not to the industry itself.
Tobacco use disorder is a major contributor to morbidity and mortality worldwide. Yet, in contras... more Tobacco use disorder is a major contributor to morbidity and mortality worldwide. Yet, in contrast to other substance use disorders, tobacco use disorder is often considered as an unhealthy lifestyle. In this article we argue that tobacco use disorder should be considered similar to other addictive disorders, and summarize supporting arguments from genetics, neuroscience, as well as treatment perspective. Considering Tobacco Use Disorder as an addictive disorder will facilitate awareness among health professionals that patients with this condition should receive proper treatment that should be reimbursed by health insurance. This will reduce the health burden of tobacco use disorder, improve quality of life of individual patients and reduce societal health care costs.
ABSTRACT Any publicity campaigns by companies bringing psychoactive substances onto the market sh... more ABSTRACT Any publicity campaigns by companies bringing psychoactive substances onto the market should be viewed with great caution. It would become our withdrawing government if it did not leave this aspect of promotion of health and lifestyle changes to local authorities, and certainly not to the industry itself.
Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar e... more Anneke van der Horst, 52 jaar, recent gescheiden, is moeder van twee dochters van 15 en 17 jaar en werkt parttime als secretaresse op een advocatenkantoor. Zij is recent opgenomen geweest wegens een beperkt voorwandinfarct waarvoor zij een PCI met plaatsing van een stent heeft ondergaan. Haar voorgeschiedenis is verder blanco op een appen dec - tomie in haar jeugd na. Als risicofactoren voor hart- en vaatziekten springt haar excessieve roken naar voren (30 sigaretten per dag gedurende bijna 40 jaar), daarnaast is er sprake van matig overgewicht: lengte 1,70 m bij een gewicht van 82 kg. Hoewel zij op dit moment lichamelijk vrijwel klachtenvrij is, voelt zij zich psychisch ‘een wrak’.
Background/Objective: The prevalence of sleep-related complaints (SRC) and the frequency of sleep... more Background/Objective: The prevalence of sleep-related complaints (SRC) and the frequency of sleep-disordered breathing (SDB) in obese patients has not been studied extensively. We investigated SRC and SDB in a group of obese persons as part of a preoperative workup for weight reduction (bariatric) surgery. Methods: All consecutive patients attending a weight-loss clinic for evaluation for bariatric surgery were asked to complete a questionnaire. The questionnaire consisted of a section on SRC and a validated general sleep questionnaire (Sleep Wake Experience List). The patients underwent sleep studies in which an Edentrace recorder registered heart rate, chest wall movements by impedance, airflow and oxygen saturation. Results: Fifty-one patients (14 men, 37 women) were evaluated. Mean body mass index (BMI) was 45 kg/m2 (range 33–61). Eighteen patients (35%) demonstrated SDB, defined as (a) an apnea/hypopnea index ≥5, and/or (b) more than 2% of registration time with an oxygen satur...
Recently a systemic review and meta-analysis of studies on preoperative smoking and postoperative... more Recently a systemic review and meta-analysis of studies on preoperative smoking and postoperative complications was published. The meta-analysis showed that wound healing is better if patients do not smoke before surgery. Also, in major surgery there were fewer postoperative pulmonary complications, wound healing was better and patients who did not smoke stayed fewer days on Intensive Care. In bone surgery the consolidation process was better in non-smoking patients. We suggest that every surgeon should give well-founded and motivational advice on stopping smoking before every operation. If there is time to postpone the operation, as is the case in gastric bypass surgery for obesity, stopping smoking should generally be a conditio sine quanon for surgery. We require surgeons to be fit to operate. Likewise, for improvement of short term and long term results we should require patients to be as fit as possible to be operated on.
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