,Table of Contents
Public Health ......................................................................................................................................................................................................................................... 9
(On)Gezondheid .................................................................................................................................................................................................................................................................................. 9
Determinanten van (On)Gezondheid ................................................................................................................................................................................................................................................10
Public Health .....................................................................................................................................................................................................................................................................................11
Public Health – Geschiedenis ............................................................................................................................................................................................................................................................12
Public Health – Verloskundige Zorg...................................................................................................................................................................................................................................................13
Preventie ...........................................................................................................................................................................................................................................................................................15
Soorten Gezondheidszorg .................................................................................................................................................................................................................................................................17
De Nederlandse Gezondheidszorg ....................................................................................................................................................................................................................................................17
De Nederlandse Gezondheidszorg – Wet- en Regelgeving ...............................................................................................................................................................................................................18
Diabetische Aandoeningen ................................................................................................................................................................................................................... 20
De Glucoseregulatie – Fysiologie ......................................................................................................................................................................................................................................................20
Diabetes Mellitus – Algemeen ..........................................................................................................................................................................................................................................................22
Diabetes Mellitus – Type 1 ................................................................................................................................................................................................................................................................27
Diabetes Mellitus – Type 2 ................................................................................................................................................................................................................................................................29
Preconceptionele Diabetes Mellitus (PDM) ......................................................................................................................................................................................................................................31
Diabetes Gravidarum / Gestational Diabetes Mellitus (GDM) ..........................................................................................................................................................................................................33
Verhoogd Maternaal / Foetaal Gewicht ................................................................................................................................................................................................ 39
Obesitas .............................................................................................................................................................................................................................................................................................40
Obesitas & Zwangerschap .................................................................................................................................................................................................................................................................43
Macrosomie / Large for Gestational Age ..........................................................................................................................................................................................................................................46
, Polyhydramnion ................................................................................................................................................................................................................................................................................49
Schouderdystocie ..............................................................................................................................................................................................................................................................................50
Epileptische Aandoeningen .................................................................................................................................................................................................................. 53
Epilepsie ............................................................................................................................................................................................................................................................................................53
Epilepsie & Zwangerschap.................................................................................................................................................................................................................................................................59
Congenitale Afwijkingen – Tractus Circulatorius .................................................................................................................................................................................... 64
Congenitale Hartafwijkingen / Aangeboren Hartafwijkingen (AHA).................................................................................................................................................................................................64
Congenitale Hartafwijkingen – Atrium Septumdefect (ASD) ............................................................................................................................................................................................................66
Congenitale Hartafwijkingen – Ventrikel Septumdefect (VSD) .........................................................................................................................................................................................................67
Congenitale Hartafwijkingen – Atrioventriculair Septumdefect (AVSD) ...........................................................................................................................................................................................69
Congenitale Hartafwijkingen – Aortaklepstenose.............................................................................................................................................................................................................................71
Congenitale Hartafwijkingen – Pulmonalisklepstenose ....................................................................................................................................................................................................................72
Congenitale Hartafwijkingen – Coarctatio Aortae ............................................................................................................................................................................................................................73
Congenitale Hartafwijkingen – Persisterende open Ductus Botalli / Patent Ductus Arteriosus (PDA) .............................................................................................................................................75
Congenitale Hartafwijkingen – Tetralogie van Fallot (TOF) ...............................................................................................................................................................................................................76
Congenitale Hartafwijkingen – Transpositie van de Grote Vaten (TGA) ...........................................................................................................................................................................................77
Congenitale Hartafwijkingen – Hypoplastisch Linker Hart Syndroom (HLHS) ..................................................................................................................................................................................79
Verworven Hartafwijkingen – Decompensatio Cordis / Hartfalen ....................................................................................................................................................................................................80
Verworven Hartafwijkingen – Hartinfarct / Myocardinfarct (MI) .....................................................................................................................................................................................................81
Verworven Hartafwijkingen – Hartritmestoornissen ........................................................................................................................................................................................................................82
Verworven Hartafwijkingen – Endocarditis .......................................................................................................................................................................................................................................83
Verworven Hartafwijkingen – Hartziekten t.g.v. Acute Reuma .........................................................................................................................................................................................................84
Hartafwijkingen & Zwangerschap .....................................................................................................................................................................................................................................................85
,Congenitale Afwijkingen – Tractus Digestivus ....................................................................................................................................................................................... 86
Congenitale Afwijkingen van de Tractus Digestivus ..........................................................................................................................................................................................................................87
Pylorusstenose ..................................................................................................................................................................................................................................................................................87
Necrotische Enterocolitis (NEC) ........................................................................................................................................................................................................................................................89
(congenitale) Hernia Diafragmatica / Middenrifbreuk (CHD) ...........................................................................................................................................................................................................91
(congenitale) Rectovaginale Fistel .....................................................................................................................................................................................................................................................93
Urorectale Fistel ................................................................................................................................................................................................................................................................................94
Omfalocèle ........................................................................................................................................................................................................................................................................................94
Gastroschisis ......................................................................................................................................................................................................................................................................................96
(congenitale) Hernia Umbilicalis / Navelbreuk .................................................................................................................................................................................................................................97
Oesophagusatresie (EA) ....................................................................................................................................................................................................................................................................98
Atresie en stenose van de duodenum, ileum en jejunum ..............................................................................................................................................................................................................100
Ziekte van Hirschsprung / Congenitale Intestinale Aganglionose ...................................................................................................................................................................................................101
Anusatresie......................................................................................................................................................................................................................................................................................103
Malrotatie van de Darmen ..............................................................................................................................................................................................................................................................103
Meconiumplug / Meconium Ileus ...................................................................................................................................................................................................................................................104
Congenitale Afwijkingen – Tractus Urogenitalis .................................................................................................................................................................................. 105
(antenatale) Hydronefrose ..............................................................................................................................................................................................................................................................105
Nieragenesie....................................................................................................................................................................................................................................................................................107
Syndroom van Potter .......................................................................................................................................................................................................................................................................109
Dysplasie van de Urinewegen / Nierdysplasie ................................................................................................................................................................................................................................110
Cystenieren / Polycysteuze Nierziekte ............................................................................................................................................................................................................................................111
Nierstenose / UPJ-Stenose ..............................................................................................................................................................................................................................................................112
, (Posterior) Urethrakleppen (PUV) ...................................................................................................................................................................................................................................................113
Congenitale Uterusanomaliën ........................................................................................................................................................................................................................................................114
Differences / Disorders in Sex Development (DSD).........................................................................................................................................................................................................................115
Hormonale Stoornissen – Congenitale Bijnierhyperplasie / Androgenitaal Syndroom (AGS) ........................................................................................................................................................116
Chromosomale Stoornissen – Syndroom van Turner (SvT) .............................................................................................................................................................................................................119
Chromosomale Stoornissen – Syndroom van Swyer ......................................................................................................................................................................................................................121
Differentiatiestoornissen – Mannelijke en Vrouwelijk Pseudohermafroditisme ............................................................................................................................................................................123
Congenitale Afwijkingen – Tractus Locomotorius ................................................................................................................................................................................ 123
Klompvoet / Pes Equinovarus Adductus .........................................................................................................................................................................................................................................123
Overige standsafwijkingen van de voet ..........................................................................................................................................................................................................................................126
Congenitale Heupdysplasie .............................................................................................................................................................................................................................................................127
Achondroplasie (ACH) (Dwerggroei) ...............................................................................................................................................................................................................................................129
Congenitale Afwijkingen – Tractus Neurologicus ................................................................................................................................................................................. 130
Schisis ..............................................................................................................................................................................................................................................................................................131
(Congenitale) Hydrocephalie ...........................................................................................................................................................................................................................................................133
Spina Bifida ......................................................................................................................................................................................................................................................................................136
Anencephalie...................................................................................................................................................................................................................................................................................139
Klinische Genetica .............................................................................................................................................................................................................................. 140
Basisprincipes Genetica...................................................................................................................................................................................................................................................................140
Mutaties ..........................................................................................................................................................................................................................................................................................141
Genetische Overervingsmechanismes ............................................................................................................................................................................................................................................143
Notatie.............................................................................................................................................................................................................................................................................................145
,Genetische Aandoeningen .................................................................................................................................................................................................................. 145
Trisomie 21 / Syndroom van Down .................................................................................................................................................................................................................................................145
Trisomie 18 / Syndroom van Edwards .............................................................................................................................................................................................................................................149
Trisomie 13 / Syndroom van Patau .................................................................................................................................................................................................................................................151
Fragiele X-Syndroom .......................................................................................................................................................................................................................................................................152
Spierziekte van Duchenne ...............................................................................................................................................................................................................................................................154
Dystrophia Myotonica (type 1) - Ziekte van Steinert ......................................................................................................................................................................................................................156
Dystrophia Myotonica - Ziekte van Huntington ..............................................................................................................................................................................................................................158
Phenylketonurie ..............................................................................................................................................................................................................................................................................159
Cystische Fibrose (CF) ......................................................................................................................................................................................................................................................................162
Genetische Aandoeningen & Kinderwens ......................................................................................................................................................................................................................................164
(Gynaecologische) Oncologie .............................................................................................................................................................................................................. 164
Basisprincipes Oncologie – Oncogenese .........................................................................................................................................................................................................................................165
Basisprincipes Oncologie – Algemeen Ziektebeeld.........................................................................................................................................................................................................................168
Gynaecologische Oncologie – Mammacarcinoom ..........................................................................................................................................................................................................................171
Gynaecologische Oncologie – Cervixcarcinoom..............................................................................................................................................................................................................................177
Gynaecologische Oncologie – Ovariumcarcinoom..........................................................................................................................................................................................................................183
Gynaecologische Oncologie – Endometriumcarcinoom .................................................................................................................................................................................................................186
Kanker & Zwangerschap ..................................................................................................................................................................................................................................................................188
Subfertiliteit....................................................................................................................................................................................................................................... 190
Subfertiliteit .....................................................................................................................................................................................................................................................................................190
Fertiliteitsbehandelingen – Intra Uteriene Inseminatie (IUI) ..........................................................................................................................................................................................................195
, Fertiliteitsbehandelingen – In Vitro Fertilisatie (IVF) & Intra Cytoplasmatische Sperma Injectie (ICSI) .........................................................................................................................................196
Fertiliteitsbehandelingen – Eiceldonatie.........................................................................................................................................................................................................................................197
Fertiliteitsbehandelingen – Spermadonatie / Kunstmatige Inseminatie Donorsperma (KID) ........................................................................................................................................................197
Fertiliteitsbehandelingen – Draagmoederschap .............................................................................................................................................................................................................................198
Wet- en Regelgeving ........................................................................................................................................................................................................................................................................198
Schildklierfunctiestoornissen .............................................................................................................................................................................................................. 199
De Schildklier – Fysiologie ...............................................................................................................................................................................................................................................................199
De Schildklier & Zwangerschap .......................................................................................................................................................................................................................................................204
Schildklierfunctiestoornissen – Hypothyreoïdie .............................................................................................................................................................................................................................207
Schildklierfunctiestoornissen – Hyperthyreoïdie ............................................................................................................................................................................................................................209
Schildklierfunctiestoornissen – (Postpartum) Thyreoïditis .............................................................................................................................................................................................................212
Schildklierfunctiestoornissen – Foetaal & Neonataal .....................................................................................................................................................................................................................213
Auto-Immuun Aandoeningen ............................................................................................................................................................................................................. 215
Multiple Sclerose (MS) ....................................................................................................................................................................................................................................................................215
Inflammatory Bowel Diseases .........................................................................................................................................................................................................................................................218
Inflammatory Bowel Diseases – Ziekte van Crohn / Enteritis Regionalis ........................................................................................................................................................................................219
Inflammatory Bowel Diseases – Colitis Ulcerosa ............................................................................................................................................................................................................................221
Reumatoïde Artritis (RA) .................................................................................................................................................................................................................................................................222
Systemische Lupus Erythematodes (SLE) ........................................................................................................................................................................................................................................224
Zwangerschaps Dermatosen............................................................................................................................................................................................................... 228
Huidaandoeningen & Zwangerschap ..............................................................................................................................................................................................................................................228
Intrahepatic Cholestasis of Pregnancy (ICP) ....................................................................................................................................................................................................................................230
, Pemphigoid Gestationis (PG)...........................................................................................................................................................................................................................................................233
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) .......................................................................................................................................................................................................234
Atopic Eruption of Pregnancy (AEP) – Eczema in Pregnancy ..........................................................................................................................................................................................................235
Atopic Eruption of Pregnancy (AEP) – Prurigo of Pregnancy ..........................................................................................................................................................................................................236
Atopic Eruption of Pregnancy (AEP) – Pruritic Folliculitis of Pregnancy .........................................................................................................................................................................................236
Evidence Based Midwifery .................................................................................................................................................................................................................. 237
Variabelen .......................................................................................................................................................................................................................................................................................237
Correlatie .........................................................................................................................................................................................................................................................................................240
Lineaire Regressie ............................................................................................................................................................................................................................................................................241
Lineaire Regressie ............................................................................................................................................................................................................................................................................242
Logistische Regressie .......................................................................................................................................................................................................................................................................242
,Public Health
(On)Gezondheid
Gezondheid WHO-definitie (1948) = “Gezondheid is een toestand van volledig fysiek, geestelijk en sociaal welbevinden en niet louter het ontbreken van
ziekten of gebreken.”
Machteld Huber (2011) = “Gezondheid als het vermogen zich aan te passen en een eigen regie te voeren, in het licht van de fysieke,
emotionele en sociale uitdagingen van het leven”
Ziektelast ziektelast wordt uitgedrukt in DALY’s → Disability Adjusted Life Years
= maat voor de hoeveelheid gezondheidsverlies in een populatie, waarin zowel verloren levensjaren
als verlies aan kwaliteit van leven wordt meegenomen
= opgebouwd uit het aantal verloren levensjaren (door vroegtijdige sterfte) + het aantal jaren geleefd
met gezondheidsproblemen (bijvoorbeeld een ziekte)
Nederland levensverwachting in Nederland:
(totale levensverwachting, waarvan in goede gezondheid)
Oorzaken de volgende “impactvolle determinanten” verklaren ≈ 30 - 40% van de ziektelast in nederland:
- ongezonde voeding
- weinig bewegen
- problematisch alcoholgebruik
- psychosociale arbeidsbelasting
- slechte luchtkwaliteit
er is onderzoek gedaan naar de achterliggende oorzaken en factsheets zijn voor ieder determinant apart opgesteld (https://www.rivm.nl/determinanten-van-gezondheid)
op deze manier kan een gerichtere aanpak van (preventieve) zorg opgestart worden
de bijdrage van een determinant aan de totale ziektelast is een maat voor het belang van een determinant voor onze gezondheid, hierbij wordt
uitgegaan van de prevalentie / incidentie van een determinant in de populatie, de ernst van de ziekte en de sterftekans
, Determinanten van (On)Gezondheid
Het Ecologisch Model het Dahlgren-Whitehead 'Rainbow-model’ → brengt de relatie tussen het individu, zijn omgeving en gezondheid in kaart
Determinanten determinanten van (on)gezondheid → alle factoren die de volksgezondheid beïnvloeden
- risicofactoren voor ongezondheid (pathogenese)
- (beschermende) factoren die de gezondheid positief beïnvloeden (salutogenese)
de verschillende determinanten die van invloed zijn op de gezondheid en die theoretisch door beleid te beïnvloeden zijn:
- persoonsgebonden factoren
• de natuurlijke / biologische factoren kunnen genetisch aangelegd zijn of verworven zijn in de loop van het leven
• bijv. leeftijd, geslacht, ethniciteit, bloeddruk, overgewicht etc.
- individuele leefstijl en gewoonten
• het gedrag dat een gunstige of een ongunstige invloed kan hebben op de gezondheid (kan per periode verschillen)
• bijv. roken, alcoholgebruik, voeding, lichaamsbeweging, sesksueel risicogedrag, slapen etc.
- sociale normen en netwerken
• de sociale omgeving rond een individu en het geheel van sociale, culturele en levensbeschouwelijke factoren dat van invloed is op het
menselijk gedrag
• bijv. geloof, cultuur, sociale cohesie of juist eenzaamheid, veiligheid / veilig voelen
- leef-, woon- en werkomstandigheden
• de fysieke leefomgeving waarin mensen wonen, werken, studeren en/of recreëren en de beschikbaarheid van verschillende faciliteiten
• bijv. geluid, straling, luchtverontreining, water, kwaliteit van huisvesting, groen, ruimte, zorgdiensten
- de bredere sociaaleconomische, culturele en milieu omstandigheden
• de sociaaleconomische, culturele en milieu omstandigheden van een grotere omgeving / land
• bijv. de huizenmarkt, minimumloon, aanwezigheid en frequentie van natuurrampen
impact van determinanten:
- directe impact → bepaalde elementen kunnen de gezondheid rechtstreeks belasten
bijv. fijnstof, geluidsoverlast
indirecte impact → bepaalde elementen beïnvloeden de gezondheid indirect via de invloed op andere (achterliggende) determinanten
bijv. beschikbaarheid van voeding en eigen inkomen beïnvloeden eetpatronen, sociale norm beinvloed rookgedrag
- clustering → het vaker voorkomen van determinanten van gezondheid / ongezond gedrag bij eenzelfde soort persoon dan v
verwacht op basis van toeval (vaker verklaard door een overkoepelende factor)
stapeling → het samen optreden van fysieke omgevingsfactoren
Public Health ......................................................................................................................................................................................................................................... 9
(On)Gezondheid .................................................................................................................................................................................................................................................................................. 9
Determinanten van (On)Gezondheid ................................................................................................................................................................................................................................................10
Public Health .....................................................................................................................................................................................................................................................................................11
Public Health – Geschiedenis ............................................................................................................................................................................................................................................................12
Public Health – Verloskundige Zorg...................................................................................................................................................................................................................................................13
Preventie ...........................................................................................................................................................................................................................................................................................15
Soorten Gezondheidszorg .................................................................................................................................................................................................................................................................17
De Nederlandse Gezondheidszorg ....................................................................................................................................................................................................................................................17
De Nederlandse Gezondheidszorg – Wet- en Regelgeving ...............................................................................................................................................................................................................18
Diabetische Aandoeningen ................................................................................................................................................................................................................... 20
De Glucoseregulatie – Fysiologie ......................................................................................................................................................................................................................................................20
Diabetes Mellitus – Algemeen ..........................................................................................................................................................................................................................................................22
Diabetes Mellitus – Type 1 ................................................................................................................................................................................................................................................................27
Diabetes Mellitus – Type 2 ................................................................................................................................................................................................................................................................29
Preconceptionele Diabetes Mellitus (PDM) ......................................................................................................................................................................................................................................31
Diabetes Gravidarum / Gestational Diabetes Mellitus (GDM) ..........................................................................................................................................................................................................33
Verhoogd Maternaal / Foetaal Gewicht ................................................................................................................................................................................................ 39
Obesitas .............................................................................................................................................................................................................................................................................................40
Obesitas & Zwangerschap .................................................................................................................................................................................................................................................................43
Macrosomie / Large for Gestational Age ..........................................................................................................................................................................................................................................46
, Polyhydramnion ................................................................................................................................................................................................................................................................................49
Schouderdystocie ..............................................................................................................................................................................................................................................................................50
Epileptische Aandoeningen .................................................................................................................................................................................................................. 53
Epilepsie ............................................................................................................................................................................................................................................................................................53
Epilepsie & Zwangerschap.................................................................................................................................................................................................................................................................59
Congenitale Afwijkingen – Tractus Circulatorius .................................................................................................................................................................................... 64
Congenitale Hartafwijkingen / Aangeboren Hartafwijkingen (AHA).................................................................................................................................................................................................64
Congenitale Hartafwijkingen – Atrium Septumdefect (ASD) ............................................................................................................................................................................................................66
Congenitale Hartafwijkingen – Ventrikel Septumdefect (VSD) .........................................................................................................................................................................................................67
Congenitale Hartafwijkingen – Atrioventriculair Septumdefect (AVSD) ...........................................................................................................................................................................................69
Congenitale Hartafwijkingen – Aortaklepstenose.............................................................................................................................................................................................................................71
Congenitale Hartafwijkingen – Pulmonalisklepstenose ....................................................................................................................................................................................................................72
Congenitale Hartafwijkingen – Coarctatio Aortae ............................................................................................................................................................................................................................73
Congenitale Hartafwijkingen – Persisterende open Ductus Botalli / Patent Ductus Arteriosus (PDA) .............................................................................................................................................75
Congenitale Hartafwijkingen – Tetralogie van Fallot (TOF) ...............................................................................................................................................................................................................76
Congenitale Hartafwijkingen – Transpositie van de Grote Vaten (TGA) ...........................................................................................................................................................................................77
Congenitale Hartafwijkingen – Hypoplastisch Linker Hart Syndroom (HLHS) ..................................................................................................................................................................................79
Verworven Hartafwijkingen – Decompensatio Cordis / Hartfalen ....................................................................................................................................................................................................80
Verworven Hartafwijkingen – Hartinfarct / Myocardinfarct (MI) .....................................................................................................................................................................................................81
Verworven Hartafwijkingen – Hartritmestoornissen ........................................................................................................................................................................................................................82
Verworven Hartafwijkingen – Endocarditis .......................................................................................................................................................................................................................................83
Verworven Hartafwijkingen – Hartziekten t.g.v. Acute Reuma .........................................................................................................................................................................................................84
Hartafwijkingen & Zwangerschap .....................................................................................................................................................................................................................................................85
,Congenitale Afwijkingen – Tractus Digestivus ....................................................................................................................................................................................... 86
Congenitale Afwijkingen van de Tractus Digestivus ..........................................................................................................................................................................................................................87
Pylorusstenose ..................................................................................................................................................................................................................................................................................87
Necrotische Enterocolitis (NEC) ........................................................................................................................................................................................................................................................89
(congenitale) Hernia Diafragmatica / Middenrifbreuk (CHD) ...........................................................................................................................................................................................................91
(congenitale) Rectovaginale Fistel .....................................................................................................................................................................................................................................................93
Urorectale Fistel ................................................................................................................................................................................................................................................................................94
Omfalocèle ........................................................................................................................................................................................................................................................................................94
Gastroschisis ......................................................................................................................................................................................................................................................................................96
(congenitale) Hernia Umbilicalis / Navelbreuk .................................................................................................................................................................................................................................97
Oesophagusatresie (EA) ....................................................................................................................................................................................................................................................................98
Atresie en stenose van de duodenum, ileum en jejunum ..............................................................................................................................................................................................................100
Ziekte van Hirschsprung / Congenitale Intestinale Aganglionose ...................................................................................................................................................................................................101
Anusatresie......................................................................................................................................................................................................................................................................................103
Malrotatie van de Darmen ..............................................................................................................................................................................................................................................................103
Meconiumplug / Meconium Ileus ...................................................................................................................................................................................................................................................104
Congenitale Afwijkingen – Tractus Urogenitalis .................................................................................................................................................................................. 105
(antenatale) Hydronefrose ..............................................................................................................................................................................................................................................................105
Nieragenesie....................................................................................................................................................................................................................................................................................107
Syndroom van Potter .......................................................................................................................................................................................................................................................................109
Dysplasie van de Urinewegen / Nierdysplasie ................................................................................................................................................................................................................................110
Cystenieren / Polycysteuze Nierziekte ............................................................................................................................................................................................................................................111
Nierstenose / UPJ-Stenose ..............................................................................................................................................................................................................................................................112
, (Posterior) Urethrakleppen (PUV) ...................................................................................................................................................................................................................................................113
Congenitale Uterusanomaliën ........................................................................................................................................................................................................................................................114
Differences / Disorders in Sex Development (DSD).........................................................................................................................................................................................................................115
Hormonale Stoornissen – Congenitale Bijnierhyperplasie / Androgenitaal Syndroom (AGS) ........................................................................................................................................................116
Chromosomale Stoornissen – Syndroom van Turner (SvT) .............................................................................................................................................................................................................119
Chromosomale Stoornissen – Syndroom van Swyer ......................................................................................................................................................................................................................121
Differentiatiestoornissen – Mannelijke en Vrouwelijk Pseudohermafroditisme ............................................................................................................................................................................123
Congenitale Afwijkingen – Tractus Locomotorius ................................................................................................................................................................................ 123
Klompvoet / Pes Equinovarus Adductus .........................................................................................................................................................................................................................................123
Overige standsafwijkingen van de voet ..........................................................................................................................................................................................................................................126
Congenitale Heupdysplasie .............................................................................................................................................................................................................................................................127
Achondroplasie (ACH) (Dwerggroei) ...............................................................................................................................................................................................................................................129
Congenitale Afwijkingen – Tractus Neurologicus ................................................................................................................................................................................. 130
Schisis ..............................................................................................................................................................................................................................................................................................131
(Congenitale) Hydrocephalie ...........................................................................................................................................................................................................................................................133
Spina Bifida ......................................................................................................................................................................................................................................................................................136
Anencephalie...................................................................................................................................................................................................................................................................................139
Klinische Genetica .............................................................................................................................................................................................................................. 140
Basisprincipes Genetica...................................................................................................................................................................................................................................................................140
Mutaties ..........................................................................................................................................................................................................................................................................................141
Genetische Overervingsmechanismes ............................................................................................................................................................................................................................................143
Notatie.............................................................................................................................................................................................................................................................................................145
,Genetische Aandoeningen .................................................................................................................................................................................................................. 145
Trisomie 21 / Syndroom van Down .................................................................................................................................................................................................................................................145
Trisomie 18 / Syndroom van Edwards .............................................................................................................................................................................................................................................149
Trisomie 13 / Syndroom van Patau .................................................................................................................................................................................................................................................151
Fragiele X-Syndroom .......................................................................................................................................................................................................................................................................152
Spierziekte van Duchenne ...............................................................................................................................................................................................................................................................154
Dystrophia Myotonica (type 1) - Ziekte van Steinert ......................................................................................................................................................................................................................156
Dystrophia Myotonica - Ziekte van Huntington ..............................................................................................................................................................................................................................158
Phenylketonurie ..............................................................................................................................................................................................................................................................................159
Cystische Fibrose (CF) ......................................................................................................................................................................................................................................................................162
Genetische Aandoeningen & Kinderwens ......................................................................................................................................................................................................................................164
(Gynaecologische) Oncologie .............................................................................................................................................................................................................. 164
Basisprincipes Oncologie – Oncogenese .........................................................................................................................................................................................................................................165
Basisprincipes Oncologie – Algemeen Ziektebeeld.........................................................................................................................................................................................................................168
Gynaecologische Oncologie – Mammacarcinoom ..........................................................................................................................................................................................................................171
Gynaecologische Oncologie – Cervixcarcinoom..............................................................................................................................................................................................................................177
Gynaecologische Oncologie – Ovariumcarcinoom..........................................................................................................................................................................................................................183
Gynaecologische Oncologie – Endometriumcarcinoom .................................................................................................................................................................................................................186
Kanker & Zwangerschap ..................................................................................................................................................................................................................................................................188
Subfertiliteit....................................................................................................................................................................................................................................... 190
Subfertiliteit .....................................................................................................................................................................................................................................................................................190
Fertiliteitsbehandelingen – Intra Uteriene Inseminatie (IUI) ..........................................................................................................................................................................................................195
, Fertiliteitsbehandelingen – In Vitro Fertilisatie (IVF) & Intra Cytoplasmatische Sperma Injectie (ICSI) .........................................................................................................................................196
Fertiliteitsbehandelingen – Eiceldonatie.........................................................................................................................................................................................................................................197
Fertiliteitsbehandelingen – Spermadonatie / Kunstmatige Inseminatie Donorsperma (KID) ........................................................................................................................................................197
Fertiliteitsbehandelingen – Draagmoederschap .............................................................................................................................................................................................................................198
Wet- en Regelgeving ........................................................................................................................................................................................................................................................................198
Schildklierfunctiestoornissen .............................................................................................................................................................................................................. 199
De Schildklier – Fysiologie ...............................................................................................................................................................................................................................................................199
De Schildklier & Zwangerschap .......................................................................................................................................................................................................................................................204
Schildklierfunctiestoornissen – Hypothyreoïdie .............................................................................................................................................................................................................................207
Schildklierfunctiestoornissen – Hyperthyreoïdie ............................................................................................................................................................................................................................209
Schildklierfunctiestoornissen – (Postpartum) Thyreoïditis .............................................................................................................................................................................................................212
Schildklierfunctiestoornissen – Foetaal & Neonataal .....................................................................................................................................................................................................................213
Auto-Immuun Aandoeningen ............................................................................................................................................................................................................. 215
Multiple Sclerose (MS) ....................................................................................................................................................................................................................................................................215
Inflammatory Bowel Diseases .........................................................................................................................................................................................................................................................218
Inflammatory Bowel Diseases – Ziekte van Crohn / Enteritis Regionalis ........................................................................................................................................................................................219
Inflammatory Bowel Diseases – Colitis Ulcerosa ............................................................................................................................................................................................................................221
Reumatoïde Artritis (RA) .................................................................................................................................................................................................................................................................222
Systemische Lupus Erythematodes (SLE) ........................................................................................................................................................................................................................................224
Zwangerschaps Dermatosen............................................................................................................................................................................................................... 228
Huidaandoeningen & Zwangerschap ..............................................................................................................................................................................................................................................228
Intrahepatic Cholestasis of Pregnancy (ICP) ....................................................................................................................................................................................................................................230
, Pemphigoid Gestationis (PG)...........................................................................................................................................................................................................................................................233
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) .......................................................................................................................................................................................................234
Atopic Eruption of Pregnancy (AEP) – Eczema in Pregnancy ..........................................................................................................................................................................................................235
Atopic Eruption of Pregnancy (AEP) – Prurigo of Pregnancy ..........................................................................................................................................................................................................236
Atopic Eruption of Pregnancy (AEP) – Pruritic Folliculitis of Pregnancy .........................................................................................................................................................................................236
Evidence Based Midwifery .................................................................................................................................................................................................................. 237
Variabelen .......................................................................................................................................................................................................................................................................................237
Correlatie .........................................................................................................................................................................................................................................................................................240
Lineaire Regressie ............................................................................................................................................................................................................................................................................241
Lineaire Regressie ............................................................................................................................................................................................................................................................................242
Logistische Regressie .......................................................................................................................................................................................................................................................................242
,Public Health
(On)Gezondheid
Gezondheid WHO-definitie (1948) = “Gezondheid is een toestand van volledig fysiek, geestelijk en sociaal welbevinden en niet louter het ontbreken van
ziekten of gebreken.”
Machteld Huber (2011) = “Gezondheid als het vermogen zich aan te passen en een eigen regie te voeren, in het licht van de fysieke,
emotionele en sociale uitdagingen van het leven”
Ziektelast ziektelast wordt uitgedrukt in DALY’s → Disability Adjusted Life Years
= maat voor de hoeveelheid gezondheidsverlies in een populatie, waarin zowel verloren levensjaren
als verlies aan kwaliteit van leven wordt meegenomen
= opgebouwd uit het aantal verloren levensjaren (door vroegtijdige sterfte) + het aantal jaren geleefd
met gezondheidsproblemen (bijvoorbeeld een ziekte)
Nederland levensverwachting in Nederland:
(totale levensverwachting, waarvan in goede gezondheid)
Oorzaken de volgende “impactvolle determinanten” verklaren ≈ 30 - 40% van de ziektelast in nederland:
- ongezonde voeding
- weinig bewegen
- problematisch alcoholgebruik
- psychosociale arbeidsbelasting
- slechte luchtkwaliteit
er is onderzoek gedaan naar de achterliggende oorzaken en factsheets zijn voor ieder determinant apart opgesteld (https://www.rivm.nl/determinanten-van-gezondheid)
op deze manier kan een gerichtere aanpak van (preventieve) zorg opgestart worden
de bijdrage van een determinant aan de totale ziektelast is een maat voor het belang van een determinant voor onze gezondheid, hierbij wordt
uitgegaan van de prevalentie / incidentie van een determinant in de populatie, de ernst van de ziekte en de sterftekans
, Determinanten van (On)Gezondheid
Het Ecologisch Model het Dahlgren-Whitehead 'Rainbow-model’ → brengt de relatie tussen het individu, zijn omgeving en gezondheid in kaart
Determinanten determinanten van (on)gezondheid → alle factoren die de volksgezondheid beïnvloeden
- risicofactoren voor ongezondheid (pathogenese)
- (beschermende) factoren die de gezondheid positief beïnvloeden (salutogenese)
de verschillende determinanten die van invloed zijn op de gezondheid en die theoretisch door beleid te beïnvloeden zijn:
- persoonsgebonden factoren
• de natuurlijke / biologische factoren kunnen genetisch aangelegd zijn of verworven zijn in de loop van het leven
• bijv. leeftijd, geslacht, ethniciteit, bloeddruk, overgewicht etc.
- individuele leefstijl en gewoonten
• het gedrag dat een gunstige of een ongunstige invloed kan hebben op de gezondheid (kan per periode verschillen)
• bijv. roken, alcoholgebruik, voeding, lichaamsbeweging, sesksueel risicogedrag, slapen etc.
- sociale normen en netwerken
• de sociale omgeving rond een individu en het geheel van sociale, culturele en levensbeschouwelijke factoren dat van invloed is op het
menselijk gedrag
• bijv. geloof, cultuur, sociale cohesie of juist eenzaamheid, veiligheid / veilig voelen
- leef-, woon- en werkomstandigheden
• de fysieke leefomgeving waarin mensen wonen, werken, studeren en/of recreëren en de beschikbaarheid van verschillende faciliteiten
• bijv. geluid, straling, luchtverontreining, water, kwaliteit van huisvesting, groen, ruimte, zorgdiensten
- de bredere sociaaleconomische, culturele en milieu omstandigheden
• de sociaaleconomische, culturele en milieu omstandigheden van een grotere omgeving / land
• bijv. de huizenmarkt, minimumloon, aanwezigheid en frequentie van natuurrampen
impact van determinanten:
- directe impact → bepaalde elementen kunnen de gezondheid rechtstreeks belasten
bijv. fijnstof, geluidsoverlast
indirecte impact → bepaalde elementen beïnvloeden de gezondheid indirect via de invloed op andere (achterliggende) determinanten
bijv. beschikbaarheid van voeding en eigen inkomen beïnvloeden eetpatronen, sociale norm beinvloed rookgedrag
- clustering → het vaker voorkomen van determinanten van gezondheid / ongezond gedrag bij eenzelfde soort persoon dan v
verwacht op basis van toeval (vaker verklaard door een overkoepelende factor)
stapeling → het samen optreden van fysieke omgevingsfactoren
