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Fibres from the peripheral parts of the retina end in the anterior part of Optic Nerve diet for gastritis sufferers order 10 mg omeprazole with amex, Optic Chiasma gastritis diet avocado purchase omeprazole with amex, and Optic Tract the lateral geniculate body gastritis diet yogurt best omeprazole 20mg. The upper half of the retina is represented laterally and the lower half of the retina is the optic nerve is made up of axons of the ganglion represented medially gastritis gas buy omeprazole uk. In turn, the fibres from all parts of the retina converge on the specifc points of this body project to specifc points in the optic disc. In this way, a point-to-point relationship apertures and is, therefore, called the lamina cribrosa is maintained between the retinae and the visual cortex (crib = sieve). The fbres of the nerve arising Geniculocalcarine Tract and Visual Cortex from the four quadrants of the retina maintain the same relative position within the nerve. Fibres arising from cells of the lateral geniculate body The fbres of the optic nerve arising in the nasal half constitute the geniculocalcarine tract or optic radiation. The optic radiation ends in the visual half of each retina enter the optic tract of the same side area of the cerebral cortex (area 17) ure 7. T us, the right optic tract comes to contain the optic radiation, from the lower half of the retina (upper fbres from the right halves of both retinae and the left tract field of vision) loop forward and downward into the from the left halves. In other words, all optic nerve fbres temporal lobe (to swerve around the atrium and inferior carrying impulses relating to the left half of the feld of horn of lateral ventricle) before turning backward to the vision are brought together in the right optic tract and vice occipital lobe. The cortex of The frst-order sensory neurons carrying visual sensations each hemisphere receives impulses from the retinal halves are bipolar cells of retina. The macular area has dual blood supply (posterior to form the optic chiasma, where fbres from nasal half cerebral artery and branches of middle cerebral artery). Loss of vision in one half (right or left) of the visual feld is called hemianopia. If the same half of the visual feld is lost in both eyes the defect is said to be homonymous and if diferent halves are lost the defect is said to be heteronymous. An ophthalmoscope will show the central artery of retina enter the eye through the optic disc and divides into an upper division and a lower division to supply the upper and lower halves of retina. Glaucoma (increased intraocular pressure) compresses the peripheral fbres of optic nerve when they curve and enter the optic disc resulting in peripheral loss of feld of vision. Injury to the optic nerve will obviously produce total blindness in the eye concerned, i. Complete destruction of the optic tract, the lateral geniculate body, the optic radiation or the visual cortex of one side, results in loss of the opposite half of the feld of vision ure 7. A lesion in the lower part of optic radiation called Meyers loop, (more susceptible due to its longer course and being more superfcial in the temporal lobe), results in superior quadrantic anopia (quarter loss of feld of vision). Vascular lesions of visual cortex results in macular sparing, because of the dual vascular supply of macular region by posterior cerebral and middle cerebral arteries. The fbres from temporal half of each The crossing fbres of the two sides form a conspicuous retina enter the optic tract of the same side to terminate in mass of fbres called the trapezoid body. The medial superior olivary nucleus the optic radiation, which projects to the visual cortex. The internal ear contains the organ of hearing called the Some cochlear fbres that do not relay in the superior cochlea. The cochlea has a central bony core called the olivary nucleus join the lateral lemniscus after relaying modiolus, and a spiral canal runs around it. The organ of in scattered groups of cells lying within the trapezoid Corti, which is the sensory epithelium of hearing, sits on body. These cells constitute the trapezoid nucleus the inner surface of the basilar membrane ure 7. The first order neurons of this pathway (primary Still other cochlear fbres relay in cells that lie within auditory pathway) are located in the spiral ganglion. T eir peripheral processes reach the hair cells in midbrain and terminate in the inferior colliculus. Fibres arising in the colliculus enter the inferior The central processes of the neurons form the cochlear brachium to reach the medial geniculate body. The neurons in these nuclei are, medial geniculate body without relay in the inferior therefore, second order neurons. Since each lateral lemniscus are as follows: carries impulses arising in the right and left cochlea, Most of them cross to the opposite side, (but some lesions of temporal lobe will not cause complete deafness remain uncrossed), and form the lateral lemniscus. This is because auditory sensation is represented bilaterally in the cortex (but predominantly on the contralateral side). These receptors are in synaptic contact with the dendrites of gustatory nerves ure 7. The peripheral processes (dendrites) pass via the chorda tympani nerve, lingual nerve, and reach the anterior two-thirds of the tongue. The central processes end in the upper part of the nucleus of the solitary tract which is sometimes called the gustatory nucleus (second order neurons). The central processes end in neurons lie in the geniculate ganglion of facial nerve. The peripheral processes pass via the greater petrosal From the valleculae: Cell bodies of the first order nerve to the pterygopalatine fossa and from there neurons lie in the inferior ganglion of vagus nerve through the palatine nerves to the soft palate. The peripheral processes pass central processes end in the upper part of the nucleus through the internal laryngeal branch of superior of the solitary tract (Flowchart 7. The central processes Second order gustatory axons start from the nucleus end in the upper part of the nucleus of the solitary tract. The fibres going to thalamus cross the midline and The ascending fbres ending in the hypothalamus, reach terminate in the ventral posteromedial nucleus (along the limbic system, which allow autonomic reactions to with the trigeminal lemniscus). Which of the following is the centre for pupillary light receptors located in the: reflex The cells present in retina in its outer nuclear layer are: sensations, terminate in: A. This is about 10% of the weight of the superior (or anterior) medullary velum, a lamina of white cerebral hemispheres. It has been estimated Parts of Cerebellum that the surface area of the cerebellar cortex is about 50% The cerebellum consists of a part lying near the midline of the area of the cerebral cortex. It is separated from the cerebrum by a fold of dura mater Surfaces of Cerebellum called the tentorium cerebelli. Anteriorly, the fourth ventricle intervenes between the cerebellum (behind), and It has two surfaces, superior and inferior. Sections of the cerebellum cut each side, the vermis is separated from the corresponding at right angles to this axis have a characteristic tree-like cerebellar hemisphere by a paramedian sulcus. Fissures and Lobes of Cerebellum Some of the fssures on the surface of the cerebellum ures 8. They divide the cerebellum into the surface of the cerebellum is marked by a series of lobes within which smaller lobules may be recognized fissures that run more or less parallel to one another. In the middle lobe, the posterior quadrangular superior surface and those below the fssure form the lobule lies lateral to the declive, the superior semilunar inferior surface of the cerebellum. The part anterior to the to the pyramid, and the tonsil lies lateral to the uvula. The part between the nodule is continuous laterally with the focculus through two fssures is anatomically, theposterior lobe (also called the inferior medullary velum (Table 8. The remaining part is the focculonodular lobe, present in the From developmental, phylogenetic and functional points inferior surface of the cerebellum. Anatomically, it consists of lobe); the declive, folium, tuber, pyramid and uvula (in flocculonodular lobe and lingula. The neocerebellum has extensive connections with the cerebral cortex (through pontine nuclei, hence called cerebrocerebellum or pontocerebellum). It is usually regarded as being responsible for fne coordination of voluntary movements. From the point of view of its connections, the cerebellar cortex may also be divided into a vermal (vermis), paravermal (or paramedian) and lateral parts longitudinal parcellation ure 8. The cerebellum is made-up of a thin surface layer of grey matter, the cerebellar cortex and a central core of white Figure 8. Embedded within the central core of white matter are masses of grey matter called intracerebellar nuclei. The grey matter of cerebellum is represented by: Paleocerebellum: Phylogenetically, it is the next part The cerebellar cortex of cerebellum to arise and is well developed in reptiles The intracerebellar nuclei and birds. Anatomically, it consists of anterior lobe (except lingula) and pyramid and uvula of the posterior Structure of Cerebellar Cortex lobe. The paleocerebellum is connected predominantly to the spinal cord (hence, called spinocerebellum).

It consists of 10 items that are responded to gastritis je purchase 10 mg omeprazole with visa on a 4-point scale (ranging from very much to gastritis diet 900 discount 10 mg omeprazole not at all) gastritis diet 91352 order omeprazole 20mg on line. The questions refer to gastritis chest pain cheap 10 mg omeprazole amex the mood in the last week and they are responded to on a 4-point scale. Respondents answer on a 4-point Likert scale (from seldom or almost never to very often/ frequently). Each subscale consists of 6 statements answered on a 4-point Likert scale (from not at all to completely), with higher scores indicating higher levels of the illness cognition. It consists of 41 items with a dichotomous response format (yes/no), with higher scores refecting higher levels of the personality trait. Selection of the number of factors for the most optimal solution was based on conjunctive criteria requiring the eigenvalue of a factor being at least 1. To assess the reliability of the new questionnaire, Cronbachs were computed for the three scales. To examine associations between body awareness and measures of physical and psychological functioning and sociodemographic characteristics, Pearson correlation coefcients were computed for measures of physical and psychological wellbeing, personality characteristics, coping, illness cognitions, and sociodemographic Body attention, ignorance and awareness 35 characteristics. All analyses were performed using Statistical Packages for the Social Sciences version 20. Missing values on this question naire were present in 1% of data and were randomly distributed. Due to their low percent age and random distribution, the impact of these missing values is considered to be negligible. No cases with extreme values on one or more variables were observed; all values were within 3 standard deviations of the mean and all variables were normally distributed (skewness and kurtosis < 1. The frst component, Body Ignorance (not recognizing and/or ignoring bodily signals), explained 23. Body attention, Ignorance and awareness scale: means and associations with sociodemographic variables Based on the above-mentioned components, mean scores on the three scales were calculated by adding the scores of the items and dividing them by the total number of items of that scale. If more than one-third of the items on one particular scale were missing, the mean score of the scale was not calculated. Women scored slightly higher than men on Body Awareness (t(469) 36 Chapter 2 = 2. Patients with a higher educational level scored lower on Body Ignorance (F(2, 452) = 13. Reliability and intercorrelations of the Body attention, Ignorance and awareness Scale the internal consistency was satisfactory for the Body Ignorance ( =. The subscale Body Attention showed a moderate correlation with the subscale Body Awareness (r =. No signifcant correlation was found between the Body Awareness and Body Ignorance subscales (r = . As reported in Table 4, higher levels of Body Ignorance were associated with higher levels of itch, pain, and fatigue, more scratching, a decreased quality of life, higher levels 2 of anxious and depressive symptoms, more avoidant coping, less active coping, higher levels of neuroticism and helplessness, and lower levels of extraversion and acceptance. Correlations between the Body Attention subscale and measures of physical and psychological wellbeing were mostly non-signifcant, with the exception of small cor relations of higher Body Attention with higher levels of active coping, acceptance, and extraversion. Similarly, small correlations were found for higher Body Awareness, with higher levels of active coping and higher levels of anxiety, neuroticism and extraversion. In addition, body ignorance and, to a lesser extent, body aware ness and attention were related to physical and psychological functioning. In particular, patients who do not recognize and/or ignore their bodily signals experience lower levels of physical and psychological wellbeing. Higher levels of body attention and body awareness were not related to physical and psychological wellbeing, but slightly to aspects of coping and personality that are generally perceived as adaptive (active coping and extraversion). Results suggest that body awareness is not a unidimensional construct, but rather consists of multiple aspects that may be independently associated with physical and psychological functioning. The concepts of body awareness and body ignorance seem to have inherently diferent meanings. While body awareness refers to the general tendency to be aware of and pay at tention to bodily signals, body ignorance is related more to not recognizing or to actively ig noring bodily signals. For example, parallels can be drawn between body ignorance and the emotion regulation strategies of avoidance and suppression, which were found to be related to psychopathol ogy in meta-analysis with moderate to large efect sizes [47]. Body ignorance may also be related to the maladaptive emotion regulation construct of experiental avoidance; the suppression or avoidance of a broader range of psychological experiences, including bodily signals, but also, for instance, cognitions, emotions, memories and sensations [48, 49]. Body ignorance might be related to problems with adherence; bodily signals often have a certain threat value due to signals of disease, and are therefore potentially avoided or ignored in patients who score high on body ignorance. In contrast, the construct body attention is hypothesized and operationalized to be more related to mindfulness and perhaps a broad awareness of, or sensitivity to, signals in general. When this sensitivity is accompanied by excessive worrying about bodily signals, this process may become maladaptive, as in health anxiety [15]. Body attention, ignorance and awareness 39 the body ignorance subscale was found to be associated with more physical symp toms of itch, pain, and fatigue, as well as more scratching behavior. Because treatment of chronic skin conditions relies heavily on adequate self-care behavior and treatment compliance [11], being aware of bodily sensations and taking appropriate action may be especially important in this population. In addition, not being conscious of bodily 2 sensations such as itch could also lead to unaware, automatic ways of dealing with these sensations, for instance through more frequent automatic scratching behavior. Scratch ing may cause further damage to the skin and lead to more itch, a process called the itch-scratch cycle. Body ignorance was also found to be correlated with psychological wellbeing; pa tients who do not recognize or ignore bodily signals were found to be more anxious and depressed. In addition, they scored higher on generally maladaptive personality traits and coping styles. These fndings may suggest that patients who do not recognize or pay attention to their bodily signals may be at risk for psychological problems. This may be relevant not only for patient wellbeing, but also for dermatological treatment outcomes, as it is known that psychological distress plays a signifcant role in the exac erbation of psoriasis [50]. An alternative explanation could be that patients with high levels of psychological distress may be less aware of their bodily signals as they are fo cused on exaggerated worries of, for example, health anxiety. Further research is needed on the association between body awareness in its current conceptualization and these distress-related constructs of health anxiety and hypervigilance, which are known to be associated with both increased symptom reporting and increased attention to bodily signals [e. These results correspond with the notion that women [51] and individuals with a higher educational level [52] have also been found to score lower on the related emotion regulation construct alexithymia. The fndings of this study should be considered in light of its limitations, which may be addressed in future research. Also, this study was conducted in a sample of psoriasis patients with relatively mild to moderate disease severity from various hospitals, which raises the issue of representativeness and possible foor efects in the development of the questionnaire. However, all three body awareness subscales showed a normal distribution and few participants scored the high est or lowest possible values, indicating that foor efects were not likely to be a problem. Moreover, none of the three body awareness scales correlated with disease severity. In addition, disease severity in psoriasis is known to be, on average, mild to moderate in 40 Chapter 2 general practice [e. However, in order to generalize beyond this group, studies need to be conducted that replicate these results in patients with more severe disease activity, other chronic conditions, such as atopic dermatitis, and healthy participants. The developed questionnaire should also be administered to other independent samples to confrm its factor structure and further test its psychometric properties, such as test-retest reliability and sensitivity to change. In addition, it would be informative to perform a qualitative assessment on comprehension of the scale for respondents with diverse educational levels and cultural backgrounds, in order to examine whether the scale is equally comprehensible for all respondents. As research clearly suggests that psoriasis patients are at an increased risk for several other chronic somatic conditions, such as diabetes and cardiovascular conditions [see for an overview: 54], excluding these patients would leave us with a sample that would probably not be very clinically representative. However, this leaves the possibility that diferences in body awareness according to medical conditions may have infuenced our results. For example, diabetics are taught to be attuned to physiological sensations as they need to detect possible hypoglycemia in an early stage. Even though in the cur rent study no diferences in body awareness between patients with and without these medical conditions were observed, future studies should shed more light on this matter. Thirdly, while correlations between the body ignorance scale and psychological and physical functioning were consistently in the same direction, the magnitude of the cor relations was generally small to moderate. This corresponds with the knowledge that a multitude of factors can contribute to poor physical and psychological wellbeing, with body awareness being one of these factors. While it could be hypothesized that a low awareness of bodily signals leads to poorer self-care behavior and, therefore, poorer skin status and lower physical and psychological wellbeing, alternative hypotheses cannot be ruled out.

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Cognitive bias modifcation and cognitive control training in addiction and related psychopathology mechanisms granulomatous gastritis symptoms buy omeprazole with visa, clinical perspectives gastritis best diet cheap generic omeprazole canada, and ways forward dr weil gastritis diet safe omeprazole 10 mg. Efcacy of cognitive bias modifcation interventions in anxiety and depression: meta-analysis gastritis remedies diet order omeprazole with amex. A metaanalysis of the efectiveness of psychological interven tions for adults with skin conditions. Evaluating the efectiveness of psychological and/or educational inter ventions in psoriasis: a narrative review. A systematic literature review of empiri cal evidence on computer games and serious games. Can interest and enjoyment help to increase use of Internet delivered interventions DeSmet A, Van Ryckeghem D, Compernolle S, Baranowski T, Thompson D, Crombez G, et al. Placebos without 9 deception: a randomized controlled trial in irritable bowel syndrome. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Computer therapy for the anxiety and depressive disorders is efective, acceptable and practical health care: a meta-analysis. Samenvatting List of Publications PhD Portfolio Dankwoord Curriculum Vitae Samenvatting 209 Chronische huidaandoeningen komen veel voor en gaan regelmatig gepaard met een grote invloed op het dagelijks leven van patienten, zoals beperkingen in het psycholo gisch en lichamelijk functioneren. Deze gevolgen van een chronische huidaandoening kunnen ook een belangrijke rol spelen in de verergering van de huidaandoening. Hoewel de rol van psychologische factoren bij chronische huidaandoeningen steeds meer erkend wordt, is er tot nu toe nog maar relatief weinig onderzoek verricht naar psychologische factoren die van invloed zijn op chronische huidaandoeningen. Ook zijn er nog maar weinig psychologische behandelingen voor deze patientgroepen onderzocht. Het vakgebied binnen het wetenschappelijk onderzoek en de klinische praktijk dat zich bezighoudt met het complexe samenspel van psychologische factoren en de huid wordt psychodermatologie genoemd. Dit proefschrift heeft als doel om een bijdrage the leveren aan het vakgebied van de psychodermatologie, door wetenschap pelijk onderzoek gericht op 1) nieuwe concepten binnen de psychodermatologie, zoals lichaamsbewustzijn; 2) nieuwe methoden binnen de psychodermatologie, zoals het gebruik van zowel directe en indirecte methoden bij het meten van stigmatisatie en 3) nieuwe psychologische behandelmethoden binnen de psychodermatologie, zoals de (kosten)efectiviteit van een door een coach begeleide online cognitief gedragsthera peutische behandeling. Het overgrote deel van de studies in dit proefschrift is uitge voerd bij patienten met psoriasis, als illustratief voorbeeld van een veelvoorkomende chronische infammatoire huidaandoening. Omdat zelfzorg van groot belang is bij de behandeling van veel huidaan doeningen, zoals psoriasis, wordt over het algemeen van patienten verwacht dat zij een actieve rol spelen bij de behandeling van hun aandoening. Dit zou erop kunnen duiden A dat lichaamsbewustzijn met name van belang kan zijn bij psoriasis, wat nog niet was onderzocht. De resultaten lieten zien dat deze vragenlijst op een betrouwbare wijze drie aspecten van lichaamsbewustzijn kan meten: 1) het zich bewust zijn van lichamelijke signalen en hier aandacht aan schenken (Aandacht); 2) het door de persoon ervaren belang en attitude ten aanzien van lichaams bewustzijn (Bewustzijn); 3) het niet herkennen en/of negeren van lichamelijke signalen (Ignoreren). Het onderzoek naar verbanden van lichaamsbewustzijn met lichamelijk en psychologisch functioneren liet zien dat met name de subschaal Ignoreren samen hing met verminderd functioneren. Omdat verminderd psychologisch functioneren 210 Samenvatting een negatieve invloed kan hebben op behandeluitkomsten, kan het daarom klinisch relevant zijn om lichaamsbewustzijn in kaart the brengen bij patienten met chronische huidaandoeningen. In hoofdstuk 3 werden voorspellers van ervaren stigmatisatie onderzocht via zelf rapportagevragenlijsten bij patienten met psoriasis. In dit onderzoek vulden patienten vragenlijsten in waarmee ervaren stigmatisatie gemeten werd, naast vragenlijsten over 5 soorten mogelijke voorspellers van ervaren stigmatisatie: sociaal-demografsche va riabelen (bijv. De resultaten lieten zien dat 73% van de patienten zich in meer of mindere mate gestigmatiseerd voelde. Ervaren stig matisatie werd met name voorspeld door sociaal-demografsche, ziekte-gerelateerde en persoonlijkheidsvariabelen. Deze resultaten kunnen mogelijk gebruikt worden voor de ontwikkeling van screeningsinstrumenten en efectieve interventies, aangezien hiermee aanwijzingen kunnen worden verkregen over welke patienten kwetsbaar zijn voor ervaren stigmatisatie. In hoofdstuk 4 werd onderzocht in hoeverre patienten met huidaandoeningen, en hun naasten, vertekeningen laten zien in hoe ze reageren op stimuli die met ervaren stigmatisatie the maken hebben. We maakten gebruik van computertaken om reactietij den the meten terwijl patienten met alopecia en psoriasis reageerden op stimuli die the maken hadden met huidaandoeningen en sociale dreiging. In een aangepaste Stroop taak werden deelnemers onder andere ziekte-gerelateerde woorden (bijv. Uit de resultaten bleek dat pa tienten met alopecia langzamer reageerden dan mensen zonder huidaandoeningen in het benoemen van de kleuren van ziekte-gerelateerde woorden dan in het benoemen van de kleuren van neutrale woorden. Deze vertekening in de aandacht voor ziekte gerelateerde stimuli werd ook gevonden bij hun naasten. Bij patienten met psoriasis en Samenvatting 211 hun naasten werd dit niet gevonden. Bij deze groepen werd echter wel een vertekening in hun reacties gevonden met behulp van een computertaak waarbij zij werden ge vraagd om met een joystick fotos van gezichten met verschillende gezichtsuitdrukkin gen the benaderen of the vermijden. De resultaten lieten zien dat patienten met psoriasis vooral de fotos van gezichten met een walgende gezichtsuitdrukking sneller vermeden, vergeleken met mensen zonder huidaandoening. De resultaten duiden erop dat impliciete ervaringen van stigmatisatie mogelijk verschillen tussen huidaandoeningen, waarbij mensen met psoriasis meer beinvloed worden door sociale reacties (met name walgende gezichtsuitdrukkingen) en mensen met alopecia door ziekte-gerelateerde signalen. Daarnaast suggereerden de resultaten dat deze vertekeningen ook van toepassing zijn op de naasten van deze patienten. In totaal werden er 23 gerandomiseerde gecontroleerde studies opgenomen in deze review en meta-analyse. Op basis van de samengevoegde resultaten van deze individuele studies werd de overkoepelende efec tiviteit berekend voor drie soorten uitkomstmaten: algemene psychologische uitkomst maten (bijv. Toekomstig onderzoek in afzonderlijke chronische lichamelijke aandoeningen is nodig om deze resultaten verder the ondersteunen, gezien dit overzichtsartikel gebaseerd was op een relatief klein aantal studies. Bij deze patienten was met behulp van vragenlijsten vastgesteld dat zij een psychologisch risicoprofel hadden, bestaand uit een verhoogd distress niveau. Er werden geen verschillen tussen de twee groepen ge vonden op het gebied van psychologisch functioneren (angstklachten en depressieve klachten), noch in de secundaire uitkomstmaten ziekte-ernst en therapietrouw bij de dermatologische behandeling. De studies uit dit proefschrift onderstrepen het belang van nog niet eerder onder zochte psychologische concepten bij chronische huidaandoeningen, zoals de relevantie van lichaamsbewustzijn en van impliciete processen gerelateerd aan stigmatisatie. Toekomstig onderzoek kan voortbouwen op de resultaten uit dit proefschrift om de psychodermatologische kennis the vergroten en hieraan gerelateerde interventies the optimaliseren voor implementatie in de klinische praktijk. A tailored guided internet-based cognitive-be havioral intervention for patients with rheumatoid arthritis as an adjunct to standard rheumatological care: results of a randomized controlled trial. Tailored therapist-guided internet-based cognitive behav ioral treatment for psoriasis: a randomized controlled trial. Implicit stigmatization-related biases in individuals with skin conditions and their signifcant others. Body attention, ignorance and awareness scale: assessing relevant concepts for physical and psychological functioning in psoriasis. Internet-based cognitive behavioral therapy for patients with chronic somatic conditions: a meta-analytic review. What patients think about E-Health; Pa tients perspective on internet-based cognitive behavioral treatment for patients with rheumatoid arthritis and psoriasis. Mindfulness based stress reduction and physiological activity during acute stress: a randomized controlled trial. Efects of mindfulness-based stress reduction on distressed (Type D) personality traits: a randomized controlled trial. Ehealth cognitieve gedragstherapie voor patienten met chronische somatische aandoenin gen. Economic evaluation of a tailored therapist-guided internet-based cognitive behavioral treatment for psoriasis. Thesis: De rol van automatische processen bij patienten met psoriasis: een exploratief onderzoek. Thesis: the efect of watching masticatory videos on masticatory function, quality of life and cognitive ability of elderly people with dementia 2015-2016 5. Thesis: Exploring associations between attention bias and interpretation bias with anxiety in clinically anxious youth 2016 1. Thesis: Will cerebellar transcranial direct current stimulation improve cognitive function Allereerst natuurlijk alle mensen met huidaandoeningen die geheel belangeloos hebben meegewerkt aan de onderzoeken die beschreven staan in dit proefschrift. Dit proefschrift was nooit tot stand gekomen als zij niet de moeite hadden genomen om de vele vragenlijsten in the vullen en de tijd hadden genomen voor extra bezoeken op de polikliniek en voor deelname aan de eHealth interventie. Mijn speciale dank gaat uit naar mijn promoteren, Andrea Evers en Peter van de Kerk hof. Andrea, veel dank voor het vertrouwen dat je in me hebt gesteld, voor je betrokken heid, voor je inspirerende drive voor de wetenschap, voor je kritische blik, en voor alle kansen die je mij gegeven hebt.

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Fur die hiermit vorliegende Leitlinie wurde zunachst die Literatur ab dem Jahr 2006 fur die 17 Krebslokalisationen erfasst, die auch im Ernahrungsbericht 2008 behandelt wurden. Fur die Krebslokalisationen Mund/Rachen, Kehlkopf, Mastdarm, Lunge, Gebarmutterhals, Eier stock, Prostata, Blase, Niere, Leber und Haut ergab die systematische Literaturerfassung seit 2006 nur wenige Studienergebnisse zu den einzelnen Kohlenhydratfraktionen. Zu den Krebslokalisationen, die in dieser Leitlinie aufgrund der neuen Literatur seit 2006 behan delt werden, gehoren Speiserohre, Magen, Darm, Brust, Gebarmutterschleimhaut und Pan kreas. In der vorliegenden Leitlinie wurden nur solche Studienergebnisse bei der Bewertung der Evidenz herangezogen, die mit einem prospektiven Studiendesign (Kohorten und Interven tionsstudien) erzielt wurden (s. Auch ist der Einfluss gangiger Risikofaktoren wie Rauchen, Ubergewicht, mangelnde korperliche Aktivitat und unausgewogene Ernahrung auf die Krebsentstehung geringer als auf die Entstehung von Diabetes mellitus Typ 2 und Herz-Kreislauf-Krankheiten. Die neue Methode der Ganzgenomscans hat mittlerweile fur viele Krebskrankheiten erste risikorelevante genetischen Varianten identifiziert, die zum Teil erst beim Vor handensein bestimmter Risikofaktoren wirksam werden (Lips et al. Kohlenhydrate konnen, sofern der Energiebedarf uberschritten wird, zu einer positiven Ener giebilanz beitragen und damit zu Ubergewicht fuhren. Jedoch konnen Kohlenhydrate in Form von Ballaststoffen wiederum zu einer geringeren Energiedichte der Nahrung fuhren und 139 Kapitel 9: Kohlenhydratzufuhr und Pravention von Krebskrankheiten damit das Risiko fur eine Gewichtszunahme verringern (Du et al. Hierzu zahlen Krebs im Dick darm, in der Brust nach der Menopause, der Gebarmutterschleimhaut, der Niere und die Adenokarzinome der Speiserohre. Die Trennung des Energieeffekts von dem der Kohlen hydratzufuhr erfordert daher statistische Analysemodelle, die fur die Nahrungsenergie adjustiert sind. Ein weiterer Wirkmechanismus einer kohlenhydrathaltigen Ernahrung besteht in der lokalen 2 Wirkung im Darmlumen durch die Aktivitat der Mikroflora, die durch menschliche Enzyme nicht abbaubare Nahrungsbestandteile (Ballaststoffe) in Magen und Dunndarm abbaut. Dies fuhrt zur Entstehung von leicht fluchtigen Sauren wie Butter und Essigsaure, die sich wiederum z. Eine hohe Zufuhr von leicht verdaulichen Kohlenhydraten bei einer Mahlzeit ist mit einem starken postprandialen Anstieg der Insulin und Glucosekonzentration im Blut (hoher glykamischer Index) verbunden, der sich auch auf die Konzentrationen der Sexual und Wachstumshormone im Blut und die Verfugbarkeit von Transportproteinen auswirkt. Sowohl die Hohe der Glucosekonzentration als auch die Hohe der Konzentrationen an Sexual und Wachstumshormonen sind mit dem Krebsrisiko assoziiert. In der Womens Lifestyle and Health Cohort Study aus Schweden wurde eine solche Analyse durchgefuhrt. Es konnte keine Assoziation zwischen der Zufuhr energieliefernder Nahrstoffe einschlielich der Kohlenhydrate und dem Krebsrisiko fest gestellt werden (Lagiou et al. Im Folgenden werden die Ergebnisse fur die einzelnen Krebslokalisationen dargestellt. Krebs in der Speiserohre Die Speiserohre ist ursprunglich mit einem Plattenepithel ausgekleidet. Dieses ursprungliche Epithelgewebe kann sich mit dem Alter verandern und intestinale Gewebestrukturen annehmen. Ein wichtiger Risikofaktor dafur ist das bauchbetonte Ubergewicht, das einen Ruckfluss des Speisebreis aus dem Magen in die Speiserohre begunstigt, der wiederum als eine der Ursachen fur den Gewebeumbau angesehen wird. Maligne Tumoren, die aus diesen neuen 2 Fur Mikroflora wird haufig auch der Begriff Mikrobiota verwendet. Oft werden die Risikofaktoren fur diese Adenokarzinome zusammen mit den Adenokarzinomen des Magens untersucht. Obwohl die Haufigkeit der Adenokarzinome in der Speiserohre in den letzten Jahrzehnten stark zugenommen hat, stellen Plattenepithelkarzinome auch heute noch die Mehrzahl der Karzinome der Speiserohre. Fur die Plattenepithelkarzinome sind Tabak rauchen und Alkoholkonsum die wichtigsten Risikofaktoren (Siewert und Ott 2007). Bei der weiteren Literatursuche konnten keine Studien identifiziert werden, die prospektiv die Kohlenhydratzufuhr in Bezug auf maligne Tumoren der Speiserohre untersucht haben. In einer jungeren schwedischen Kohortenstudie mit Frauen konnte keine Risikobeziehung der Kohlenhydratzufuhr zum Magenkrebs beobachtet werden (Larsson et al. Neben Studien, in denen keine Risikobeziehung 141 Kapitel 9: Kohlenhydratzufuhr und Pravention von Krebskrankheiten beobachtet wurde (Giles et al. Die Evidenz fur den Einfluss der Kohlenhydratzufuhr insgesamt auf die Entstehung maligner Tumoren in der Speiserohre wird aufgrund der geringen Studienzahl als unzureichend eingestuft. Dies gilt aufgrund der Vielzahl der Studien auch fur Krebs im Kolorektum, auch wenn 2 neue Kohortenstudien auf eine inverse Risikobeziehung hindeuten. Es konnten auch keine neueren Studien zu der Beziehung zwischen malignen Tumoren im Magen und Mono-und Disacchariden und zuckergesuten Getranken identifiziert werden. In einer weiteren Studie zu diesem Thema aus dem Jahr 2008 konnte die Zuckerzufuhr nicht mit malignen Tumoren im Kolo rektum in Verbindung gebracht werden (Kabat et al. In einer kurzlich durch gefuhrten Analyse von 13 Kohortenstudien aus dem Pooling-Projekt war die Zufuhr von zuckergesuten Getranken nicht mit dem Risiko fur maligne Tumoren im Kolorektum asso ziiert (Zhang et al. Es liegen 143 Kapitel 9: Kohlenhydratzufuhr und Pravention von Krebskrankheiten weder zum Konsum von Monosacchariden noch von zuckergesuten Getranken Kohorten studien vor. In dieser Studie gab es kein signifikant erhohtes Risiko in Bezug auf hohe Fructosezufuhr. Die Zufuhr von Mono und Disacchariden war dagegen in der Netherlands Diet and Health Study nicht mit dem Risiko fur Pankreaskrebs assoziiert (Heinen et al. Ebenso waren der Konsum von Suigkeiten oder Konfiture keine Risiko faktoren fur maligne Tumoren im Pankreas (Larsson et al. Die Beziehung zwischen dem Konsum zuckergesuter Getranke und malignen Tumoren in der Bauchspeicheldruse wurde im Rahmen einer Meta-Analyse untersucht (Gallus et al. Bei Einbezug von mehreren Kategorien des Konsums von zuckergesuten Getranken ergab die Studie des Karolinska-Instituts (Larsson et al. Die Evidenz fur einen Zusammenhang zwischen der Zufuhr von Monosacchariden und dem Risiko fur maligne Tumoren in der Speiserohre, im Kolorektum und in der Brust wird mit unzureichend bewertet. Die Evidenz fur einen Zusammenhang zwischen der Zufuhr von Disacchariden und Krebs in der Speiserohre und in der Gebarmutterschleimhaut ist ebenfalls unzureichend. Die Evidenz fur eine fehlende Risikobeziehung zwischen der Zufuhr von Disacchariden und der Entstehung maligner Tumoren im Kolorektum, in der Brust und der Bauchspeicheldruse wird mit moglich bewertet. Mit moglicher Evidenz gibt es 144 Kapitel 9: Kohlenhydratzufuhr und Pravention von Krebskrankheiten einen positiven Zusammenhang zwischen der Zufuhr von Monosacchariden und malignen Tumoren in der Bauchspeicheldruse. Zum Zusammenhang zwischen der Zufuhr von Monosacchariden und dem Risiko fur maligne Tumoren im Magen und der Gebarmutterschleimhaut, sowie zwischen der Zufuhr von Disacchariden und dem Risiko fur Magenkrebs und zwischen der Zufuhr von zucker gesuten Getranken und dem Risiko fur maligne Tumoren in der Speiserohre, im Magen, in der Brust und in der Gebarmutterschleimhaut wurden keine Kohorten oder Interventions studien identifiziert. Getreideprodukte aus Mehl mit niedrigem Ausmahlungsgrad Das wichtigste Polysaccharid in der Nahrung ist die Starke. Die Studienergebnisse zu Getreideprodukten aus Mehl mit niedrigem Ausmahlungsgrad werden ebenfalls in diesem Abschnitt beschrieben. Der Verzehr von Reis, Nudeln und Getreide aus Mehl mit niedrigem Ausmahlungsgrad wurde in insgesamt 5 Kohortenstudien untersucht. Auch eine neuere Studie ergab keine Risikobeziehung in Bezug auf die Polysaccharidzufuhr (Nielsen et al. Zum Verzehr von Getreideprodukten aus Mehl mit niedrigem Ausmahlungs grad gab es 1 Kohortenstudie. Eine jungere Kohortenstudie zur Risikobeziehung zwischen malignen Tumoren in der Gebar mutterschleimhaut und der Starkezufuhr zeigte ebenfalls keinen Zusammenhang (Cust et al. Die Evidenz fur eine fehlende Risikobeziehung zwischen der Polysaccharidzufuhr und Krebs in Magen, Kolorektum und Bauchspeicheldruse wird mit moglich bewertet. Getreideprodukte aus Mehl mit hohem Ausmahlungsgrad Ballaststoffe entfalten zunachst ihre Wirkungen lokal im Magen, Dick und Mastdarm. Die potenziellen Effekte auf andere Organe sind indirekt und beruhen im Wesentlichen auf den metabolischen Wirkungen der Ballaststoffe, insbesondere auf deren Wirkung auf den Glucosestoffwechsel. Sie berichtet ohne weitere statistische Angaben uber ein abgesenktes Risiko fur Speise 146 Kapitel 9: Kohlenhydratzufuhr und Pravention von Krebskrankheiten rohrenkrebs im Zusammenhang mit einer hoheren Zufuhr von Ballaststoffen und Getreideprodukten. Bei den 5 Kohortenstudien zu Dickdarmkrebs ergab die Risikoschatzung aus der quantitativen Meta-Analyse ein ahnliches Ergebnis. Von 3 Kohortenstudien aus Asien konnte in der chine sischen Studie keine Assoziation zwischen der Zufuhr von Ballaststoffen und malignen Tumoren im Kolorektum beobachtet werden (Shin et al.