Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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Mortality in patients with rheumatoid arthritis : a 15-year prospective cohort study
Hoek, J. van den; Boshuizen, H.C. ; Roorda, L.D. ; Tijhuis, G.J. ; Nurmohamed, M.T. ; Bos, G.A.M. van den; Dekker, J. - \ 2017
Rheumatology International 37 (2017)4. - ISSN 0172-8172 - p. 487 - 493.
Cause of death - Cohort study - Comorbidity - Longitudinal studies - Mortality - Rheumatoid arthritis - Survival
The aim of this study was to investigate (a) the mortality in a clinical cohort of patients with established rheumatoid arthritis in comparison with the general Dutch population over 15 years, (b) the trend in the mortality ratio during the study period, and (c) causes of death and compare these with the general population. In 1997, a sample of 1222 patients was randomly selected from the register of a large rheumatology outpatient clinic. Their mortality and primary causes of death between 1997 and 2012 were obtained from Statistics Netherlands. The standardized mortality ratio (SMR) for all-cause mortality and the number of life-years lost in the study period, adjusted for age, sex, and calendar year, were calculated. A linear poisson regression analysis was performed to evaluate change in all-cause SMR over time. Finally, the SMRs for cause-specific mortality were calculated. The mean age of the population at baseline was 60.4 (SD 15.4) years, and 72.6% of the patients were women. The estimated SMR (95% CI) for all-cause mortality was 1.54 (1.41, 1.67) with about one life-year lost over the study period. There was a trend to decreasing SMR (2% annually, p = .07). Mortality was higher compared with the general population for circulatory system diseases, respiratory system diseases, musculoskeletal system diseases, and digestive system diseases (p <.05). The observed mortality among patients with RA was 54% higher than in the general population after adjustment for age, sex and calendar year. More than one life-year was lost over 15 years, and the mortality tended to decrease over time. The mortality was higher for cardiovascular, respiratory, musculoskeletal and digestive diseases.
Trend in and predictors for cardiovascular mortality in patients with rheumatoid arthritis over a period of 15 years : A prospective cohort study
Hoek, Joëlle van den; Roorda, Leo D. ; Boshuizen, Hendriek C. ; Tijhuis, Gerard J. ; Dekker, Joost ; Bos, Geertrudis A. van den; Nurmohamed, Michael T. - \ 2016
Clinical and Experimental Rheumatology 34 (2016)5. - ISSN 0392-856X - p. 813 - 819.
Cardiovascular - Cohort study - Comorbidity - Longitudinal studies - Mortality - Rheumatoid arthritis

Objectives: To investigate a) the cardiovascular (CV) mortality in a clinical cohort of patients with established rheumatoid arthritis (RA) in comparison with the general population over 15 years, b) the trend in this CV mortality during the study period, and c) for a broad range of predictors, which baseline variables predict CV mortality. Methods In 1997, a sample of 1222 patients was randomly selected from the register of a rheumatology outpatient clinic in Amsterdam. Their CV mortality between 1997 and 2012 was obtained from Statistics Netherlands. The standardised mortality ratio (SMR) for CV mortality was calculated. A linear poisson regression analysis was performed to investigate if there was a trend in SMR over time. A Cox regression analysis was performed to determine which baseline variables predicted CV mortality. Results: Mean age of the population at baseline was 60.4 (SD 15.4) years and 72.6% of the patients were women. Estimated SMR (95% confidence interval) for CV mortality was 1.24 (1.05, 1.43). The SMR decreased with 3% annually (p=0.16). Higher age, higher erythrocyte sedimentation rate, having CV comorbidity and diabetes mellitus (DM) were predictors for CV mortality. Conclusions: CV mortality among patients with RA in the past 15 years was still higher than in the general population. CV mortality decrease was not statistically significant. As CV mortality in RA is still higher than in the general population, continued attention for CV diseases in RA is important. Both tight control of disease activity and good care for comorbid conditions (CV diseases and DM) are advocated.

Association of Somatic Comorbidities and Comorbid Depression With Mortality in Patients With Rheumatoid Arthritis : A 14-Year Prospective Cohort Study
Hoek, J. van den; Boshuizen, H.C. ; Roorda, L.D. ; Tijhuis, G.J. ; Nurmohamed, M.T. ; Dekker, J. ; Bos, G.A.M. van den - \ 2016
Arthritis Care & Research 68 (2016)8. - ISSN 2151-464X - p. 1055 - 1060.

Objective: Patients with rheumatoid arthritis (RA) have a significantly increased risk of mortality compared with the general population. One of the most important predictors for mortality is somatic comorbidity. Moreover, studies have demonstrated that comorbid depression is associated with mortality. Which specific comorbidities are associated with mortality is less investigated. The purpose of this study was to investigate the association of a wide range of comorbidities with mortality in patients with RA. Methods: Longitudinal data over a 14-year period were collected from 882 patients with RA. Data were assessed with questionnaires. The mortality status was obtained from the Statistics Netherlands for the period 1996–2011 for 99% of the patients. Somatic comorbidity was assessed in 1997, 1998, 1999, and 2008 and measured by a national population-based questionnaire including 20 chronic diseases. Comorbid depression was assessed in 1997, 1998, and 1999 and measured with the Center for Epidemiologic Studies Depression Scale. Cox regression was used to study the relationship between comorbidity and mortality. Results: At baseline, 72% of the patients were women. The mean ± SD age was 59.3 ± 14.8 years, and the median (interquartile range) disease duration was 5.0 (2.0–14.0) years. A total of 345 patients died during the study period. Comorbidities that were associated with mortality were circulatory conditions (hazard ratio [HR] 1.60 [95% confidence interval (95% CI) 1.15–2.22]), respiratory conditions (HR 1.43 [95% CI 1.09–1.89]), cancer (HR 2.00 [95% CI 1.28–3.12]), and depression (HR 1.35 [95% CI 1.06–1.72]). Conclusion: Comorbid circulatory conditions, respiratory conditions, cancer, and depression are associated with mortality among patients with RA. Careful monitoring of these comorbidities during the course of the disease and adequate referral may improve health outcomes and chances of surviving.

Physical and mental functioning in patients with established rheumatoid arthritis over an 11-year followup period : The role of specific comorbidities
Hoek, Joëlle Van Den; Roorda, Leo D. ; Boshuizen, Hendriek C. ; Tijhuis, Gerard J. ; Bos, Geertrudis A. Van Den; Dekker, Joost - \ 2016
The Journal of Rheumatology 43 (2016)2. - ISSN 0315-162X - p. 307 - 314.
Comorbidity - Depression - Longitudinal - Mental functioning - Physical functioning - Rheumatoid arthritis

Objective. To investigate the longterm association of a wide range of comorbidities with physical and mental functioning in patients with rheumatoid arthritis (RA). Methods. Longitudinal data over a period of 11 years were collected from 882 patients with RA. Somatic comorbidity and comorbid depression were measured at baseline, with a questionnaire including 20 chronic diseases and with the Center for Epidemiologic Depression Scale, respectively. Physical functioning was measured at 5 timepoints with a disease-specific measure [Health Assessment Questionnaire (HAQ)] and a generic measure [physical scales of the Medical Outcomes Study Short Form-36 (SF-36)]. Mental functioning was measured with the mental scales of the SF-36. To determine the association of baseline-specific comorbidities with functioning over time, we performed longitudinal analyses. Results.At baseline, 72% percent of the patients were women, mean age ± SD was 59.3 ± 14.8 years, median RA disease duration was 5.0 years, and 68% had ? 1 comorbid condition. The effect of comorbid conditions was more apparent when physical functioning was measured with SF-36, a disease-generic measure, compared with the HAQ, a disease-specific measure. Circulatory conditions and depression were associated (p <0.05) with worse physical functioning according to the HAQ. Respiratory conditions, musculoskeletal conditions, cancer, and depression were associated (p <0.05) with worse physical functioning according to the SF-36. Respiratory conditions and depression were associated with worse mental functioning. Conclusion. Patients with specific comorbid conditions have an increased risk of low functioning in the long term. Targeted attention for these specific comorbid conditions by clinicians is recommended. The Journal of Rheumatology.

Analysis of a motion planning problem for sweet-pepper harvesting in a dense obstacle environment
Bac, C.W. ; Roorda, T. ; Reshef, R. ; Berman, S. ; Hemming, J. ; Henten, E.J. van - \ 2016
Biosystems Engineering 146 (2016). - ISSN 1537-5110 - p. 85 - 97.
To reach a fruit in an obstacle-dense crop environment, robotic fruit harvesting requires a collision-free motion of the manipulator and end-effector. A novel two-part analysis was conducted of a sweet-pepper harvesting robot based on data of fruit (N = 158) and stem locations collected from a greenhouse. The first part of the analysis compared two methods of selecting the azimuth angle of the end-effector. The new ‘constrained-azimuth’ method avoided risky paths and achieved a motion planning success similar to the ‘full-azimuth’ method. In the second part, a sensitivity analysis was conducted for five parameters specifying the crop (stem spacing and fruit location), the robot (end-effector dimensions and robot position) and the planning algorithm, to evaluate their effect on successfully finding a collision-free goal configuration and path. Reducing end-effector dimensions and widening stem spacing are promising research directions because they significantly improved goal configuration success, from 63% to 84%. However, the fruit location at the stem is the strongest influencing parameter and therefore provides an incentive to train or breed plants that develop more fruit at the front side of the plant stem. The two analyses may serve as useful tools to study motion planning problems in a dense obstacle environment
Somatic cormobidities and comorbid depression are associated with mortality among patients with rheumatoid arthritis: a 14-year prospective cohort study
Hoek, J. van den; Boshuizen, H.C. ; Roorda, L.D. ; Tijhuis, G.J. ; Nurmohamed, M.T. ; Dekker, J. ; Bos, G.A. van den - \ 2014
In: Scientific Abstracts EULAR 2014. - - p. 453 - 453.
Background Patients with rheumatoid arthritis (RA) have a significantly increased risk of mortality compared with the general population [1]. Although the management of RA improved in the last decades, the survival in patients with RA has not improved to the same degree as that of the general population [2,3]. One of the most important predictors for mortality is somatic comorbidity. Moreover, studies have demonstrated that comorbid depression is associated with mortality. Which specific comorbidities are associated with mortality is less investigated. Objectives To investigate the association of a wide range of comorbidities with mortality in patients with RA. Methods Longitudinal data over a 14-year period were collected from 882 patients with RA. Data were assessed with self-reported questionnaires. The mortality status was obtained from the Statistics Netherlands for the period 1996-2011 for almost all of the participants included at baseline (99,8%). Somatic comorbidity was assessed in 1997, 1998, 1999 and 2008. Somatic comorbidity was measured by a national population-based questionnaire including 20 chronic diseases, of which nine categories of chronic somatic comorbidity were created. Comorbid depression was assessed in 1997, 1998 and 1999. Comorbid depression was measured with the Center for Epidemiologic Depression Scale. Cox regression was used to study the relationship between comorbidity and mortality. Results At baseline, 72% of the patients were women. The mean age was 59.3 (SD 14.8) years and the median disease duration was 5.0 (IQR 2.0-14.0) years. Comorbidities that were associated (Hazard Ratio [95% confidence intervals]) with mortality were circulatory conditions (1.62 [1.17-2.26]), respiratory conditions (1.46 [1.11-1.93]), digestive conditions (1.51 [1.02–2.22]), cancer (2.03 [1.30-3.18]) and depression (1.39 [1.09-1.77]). Conclusions Comorbid cardiovascular conditions, respiratory conditions, digestive conditions, cancer, and depression are associated with mortality among patients with RA. Careful monitoring of these comorbidities during the course of the disease and adequate referral may improve health outcomes and chances of surviving.
Physical and Mental Functioning in Patients with Established Rheumatoid Arthritis over a 11-Year Follow-up Period: The Role of Specific Comorbidities.
Hoek, J. van den; Roorda, L.D. ; Boshuizen, H.C. ; Tijhuis, G.J. ; Bos, T. van den; Dekker, J. - \ 2014
In: Book of abstracts of the American College of Reumatology. - Wiley - p. S903 - S903.
Background/Purpose Comorbidity in patients with Rheumatoid Arthritis (RA) is highly prevalent and plays an important role in determining RA related outcomes. Several studies have reported the negative association of comorbidity with functioning in general. The information about the association of specific comorbidities with functioning in patients with RA is limited. Evaluating specific comorbidities will provide valuable information for clinical practice and the management of patients with RA. The aim of this study was to investigate the long term association of a wide range of specific comorbidities with physical and mental functioning in patients with RA. Methods Longitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Somatic comorbidity was measured at baseline, with a questionnaire including 20 chronic diseases, from which 9 categories of chronic somatic comorbidity were created. Comorbid depression was measured at baseline, with the Center for Epidemiologic Depression Scale. Physical functioning was measured with the Health Assessment Questionnaire (HAQ) and with the physical component summary of the Short Form 36 health survey (SF-36). Mental functioning was measured with the mental component summary of the SF-36. To determine the impact of specific comorbid conditions on functioning and on change in functioning we performed a longitudinal analysis. Results The mean age of the patients at was 59.3 (SD 14.8) years, 72% of the patients were women, their median disease duration was 5.0 (IQR 2.0-14.0) years, and 68% had = 1 comorbid condition. The mean HAQ score for an average patient was 0.98 on average over the 11-years follow-up period. Circulatory conditions (mean HAQ score + 0.28) and depression (+0.38) were associated (p
Mortality Decreases in Patients with Rheumatoid Arthritis: a 15-Year Prospective Cohort Study
Hoek, J. van den; Boshuizen, H.C. ; Roorda, L.D. ; Tijhuis, G.J. - \ 2014
In: Book of abstracts of the American College of Reumatology. - Wiley - p. S903 - S903.
Background/Purpose Patients with rheumatoid arthritis (RA) have a higher mortality risk than the general population, with similar patterns over the last decades. However, more recent studies show conflicting results. Given these conflicting results, there is an obvious need to evaluate the risk of mortality in patients with RA, over a long period, using more recent mortality data. Objectives To investigate a) the mortality in a clinical cohort of patients with established rheumatoid arthritis in comparison with the general Dutch population over 15 years, b) the trend in the mortality ratio during the study period, and c) the causes of death and compare these with the general population. Methods In 1997, a sample of 1222 patients was randomly selected from the register of a large rheumatology outpatient clinic in Amsterdam. Their mortality and causes of death between 1997 and 2012 were obtained from Statistics Netherlands. The Standardized Mortality Ratio (SMR) for all-cause mortality and the number of life-years lost in the study period were calculated. Linear poisson regression analysis was performed to evaluate change in all-cause SMR over time. Finally, the SMRs for cause-specific mortality were calculated. Results The mean age of the population at baseline was 60.4 (SD 15.4) years and 72.6% of the patients were women. The estimated SMR (95% CI) for all-cause mortality was 1.54 (1.41, 1.67) with about one life-year lost over the study period. The SMR decreased with 2% annually (p = .05). Mortality increased for diseases of the circulatory system, respiratory system, musculoskeletal system, and digestive system (p <.05). Conclusion The observed mortality among patients with RA was more than 50% higher than in the general population. More than one life-year was lost over 15 years and the mortality seemed to decrease over time. The most frequent causes of death were the same as those in the general population. (...) Annual Standardized Mortality Ratio and 95% Confidence Interval.
Somatic comorbidity and comorbid depression are associated with mortality among patients with established rheumatoid arthritis: an eleven years follow-up cohort study
Hoek, J. ; Roorda, L.D. ; Boshuizen, H.C. ; Tijhuis, G.J. ; Dekker, J. ; Bos, G.A. van den - \ 2013
Annals of the Rheumatic Diseases 72 (2013)Suppl.3. - ISSN 0003-4967
Background Rheumatoid Arthritis (RA) is associated with premature mortality (1). Somatic comorbidity has been found to be one of the most important predictors for premature mortality (2). Comorbid conditions that are associated with premature mortality are: cardiovascular diseases, respiratory diseases, gastrointestinal system disorders, genitourinary diseases, hematologic diseases, infectious diseases, and malignancies. A few studies have found comorbid depression to be associated with an increased risk for mortality (3). The combination of both somatic comorbidity and comorbid depression as a risk factor for mortality has not yet been investigated. Whether this combination is an additional risk factor for premature mortality is important information for clinicians to be able to adapt their screening process and when necessary their treatment.

Objectives To investigate which comorbid conditions are associated with premature mortality and if the combination of a somatic comorbid condition and comorbid depression is more associated with premature mortality than one of these conditions alone.

Methods Longitudinal data over a period of eleven years were collected from 882 patients with RA at study inclusion. Data by means of self-reported questionnaires were collected in 1997, 1998, 1999, 2002 and 2008. Of all of the participants included at baseline, the mortality status was obtained from the register of the Statistics Netherlands. Somatic comorbidity was measured by a questionnaire including 20 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Depression Scale. To study the relationship between comorbidity and survival among RA patients, we performed a Cox regression analysis.

Results 78% of the patients at baseline were women. The mean age was 59.3 (SD 14.8) years and the median disease duration was 5.0 (IQR 2.0-14.0) years. Comorbid conditions that were associated with premature mortality were respiratory conditions, gastrointestinal conditions, cancer and comorbid depression. The combination of a somatic comorbid condition and comorbid depression did not lead to an additional risk for premature mortality.

Conclusions Both somatic comorbidity and comorbid depression are a risk factor for premature mortality among patients with RA. These results emphasize the importance of paying attention to both somatic comorbidity and comorbid depression in clinical practice, and highlight the importance of ascertaining the presence of such comorbidities and to adjust treatment when necessary.
Somatic Comorbidity in patients with chronic widespread pain in an outpatient secondary care center for rheumatology and rehabilitation in The Netherlands
Crins, M. ; Roorda, L.D. ; Beuving, W. ; Boshuizen, H.C. ; Dekker, J. - \ 2013
Annals of the Rheumatic Diseases 72 (2013)S3. - ISSN 0003-4967 - p. 1054 - 1054.
Background: Comorbidity, defined as one or more additional disease(s) among patients with an index-disease, can affect the treatment and the prognosis of the index disease.1,2 Although numerous studies address the prevalence of somatic complaints in patients with chronic widespread pain (CWP), the prevalence of somatic comorbidity has not been studied in detail in these patients and, more specifically, this prevalence has not been compared to the prevalence in the general population.2 Objectives: First aim was to describe the prevalence of somatic comorbidity in patients with CWP. Second aim was to compare this prevalence with the prevalence rates in the general Dutch population and to describe the risk factor of these comorbidities for patients with CWP. Methods: A cohort study on somatic comorbidity was conducted among 1238 patients with CWP referred to an outpatient secondary care center for rheumatology and rehabilitation in the Netherlands. Data on comorbidity were collected by means of a questionnaire including 15 chronic somatic conditions, adapted from the Health Interview Survey of the Statistics Netherlands.3 Statistical analyses included descriptive statistics, Chi-square tests and Standardized Mortality Ratios (SMR). SMR quantifies the disease risk of a study population compared to the general population. Results: 84% of the subjects reported one or more somatic comorbidities. The most frequently reported comorbidities were migraine (52%), dizziness with falling (24%), hypertension (23%), incontinence (19%) and chronic pulmonary disease (15%). In comparison with the Dutch population, 13 of the 15 somatic comorbidities were significantly (P
Long-Term Physical Functioning and Its Association With Somatic Comorbidity and Comorbid Depression in Patients With Established Rheumatoid Arthritis: A Longitudinal Study
Hoek, J. ; Roorda, L.D. ; Boshuizen, H.C. ; Hees, J. van; Rupp, I. ; Tijhuis, G.J. ; Dekker, J. ; Bos, G.A.M. van den - \ 2013
Arthritis Care & Research 65 (2013)7. - ISSN 2151-464X - p. 1157 - 1165.
quality-of-life - chronic disease - health survey - co-morbidity - metaanalysis - prevalence - classification - outcomes - impact - sf-36
ObjectiveTo describe long-term physical functioning and its association with somatic comorbidity and comorbid depression in patients with established rheumatoid arthritis (RA). MethodsLongitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Patient-reported outcomes were collected in 1997, 1998, 1999, 2002, and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the physical component summary score of the Short Form 36 health survey. Somatic comorbidity was measured by a questionnaire including 12 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Studies Depression Scale. We distinguished 4 groups of patients based on comorbidity at baseline. ResultsSeventy-two percent of the patients at baseline were women. The mean +/- SD age was 59.3 +/- 14.8 years and the median disease duration was 5.0 years (interquartile range 2.0-14.0 years). For the total group of patients with RA, physical functioning improved over time. Patients with somatic comorbidity, comorbid depression, or both demonstrated worse physical functioning than patients without comorbidity at all data collection points. Both groups with comorbid depression had the lowest scores. Only patients with both somatic comorbidity and comorbid depression showed significantly less improvement in physical functioning over time. ConclusionBoth somatic comorbidity and comorbid depression were negatively associated with physical functioning during an 11-year followup period. Furthermore, their combination seems to be especially detrimental to physical functioning over time. These results emphasize the need to take somatic comorbidity and comorbid depression into account in the screening and treatment of patients with RA.
Transition management at the local scale. An analysis of challenges in transition management at the local scale in two case studies.
Spekkink, W. ; Eshuis, J. ; Roorda, C. ; Stuiver, M. ; Steenbergen, F. van - \ 2013
Rotterdam : Dutch Research Institute for Transitions Erasmus University Rotterdam - 23 p.
Mental functioning in patients with rheumatoid arthritis over an eleven years follow-up period: the role of comorbidity
Hoek, J. van den; Roorda, L.D. ; Boshuizen, H.C. ; Bos, G.A. van den; Hees, J. van; Rupp, I. ; Tijhuis, G. ; Dekker, J. - \ 2012
Annals of the Rheumatic Diseases 71 (2012)Suppl.3. - ISSN 0003-4967 - p. 737 - 737.
Background Mental functioning is reported as an important outcome measure in patients with Rheumatoid Arthritis (RA). Patients show lower mental functioning scores than the general population (1). A factor that has great impact on the overall health outcomes is comorbidity (2). Both somatic and depression comorbidity are common in patients with RA. Investigating the influence of comorbidity on mental functioning provides clinicians long term information for a particular patient. Objectives To asses the long term association of somatic and depression comorbidity and mental functioning in patients with RA. Methods Longitudinal data over a period of eleven years were collected among 882 patients with RA of varying disease duration. Patient reported outcomes were collected in 1997, 1998, 1999, 2002 and 2008. Mental functioning was measured with the Mental Component Scale of the Short Form-36 Health Survey. Somatic comorbidity was measured by a self administered questionnaire including 13 chronic diseases. Depression comorbidity was measured with the Center for Epidemiologic Depression Scale. We distinguished four groups of patients based on comorbidity at baseline: patients 1) without comorbidity 2) with only somatic comorbidity 3) with only depression comorbidity and 4) with both somatic and depression comorbidity. The influence of comorbidity at baseline on mental functioning over time was investigated in a longitudinal analysis. Results 882 patients responded to the questionnaire, of whom 78% were women. The mean age of the patients at baseline was 59.3 (SD 14.8) years and the mean disease duration was 8.9 (SD 9.9) years. For the total group of patients with RA mental functioning stayed stable over time. There was no difference in mental functioning between patients without comorbidity and patients with somatic comorbidity. Patients without comorbidity at baseline had better mental functioning at all time points than patients with depression comorbidity and patients with both somatic and depression comorbidity (p<0.01). However, the difference in mental functioning between patients without comorbidity and patients with both somatic and depression comorbidity decreased between baseline and eleven years follow up (p<0.01). Conclusions Depression comorbidity and the combination of both somatic and depression comorbidity was negatively associated with mental functioning and this association was present during eleven years follow up. Because of its long term consequences, early screening for depression comorbidity in RA would be recommended, so additional intervention can start early in the disease process to reduce the negative effects of this comorbidity.
The influence of somatic and depression comorbidity on physical functioning over eleven years in patients with rhematoid arthritis (FRI0116)
Hoek, J. ; Roorda, L.D. ; Boshuizen, H.C. ; Dekker, J. ; Hees, J. van; Rupp, I. ; Tijhuis, G. ; Bos, G.A. van den - \ 2012
Annals of the Rheumatic Diseases 71 (2012)S3. - ISSN 0003-4967 - p. 349 - 349.
Background The prevalence of comorbidity in patients with rheumatoid arthritis (RA) is higher than in the general population (1). There is increasing evidence that comorbidity plays an important role in determining RA-related outcomes, like physical functioning (2). Little is known about the impact of comorbidity on the long term. Further, the studies that investigated the effects of comorbidity on physical functioning, did not compare the influence of both somatic and depression comorbidity. With this information clinicians can early adjust their treatment to the comorbidity. Objectives To asses the long term association of comorbidity and physical functioning in patients with established RA. Methods Longitudinal data were collected among 882 patients with RA of varying disease duration at inclusion in the study. Patient reported outcomes were collected in 1997, 1998, 1999, 2002 and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the Physical Component Scale of the SF-36 Health Survey. Somatic comorbidity was measured by a self administered questionnaire including 13 chronic diseases. Depression comorbidity was measured with the Center for Epidemiologic Depression Scale. We distinguished four groups of patients based on comorbidity at baseline: patients 1) without comorbidity 2) with only somatic comorbidity 3) with only depression comorbidity and 4) with both somatic and depression comorbidity. The influence of comorbidity on physical functioning over time was investigated in a longitudinal analysis. Results 882 patients respond to the questionnaire, of whom 78% were woman. The mean (SD) age of the patients at baseline was 59.3 (SD 14.8) years and the mean (SD) disease duration was 8.9(SD 9.9) years. For the total group of patients with RA, physical functioning improved over an eleven year period. Patients with comorbidity had a worse physical functioning than patients without comorbidity at all time points, by which both groups with depression comorbidity had the lowest score (p
A systems analysis methodology for exploring urban sustainability transitions
Maas, S. ; Fortuin, K.P.J. ; Frantzeskaki, N. ; Roorda, C. - \ 2012
Challenges and Tensions in Area Based Transitions
Spekkink, W. ; Eshuis, J. ; Loorbach, D. ; Roorda, C. ; Stuiver, M. ; Steenbergen, F. van - \ 2012
Vernieuwende fysisch-chemische voorzuivering?
Mels, A.R. ; Nieuwenhuijzen, A.F. van - \ 2000
In: Voordrachtenbundel nieuwe ontwikkelingen in de afvalwaterketen : 19e vakantiecursus in riolering en afvalwaterbehandeling / van Nieuwenhuijzen, A.F., Roorda, J.H., - p. 57 - 66.
afvalwaterbehandeling - voorbehandeling - fysisch-chemische methoden - waste water treatment - pretreatment - physicochemical methods
Traffic related air pollution in city districts near motorways
Roorda-Knape, M.C. ; Janssen, N.A.H. ; Hartog, J. de; Vliet, P.H.N. van; Harssema, H. ; Brunekreef, B. - \ 1999
Science of the Total Environment 235 (1999). - ISSN 0048-9697 - p. 339 - 341.
Air pollution from traffic in city districts near major motorways.
Roorda-Knape, M.C. ; Janssen, N.A.H. ; Hartog, J. de; Vliet, P.H.N. van; Harssema, H. ; Brunekreef, B. - \ 1998
Atmospheric Environment 32 (1998). - ISSN 1352-2310 - p. 1921 - 1930.
De geboorte van het Hoogheemraadschap van Delfland : ontginning en bedijking in de Vroege Middeleeuwen
Roorda van Eysinga, N.P.H.J. - \ 1988
Agricultural University. Promotor(en): L.J. Pons; G.J. Borger. - S.l. : Roorda van Eysinga - 150
kusten - dijken - geschiedenis - hydraulische systemen - land - landschap - bescherming - ontginning - waterbeheer - waterwegen - Nederland - raden - natuurlandschap - waterschappen - zuid-holland - coasts - dykes - history - hydraulic structures - land - landscape - protection - reclamation - water management - waterways - Netherlands - boards - natural landscape - polder boards - zuid-holland

The history of the public waterboard or the Hoogheemraadschap van Delfland, dates back to the year 1317.
Uninterrupted management of water conditions over an era of almost seven centuries is in itself an impressive record. Moreover, we heve to state that the region includes almost the entire agglomeration of 's- Gravenhage (The Hague), the famous horticultural district of the Westland (with 33 million m 2greenhouses) and also important sections of the Rotterdam agglomeration and harbours. Altogether an area with 1.200.000 inhabitants on a surface of 41.000 ha. It is easy to understand that the last centuries of industrial revolution and urban explosion changed the face of that area considerably and also the mangement of waterconditions.

It is supposed that, before those recent changes, Holland got its traditional shape and form in the medieval frontier or "grote ontginning", during the XIIth and XIIIth centuries. This process has been analysed by H. van der Linden in De Cope (1956), and recently been commented in the english language by William TeBrake (1985).

After the medieval frontier and before modern industrialisation, to be exact in 1712, a skilfull catographer named Cruquius finished his detailed and accurate map of Delfland, ordered by the same waterboard.
Studying that map to-day, one can distinguish between ortogonic, or at least rectilineair structures that only can be introduced by human decisions, and more accidently shaped structures apparently of natural origine (see map, pag 5). Now the question is put, can we reach solid conclusions about the landscape and development in early medieval times, before the great frontier, by carefully studying the map of Cruquius?

Successively examining the available and relevant literature, and studying the map precisely, the author searches for an answer to that question.
Starting in the dune area along the North Sea (A), he discusses the reclamation of 's-Gravenzande in the mouth of the Maas (C) and the inundation of the Westland by a XIIth century waterstorm (B). Interpretation of the Liersystem (D) at first met with many difficulties. Therefore the author passes on to Maasland (F) and Vlaardingen (G). Via Schie (H) he turns back inland to analyse the situation of Delft (K) and Oude Leede (1). There he finds clear indications to interprete also the Liersystem (D), including 't Woud (E) and Zouteveen (i).
Summarizing, he traces the evolution of the local peat- bogs since Roman times, the existance of the old county of Masalant and the birth of the medieval waterboard of Delfland.

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