So far, public health research paid relatively little attention to the association of factors related to social and community networks with health outcomes. There is a need to gain a better understanding of associations between ‘social factors’ and health and wellbeing in all stages of life.
This dissertation focused on two social factors: perceived social support and loneliness. Perceived social support was examined among parents of children aged 0-8 years, living in the Netherlands. Loneliness was examined among older adults aged 70+ years, living in five European countries. Emotional and social loneliness were distinguished.
The studies presented in this dissertation provide empirical support for multiple ways in which perceived social support and loneliness are related to health and wellbeing across the lifespan. Strengthening perceived social support and reducing loneliness may be potentially promising directions to improve public health and to foster the resilience of health care systems.
If you are interested to read the thesis you can send an email to : i.fierloos@erasmusmc.nl
Health behavior interventions mostly fail to find meaningful long-term effects. A key factor in the failure of many interventions is likely an inadequate targeting of the theory-based processes that determine behavior. This study set out to address this limitation.
The objective of this thesis was threefold. Firstly, it aimed to design an innovative theory- and evidence-based mHealth intervention to reduce the risk for cardiovascular disease. Second, it set out to implement it in a manner that resonates with its intended audience. Third, it aimed to evaluate the short-term effects of the resulting intervention. Taken together, the studies presented in the current thesis provide insight into both the theory and practice of delivering cardiovascular mHealth promotion programs.
https://www.globalacademicpress.com/ebooks/lili_kokai/
The HIV pandemic has been one of the most devastating public health threats in recent history. After emerging as a new human pathogen during the mid-20th century, the virus spread rapidly, infecting more than 79 million people worldwide, of whom 36 million have died due to its consequences. In the late 1990s, HIV related mortality peaked worldwide, with over 2 million deaths annually. The pandemic was especially severe in sub-Saharan Africa, where over 10% of the population was infected in many countries, and the high mortality rates had altogether reduced overall life expectancies. However, scientific breakthroughs coupled with an unprecedented global effort to control the pandemic have substantially expanded worldwide access to a wide range of biomedical and behavioural interventions to treat and prevent HIV infection, sparking optimism that the end of the pandemic could be in sight. Nowadays, about 75% of all people living with HIV worldwide are receiving life-saving treatment, even in the poorest countries of the world, and the number of new infections has been declining tremendously. In a landmark General Assembly on HIV and AIDS in 2016, the United Nations endorsed the ambitious commitment to end the pandemic by 2030. While progress towards this noble endeavour has been substantial, many obstacles still exist in reaching sustainable control of the pandemic. This thesis presents scientific research on the epidemiology of HIV and the potential of health systems innovations, which might contribute to overcoming some of these obstacles, and thereby help to ensure that we are truly living in the last decade of HIV.
The Last Decade of HIV? (ogc.nl)
The combination of urbanization and ageing can lead to new public health challenges, such as a higher risk of mental disorders and physical inactivity, but can also offer opportunities for the implementation of policies and interventions that promote public health. The city has therefore become a key site for the implementation of prevention and early identification policies on the trajectories of ageing and mental well-being. However, the implementation of such policies requires a good understanding of how the urban environment relates to health and well-being. The aim of this thesis is to explore the variation in urban environments and how this variation relates to physical activity and mental well-being by using data from different European cities. The studies presented in this thesis use data harmonized within the MINDMAP project. The MINDMAP project aimed to identify the opportunities and challenges posed by the urban environment for the promotion of mental health and well-being of middle-aged and older adults.
Link to the entry in the Kennisbank https://www.mulierinstituut.nl/publicaties/27287/urban-environments-physical-activity-and-mental-well-being/
Death rattle is a symptom of the dying phase. The sound is caused by the presence of mucus in the upper respiratory tract. The burden of death rattle for the patient is unknown, but the sound is disturbing for relatives and health care professionals.
Most of the studies described in this thesis were part of the research project ‘Death rattle in the dying phase: is prophylactic treatment useful?’, funded by the Netherlands Organisation for Health Research and Development (ZonMw). In this project we tried to understand the underlying causes of the various experiences of death rattle of bereaved relatives, studied the effect of prophylactically administered scopolamine butylbromide (medication that diminishes mucus) on the occurrence of death rattle, and assessed how a randomized, double-blind placebo-controlled trial in the dying phase can be feasible.
We found that death rattle can be a stressful symptom for relatives that is influenced by more factors than the intensity of the sound alone. Adequate information and communication cannot always relieve the burden for relatives. We showed that prophylactic subcutaneous scopolamine butylbromide significantly reduced the occurrence of death rattle in a hospice population. We found that the robust design and strategies to facilitate patient recruitment have resulted in a successful study with sufficient participants. According to relatives, patients’ participation in a double-blind placebo-controlled medication trial at the end of life need not be burdensome and does not interfere with the dying process.
The results are at this moment implemented in the guideline “Care in the dying phase”.
Geographical related health inequalities and inequities are of huge societal concern, especially when it comes to perinatal health and child welfare. Preventive Child Healthcare (PCHC) in the Netherlands has a unique opportunity to address vulnerable families. In this thesis the aim was to design, implement and study the effectiveness of a postnatal risk assessment in PCHC, as well as to study handover from obstetric care to PCHC and finally, to reduce child growth and developmental problems, particularly in families with a low socio-economic status.
Onchocerciasis and lymphatic filariasis (LF) are two important parasitic infectious diseases of the tropics. They are caused by a specific species of filarial worms and can cause a wide spectrum of clinical morbidity in the affected population, including blindness (onchocerciasis) and elephantiasis or “elephant legs” (LF). The PhD research focussed on how the disease burden of onchocerciasis and LF, in terms of total number of cases and disability-adjusted life years (DALYs), has changed since the introduction of large-scale mass treatment programmes in Africa and what burden will remain by 2030. DALYs are a measure that accounts for both loss in quality of life as well as premature mortality. In order to calculate this, she first quantified the pre-control association between community-based infection and morbidity levels. Mathematical modelling was then used to estimate the impact of interventions on the pre-control infection levels of onchocerciasis and LF throughout Africa. She predicted the past, current and future disease prevalence, number of cases, and DALYs lost due to onchocerciasis and LF. One major conclusion of this work was that interventions have a remarkable impact on levels of onchocerciasis and LF, although still millions of people will be suffering from morbidity by 2030 by either or both infections in Africa.
Parents play an important role in children’s (especially young children) environment, everyday experiences and lives. Identifying factors that are associated with optimal parenting and the health and wellbeing of parents and children could better support parents, children and their families. In this thesis, we aim to investigate factors associated with parenting and health outcomes in parents and children, and to investigate the effects of parenting support in a ‘real-world’ setting.
Ischemic stroke is often a devastating disease and a common cause of death or permanent disability. Neurological deficits can be reversible if blood flow is restored in time. Since the 1990s, treatment with intravenous thrombolytics (IVT) is registered for ischemic stroke. In 2015 the additional benefit of endovascular thrombectomy (EVT) to IVT was proven in patients with ischemic stroke with a large vessel occlusion. With the introduction of new treatments, it is important to measure the effects on quality of ischemic stroke care. The research presented in this thesis aimed to provide insight in the measurement and improvement of quality of ischemic stroke care by quality indicators. In Part I, we described generic quality indicators for stroke care and opportunities for improvement. In Part II, we investigated new disease-specific quality indicators of ischemic stroke care. In Part III, we focused on targets for quality improvement interventions in ischemic stroke care.
Traumatic brain injury (TBI) is a sudden change in brain function or damage to the brain caused by an external force, for instance in a motor vehicle or sports accident, fall or a violent incident. The majority of patients (75-90%) present with “mild” TBI. A substantial proportion of these individuals suffer long term consequences in terms of incomplete return to their preinjury level of functioning, including work, social and everyday activities. In this thesis, we aim to provide a better insight into the treatment and outcome of (mild) TBI and relations with sex/gender, age and comorbidity (PART 1), and to improve the identification of mild TBI patients with a higher risk of suboptimal short-term and longer-term outcomes (PART 2).