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).
About 15-20% of the children in Western countries suffer from emotional and/or behavioural problems. However, only half of these children do receive care. To get insight into which children do and do not receive care, it is essential to identify the determinants of mental health care use. This thesis focusses on the determinants of children’s and adolescents’ mental health care use. Determinants were studied on the individual level, e.g. sex, migrant origin and mental health problems, and on the contextual level, e.g. neighbourhood characteristics and screening for mental health problems. The thesis consists of two systematic reviews on these determinants. Furthermore, it contains four original studies, using the data of the Generation R Study (www.generationr.nl).
Public health and health promotion can be employed at international, national, regional and local levels. Particularly local governmental bodies such as municipalities play an increasingly important role in promoting the health and well-being of children and adolescents and in reducing health inequalities. For example in reducing mental health problems, overweight/obesity and socioeconomic inequalities in health by implementing preventive policies, policy programs or interventions. How exactly local public health can promote the health and well-being of children and adolescents relies partly on the available knowledge.
Research is important for designing and implementing effective interventions, policies and policy programs at the local level. This thesis contributes to the knowledge of health and well-being of children and adolescents by studying potential target populations, by investigating health outcomes and their risk and preventive factors and by evaluating local interventions and programs to promote healthy lifestyles, health and well-being.
People living in the immediate vicinity of industrial activities can be exposed to air pollution, such as particular matter (PM2.5 and PM10), nitrogen oxide (NOX), sulphur dioxide SO2 and volatile organic compounds (VOC), which can cause different health effects (e.g. asthma, chronic obstructive pulmonary disease, and mortality). The release of air pollution can take place under stable conditions (average exposure) and during accidents in plants, disruption of production, or during transportation of hazardous materials (peak exposure). The influence of air pollution from industrial activities on health and the how industrial activities (including incidents) influence citizens’ risk perception and (protective) behaviour are investigated by Arnold Bergstra.
Breast cancer is the most common cancer in women. In the Netherlands, women aged 50 to 74 years are invited every two years for a mammogram to screen for breast cancer. Women who are at high risk of developing breast cancer due to a pathogenic variant in BRCA1/2 genes are offered MRI screening. However, more subgroups of women who have an increased risk of developing breast cancer may benefit from MRI screening as well but still undergo mammography screening. In this thesis the effectiveness of MRI screening for several risk groups was investigated. These risk groups consisted of women with a family history of breast cancer, women with a pathogenic variant in ATM, CHEK2 and PALB genes, and women with extremely dense breast tissue. Besides the use of randomized controlled trials, we used microsimulation modelling to investigated what the optimal screening interval and starting/stopping ages would be for these women. Furthermore, we conducted cost-effectiveness analyses and evaluated the preferences of women themselves.
ls patiënt vind je het belangrijk dat zorgverleners jouw autonomie en uniekheid respecteren, dat je een echte professional als zorgverlener krijgt die bovendien naar je luistert en empathisch is. Een zorgverlener die jou empowert en met jou een partnership aangaat. Deze dimensies zijn onderzocht door Carla Bastemeijer in haar promotie onderzoek. Zij promoveert op woensdag 11 mei om 10.30 in het Erasmus MC en de verdediging is live. Haar proefschrift kan je hier vinden. Haar werk was onderdeel van het Erasmus MC Waardegedreven Zorg Programma en is gedeeltelijk ondersteund geweest door het Citrienfonds van de NFU.”
The premise of Big Data in acute medicine is to make medicine more efficient and effective. However, the translation of large observational
data to knowledge is difficult. This thesis explores and discusses the three main types of research questions which can be asked
from large observational data:
1. What is current clinical practice?
2. What is best practice?
3. What patients need to be prioritised?
This thesis will focus on traumatic brain injury and in-hospital cardiac arrest.