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.
With increased pressure to work until older age, one of the major challenges for Western societies lies in ensuring that the more vulnerable groups, such as low educated workers and those in ill health, will be able to remain at work until retirement age. Men and women with a chronic illness have considerable less access to the labour market than their healthy counterparts, especially among lower educated persons. This weaker position of lower educated persons is mostly related to the higher prevalence of ill health among this group, not to a difference in the strength of the association.
This thesis furthermore describes the influence of substantially changing working conditions on the risk of exit from paid employment for workers with ill health and concludes the more adverse changes in working conditions, the higher the risk of exit from paid employment. Looking at differences in working years lost for different socioeconomic groups these are primarily attributable to unemployment, while differences in working years lost between workers with different physical work load factors was primarily attributable to disability.
The research is important because it adds to the theory building as well as to practice – namely, how can we keep vulnerable groups being in paid employment. Insights that emerge from this research project will be of use to policy makers and practitioners, contributing to knowledge building that can, for instance, strengthen the use of social indicators such as working life expectancy and working years lost into public administration.
Breast cancer is a major public health problem in Europe. It is the most frequently diagnosed neoplasm and leading cause of death in European women. But encouragingly, breast cancer mortality has been declining, essentially due to advancements in early diagnosis and improved treatment.
Breast cancer screening aims to reduce morbidity associated with advanced stages of the disease, as well as cancer-specific mortality. At present, breast cancer screening programs are well established in most European countries. But the burden of breast cancer as well as breast cancer screening programs vary considerably throughout Europe and the long-term effectiveness of screening has only been assessed in a few countries. These substantial differences may result in inappropriate interventions, excessive screening, and overtreatment on the one hand, or under-screening, delayed provision of appropriate treatment on the other.
In this thesis, the consequences of variations of breast cancer screening practices and potential ways to (further) optimize screening programs across Europe are investigated. Part 1 describes the effectiveness of breast cancer screening in Europe. In Part 2, an established microsimulation model (MISCAN-Breast) was used to estimate the impact of current screening policies and the potential harms and benefits of specific health policy changes. Furthermore, MISCAN-Breast was standardized into a user-friendly online application as part of the EU-TOPIA project (www.eu-topia.org).
With this study on mortality, health problems, accessibility to care, we show that homeless people belong to an extremely vulnerable group.
We observe a variety of serious diseases and disorders among homeless people in a shorter life. Homeless people do not die from homelessness but from preventable and/or treatable causes and health problems.
In terms of accessibility of care, a constant fight against deterioration was needed. New regulations in 2015 -homeless people have since lost their health care insurance if they no longer have an address- has complicated the accessibility of care.
We have presented recommendations for future research. A scheme for the uninsured can contribute to solving the problems around uninsured people, but the application of the scheme in practice must be improved. Furthermore, social medical care for homeless people must be intensified in all municipalities in the Netherlands.
Policies to prevent homelessness remain needed and should be intensified. This study describes the value of a national action plan to combat homelessness.
Taking good care of homeless people is beneficial for homeless people themselves and for the general population. This thesis argues for inclusion of homeless people in our society.