Lifestyle determinants, together with the aging population leads to a high prevalence of CVD and fall incidents. Prevention programs exist, but implementation of prevention programs remains difficult. The main focus of this thesis is to study conditions for successful implementation of prevention programs. Programs on cardiovascular disease prevention in the hospital and programs for fall prevention in the hospital and community setting were selected as illustrative examples. This thesis showed that the use of familiar healthcare settings or familiar healthcare providers is crucial for the success of recruiting individuals for prevention. To keep both involved, programs with room for adjustments to needs and preferences of participants and participant health status has proved important. Furthermore, this thesis described that simple and short programs can be a first step towards behavioral change. However for adherence to advice and actual behavioral change, more intensive interventions and collaboration among healthcare providers is necessary.
Changes in the environment cannot be studied like a drug. This thesis uses so-called “natural experiments”, sudden changes in the environment, to evaluate the effects of these changes in real-world settings. We found that play facilities near home makes it easier for children to play outside. The current fast food paradises where children grow up could be a barrier for healthy dietary behaviours. The hosting of international sport events may contribute to increasing sport participation levels in the population, and largest effects were found following the Grand Départ of the Tour de France. We also reviewed international evidence on smoke-free car policies, and found that these initiatives can considerably reduce the harmful effects of tobacco smoke exposure in children.
A healthy population starts by creating a healthy environment. We should shift our priorities from interventions primarily targeting behaviour of individuals, towards interventions targeting the environment to which individuals are exposed. We need to intervene in the environment to ensure that the healthy choice becomes the easy choice.
Colorectal cancer is an important global public health issue. With over 1.8 million new diagnoses in 2018, colorectal cancer was the third leading cause of cancer incidence. Each year, almost half of all colorectal cancer patients die from the disease, making it the second leading cause of cancer-related deaths.
Encouragingly, the burden of colorectal cancer can be reduced with screening. However, although screening has been widely implemented, programs differ markedly throughout the world. While some variation is not entirely unexpected given that risk of colorectal cancer varies significantly, the extent of variety suggests there may be room to improve screening programs.
In this thesis we investigate pathways to improve colorectal cancer screening programs. In the first instance, we explore pathways to optimise uniform screening programs to ensure they are designed and implemented to achieve the best possible outcomes for the average risk population. Subsequently, as it is increasingly recognised that individuals may not benefit equally from the same screening protocol, we investigate personalisation as a pathway to improve colorectal cancer screening programs.
Een jaar geleden zijn we overvallen door het coronavirus, een pandemie die de wereld nog steeds op zijn kop zet. Niets was meer zoals het was en alles moest anders. De opgaven waren enorm en de kennislacune was groot en breed. In Rotterdam kon door de bestaande kennisinfrastructuur zeer snel gewerkt worden aan nieuwe kennis, kennis worden uitgewisseld én ingezet bij beleid.
In deze gezamenlijke bijeenkomst ‘Kennis en Corona’ maken we nu, na één jaar corona, de tussenbalans op. Wat weten we nu, wat weten we nog niet en waar moeten we in de toekomst aan werken?
Met een afwisselend programma van discussies en presentaties willen we met elkaar nadenken welke grote opgaven én kennisleemtes er zijn. En hoe de Rotterdamse kennisinfrastructuur daarbij kan helpen.
We voeren de discussie zowel plenair in Studio Kennis als in parallelsessie op thema’s als: Veerkracht, Gedrag, Economie, Jongeren, Kwetsbaarheid, Welbevinden en meer … .
Bent u beleidsmedewerker, directeur of onderzoeker – gaat handelen o.b.v. kennis u aan het hart – zet dan de datum in uw agenda en meldt u aan!
Inschrijving is geopend, zie aanmeldlink.
Organisatie:
dr. ir. Beitske Boonstra, Kenniswerkplaats Leefbare wijken
dr. Mariëlle Beenackers, Academische werkplaats Cephir
Marjolein Kooistra, Academische Zaken EUR | ESSB (e-mail voor meer informatie)
drs. Marco Bik, Kenniscoördinator gemeente Rotterdam
Organised cervical cancer screening has been offered in the Netherlands for more than thirty years. A major reorganisation of the Dutch cervical cancer screening programme took place in 2017. The primary screening test changed from cervical cytology to high-risk human papillomavirus (hrHPV) testing. Other policy and organisational changes were implemented alongside with change in the test. Monitoring and evaluation are essential for assessing the impact of these changes on the quality of the programme. Therefore, this thesis aimed to evaluate the Dutch cervical cancer screening programme as a whole, as well as each stage of the screening process – attendance, test and referral and clinical care –with a particular focus on the transition from cytology-based screening to hrHPV-based screening.
This research is part of the CENTER-TBI study. Data were being collected for 2000 patients at the intensive care unit (ICU) in 21 European countries. The focus of my study was on patients with traumatic brain injury (TBI) at the ICU with the following aims:
– To describe variation in care between European ICU’s .
– To develop performance indicators to evaluate TBI care.
– To identify effective clinical care for TBI using comparative effectiveness research (CER).
In our research we found:
– Substantial variation in treatment of patients with TBI at the ICU between European centers.
– We developed quality indicators to assess current quality of care and we validated these with patient data of the CENTER-TBI study.
– We identified centers that use high intensity treatments, while low intensity treatments might be more effective. Also, we found that the use of deep venous thrombosis prophylaxis might contribute to improved 6-month outcome.
Livestream: https://media.eur.nl/Mediasite/Play/74f21a7b7c0c493583971b208a24676f1d
In de laatste decennia is een verschuiving zichtbaar van gezondheidszorg gebaseerd op het biomedische model naar het biopsychosociale model, waarbij er meer nadruk wordt gelegd op de individuele keuze en autonomie van de patiënt en waarin gedeelde besluitvorming een belangrijke rol speelt. De patiënt heeft een grotere rol en verantwoordelijkheid, terwijl tegelijkertijd de gezondheidszorg versnippert en steeds meer gespecialiseerd en complex raakt. Het is niet bekend in hoeverre de patiënt deze actieve rol wil en kan vervullen, met name wanneer de ziekte in een gevorderd stadium is. Zelfmanagement krijgt steeds meer aandacht in onderzoek en de klinische praktijk, maar is nog weinig onderzocht bij patiënten met gevorderde ziekten. Daarnaast is advance care planning, het reflecteren op, communiceren van en rapporteren over wensen en voorkeuren voor toekomstige behandeling en zorg, nog weinig onderzocht bij patiënten met andere gevorderde ziekten dan kanker. Het doel van dit proefschrift was om inzicht te krijgen in zelfmanagement en ACP van patiënten met een gevorderde ziekte. Zelfmanagement werd onderzocht in een populatie van patiënten met gevorderde kanker en ACP werd onderzocht in een populatie van patiënten met een implanteerbare cardioverter defibrillator.
This thesis aimed to contribute to promoting physical, mental, and social well-being of adolescents and young adults. In the first part of this thesis, there is a focus on evaluation and analysis of health and quality of life, of self-sufficient daily functioning and of the recreational use of nitrous oxide (i.e. laughing gas) as a risk behavior. In the second part of this thesis, there is a focus on evaluation and analysis of health promotion in the form of intervention evaluation and analysis of help-seeking behavior.
Mammography screening can result in early detection and possibly earlier treatment and better prognosis of breast cancer. In the Netherlands, women aged 50-74 are invited biennially to digital mammography screening. The aim of this thesis was to quantify the effects of current screening in the Netherlands and to determine the effects and cost-effectiveness of alternative screening strategies, using micro-simulation modelling.
With respect to current screening, we found that digital mammography leads to the detection of more breast cancers than film-screen mammography, but also to more referrals and false-positives. The number of cancers detected during the screening interval is unaffected, compared to film-screen mammography. Further, we found that the breast cancer mortality rate in the Netherlands decreased by 30% since the introduction of screening until 2010, in women aged 55-74 years. Mammography screening and (improvements in) adjuvant therapy contributed to this decrease.
Using microsimulation, we showed that earlier screening, starting between 40-50 years, is cost-effective and increases the screening benefit, especially in women with a high relative risk of breast cancer, but at the same time results in more false-positives. In addition, we found that triennial screening in women with a low relative risk results in a better balance of benefits and harms than biennial screening. Finally, we found that the rather new technique digital breast tomosynthesis, which creates a pseudo 3D breast image, has a lower chance of being cost-effective than digital mammography. However, at a slightly higher cost-effectiveness threshold than currently used, tomosynthesis becomes more cost-effective than digital mammography.
The main aim of this thesis was to study social inequalities in children’s lifestyle behaviors and child overweight, asthma, and health-related quality of life (HRQoL). The studies conducted in this thesis were embedded in the Generation R Study. The following conclusions can be drawn from the studies presented in this thesis. Social inequalities in the clustering of children’s lifestyle behaviors (screen time, physical activity, calorie-rich snack, and sugar-sweetened beverages) are present among school-aged children. From preschool to school-age the trajectories of children’s television time may vary according to indicators of social status. Findings also indicate that social inequalities in childhood asthma and indicators of lung function are present among school-aged children. Experiencing family poverty, either as an intermittent episode or as a chronic situation, is associated with childhood overweight, asthma, and HRQoL. When parents obtain a higher level of education after their child is born, this might be beneficial to attenuate the risk of the child developing overweight at school age. A joint effort between parents, schools, community, public health professionals, and policymakers is needed to reduce these inequalities.