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.
Colorectal cancer is one of the leading causes of cancer death, and is an increasing public health concern for many countries worldwide. Screening can prevent colorectal cancer death through removal of premalignant lesions or through early detection of colorectal cancer. The aim of this thesis was to estimate population-level effects of colorectal cancer screening policy changes or interventions. Our analyses focused on three different policy domains. First, we attempted to optimize colorectal cancer screening guidelines in light of contemporary trends in colorectal cancer screening incidence in the United States. We demonstrated that screening initiation at age 45 years rather than age 50 years has a favorable balance between screening benefits, burden and costs. Second, we evaluated the cost-effectiveness of interventions that potentially increase screening participation. Waiving all out-of-pocket costs for colorectal cancer screening, mailing a stool-based test to individuals eligible for screening, and offering an alternative blood-based test for individuals that otherwise do not want to participate in screening are cost-effective interventions. Third, we focused on improving the detection and clinical management of Lynch syndrome patients. Our analyses suggest that testing colorectal cancer cases for Lynch syndrome, and subsequently testing first-degree relatives of those found to have Lynch syndrome, provides a good balance between costs and long-term benefits.
Op vrijdag 23 oktober om 16.00 uur zal Professor Mackenbach zijn afscheidscollege houden in de Aula van de Erasmus Universiteit in Rotterdam.
Vanwege de COVID-19 epidemie is in de grote Aula van de EUR slechts een beperkt aantal plaatsen beschikbaar. Het afscheidscollege zal daarom ook via een livestream worden uitgezonden. Voor beide is aanmelding noodzakelijk. Na aanmelding hoort u in de week van 12 oktober of u in de Aula aanwezig kunt zijn, resp. hoe u het afscheidscollege op afstand kunt volgen.
n.b. Inschrijving is gesloten. Neem bij vragen contact op met: secretariaat.mgz@erasmusmc.nl
On Friday, October 23, 4:00 PM, Professor Mackenbach will give his farewell lecture in the Aula of Erasmus University Rotterdam. The lecture will be in Dutch, but English subtitles will be provided. You can attend the lecture either in person or via the livestream. Registration is required.
n.b. Registration is closed. For questions, please contact: secretariaat.mgz@erasmusmc.nl
Trauma, defined as a physical injury, is a global public health problem and is a leading cause of death among young adults. In countries with advanced health care mortality rates after trauma decreased the past decades. The focus on trauma outcome has been, next to fatal outcome, complemented with non-fatal consequences, such as physical, psychological and social functioning after trauma. The main aim of this thesis was to evaluate, develop and validate fatal and non-fatal outcome prediction models in the trauma population. A new survival prediction model was developed and validated, which enables the inclusion of elderly patients with an isolated hip fracture in the evaluation of quality of trauma care. This project developed a model to predict health status after trauma for the evaluation of quality of trauma care. Baseline conditions (before injury) are essential to consider in predicting non-fatal outcome.
In this thesis, we studied health promotion with regard to people with frailty and chronic conditions in order to provide insights and directions in developing health promotion to support healthy ageing of older people. We suggest future research on the development and effects of interventions to target people at an earlier age to prevent frailty in later life and to promote healthy ageing. On-going support may be important for the prevention and better management of frailty and chronic conditions. We recommend to develop strategies to enable the sustainability of newly developed (effective) approaches.
https://www.publicatie-online.nl/publicaties/xuxi-zhang
Both PDF and E-pub are available on this link; the password is 20200924
You can watch the defence online: https://media.eur.nl/Mediasite/Play/404de4964b3d4eae8c6394894bc75c421d