Short description
Erasmus MC set its strategic goals for a newly built hospital in 2000. It wanted to create an innovative care environment to cater for its tertiary care patients, often requiring multidisciplinary care, that would combine ‘high tech’ with ‘high touch’. For the built environment itself the ambition was to create a safe, pleasant, and sustainable spaces. Between ambitions and realisation, many stakeholders influence design and decision-making processes. This study reconstructs the engagement of stakeholders in the transformative change process for Erasmus MC’s newly built hospital, and it tries to understand the trade-offs based on stakeholder voices during this process as experienced by end-users, e.g. after the building has been taken into use in 2013 and 2018. Design quality as experiences by end-users is influenced by the balance between bricks, bytes, and behaviour, or by the fit of the human-building-technology interactions. And, collecting lessons learned through evaluation research helps shape better (hospital) buildings.
Gastric cancer is highly fatal, but can be prevented. The challenge is to find the strategies that work best, for whom and at what cost. This thesis investigates which prevention strategies save most lives, while balancing inherent harms related to screening.
The research focuses on two main approaches: screen-and-treat of Helicobacter pylori, the bacterium causing most gastric cancers, and endoscopic screening to catch cancer early. By combining data analysis, ethical reflections and microsimulation modelling, the work evaluates the benefits, harms and trade-offs of these strategies across populations in Europe, Asia and the United States.
A highlight of this thesis is the development of MISCAN-gastric, a new disease model in the MISCAN family, that is readily available for health policy analysis. The research also explores broader challenges, including antibiotic resistance, surveillance of precancerous lesions and the ethics of screening people based on race or ethnicity.
Most lung cancer cases are detected only after the disease has spread to other organs. At this advanced stage, survival remains low—28% after one year—even with new treatments. Earlier detection through CT screening has been shown in large trials to find cancers sooner and reduce lung‑cancer mortality by 24%. However, it was still unclear how these trial results would translate into population‑level costs and health benefits.
The thesis uses microsimulation modelling to project real‑world outcomes at the national level. It estimates the costs of a large‑scale screening program and the number of life‑years that could be gained. The study addresses key questions raised by the Health Council in 2025, such as which risk metrics should determine eligibility,, the optimal screening ages, and whether annual or biennial screening is most effective.
For the Netherlands, screening high‑risk individuals aged 55–75 could prevent around 1,000 deaths per year—about 10% of current lung‑cancer mortality—at an estimated €12,000 per life‑year gained, within acceptable national cost‑effectiveness thresholds. Personalized risk scores could further improve efficiency by adjusting the age of first screening based on individual risk levels. Moreover, the thesis shows that the onset of expensive treatments for late-stage lung cancer have made early detection increasingly cost-efficient.
Short discription of the thesis
The studies underlying this dissertation explores the ethical and psychosocial issues involved in the development and implementation of the bio-artificial pancreas (BAP) for people with type 1 diabetes. The BAP aims to stabilize blood glucose levels and eliminate the need for insulin administration trough transplantation without toxic immunosuppressive medication. However, initiating early-phase clinical trials raises ethical concerns due to the invasive and risky nature of the procedure, uncertain benefits, and existing alternative treatment options. This dissertation addresses four central questions: (1) which ethical considerations are essential for conducting responsible research, (2) which are relevant for responsible implementation, (3) what is the social value of the BAP compared with current therapies for people with type 1 diabetes, and (4) how do diabetes stakeholders evaluate this therapy? The studies combine systematic reviews, ethical analyses, and qualitative research. Interviews with patients and professionals reveal hopes for greater flexibility, and privacy in daily life, alongside concerns about safety, functionality, and equity. The findings provide a foundation for responsible clinical translation and implementation of the BAP.
Short description thesis:
Since the emergence of gene therapy research in the 1990s, people with hemophilia and their healthcare providers have hoped that this innovation might one day provide a cure. However, gene therapy also raises ethical questions. Therefore, this thesis scrutinizes the meaning of ‘cure’ and investigates how gene therapy for hemophilia can be further developed and implemented in an ethically responsible manner, responsive to the needs of stakeholders.
The analysis demonstrates that “cure” can refer to normalization of the body, obtaining a normal life, or change in narrative identity. Given these variations, the term should be used cautiously and context-specifically to prevent misunderstanding and unrealistic expectations.
I end with three concrete recommendations for the further development of gene therapy and hemophilia care in general: to reflect on the goals of gene therapy, to have attention for the ethics of communicating about gene therapy and to design care for hemophilia in a way that can enhance the independence of people living with hemophilia.
Short description of thesis:
Post-acute infection syndromes, such as post COVID-19 condition (PCC) and Q-fever fatigue syndrome (QFS), present a major public health challenge due to the large impact on both affected individuals and on society. Patients experience a wide range of symptoms and varying degrees of functional limitations, which hinder their daily life and societal participation. The heterogenous presentation in terms of symptoms, functioning and longitudinal trajectory presents notable challenges for both patients suffering from these conditions and for professionals tasked with the care for these patients. To gain more insight into these conditions, this thesis aimed to evaluate outcomes in patients with post-acute infection syndromes, to explore determinants associated with these outcomes, to examine heterogeneity in outcomes in this patient population, and to identify opportunities for improving healthcare for these patients.
Short description of thesis:
This thesis investigates the potential effectiveness of pancreatic cancer surveillance. In the first part, we used our microsimulation model to evaluate the impact of several uncertainties (e.g. pancreatic cancer risk, natural disease course) on surveillance effectiveness. We adjusted our microsimulation model to gain insight into the natural disease course of pancreatic cancer and found a 4 year window of opportunity for HGD detection. In the second part, we evaluated the maximum effect of pancreatic cyst surveillance and found a number needed to surveil so high that cyst surveillance seems inefficient with currently used expensive and burdensome tests. In the third part, dedicated to individuals with a hereditary increased pancreatic cancer risk, we performed a clinical surveillance study of high risk individuals. Finally, we used our microsimulation model to evaluate long-term effectiveness of pancreatic cancer surveillance in CDKN2A mutation carriers.
This doctoral thesis by Parinita Bhattacharjee examines the risks and vulnerabilities of young women who sell sex in Kenya and highlights the urgent need for their inclusion in HIV prevention programmes. Globally, key populations, particularly female sex workers, experience a disproportionate burden of HIV. While HIV programmes have achieved notable success in scaling up interventions for female sex workers through strategies such as peer education and micro-planning, young women who sell sex remain largely invisible within the HIV response.
Young women who sell sex face heightened risks of HIV acquisition due to multiple factors, including higher client volumes, economic dependence on sex work, and frequent mobility across locations. In addition, they also experience structural vulnerabilities such as violence, stigma, and discrimination. Despite these risks and vulnerabilities, young women who sell sex consistently report lower access to and utilisation of HIV prevention and treatment services compared to older FSWs, underscoring a significant gap in current programming.
The thesis argues that tailored interventions for young women who sell sex are both feasible and effective. It calls for location-specific research and the scale-up of comprehensive, peer-led, and participatory programmes to address their unique needs and ensure meaningful inclusion in HIV responses.
Description of thesis:
Colorectal cancer has a significant impact on global health. In 2022, colorectal cancer accounted for nearly two million new cases and one million deaths, ranking it the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality worldwide.
The identifiability, treatability and slow progression of precursor lesions, along with the favorable prognosis of early-stage cancers, make colorectal cancer particularly suitable for screening. As a result, colorectal cancer screening programs have been implemented in many countries across the globe. Screening reduces colorectal cancer incidence and colorectal cancer-related mortality through the detection and removal of precursor lesions and the early detection of cancers.
To maintain their effectiveness, colorectal cancer screening programs should be continuously evaluated and opportunities for improvement should be investigated. The aim of this thesis is twofold: (1) to evaluate equity and quality within the Dutch colorectal cancer screening program, and (2) to explore opportunities for optimization of colorectal cancer screening, focusing on resource constraints, cost-effectiveness and risk-stratification.