Death rattle is a symptom of the dying phase. The sound is caused by the presence of mucus in the upper respiratory tract. The burden of death rattle for the patient is unknown, but the sound is disturbing for relatives and health care professionals.
Most of the studies described in this thesis were part of the research project ‘Death rattle in the dying phase: is prophylactic treatment useful?’, funded by the Netherlands Organisation for Health Research and Development (ZonMw). In this project we tried to understand the underlying causes of the various experiences of death rattle of bereaved relatives, studied the effect of prophylactically administered scopolamine butylbromide (medication that diminishes mucus) on the occurrence of death rattle, and assessed how a randomized, double-blind placebo-controlled trial in the dying phase can be feasible.
We found that death rattle can be a stressful symptom for relatives that is influenced by more factors than the intensity of the sound alone. Adequate information and communication cannot always relieve the burden for relatives. We showed that prophylactic subcutaneous scopolamine butylbromide significantly reduced the occurrence of death rattle in a hospice population. We found that the robust design and strategies to facilitate patient recruitment have resulted in a successful study with sufficient participants. According to relatives, patients’ participation in a double-blind placebo-controlled medication trial at the end of life need not be burdensome and does not interfere with the dying process.
The results are at this moment implemented in the guideline “Care in the dying phase”.
Geographical related health inequalities and inequities are of huge societal concern, especially when it comes to perinatal health and child welfare. Preventive Child Healthcare (PCHC) in the Netherlands has a unique opportunity to address vulnerable families. In this thesis the aim was to design, implement and study the effectiveness of a postnatal risk assessment in PCHC, as well as to study handover from obstetric care to PCHC and finally, to reduce child growth and developmental problems, particularly in families with a low socio-economic status.
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.