Now showing items 21-40 of 1404

    • Assessment of impact of traffic-related air pollution on morbidity and mortality in Copenhagen Municipality and the health gain of reduced exposure.

      Brønnum-Hansen, Henrik; Bender, Anne Mette; Andersen, Zorana Jovanovic; Sørensen, Jan; Bønløkke, Jakob Hjort; Boshuizen, Hendriek; Becker, Thomas; Diderichsen, Finn; Loft, Steffen (2018-12-01)
      Health impact assessment (HIA) of exposure to air pollution is commonly based on city level (fine) particle concentration and may underestimate health consequences of changing local traffic. Exposure to traffic-related air pollution can be assessed at a high resolution by modelling levels of nitrogen dioxide (NO We utilized residential NO The annual mean NO Reducing the NO
    • Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America, Western Europe, and Australia, 2000-2014.

      Chapin-Bardales, Johanna; Schmidt, Axel J; Guy, Rebecca J; Kaldor, John M; McGregor, Skye; Sasse, André; Archibald, Chris; Rank, Claudia; Casabona Barbarà, Jordi; Folch, Cinta; Vives, Núria; Cowan, Susan A; Cazein, Françoise; Velter, Annie; An der Heiden, Matthias; Gunsenheimer-Bartmeyer, Barbara; Marcus, Ulrich; Op de Coul, Eline L M; van Sighem, Ard; Aldir, Isabel; Cortes Martins, Helena; Berglund, Torsten; Velicko, Inga; Gebhardt, Martin; Delpech, Valerie; Hughes, Gwenda; Nardone, Anthony; Hall, H Irene; Johnson, Anna S; Sullivan, Patrick S (2018-12-01)
      The aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia. Data on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively. Six countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM. Since 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.
    • The impact of social capital, land use, air pollution and noise on individual morbidity in Dutch neighbourhoods.

      Zock, Jan-Paul; Verheij, Robert; Helbich, Marco; Volker, Beate; Spreeuwenberg, Peter; Strak, Maciek; Janssen, Nicole A H; Dijst, Martin; Groenewegen, Peter (2018-12)
      Both social and physical neighbourhood factors may affect residents' health, but few studies have considered the combination of several exposures in relation to individual health status.
    • Persistence of immune response following bivalent HPV vaccination: A follow-up study among girls routinely vaccinated with a two-dose schedule.

      Schurink-van 't Klooster, Tessa M; Donken, Robine; Schepp, Rutger M; van der Klis, Fiona R M; de Melker, Hester E (2018-11-26)
      In this cohort study, we examined antibody levels and avidity after a two-dose schedule (0, 6 months) of the bivalent HPV-vaccine in girls routinely vaccinated in the Dutch HPV-vaccination program, up to 2 years following vaccination. A blood sample at 7, 12 and 24 months after the first dose and questionnaire data were collected (n = 56). HPV type-specific antibody concentrations (lU/ml) against seven types (HPV16/18/31/33/45/52/58) were assessed using a validated virus-like particles (VLP) multiplex immunoassay. Avidity was tested using a modification of this assay. Seropositivity for vaccine types HPV 16 and 18 was 100% up to month 24, but declined for HPV-types 31/33/45/52/58, although not statistically significant for HPV45. All Geometric Mean Concentrations (GMCs) declined by months 12 and 24, but remained high for HPV16/18. Between month 7 and 12, GMCs declined more for other types. High avidity antibodies were induced up to 24 months for vaccine types (75%, 76-78% and 81-82% at months 7, 12 and 24, respectively), but for other types antibody avidity was 16-29% at month 7, 20-32% at month 12 and 19-32% at month 24. GMCs declined over time for HPV-types 16/18/31/33/45/52/58, but remained high for vaccine-types HPV16/18 up to 24 months of follow-up. Antibody avidity was >75% for vaccine types but <35% for other HPV-types. Further follow-up of this cohort will provide insight into antibody and avidity kinetics over time.
    • Towards improved process efficiency in vaccine innovation: The Vaccine Innovation Cycle as a validated, conceptual stage-gate model.

      Van de Burgwal, L H M; Ribeiro, C Dos S; Van der Waal, M B; Claassen, E (2018-11-26)
      Continuing investments in vaccine innovation are insufficiently translated into market entries of novel vaccines. This innovation paradox is in part caused by stakeholders lacking complete understanding of the complex array of steps necessary for vaccine development and collaboration difficulties between the wide variety of stakeholders involved. Models providing cross-domain understanding can improve collaboration but currently lack both comprehensibility and granularity to enable a prioritized view of activities and criteria. Key opinion leaders (KOLs) were asked to contribute to the definition of a vaccine innovation cycle (VIC). In a first step, 18 KOLs were interviewed on the stages (activities and results) and gates (evaluation criteria and outcomes) of vaccine innovation. This first description of the VIC was subsequently validated and refined through a survey among 46 additional KOLs. The VIC identifies 29 distinct stages and 28 corresponding gates, distributed in ten different but integrated workstreams, and comprehensibly depicted in a circular innovation model. Some stage-gates occur at defined moments, whereas the occurrence and timing of other stage-gates is contingent on a variety of contextual factors. Yet other stage-gates continuously monitor internal and external developments. A gap-overlap analysis of stage-gate criteria demonstrated that 5 out of 11 criteria employed by vaccine developers correspond with criteria employed by competent (regulatory) authorities. The VIC provides a comprehensive overview of stage-gates throughout the value chain of vaccine innovation. Its cyclical nature highlights the importance of synchronizing with unmet needs and market changes, and conceptualizes the difference between incremental and radical vaccine innovation. Knowledge on the gap between internal and external criteria will enhance the viability of newcomers to the field. The VIC can be used by stakeholders to improve understanding and communication in forming collaborative alliances and consortia. Such a boundary-spanning function may contribute to the reduction of process inefficiencies, especially in public-private partnerships.
    • Chikungunya virus outbreak in Sint Maarten: Long-term arthralgia after a 15-month period.

      Peters, C M M; Pijnacker, R; Fanoy, E B; Bouwman, L J T; de Langen, L E; van den Kerkhof, J H T C; Reimerink, J; Pilot, E; Henry, M; Oostburg, V Asin; Braks, M A H (2018-11-19)
      The first chikungunya (CHIK) epidemic in the Americas was reported in December 2013. Chikungunya virus (CHIKV) causes an acute febrile illness and is transmitted to humans by Aedes mosquitoes. Although earlier studies have described long-term clinical manifestations of CHIK patients infected with the East/Central/South African (ECSA) genotype, little is known about persistent manifestations in the Caribbean region, for which the Asian genotype is responsible. The objective of this study was to describe the presence of persisting clinical manifestations, specifically arthralgia, in CHIKV-infected patients on the Caribbean Island, Sint Maarten, 15 months after onset of the disease.
    • Use of quantum-chemical descriptors to analyse reaction rate constants between organic chemicals and superoxide/hydroperoxyl (O2•-/HO2•).

      Nolte, Tom M; Peijnenburg, Willie J G M (2018-11-13)
      The reaction between superoxide (O2•-) and organic chemicals is of interest in many scientific disciplines including biology and synthetic chemistry, as well as for the evaluation of chemical fate in the environment. Due to limited data and lack of congeneric modelling, the involvement of superoxide in many complex processes cannot be adequately evaluated. In this study, we developed new quantitative structure-property relationship (QSPR) models for the prediction of the aqueous-phase rate constant for the reaction between superoxide and a wide variety of organic chemicals reacting via one-electron oxidation, reduction and hydrogen-transfer. It is shown that the relative importance of these pathways is related to frontier molecular orbital (FMO) interaction and to pH. The class-specific QSPRs developed have good statistics (0.84 ≤ R2 ≤ 0.92). For non-congeneric chemicals it is demonstrated that the reactivity toward superoxide can be described by applying explicit descriptions for competition kinetics and speciation. Therefore, the relationships developed in this study are useful as a starting point to evaluate more complex molecules having, for example, multiple reactive functional groups, labile H bonds, or delocalised cationic charges. However, additional kinetic data and more rigorous computation are needed to evaluate such molecules.
    • Assessment of herd effects among women and heterosexual men after girls-only HPV16/18 vaccination in the Netherlands: A repeated cross-sectional study.

      Woestenberg, Petra J; Bogaards, Johannes A; King, Audrey J; Leussink, Suzan; van der Sande, Marianne Ab; Hoebe, Christian Jpa; van Benthem, Birgit Hb (2018-11-13)
      Data on the impact of human papillomavirus (HPV) vaccination on the population HPV prevalence are largely obtained from women. We assessed the impact of the girls-only HPV16/18 vaccination program in the Netherlands that started in 2009, on trends in HPV prevalence among women and heterosexual men, using data from the PASSYON study. In this cross-sectional study, the HPV prevalence among 16- to 24-year-old visitors to sexually transmitted infection clinics was assessed in 2009, 2011, 2013, and 2015. We compared the genital postvaccination HPV prevalence with the prevaccination prevalence (2009) using Poisson GEE models. In total, we included 4,996 women and 1,901 heterosexual men. The percentage of women who reported to be vaccinated increased from 2.3% in 2009 to 37% in 2015. Among all women, the HPV16/18 prevalence decreased from 23% prevaccination to 15% in 2015 (adjusted prevalence ratio [aPR] 0.62, p
    • Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis.

      Rozhnova, Ganna; Heijne, Janneke; Bezemer, Daniela; van Sighem, Ard; Presanis, Anne; De Angelis, Daniela; Kretzschmar, Mirjam (2018-11-13)
      Preexposure prophylaxis (PrEP) is a promising intervention to help end the HIV epidemic among men who have sex with men (MSM) in the Netherlands. We aimed to assess the impact of PrEP on HIV prevalence in this population and to determine the levels of PrEP coverage necessary for HIV elimination. We developed a mathematical model of HIV transmission in a population stratified by sexual risk behavior with universal antiretroviral treatment (ART) and daily PrEP use depending on an individual's risk behavior. We computed the effective reproduction number, HIV prevalence, ART and PrEP coverage for increasing ART and PrEP uptake levels, and examined how these were affected by PrEP effectiveness and duration of PrEP use. At current levels of ART coverage of 80%, PrEP effectiveness of 86% and PrEP duration of 5 years, HIV elimination required 82% PrEP coverage in the highest risk group (12 000 MSM with more than 18 partners per year). If ART coverage increased by 9%, the elimination threshold was at 70% PrEP coverage. For shorter PrEP duration and lower effectiveness elimination prospects were less favorable. For the same number of PrEP users distributed among two groups with highest risk behavior, prevalence dropped from the current 8 to 4.6%. PrEP for HIV prevention among MSM could, in principle, eliminate HIV from this population in the Netherlands. The highest impact of PrEP on prevalence was predicted when ART and PrEP coverage increased simultaneously and PrEP was used by the highest risk individuals.
    • Predicting Mortality in Nursing Home Residents with Dementia and Pneumonia Treated with Antibiotics: Validation of a Prediction Model in a More Recent Population.

      Rauh, Simone P; Heymans, Martijn W; van der Maaden, Tessa; Mehr, David R; Kruse, Robin L; de Vet, Henrica C W; van der Steen, Jenny T (2018-11-12)
      We aimed to find the best predictive model for 14-day mortality in antibiotic-treated nursing home residents with dementia and pneumonia by first applying an existing model to the recent PneuMonitor study. Second, we evaluated whether model performance improved by revising variables or adding variables related to recent changes in the care for older people. The original prognostic model included gender, respiratory rate, respiratory difficulty, pulse rate, decreased alertness, fluid intake, eating dependency and pressure sores. This model was applied to 380 recent pneumonia episodes in nursing home residents with dementia, updated by considering revising and/or adding variables, internally validated using bootstrapping, and transformed into a simplified risk score that can be used in clinical practice. Model performance was evaluated by Hosmer-Lemeshow statistics (HL) and calibration graphs to assess calibration; and area under the receiver operating characteristic curve (AUC) to assess discrimination. The newer cohort had lower 14-day mortality and was less often dehydrated or malnourished. Median AUC of the original model over the imputed datasets was 0.76 (IQR: 0.76-0.77), compared to 0.80 in the old cohort. Extending the model with dehydration, bowel incontinence, increase in eating dependency and cardiovascular history, while removing pressure sores, improved AUC: 0.80 (IQR: 0.80-0.81) after internal validation. Calibration remained adequate (HL: p=0.67). In the newer cohort with less severe illness, model performance of the existing model was adequate, but a new extended model distinguished better between residents at low and high mortality risk.
    • Association of plasma vitamin D metabolites with incident type 2 diabetes: EPIC-InterAct case-cohort study.

      Zheng, Ju-Sheng; Imamura, Fumiaki; Sharp, Stephen J; van der Schouw, Yvonne T; Sluijs, Ivonne; Gundersen, Thomas E; Ardanaz, Eva; Boeing, Heiner; Bonet, Catalina; Gómez, Jesus Humberto; Dow, Courtney; Fagherazzi, Guy; Franks, Paul W; Jenab, Mazda; Kühn, Tilman; Kaaks, Rudolf; Key, Timothy J; Khaw, Kay-Tee; Lasheras, Cristina; Mokoroa, Olatz; Mancini, Francesca Romana; Nilsson, Peter M; Overvad, Kim; Panico, Salvatore; Palli, Domenico; Rolandsson, Olov; Sieri, Sabina; Salamanca-Fernández, Elena; Sacerdote, Carlotta; Spijkerman, Annemieke Mw; Stepien, Magdalena; Tjonneland, Anne; Tumino, Rosario; Butterworth, Adam S; Riboli, Elio; Danesh, John; Langenberg, Claudia; Forouhi, Nita G; Wareham, Nicholas J (2018-11-09)
      Existing evidence for the prospective association of vitamin D status with type 2 diabetes (T2D) is focused almost exclusively on circulating total 25-hydroxyvitamin D [25(OH)D] without distinction between its subtypes: non-epimeric and epimeric 25(OH)D3 stereoisomers; and 25(OH)D2, the minor component of 25(OH)D. We aimed to investigate the prospective associations of circulating levels of the sum and each of these three metabolites with incident T2D. This analysis in the EPIC-InterAct case-cohort study for T2D included 9671 incident T2D cases and 13562 subcohort members. Plasma vitamin D metabolites were quantified by liquid-chromatography mass-spectrometry. We used multivariable Prentice-weighted Cox regression to estimate hazard ratios (HRs) of T2D for each metabolite. Analyses were performed separately within country, and estimates combined across countries using random-effects meta-analysis. The mean concentrations (standard deviation) of total 25(OH)D, non-epimeric 25(OH)D3, epimeric 25(OH)D3 and 25(OH)D2 were 41.1 (17.2), 40.7 (17.3), 2.13 (1.31), and 8.16 (6.52) nmol/L, respectively. Plasma total 25(OH)D and non-epimeric 25(OH)D3 were inversely associated with incident T2D [multivariable-adjusted HR per 1-SD=0.81 (95%CI: 0.77, 0.86) for both variables], while epimeric 25(OH)D3 was positively associated: per 1-SD HR=1.16 (1.09, 1.25). There was no statistically significant association with T2D for 25(OH)D2 [per 1-SD HR=0.94 (0.76, 1.18)]. Plasma non-epimeric 25(OH)D3 was inversely associated with incident T2D, consistent with it being the major metabolite contributing to total 25(OH)D. The positive association of the epimeric form of 25(OH)D3 with incident T2D provides novel information to assess the biological relevance of vitamin D epimerization and vitamin D subtypes in diabetes etiology.
    • Childhood infections and common carotid intima media thickness in adolescence.

      Prins-van Ginkel, A C; Bruijning-Verhagen, P C J; Wijga, A H; Bots, M L; Gehring, U; van der Hoek, W; Koppelman, G H; van Rossem, L; Uiterwaal, C S P M; Smit, H A; van der Sande, M A B (2018-11-08)
      Atherosclerotic changes can be measured as changes in common carotid intima media thickness (CIMT). It is hypothesised that repeated infection-associated inflammatory responses in childhood contribute to the atherosclerotic process. We set out to determine whether the frequency of infectious diseases in childhood is associated with CIMT in adolescence. The study is part of the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) population-based birth cohort. At age 16 years, common CIMT was measured. We collected general practitioner (GP) diagnosed infections and prescribed antibiotics. Parent-reported infections were retrieved from annual questionnaires. Linear regression analysis assessed the association between number of infections during the first 4 years of life and common CIMT. Common CIMT measurement, GP and questionnaire data were available for 221 participants. No association was observed between the infection measures and CIMT. In a subgroup analysis, significant positive associations with CIMT were observed in participants with low parental education for 2-3 or ⩾7 GP diagnosed infections (+26.4 µm, 95% CI 0.4-52.4 and +26.8 µm, 95% CI 3.6-49.9, respectively) and ⩾3 antibiotic prescriptions (+35.5 µm, 95%CI 15.8-55.3). Overall, early childhood infections were not associated with common CIMT in adolescence. However, a higher number of childhood infections might contribute to the inflammatory process of atherosclerosis in subgroups with low education, this needs to be confirmed in future studies.
    • Association of serum markers of oxidative stress with myocardial infarction and stroke: pooled results from four large European cohort studies.

      Xuan, Yang; Bobak, Martin; Anusruti, Ankita; Jansen, Eugène H J M; Pająk, Andrzej; Tamosiunas, Abdonas; Saum, Kai-Uwe; Holleczek, Bernd; Gao, Xin; Brenner, Hermann; Schöttker, Ben (2018-11-07)
      Oxidative stress contributes to endothelial dysfunction and is involved in the pathogenesis of myocardial infarction (MI) and stroke. However, associations of biomarkers of oxidative stress with MI and stroke have not yet been addressed in large cohort studies. A nested case-control design was applied in four population-based cohort studies from Germany, Czech Republic, Poland and Lithuania. Derivatives of reactive oxygen metabolites (d-ROMs) levels, as a proxy for the reactive oxygen species burden, and total thiol levels (TTL), as a proxy for the reductive capacity, were measured in baseline serum samples of 476 incident MI cases and 454 incident stroke cases as well as five controls per case individually matched by study center, age and sex. Statistical analyses were conducted with multi-variable adjusted conditional logistic regression models. d-ROMs levels were associated with both MI (odds ratio (OR), 1.21 [95% confidence interval (CI) 1.05-1.40] for 100 Carr units increase) and stroke (OR, 1.17 [95% CI 1.01-1.35] for 100 Carr units increase). TTL were only associated with stroke incidence (OR, 0.79 [95% CI 0.63-0.99] for quartiles 2-4 vs. quartile 1). The observed relationships were stronger with fatal than with non-fatal endpoints; association of TTL with fatal MI was statistically significant (OR, 0.69 [95% CI 0.51-0.93] for 100 μmol/L-increase). This pooled analysis of four large population-based cohorts suggests an important contribution of an imbalanced redox system to the etiology of mainly fatal MI and stroke events.
    • Quantitative Assessment of the Health Risk for Livestock When Animal Viruses Are Applied in Human Oncolytic Therapy: A Case Study for Seneca Valley Virus.

      Schijven, Jack; Brizee, Sabrina; Teunis, Peter; de Vos, Clazien; Eblé, Phaedra; Rutjes, Saskia (2018-11-05)
      Some viruses cause tumor regression and can be used to treat cancer patients; these viruses are called oncolytic viruses. To assess whether oncolytic viruses from animal origin excreted by patients pose a health risk for livestock, a quantitative risk assessment (QRA) was performed to estimate the risk for the Dutch pig industry after environmental release of Seneca Valley virus (SVV). The QRA assumed SVV excretion in stool by one cancer patient on Day 1 in the Netherlands, discharge of SVV with treated wastewater into the river Meuse, downstream intake of river water for drinking water production, and consumption of this drinking water by pigs. Dose-response curves for SVV infection and clinical disease in pigs were constructed from experimental data. In the worst scenario (four log
    • Risk factors for sporadic cryptosporidiosis in the Netherlands: Analysis of a three-year population based case-control study coupled with genotyping, 2013-2016.

      Nic Lochlainn, Laura M; Sane, Jussi; Schimmer, Barbara; Mooij, Sofie; Roelfsema, Jeroen; Van Pelt, Wilfrid; Kortbeek, Titia (2018-11-03)
      In 2012, cryptosporidiosis cases increased in the Netherlands, but no single source was identified. In April 2013, we began a three year population based case-control study, coupled with genotyping, to identify risk factors for sporadic cryptosporidiosis. Cryptosporidium cases were laboratory confirmed (microscopy or PCR), followed by C. hominis and C. parvum species determination testing. We analysed data by study year, combined and by species. We performed single variable analysis and variables with a P-value ≤0.10 were included in a multivariable logistic regression model adjusting for age, sex and season. The study included 609 cases and 1,548 frequency-matched controls. C. parvum was the predominant species in the first two study years, shifting to C. hominis in the third year. Household person-to-person transmission and eating barbequed food were strongly associated with being a case. Eating tomatoes was negatively associated. By study year, person-to-person transmission was an independent risk factor. Analysis by species identified different risk factors for C. parvum and C. hominis cases. This was the first case-control study examining risk factors for sporadic cryptosporidiosis in the Netherlands. Providing information about Cryptosporidium exposure during outdoor activities and improvements in hygiene within households could prevent future sporadic infections.
    • Pro-inflammatory responses to PM 0.25 from airport and urban traffic emissions

      He, Rui-Wen; Shirmohammadi, Farimah; Gerlofs-Nijland, Miriam E.; Sioutas, Constantinos; Cassee, Flemming R. (2018-11)
    • Current EU research activities on combined exposure to multiple chemicals.

      Bopp, Stephanie K; Barouki, Robert; Brack, Werner; Dalla Costa, Silvia; Dorne, Jean-Lou C M; Drakvik, Paula E; Faust, Michael; Karjalainen, Tuomo K; Kephalopoulos, Stylianos; van Klaveren, Jacob; Kolossa-Gehring, Marike; Kortenkamp, Andreas; Lebret, Erik; Lettieri, Teresa; Nørager, Sofie; Rüegg, Joëlle; Tarazona, Jose V; Trier, Xenia; van de Water, Bob; van Gils, Jos; Bergman, Åke (2018-11)
      Humans and wildlife are exposed to an intractably large number of different combinations of chemicals via food, water, air, consumer products, and other media and sources. This raises concerns about their impact on public and environmental health. The risk assessment of chemicals for regulatory purposes mainly relies on the assessment of individual chemicals. If exposure to multiple chemicals is considered in a legislative framework, it is usually limited to chemicals falling within this framework and co-exposure to chemicals that are covered by a different regulatory framework is often neglected. Methodologies and guidance for assessing risks from combined exposure to multiple chemicals have been developed for different regulatory sectors, however, a harmonised, consistent approach for performing mixture risk assessments and management across different regulatory sectors is lacking. At the time of this publication, several EU research projects are running, funded by the current European Research and Innovation Programme Horizon 2020 or the Seventh Framework Programme. They aim at addressing knowledge gaps and developing methodologies to better assess chemical mixtures, by generating and making available internal and external exposure data, developing models for exposure assessment, developing tools for in silico and in vitro effect assessment to be applied in a tiered framework and for grouping of chemicals, as well as developing joint epidemiological-toxicological approaches for mixture risk assessment and for prioritising mixtures of concern. The projects EDC-MixRisk, EuroMix, EUToxRisk, HBM4EU and SOLUTIONS have started an exchange between the consortia, European Commission Services and EU Agencies, in order to identify where new methodologies have become available and where remaining gaps need to be further addressed. This paper maps how the different projects contribute to the data needs and assessment methodologies and identifies remaining challenges to be further addressed for the assessment of chemical mixtures.
    • Subjectively different but objectively the same? Three profiles of QoL in people with severe mental health problems.

      Buitenweg, David C; Bongers, Ilja L; van de Mheen, Dike; van Oers, Hans A M; van Nieuwenhuizen, Chijs (2018-11)
      Quality of life (QoL) is a broad outcome that is often used to assess the impact of treatment and care interventions in mental health services. QoL, however, is known to be influenced by individual values and preferences. To investigate this heterogeneity on the individual level, this study aimed to distinguish classes with distinct QoL profiles in a broad group of people with severe mental health problems and to identify the QoL domains that are most strongly related to the classes.
    • The regulatory challenge of chemicals in the environment: Toxicity testing, risk assessment, and decision-making models.

      McCarty, L S; Borgert, C J; Posthuma, L (2018-11)
      Environmental assessment for chemicals relies on models of fate, exposure, toxicity, risk, and impacts. Together, these models should provide scientific support for regulatory risk management decision-making, assuming that progress through the data-information-knowledge-wisdom (DIKW) hierarchy is both appropriate and sufficient. Improving existing regulatory processes necessitates continuing enhancement of interpretation and evaluation of key data for use in decision-making schemes, including ecotoxicity testing data, physical-chemical properties, and environmental fate processes. Yet, as environmental objectives also increase in scope and sophistication to encompass a safe chemical economy, testing, risk assessment, and decision-making are subject to additional complexity due to the ongoing interaction between science and policy models. Problems associated with existing design and implementation choices in science and policy have both limited needed development beyond chemo-centric environmental risk assessment modeling and constrained needed improvements in environmental decision-making. Without a thorough understanding of either the scientific foundations or the disparate evaluation processes for validation, quality, and relevance, this results in complex technical and philosophical problems that increase costs and decrease productivity. Both over- and under-management of chemicals are consequences of failure to validate key model assumptions, unjustified standardized views on data selection, and inordinate reification (i.e., abstract concepts are wrongly treated as facts).
    • Perceived usefulness of the International Classification of Functioning, Disability and Health (ICF) increases after a short training: A randomized controlled trial in master of advanced nursing practice students.

      Stallinga, Hillegonda A; Dijkstra, Pieter U; Napel, Huib Ten; Roodbol, Gabriël; Peters, Jeroen W B; Heerkens, Yvonne F; Roodbol, Petrie F (2018-11)
      The Master program of Advanced Nursing Practice (MANP) educates nurses to become a nurse practitioner. Nurse practitioners are health care professionals focusing on the intersection of cure and care. However, a clear model covering that area is lacking. The use of the International Classification of Functioning, Disability and Health (ICF) may be considered for incorporation in curricula due to its focus on the integration of cure and care. The purpose of this study is to test the effects of a short (= 4-h instructor-led) ICF training on perceived usefulness of the ICF. In a randomized controlled trial, 76 MANP students were randomly allocated to intervention or control group. Data were collected using an 'ICF survey and learning assessment tool'. Data of 56 students were included for analysis. Perceived usefulness of the ICF increased significantly in the intervention group immediately after training (p = 0.001) but no longer at 3-months follow-up (p = 0.388). Attitude and knowledge related to the ICF were significantly increased in the intervention group at both post-training assessments (p < 0.001 and 0.02). The positive influence of the ICF training on perceived usefulness of the ICF is relevant for including ICF in MANP curriculum.