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Promotions and symposium.

Cover Lea JabbarianWednesday June 12, 2019 - PhD Defense Lea Jasmina Jabbarian (Professor Andries Querido zaal – Erasmus MC, 13.30hr)

Title thesis:
Well-Being and Preferences of Patients Near the End of Life: Towards better care through better communication

Lea Jabbarian’s  thesis focused on patients’ well-being and preferences near the end of life. Receiving the diagnosis of a life-limiting disease is confronting for patients, with far-reaching consequences for their well-being. Patients deal with their situation in a highly individual way. Patients and healthcare professionals are generally open to engage in advance care planning discussions, but have doubts about how and when to start these conversations. High-quality care near the end of life preferably integrates the medical, social, psychological and spiritual dimension and should preeminently be patient-centered. Conversations about preferences near the end of life can possibly benefit from merging with standard medical care. Consequently, these conversations become a continuous process with the aim of getting to know the patient in all dimensions, rather than a one-time only event. A continuous process of conversations allows patients to form and reconsider their preferences and share them with their healthcare professionals and relatives. 

Cover CFranse thesisTuesday April 9, 2019 - PhD Defense Carmen Franse (Prof. Andries Queridozaal, 15.30hr)

Title thesis:
Healthy ageing in Europe - Variation and promotion among older persons

Europe has the highest proportion of persons over 65 years compared with any other continent. While some persons remain relatively healthy with aging, others become vulnerable to stressors and frail. It is therefore important to study which populations are at a higher risk of frailty and other poor health outcomes. The care system is currently often characterized by a reactive, monodisciplinary approach focussed on one disease or condition. However, older persons often may have multiple physical- and social health problems. A preventive approach which is patient-centred instead of disease-centred and coordinated from primary care could provide a solution.
This thesis aimed to study, 1) the variation in indicators of healthy ageing among older persons in Europe, and, 2) the effects and process components of a coordinated preventive health and social care approach aimed at promoting healthy ageing in Europe.
This thesis showed that there appear to be large socioeconomic and ethnic inequalities in frailty among older persons. Further, a coordinated preventive health- and social care approach among older persons in varied European settings was received positively and showed promising results. However, the effects of such a coordinated preventive care approach on the health and quality of life of older persons could be greater when older person's engagement in the approach is promoted.

Cover of thesis_Adi NugrohoWednesday March 20, 2019 - PhD Defense Adi Nugroho (Prof. Andries Queridozaal, 11.30hr)

Title thesis:
Behavioral HIV-prevention Interventions for Men who have Sex with Men and Transgender Women in Indonesia

Despite alarming HIV prevalence, programmatic coverage for men who have sex with men (MSM) and transgender women (transwomen) populations remains inadequate in Indonesia. In order to increase the program coverage and to ensure the effectiveness of the interventions, it is essential to employ insights from the behavioral sciences in developing interventions.

This thesis aims to contribute to systematic evidence-based research in determining effective intervention components and evidence-based recommendations in order to develop effective HIV-prevention interventions for MSM and transwomen in Indonesia. It covers several steps in a process of intervention development. Firstly, it describes three studies on the identification of facilitators and barriers of behavioral HIV-prevention interventions for these two populations, including those who are living with HIV. This thesis also presents a translation of the results into interventions and how these interventions were executed and evaluated.

We conclude that an outreach approach remains relevant for HIV-prevention interventions targeting MSM and transwomen in Indonesia, but interim adjustments should always be possible to keep up with their current needs. The use of internet-based platforms including social media can be beneficial both as a stand-alone intervention and as supporting media for the traditional outreach. Apart from continuously and comprehensively advancing the outreach approach, addressing structural barriers such as providing stigma-free and accessible healthcare should not be ignored.

Joost Oude GroenigerWednesday January 9, 2019 - PhD Defense Joost Oude Groeniger (Prof. Andries Queridozaal, 15.30hr)

Title thesis:
Socioeconomic Inequalities in Health: A life-course perspective on social stratification, cultural capital and health-related behaviors

Socioeconomic inequalities in health are enormous. in The Netherlands, those with a tertiary educational degree live on average five years longer than those with primary education, while inequalities in healthy life-expectancy reach almost 14 years. In order to develop effective measures to reduce these socioeconomic inequalities in health, it is important to know the risk factors that contribute to these inequalities.

This thesis showed that socioeconomic inequalities in health-related behaviors contribute to socioeconomic inequalities in health, and that socioeconomic inequalities in physical activity, health dietary patterns and obesity are affected by inequalities in cultural capital. In contemporary obesogenic societies, healthy lifestyles seem to be used by higher socioeconomic groups as a way to distinguish themselves from others, which is affected by the cultural preferences of these groups.

One of the implications of these findings is that the embeddedness of healthy and unhealthy behavior in the socio-cultural environment and as part of a collective lifestyle, could explain why it is so hard to change health behaviors. Individuals do not live in a social vacuum and should not be treated as such. Policies and interventions aimed at improving healthy behavior among lower socioeconomic groups should be better aligned to the socio-cultural identity of the target group and incorporate the wider socio-cultural environment. A better understanding on how to do so is needed.

Extra Seminar “Cultural capital and socioeconomic inequalities in health” Wednesday, January 9, 2019 (13.00 hr) prior to the PhD thesis defence by Joost Oude Groeniger, MSc (prof. A. Queridozaal, Erasmus MC, Rotterdam)

Program Seminar (Na-1203, Erasmus MC)
13.00 – 13.10 Welcome and Introduction, Prof.dr. F.J. van Lenthe (Erasmus MC Rotterdam)
13.10 – 13.40 The interplay of cultural, social and economic capital and health inequalities, Prof.dr. T. Abel (University of Bern, Switzerland)
13.40 – 14.00 Measuring ‘unconscious’ health behavior preferences: the merits of Implicit Association Tests, Dr. J. Schaap (ErasmusUniversity Rotterdam)
14.00 – 14.20 Reflections on the role of cultural capital for socioeconomic inequalities in health, Prof.dr. J.P. Mackenbach (Erasmus MC Rotterdam)
14.20 – 14.30 Wrap up and conclusions

The seminar is open for all interested; due to limited space however, those from outside the Erasmus MC are kindly asked to send an email to: f.vanlenthe@erasmusmc.nl

Guannan BaiThursday December 20, 2018 - PhD Defense Guannan Bai (Senate Hall, Woudestein 15:30 hr)

Title thesis: Health-related quality of life of mothers and children

In the context of maternal and child health, mortality and morbidity have been decreased in the last decades due to the development of medicine and technology. It is not merely enough to have life. Health-related quality of life (HRQOL) has been received increasing attention from research and practice. It is an important health outcome measures in additional to the traditional outcomes; it encompasses multiple domains related to physical, mental and social health.

This thesis aims to describe HRQOL of mothers during pregnancy and after delivery, as well as children at preschool and school age in the Netherlands. More specifically, this thesis aims to assess the trajectories of mother's HRQOL during pregnancy and the early predictors of these trajectories, and to assess the determinants of maternal HROQL after delivery and of children's HRQOL at school-age. Furthermore, this thesis aims to assess the association between maternal HRQOL during pregnancy and birth outcomes. In addition, this thesis evaluated the feasibility and validity of an instrument (i.e. Health Status Classification System-Preschool, HSCS-PS) to measure HRQOL in early childhood.

We conclude that most women had healthy trajectories of physical and mental HRQOL during pregnancy. Multiple determinants of suboptimal health-related quality of life were identified in antepartum and postpartum period. We would like to address the negative impacts of pregnancy-related physical symptoms, pregnancy-specific anxiety and postpartum psychopathological symptoms on maternal HRQOL. HRQOL in childhood was mainly influenced by health conditions/disorders. The patterns of impact by specific conditions differ. We did not confirm our hypothesis that worse maternal HRQOL during pregnancy was associated with adverse birth outcomes. To truly understand the association, more research is needed. In addition, our study supports for the feasibility and validity of HSCS-PS in general population to measure HRQOL in early childhood.

Cover Eric GeijtemanWednesday 12 December 2018 - PhD Defense Eric Geijteman (Prof. Andries Queridozaal, 15.30hr)

Title thesis:
Decisions about medical treatment in the last phase of life. Withholding and withdrawing medication and other interventions.

Continuation of potentially inappropriate interventions at the end of life seems common practice. The causes of this practice have rarely been studied and the perspectives of patients, their relatives and caregivers are not known. 

Eric Geijteman’s thesis aims to provide insight into the practice of withholding and withdrawing medical interventions in the last phase of life. The thesis includes data from repetitive nationwide studies on end-of-life decision making practices, retrospective chart review studies, questionnaire studies, an interview study, and a Delphi study. In addition, two case reports and a letter to the editor are included.

The first part of the thesis focuses on current end-of-life practices. It shows that patients with a limited life expectancy are often exposed to potentially futile and even harmful medical interventions.

In part two, we explore the perspectives of patients, their relatives and physicians regarding potentially inappropriate medications in the last phase of life. The results in this part underline that limited awareness among physicians seems to be an important factor to explain why many patients use one or more potentially inappropriate medications in the last months before their expected death. Low priority and uncertainty about the consequences are other important causes. 

In the third part, possible solutions for improvement of medical care at the end of life are described. It reveals that there is a great need of research into the consequences of deprescribing medication at the end of life. Such deprescribing studies require research methods in which participants in the control group are not aware of the trial intervention. Another solution to improve medical care is to increase physicians’ acknowledge that in the last phase of a patient’s life providing less or no interventions aimed at prolonging life is the best option.

Cover Marina KaranikolosWednesday 21 November 2018 - PhD Defense Marina Karanikolos (Prof. Andries Queridozaal, 13.30hr)

Title thesis: The impact of the financial crisis on population health and health systems

The Financial Crisis of 2008 had a profound impact on the economy of many European countries. The aims of this thesis are: to assess the consequences of the crisis for population health; to assess the impact of the crisis on health systems and identify responses that help countries to maintain stability and promote resilience. The financial crisis in Europe has posed major threats to health, but also some opportunities. It did not affect European countries equally, nor were their health systems equally well-prepared to withstand its effects. Economic crisis exacerbates major gaps and weaknesses, but where the right mechanisms are in place the impact on population health and health systems can be minimised.

Cover Arianne Brinkman-StoppelenburgTuesday 20 November 2018 - PhD Defense Arianne Brinkman-Stoppelenburg (Prof. Andries Queridozaal, 11.30hr)

Title thesis: Hospital palliative care team consultations for patients with advanced cancer: too few, too late?

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Over the past years, palliative care has also gained interest in hospitals, where specialist palliative care is often provided by palliative care teams that can be consulted by medical specialists, nurses and other professionals.

This thesis aims to describe characteristics of palliative care team consultations in Dutch hospitals and to study the effect of palliative care team consultations on quality of life, quality of dying and (costs) of care of patients with advanced cancer. Furthermore, this thesis includes additional studies on end-of-life care including a study on the developments in end-of-life decision making practices in the Netherlands, a study on consultation of SCEN physicians who provide Support and Consultation on Euthanasia in the Netherlands and a systematic review on the effects of advance care planning.

In this thesis, we conclude that palliative care team consultations in hospitals have positive effects on quality of life and quality of dying of patients with advanced cancer. However, consultations take place rather late in patients’ disease trajectories and there is a large variation in number of consultations per hospital. More patients could benefit from palliative care team consultations if teams are consulted more often and earlier in the disease trajectory.

Cover Ineke LokkerTuesday 30 October 2018 - PhD Defense Ineke Lokker (Prof. Andries Queridozaal, 15.30hr)

Title thesis: Acknowledging different perspectives – burden and management of symptoms in the the last phase of life

In order to deliver good palliative care it is important to know which symptoms may occur during a specific disease trajectory or disease phase and what their impact on daily functioning is. The aim of this thesis was to providing insight into various aspects of symptoms and symptom relief during the last phase of life. We concluded that it is important to acknowledge the presence of different perspectives concerning symptoms and symptom relief during the last phase of life. To establish this, improvement of communication within the healthcare team and with patients and family members is needed. Communication related to symptoms should preferably be a continuous process.

cover_davidblokTuesday 5 June 2018 - PhD Defense David Blok (Prof. Andries Queridozaal, 11.30hr)

Title thesis: Introducing Systems Approaches in Health Behavioral Research

This thesis aims to explore and quantify the importance of social networks as a determinant of health behaviors, and to investigate the usefulness of agent-based models (ABMs) as a tool for studying socioeconomic inequalities in health behaviors.

In this thesis, we argue that it may be beneficial to exploit models of infectious disease for health behavioral research, because the spread of unhealthy behaviors in social networks shows similarities with the spread of infectious diseases. In separate studies, we showed that healthy and unhealthy behaviors in personal social networks and neighborhoods are important for changes in health behavior. These findings support the idea that health behaviors might be contagious and indicate preference for tailored network-based interventions. We also developed two ABMs and demonstrated that these models have much potential to study complex public health problems. ABMs are in particular suitable to explore the long term impact of interventions aimed to reduce socioeconomic inequalities in health behaviors.

Voorkant proefschrift Maryse CnossenWednesday 13 December 2017 - PhD. Defense Maryse Cnossen (prof. Andries Queridozaal 13.30)

Title thesis
: Outcome and Comparative Effectiveness Research in Traumatic Brain Injury: A methodological perspective

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. Although research activity in TBI has expanded rapidly, all these endeavors have not yet resulted in major advances in our understanding of TBI.

This thesis addresses two important topics in TBI research. First, outcome following TBI including the prevalence and predictors of psychiatric disorders and post-concussion symptoms. Second, this thesis examines whether comparative effectiveness research (CER) could contribute to evidence generation in TBI, with a focus on current guideline adherence, treatment variation and analytical methods.

We found that prevalence rates of post-concussion symptoms and psychiatric disorders varied widely and were dependent on pre-injury factors, patient population, assessment, analysis strategy and the diagnostic criteria used. Etiology of TBI sequelae is complex and multifactorial and includes biological, psychological and social factors that might be difficult to capture in a prediction model. When studying prevalence and predictors of psychiatric disorders and post-concussion symptoms following TBI, the role of misattribution, research setting, attrition and the overlap in symptomatology between post-concussion symptoms and psychiatric disorders should be taken into account.

Current evidence underpinning TBI guidelines is weak, and consequently, there is large variation in policy and guideline adherence among neurotrauma centers. This variation provides an opportunity for CER. However, the effect estimate obtained in observational CER studies largely depends on the analytical method used. Since all analytical methods have their strengths and limitations and are based on untestable assumptions, it is important that researchers do not consider one particular analytical method as the most appropriate. Different analytical methods that are reasonable for the research question under study should be used as sensitivity analyses and the results of observational CER studies should be confirmed by high-quality RCTs.

Cover Kevin ten Haaf7 December 2017 - PhD Defense Kevin ten Haaf (Senaatszaal, Woudestein; 11:30)

Title thesis:
Lung Cancer Screening: Optimization through risk stratification

Lung cancer accounts for more than 1 in 10 cancer cases and 1 out of 5 cancer related deaths worldwide, which makes it the leading cause of cancer related mortality. However, the National Lung Screening Trial (NLST) indicates that lung cancer mortality can be reduced by early detection through computed tomography screening. Kevin ten Haaf's thesis describes the development of a microsimulation model for the evaluation of lung cancer screening based on individual-level data from two large randomized controlled trials. It then evaluates the long-term benefits and harms of implementing lung cancer screening programs. Finally, it investigates how risk stratification may be used to optimize lung cancer screening programs.

The studies presented in this thesis describe how high quality models can synthesize information from different sources and extrapolate the results of randomized controlled trials. The lung cancer screening program that provides the most advantageous balance between benefits and harms in the United States was identified, as well as the potential barriers for the implementation of such a program. The identification and selection of high-risk individuals was found to be essential for the cost-effective implementation of lung cancer screening. Furthermore, this thesis indicates that risk stratification based on the results of screening examinations may aid in reducing the number of false-positive results and follow-up examinations.

cover bouwineTuesday31 October 2017 - PhD Defense Bouwine Carlier (Prof. Dr. Andries Queridozaal, 15:30)

Title thesis: Health, social participation and entering paid employment among unemployed persons

Unemployed persons have poorer health compared to employed persons. In this thesis, Bouwine Carlier gained insight into determinants of re-employment and effective re-employment programs for unemployed persons with health problems. This thesis showed poor health negatively influenced job-search cognitions and coping resources, which in turn resulted in less active job-search behavior and lower likelihood to gain paid employment. Entering paid employment had a positive effect on perceived health and quality of life and also anxiety and depressive symptoms decreased after re-employment. Paid employment can be considered an effective intervention to improve the health disadvantage among unemployed persons.

The propensity score technique was used to evaluate the effectiveness of an interdisciplinary re-employment program. This program, in which employment specialists as well as mental health specialists work together in interdisciplinary teams, showed no added value compared to the regular re-employment programs. The most important missing components of the re-employment intervention were rapid job placement, coaching on the job, and direct connection and communication of employment specialists with employees.

Dwyer-LindgrenWednesday 11 October 2017 - PhD Defense Laura Dwyer-Lindgren (Prof. Andries Queridozaal, 13:30)

Title thesis: Geographic Patterns and Disparities in Health-related Behaviors and Outcomes in the United States

Health risk factors and outcomes are known to vary regionally within the United States (US), however due to the challenges posed by small numbers and the limitations of data available at a fine geographic resolution, relatively little is known about how these health indicators vary on a small geographic scale. In this thesis, Laura Dwyer-Lindgren developed a small area estimation methodology for estimating trends in health-related risk factors and outcomes at the county level. The estimates derived from these analyses reveal substantial county-level inequalities in health risk factors (smoking, alcohol use, and diabetes) and outcomes (cause-specific mortality rates, life expectancy, and self-reported health status).

In many cases, these inequalities have increased over time. In a cross-sectional analysis of county-level life expectancy, nearly three-quarters of the variation in life expectancy among counties could be explained by variation in socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care access and quality factors.

Cover MarquesWednesday 28 June 2017 - PhD Defense Tiago M.C.D. Marques (Prof. Andries Queridozaal, 11:30)

Title thesis:
Harms and Benefits of Prostate Cancer Screening and Active Surveillance

Prostate cancer is the second most commonly diagnosed cancer and the 5th cause of cancer death worldwide. The PSA-test consists of a simple blood test which gives the value of PSA in the blood. An elevated PSA value indicates a high probability of presence of cancer, though it could also be due to unrelated causes. While prostate cancer screening may save lives, it also causes harm, since many screen-detected men are overdiagnosed and overtreated.

In this thesis I use a microsimulation model (MISCAN) adapted to prostate cancer to explore multiple avenues to make PSA-based screening worthwhile and effective. I find that prostate cancer screening should be focused on younger age groups, Active Surveillance should become the primary treatment option for low-risk men, and that personalized screening strategies should be adopted to minimize the harms of screening.

Vivian Kruitwagen-vdGaarTuesday 30 May 2017 - PhD Defense Vivian Kruitwagen-van de Gaar (Prof. Andries Queridozaal, 15:30)

Title thesis:
Promoting Healthy Behaviours among Children Living in Disadvantaged Neighbourhoods. Development and evaluation of a Social Marketing intervention: the "Water Campaign"

This thesis focused on the development and evaluation of an intervention aimed to promote a healthy lifestyle among children. This intervention - the 'Water Campaign'- was developed with Social Marketing, aimed to decrease the consumption of sugar-sweetened beverages (SSB) among primary school children (aged 6 to 12 years old) by promoting the intake of water. The 'Water Campaign' targeted both children and their parents (primarily mothers) through activities at school and in the neighbourhood (i.e., school- and community-based). The campaign was developed as an enrichment of an existing school-based programme 'Enjoy Being Fit!' (Rotterdam Lekker Fit! programma). The 'Water Campaign' was implemented in two multi-ethnic, disadvantaged neighbourhoods in Rotterdam. Using a controlled-trial design, we found after one year a significant decrease of SSB intake among children who participated in the Water Campaign.

Besides the focus on effectiveness of interventions to improve lifestyle behaviours among children, this thesis also focused on the underlying determinants of children's health behaviours and on possible ways to assess nutritional behaviour of children. The various associations between determinants and the health behaviours of the child appear to be different for children with distinct ethnic backgrounds. Intervention developers and health promotors might give special attention to differences between subgroups - ethnically or culturally diverse - when developing tailored interventions and thereby improve interventions' reception, acceptance and effectiveness.

Suzette Matthijsse3 May 2017 - PhD Defense Suzette Matthijsse (Prof.dr. Andries Queridozaal, 13.30u)

Title thesis: "The impact of HPV vaccination on HPV and cervical cancer in the Netherlands"

Suzette Matthijsse's thesis aims to provide more insight into the transmission dynamics of the human papillomavirus (HPV), and on the impact of HPV vaccination on HPV and cervical cancer in the Netherlands, using microsimulation models. Both the current Dutch vaccination strategy (with observed uptake) and alternative strategies are considered.

The results of the studies presented in this thesis show that naturally acquired immunity likely plays a major role in HPV transmission. The duration of natural immunity shows large individual variation, and differs between HPV types. Furthermore, HPV vaccination is expected to substantially reduce HPV prevalence, precancerous lesions, and the incidence and mortality of cervical cancer in the Netherlands. Improving vaccine uptake among girls and extending vaccination to boys are efficient strategies to further improve HPV transmission control and prevent more cervical cancer deaths.

Steffie Naber19 April 2017 - PhD Defense Steffie Naber (Prof. Andries Queridozaal, 11.30 uur)

Title thesis: Reducing Harms and Increasing Benefits of Screening for Cervical Cancer and Colorectal Cancer - A Model-based Approach

Steffie Naber's thesis aims to improve the harm-benefit ratio of screening for cervical cancer and colorectal cancer in different settings. Major harms of screening involve psychological distress, physical pain and complications from screening and subsequent treatment. The goal and major benefit of screening for cervical and colorectal cancer is a reduction in the disease's incidence and mortality. Whereas harms (and costs) can often be reduced by limiting unnecessary screening and treatment, benefits can often be increased by expanding screening coverage or by switching to a better screening test or protocol. The impact of such changes to screening programs is estimated in different model-based studies. Additionally, opportunities for risk-stratified screening are explored. Switching from uniform to risk-stratified screening may be particularly suitable for improving the harm-benefit ratio of screening, as this can simultaneously reduce harms in those at lowest risk and increase benefits in those at highest risk.

Cover thesis B. van Straaten5 October 2016 - PhD Defense Barbara van Straaten (Prof.dr. Andries Queridozaal, 15.30hr)

Title thesis: On the Way Up? Exploring homelessness and stable housing among homeless people in the Netherlands

Barbara van Straaten's thesis focused on the situation of homeless people in the Netherlands and into developments in their situation over time. More insight into the situation of homeless people and into developments over time is relevant for practice and policymaking and to improve the quality of life of homeless people. This thesis aimed a) to explore factors - substance use, intellectual disability and care needs - related to homelessness and their development over time, b) to investigate predictors of stable housing, and c) to explore changes in indicators of social exclusion and the association between changes in indicators of social exclusion and psychological distress. A cohort consisting of 500 homeless people in the Netherlands were followed for a period of 2.5 years. The results of the studies presented in this thesis show that the participants are on the way up, but also that ongoing support is still required.

thesis cover Hu14 september 2016 - PhD Defense Yannan Hu (Prof. Andries Queridozaal, 13:30)

Title thesis: Social and Political Determinants of Population Health

Yannan Hu's thesis focused on the exploration of potential social and political determinants of population health and health inequalities from an international, European perspective. The first part of thesis focused on population health. It assessed whether democracy and income inequality were associated with mortality indicators in multiple European countries over decades. The second part of thesis focused on socioeconomic inequalities in health. It assessed the impact of health policies implemented in Europe on socioeconomic inequalities in health. As the existing studies about determinants of population health usually have insufficient controls for confounders, and the number of studies evaluating policy effects on health inequalities is still very small, with the aim to improve the evaluation, this thesis also provided a number of methods to evaluate policy effects on health and health inequalities. These methods can be considered in future research.

Proefschrift Scholten31 Augustus 2016 - PhD Defense Annemieke Scholten (Prof. Andries Queridozaal, 15.30 uur)

Title thesis: Outcome after Traumatic Brain Injury: epidemiology, impact and assessment

Annemieke Scholten's thesis focused on the incidence, health-related quality of life, psychiatric consequences and costs of traumatic brain injury (TBI), and the possible improvements of outcome assessment in the injury field. Over the past decades, the number of survivors of severe TBI has rapidly grown, though the disability due to TBI has not appreciably reduced. This has resulted in a shift in attention from mortality towards disability. Policymakers and clinicians are recognising the importance of quantifying the outcomes after TBI to assess the effects of prevention strategies and treatments. Consequently, insight into the incidence, health impact and costs of TBI is essential in order to compare the burden of injuries between patient subgroups and with other diseases, optimise health care policy and prevention, and develop effective health care and rehabilitation services.

Voorkant proefschrift Lionne Venderbos2 December 2015 - PhD Defense Lionne Venderbos (Prof. Andries Queridozaal, 11.30 uur)

Title thesis: Active surveillance for prostate cancer: quality of life and risk stratification

Lionne Venderbos's thesis focuses on quality of life in patients choosing an active surveillance management strategy and risk stratification for prostate cancer. An active surveillance strategy for low-risk prostate cancer allows men to postpone or avoid the side effects of active treatment by replacing initial curative treatment with regular surveillance visits. In case of disease reclassification/progression men will opt for curative treatment. Living with 'untreated prostate' can create a substantial emotional burden for men. In this thesis quality of life of men following an active surveillance strategy is assessed at various points in time and compared to that of men who underwent initial curative treatment and men without prostate cancer. Furthermore, as current active surveillance cohorts apply relatively simple combinations of inclusion criteria for patient selection, in the light of individualized medicine, more refined risk stratification through a nomogram is assessed.  

Proefschrift_Claudia_Fischer11 November 2015 - PhD Defense Claudia Fischer (Prof.dr. Andries Querido zaal, 09:30hr)

Title thesis: Quality indicators for hospital care: reliability and validity  
Claudia Fischer’s thesis focused on measuring quality of hospital care. Despite a rapidly growing body of scientific literature on this topic, there is currently no consensus on how to measure quality of care. Therefore the aim of the thesis was to expand our knowledge on how to measure quality of hospital care for between-hospital comparisons. Quality indicators are measurable aspects of quality and are generally used to assess quality of care. In order to be able to deliver meaningful information, quality indicators need to show certain characteristics, such as being reliable and valid. These two quality indicator characteristics were studied in this thesis. In specific, the focus was on the evaluating the effect of data quality, indicator definitions, statistical uncertainty and case-mix correction.
After the PhD defense (14.00-17.00hr ) a symposium will be held on the scientific basis for the evaluation of quality of hospital care. 
vanDishoeck11 November 2015 - PhD Defense Anne-Margreet van Dishoeck (Prof.dr. Andries Querido zaal, 11:30 a.m)

Title thesis: Indicators for quality of hospital care; beyond the numbers

This thesis addresses two major topics in measuring hospital performance using quality indicators; random variation and confounding in comparing hospitals and interpretation in improving quality of care. Considerable influence of random variation and case-mix was found in comparing hospitals. Although we found a significant relation between outcome and the quality of care processes, random variation is the major limitation for the interpretability when indicators are used for quality improvement. Like a one hand clock, we roughly know what time it is.
11 November 2015 - Symposium 'The scientific basis for the evaluation of quality of hospital care' (Education Center, Collegezaal 1, 14.00-17.00hr)

In this symposium national and international experts will explore the scientific basis for the evaluation of quality of hospital care and discuss possibilities and impossibilities of improving quality of care based on indicators.

13.00h - Walk-in lunch 
14.00h - Hester Lingsma, Erasmus MC: Welcome and introduction   
14.15h - Steven Hovius, Erasmus MC: Clinical perspective   
14.30h - Michel Wouters, NKI, DICA: DICA perspective
14.45h - Valery Lemmens, Erasmus MC, IKNL: IKNL perspective
15.00h - Jan Hazelzet, Erasmus MC: Value based health care to improve quality of care
15.30h - Perla Marang, LUMC: Can we do better? Improvement based on quality indicators
15.45h - Hanneke Takkenberg, Erasmus MC: Quality improvement in cardiac surgery: initiatives and challenges
16.00h - Niek Klazinga, AMC, OECD: International and policy perspective
16.15h - Oliver Groene, LSHTM, Royal College of Surgeons: Evaluating the quality of care: considering levels of granularity
16.30h - Ewout Steyerberg: Discussion and closure

Registration Symposium 'The scientific basis for the evaluation of quality of hospital care'

10 November 2015 - Symposium 'Quantitative Methods for Medical Research' (Education Center, Collegezaal 2, 13.00-17.00hr)

In recent years the data that are collected in clinical research and public health have increased in volume and complexity. This has necessitated the development of novel statistical techniques for the analysis of these data.

In this symposium speakers from Erasmus MC will present recent methodological developments in the areas of biostatistics, diagnostic research, prediction research, and quality of care. Professor John Ioannidis (Stanford University) will close the symposium, and discuss limitations of current medical research and suggest future directions in methods to improve the scientific basis for medical care.

13h00 - 14h00: lunch
14h00 - 14h10: Opening - The role of the Center for Quantitative Methods in Erasmus MC
14h10 - 14h35: Biostatistics: Dynamic predictions in clinical Practice
14h35 - 15h00: Clinical Epidemiology: Study Design for diagnostic test evaluation
15h00 - 15h20: Coffee Break
15h20 - 15h40: Medical Decision Making: Prognostic models for precision medicine and shared decision making
15h40 - 16h00: Quality of Care: What can we learn from observational data?
16h00 - 17h00: Prof dr John Ioannidis: Old and new methods for the scientific basis of medical care

Registration: Symposium 'Quantitative Methods for Medical Research'

PhD Defense Frederik Peters Cover(07 October 2015 - PhD Defense Frederik Peters (Prof. Andries Queridozaal, 11:30 a.m.)

Title thesis: Deviating Trends in Dutch Life Expectancy: Explanation and Projection

After almost two decades of slower improvement and partly even stagnating progress, Dutch life expectancy increased substantially since 2002. Although such a positive development represents a great societal advancement it also poses a financial burden for the Dutch welfare state, particularly for the healthcare sector, the pension funds and life annuities. The aims of this thesis were first to evaluate whether the indicator period life expectancy adequately reflects underlying mortality conditions, second to explain the recent trend reversal from stagnation to resumption of improvements in Dutch life expectancy and third to assess how the deviating Dutch life expectancy trend could be extrapolated into the future. To address these issues, the Dutch situation was assessed within a group of comparable Western countries using data at the country level but also at the individual level.

Thesis_CantorCutivaLadyCatherine_Cover15 September 2015 - PhD Defense Lady Catherine Cantor Cutiva (Prof. Andries Queridozaal, 15.30hr)

Title thesis: Causes and Consequences of Voice Disorders Among Teachers

Lady Catherine Cantor Cutiva thesis focused on the occurrence, causes and consequences of voice disorders among teachers. Voice disorders are a major problem among teachers. However, the natural variation of voice disorders among teachers is unknown due to the lack of longitudinal studies. We found that teachers had a significantly increased occurrence of voice disorders compared with other occupations, noise and acoustics might play a role in the occurrence of voice symptoms among teachers, and the increase on health care use, absenteeism and productivity loss at work due to voice disorders among teachers represent an important burden of these disorders. To improve future research, we recommend developing longitudinal studies with longer follow-up and repeated measurements to describe more accurately the changes in occurrence of voice disorders among teachers; it is also recommended to investigate the influence of barriers and facilitators in the access to health care among teachers with voice disorders.

Cover Sandra Oude Wesselink8 september 2015 - PhD Defense Sandra Oude Wesselink (prof. Andries Queridozaal, 15.30hr)

Title thesis:Towards Evidence-based Government Supervision in Healthcare

Little is known about the actual effects of the supervision programmes of healthcare inspectorates on quality of care. Therefore, the aim of this thesis is to generate empirical evidence of the effects of government supervision on quality of care and specifically health outcomes. We conclude that one supervision programme probably was effective at improving quality of care. We found no evidence that the other theme-based supervision programme also improved quality of care, but given the methodological shortcomings we also cannot exclude the possibility that the supervision programme had an effect on structures and processes of care. In addition, we conclude that the relation between structures and processes of care and health outcomes, which (by definition) can be assumed to exist in the case of evidence-based structures and processes, is difficult to demonstrate using observational data. To improve future research on the effectiveness of supervision, we propose to extend the methodological criteria for this type of research.

Cover Kroep8 july 2015 - PhD Defense Sonja Kroep (Prof. Andries Queridozaal Erasmus MC, 11:30hr)

Title thesis:
Exploring the natural history of esophageal adenocarcinoma and possibilities for early detection and intervention

Sonja Kroep her thesis focused on the natural history of esophageal adenocarcinoma (EAC) and possibilities for early detection and intervention. EAC is a disease with a high fatality rate and although its incidence among the population is low, the rising incidence over time is an alarming trend. EAC originates from Barrett's epithelium (BE), a premalignant condition. The presence of a premalignant stage provides the opportunity to prevent the development of BE related adenocarcinoma by early detection and BE treatment. Using a microsimulation model, she assessed the influence of uncertainties in natural history parameter assumptions on intervention outcomes and explored the effects driving EAC incidence and mortality.

cover Xiaona Liu07 July 2015 - PhD Defense Xiaona Liu (Prof. Andries Queridozaal, 13:30)

Title thesis:
Behavioral Aspects of HIV Prevention in China: From Determinants to Interventions

Xiaona Liu's thesis focuses on the development of effective preventive measures against HIV infections among several neglected high risk population groups. It describes a number of studies on the identification of risk factors and determinants of HIV-related behaviors among the population groups, including health care workers, college students and general internal migrants, in China, and explore the elements bridging these determinants into effective and practical HIV prevention interventions. Four major research objectives were formulated: 1) What are risk factors of HIV infections in health care settings?, 2) What are important determinants of sexual risk behaviors leading to HIV infections in high-risk general population groups?, 3) What can be learnt from evaluations of previous HIV prevention interventions?, and 4) Which elements should effective and practical behavioral HIV prevention interventions targeting high risk general population groups contain.

Cover Lucas Goede23 June 2015 - PhD Defense Luuk Goede (Prof. Andries Queridozaal, 11:30 a.m.)

Title thesis: Modelling the Effects and Costs of Colorectal Cancer Screening

Luuk Goede's thesis focused on the potential effects and costs of population-based colorectal cancer (CRC) screening by considering two overarching questions. In the first part of the thesis the potential impact of current screening policies on the CRC disease burden and costs in the population was investigated. In this part the situations in the US as a whole, the states of Louisiana and New Jersey in particular, and the province of Ontario, Canada, were considered as examples of regions with different screening policies. In the second part of the thesis different strategies were investigated by which health effects and costs of CRC screening could be optimized. In this part the focus was mainly on noninvasive CRC screening tests.
Modelling the Effects and Costs of Colorectal Cancer Screening (E-PUBS.nl)

Phd defense Rienke Bannink10 June 2015 - PhD Defense Rienke Bannink (Prof. Andries Queridozaal, 11:30 a.m.)

Title thesis:
Promoting mental health and healthy behaviors in adolescents. Studies on determinants and interventions

Rienke Bannink's thesis focuses on determinants of mental health problems and health-risk behaviors and interventions promoting adolescents' mental health and healthy behaviors. Three major research objectives were formulated: 1) to examine factors (i.e. bullying victimization, negative life events, and parent-adolescent relationship quality) that are hypothesized to play a role in the development of mental health. Furthermore, the clustering of risk behaviors and association with mental health problems is examined, 2) to evaluate the appreciation and effectiveness of three interventions (i.e. E-health4Uth, E-health4Uth with consultation, and Your Health) aiming to identify adolescents' at risk of mental health problems and health-risk behaviors, and to promote adolescents' mental health and healthy behaviors, and 3) to examine the psychometric properties of two measures of self-sufficiency among adolescents attending senior vocational education, namely a self-report questionnaire and the Dutch version of the Self-Sufficiency Matrix for professionals.

Rongen, Anne22 May 2015 - PhD Defense Anne Rongen (Senaatszaal, Woudestein; 13:30)

Title thesis:
Sustainable employability & participation in health promotion programs

Anne Rongen's thesis focuses on sustainable employability of employees. There are three main questions formulated: 1) what are the determinants of sustainable employability; 2) what is the effectiveness of workplace health promotion programs; and 3) which factors determine whether employees participate in health promotion programs? This thesis concludes that: 1) sustainable employability is influenced by individual, health, and work-related factors; 2) the effectiveness of health programs is dependent upon the methodological quality of the study and study characteristics; and 3) participation is influenced by positive intention, personal convictions about changing health, preferences for type of program, and expectations of other.

PhD defense Anne Wijtzes13 May 2015 - PhD defense Anne Wijtzes (Prof. Andries Queridozaal, 11:30 a.m.)

Title thesis:
Social inequalities in young children's lifestyle behaviors and childhood overweight: the Generation R Study

Anne Wijtzes' thesis focuses on socioeconomic and ethnic inequalities in young children's lifestyle behaviors and childhood overweight. Her studies are for the most part embedded within the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood in Rotterdam, the Netherlands. Four major research objectives were formulated: 1) to assess the independent associations between children's lifestyle behaviors and childhood overweight, 2) to assess the association between parental socioeconomic position and childhood overweight, as well potential underlying pathways, 3) to assess the associations of parental socioeconomic position with children's sedentary behaviors, physical activity behaviors, and dietary behaviors, as well as potential underlying pathways, and 4) to investigate the effectiveness of current interventions to improve lifestyle behaviors or prevent childhood overweight among socially disadvantaged children (0-12 years) in Europe.

Voorkant proefschrift Bruinsma14 April 2015 - PhD defense Sophie Bruinsma (Prof. Andries Queridozaal, 13:30 uur)

Title thesis:
The experiences of bereaved relatives with palliative sedation and other end-of-life care practices

Sophie Bruinsma's thesis focuses on bereaved relatives' experiences with the practice of palliative sedation and other end-of-life care practices. Palliative sedation is defined as the deliberate lowering of a patient's level of consciousness in the last stages of life. Relatives play an important role in the trajectory when sedation is being considered and while it is carried out. Palliative sedation is a far-reaching intervention that may have a significant impact on the experience of the dying process both for patients and their relatives. This thesis aims to provide a comprehensive overview of bereaved relatives' experiences with the practice of palliative sedation. Further, the aim is to gain more insight into the potential life-shortening effect of palliative sedation and in the risk factors for complicated grief in older adults.

Voorkant proefschrift Kluizenaar8 April 2015 - PhD Defence Yvonne de Kluizenaar (prof. Andries Queridozaal, 15:30)

Title thesis:
Adverse effects of long term exposure to road traffic noise

Yvonne de Kluizenaar's thesis focuses on the adverse effects of long term exposure to road traffic noise. Associations between exposure and effects were investigated in large population studies: the GLOBE cohort (Eindhoven region), a large random sample of inhabitants of Groningen city, the PREVEND cohort (city of Groningen), and a population study in Amsterdam. The first part of the thesis focuses on the association between night time exposure and self-reported sleep problems. The second part of the thesis focuses on the association with hypertension and incidence of cardiovascular events, taking exposure to air pollution into account. The third part of the thesis investigates if (and to what extent) a relatively quiet façade to the dwelling may reduce the effects of traffic noise exposure, contributing to increasing insight into the potential impact of reducing noise exposure at the least exposed façade as a measure to decrease the adverse effects of noise.

Voorkant proefschrift Witkamp7 April 2015 - PhD Defense Erica Witkamp (prof. Andries Queridozaal, 13:30)

Title thesis:
What Happens and What Matters; a study on Palliative and Terminal Care in the Hospital (PalTeC-H)

Erica Witkamp's thesis focuses on the quality of dying of patients in the hospital, as experienced by bereaved relatives, physicians and nurses. The thesis includes a validation study of an instrument to assess knowledge and opinions of nurses regarding palliative care, a quantitative and a qualitative study on the experiences of relatives regarding the quality of dying and quality of care in the dying phase; a comparison of the experiences of relatives, physicians and nurses; a study on recognition of the dying phase in relation to medical care; and two controlled before and after studies on the effects of an intervention with palliative care nurse champions on the quality of hospital end-of-life care.

Ingrid Kruizinga11 March 2015 - PhD Defense Ingrid Kruizinga (prof. Andries Queridozaal, 15:30)

Title thesis:
Early detection of emotional and behavioural problems in preschool children. The use of the Brief Infant-Toddler Social and Emotional Assessment in preventive child health care.

Ingrid Kruizinga's thesis focuses on the BITSEA, an early detection tool for psychosocial problems in children aged 1-3 years. The study had two main objectives: 1) evaluating the psychometric properties of the BITSEA, and 2) assessing whether psychosocial well-being was better when the BITSEA was applied during the well-child visit, compared to care as usual (i.e. the application of an instrument intended to guide the conversation between parent and child health professional; the KIPPPI).

Selma Bouthoorn3 March 2015 - PhD Defense Selma Bouthoorn (prof. Andries Queridozaal, 15.30)

Title thesis:
Social inequalities in cardiovascular health among mothers and their offspring.

Selma Bouthoorn's thesis focused on the pre-, peri- and postnatal development of socioeconomic inequalities in cardiovascular risk factors. Her study was embedded within the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood in Rotterdam, the Netherlands. In the first part of her thesis she investigated social inequalities in maternal cardiovascular health during pregnancy, including gestational diabetes, gestational weight gain and abnormal placentation. It was hypothesized that women with a low socioeconomic position may have an adverse cardiovascular risk profile during pregnancy more frequently than women with a high socioeconomic position. The second part of her thesis focused on social inequalities in cardiovascular risk factors, such as body mass index and blood pressure, in early childhood. Also, potential underlying mechanisms explaining the social inequalities in cardiovascular risk factors among mothers and their offspring were investigated.

Kirsten Asmus-Szepesi18 February 2015 - PhD Defence Kirsten Asmus-Szepesi (Prof Andries Queridozaal, 15.30)

Title thesis:
Prevention of Functional Decline among Hospitalized Older People

Kirsten Asmus-Szepesi's thesis is focused on the results of the evaluation of the Prevention and Reactivation Care Program (PReCaP). The PReCaP aims to prevent hospital-related functional decline among older hospitalized patients. It's main elements are early identification of older patients at risk of functional decline through a short questionnaire; offering integrated, multidisciplinary individualized care throughout hospital stay, offering geriatric case management from hospital admission up to six months after hospital discharge, and if needed, follow-up and treatment up to three months in a specific care environment after hospital discharge, the Prevention and Reactivation Center.

Kulhánová_Cover of the PhD thesis27 January 2015 - PhD Defence Ivana Kulhánová (Prof. Andries Queridozaal, 15:30)

Title thesis:
Exploring Educational Inequalities in Mortality in Europe

Ivana Kulhánová´s thesis focused on educational inequalities in all-cause and cause-specific mortality in Europe in a comparative perspective. In the first part of her thesis she investigated the quality of cause-specific mortality data by assessing educational differences in the proportion of ill-defined causes of death. In the second part of her thesis, the magnitude of educational inequalities in mortality was estimated and the trends in these inequalities between the 1990s and the 2000s were analysed. Finally, the third part of her thesis focused on quantifying the potential health gains and inequality reductions due to different policies and interventions using the Population Attributable Fraction (PAF) methodology.

Cathelijne Mieloo27 January 2015 Date - PhD Defense Cathelijne Mieloo (Professor Andries Queridozaal, 13.30u)

Title thesis:
Identifying and referring young children with psychosocial problems in preventive child health care. An evaluation of the use of the Strengths and Difficulties Questionnaire

Cathelijne Mieloo her thesis focused on identifying and referring 5-6 year old children with psychosocial problems in the preventive child health care. The thesis first focuses on the validation of SDQ in 5-6 year old children in term of validity, reliability and discriminatory power. It then focuses on the use of the SDQ within the preventive child health care in terms of identifying children with psychosocial problems, parental problem perception, referral for these problems. Finally it focuses on actual care use within 24 months after signalling. In all three parts of this thesis differences between ethnic groups were analysed.

Britt Van Lettow14 November 2014 - PhD Defense Britt van Lettow (Senaatszaal, Woudestein)

Title thesis: Thinking about Drinking: Explaining drinking behaviour by drinker prototypes

Britt van Lettow her thesis focused on drinker prototypes as explaining factor of (excessive) drinking behaviour among young adults. 'Prototypes' are perceptions that people hold of other people engaging in or refraining from certain behaviour (such as drinking, smoking, exercise). The thesis first focuses on the explanatory value of prototypes in explaining behaviour, intentions, and behavioural willingness. It then focuses on the differentiation between five drinker prototypes (abstainer, moderate drinker, heavy drinker, tipsy person, drunk person) in terms of personal characteristics attributed to them, their favourability and perception of being similar to them and how these relate to drinking behaviour. Finally, in an RCT the effects of prototype alteration and a cue reminder as additional strategies to the existing Drinktest.nl are tested regarding changes in drinking behaviour.

Proefschrift Robine Hofman4 november 2014 - PhD Defense Robine Hofman (Prof. Andries Queridozaal, 13:30)
Title thesis:
Girls' and parents' decision-making about HPV vaccination uptake

Robine Hofman's PhD thesis focuses on the acceptance of HPV vaccination by girls and their parents. During the introduction of the vaccine, an intensive societal debate involving politics, physicians, media, parents and girls developed in the Netherlands. Hofman's study started before this introduction and ended three years later. Before, during and following the introduction the decision-making about HPV vaccination was assessed in girls and parents.

1 July 2014 - PhD Defense "Rui Cai" (Eg-370, 11:30 h)
Title thesis:
Risk factors and interventions for HIV control in China

Rui Cai her thesis focused on risk factors and interventions for HIV control in China. We aim to identify promising new avenues to control sexual transmission of HIV in different population groups (i.e. general population, female sex workers and men who have sex with men) in China. By a systematic review, we studied the tendency of engaging in sexual risk behaviors among general population groups. We also studied risk factors of syphilis and determinants of the low uptake of HIV-related intervention services in Shenzhen, China. This thesis also studies the extent to which men who have sex with men and women are going to bridge the HIV epidemic to the female population and the determinants of HIV testing among men who have sex with men. Finally, we compared two sampling methods and assessed how men who have sex with men can be best reached for surveillance and developed an innovative way of reaching them for interventions.

1 July 2014 - PhD Defense Richard Steen (Prof A. Queridozaal 09:30)
Title thesis:
Occupational hazards, public health risks: sex work and sexually transmitted infections, their epidemiological liaisons and disease control challenges

Richard Steen's thesis focuses on sex work and sexually transmitted infections, and critically examines the current approach to HIV in generalised African epidemics. It considers whether STI control in sex work is feasible and beneficial to sex workers themselves, whether it contributes to STI reductions among clients and in the general population, and whether these changes are important for control of HIV epidemics.

hafkamp21 May 2014 - PhD Defence "Esther Hafkamp-de Groen" (Eg-370, 11:30h)
Title thesis: Asthma symptoms in early childhood: a public health perspective
Esther Hafkamp

Esther Hafkamp-de Groen her thesis focused on asthma symptoms in early childhood. From a public health perspective, we aim to improve health and health-related quality of life through the prevention of asthma symptoms and by signaling, counselling or management of children who are at a high risk of developing asthma. The public health approach that we used in this thesis provides a useful framework to study the association between social indicators and asthma symptoms in early childhood and the underlying pathways. This thesis also studies the impact of asthma on the child's health-related quality of life and evaluates the systematic assessment of asthma symptoms and environmental tobacco smoke exposure at preventive youth healthcare centers. Finally, we developed an asthma risk appraisal tool to assess the risk on asthma at school age in preschool children who present with asthma symptoms at well-child care.

cephirSymposium (CEPHIR Seminar): Thursday June 5th, 15:00-17:00h (Arminius Church).
For programme, location and registration/ subscription, please see: Actuele seminars Cephir

CoeberghOn friday 25th of april 2014 at 4.00 p.m. - Prof. Jan Willem Coebergh
will give his valedictory lecture 'Hoezo registrerenderwijs ….' in the auditorium (aula) of the Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam. After the lecture there is a reception in the same building.
Prior to the valedictory lecture there is a symposium. Hier kunt u zich aanmelden voor het symposium 'Bomen over kankersurveillance'.

February 7th 2014 - PhD Defence Arjen Joosse ( )
Title thesis:

February 4th 2014 - PhD Defence Lydian Veldhuis (Prof. Andries Queridozaal, 15:30 - 17.00)
Title thesis:
Overweight in 5-year-old children: assessment and risk factors - the 'Be active, eat right' study

Lydian Veldhuis thesis focused on overweight among 5-year-old children. The studies that are described are all embedded in the 'Be active, eat right' study. The overall aim of the thesis was to provide new insights into overweight assessment and risk factors for overweight in young children, which might contribute to the improvement of prevention of childhood overweight and obesity.

18 December 2013 - PhD Defence Luc Coffeng (Prof A. Queridozaal, Erasmus MC, 15.30)
Title thesis:
The Health Impact of Onchocerciasis Control in Africa

Luc Coffeng’s thesis focused on quantifying the impact of ivermectin mass treatment on the burden of onchocerciasis and prospects of elimination of infection in Africa, using statistical and mathematical modeling (microsimulation).

June 5th, 2013 - PhD Defence Natasja Johanna Helena Raijmakers (Prof. Andries Queridozaal, 11.30-14:00)
Title thesis: End of life care and decision-making. Opinions and experiences of the general public, bereaved relatives, and professionals.

Natasja Raijmakers thesis focused on public opinion on end-of-life decision-making in the Netherlands, and on artificial nutrition and hydration at the end of life.

One of the findings is that there is ample support for the Dutch Euthanasia Act, both among the general public and healthcare professionals, especially in the presence of physical symptoms. Both the general public and professionals consider euthanasia more problematic if a patient’s unbearable suffering is rooted in psychosocial problems or spiritual issues.
Furthermore, at this moment providing artificial nutrition and hydration at the end of life is a frequent practice, although the effects on comfort seem limited. End-of-life decision-making regarding artificial nutrition and hydration can substantially improve by more evidence-based guidance, in which special attention is needed for communication about the impact of nutrition and hydration at the end of life.

May 21st 2013 - PhD Defence Nicolien van Ravesteyn (Prof. Andries Queridozaal, 15:30-17:00)
NicolienVanRavesteyn-VoorkantBoekjeTitle thesis
: The impact of breast cancer screening on population health

The thesis describes the impact of breast cancer screening in the population and compares the effects to the effects of other interventions.

We found that mammography screening has had a substantial impact on breast cancer mortality in the U.S. and is projected to continue to do so in the future. Screening women biennially from age 50 to 74 years leads to a favorable balance between benefits and harms. More intensive screening (either extending the age ranges or increasing the screening frequency) leads to more benefits (lives saved), but harms increase more steeply. Targeting screening to subgroups with the highest chance for benefit and the lowest chance for harm has the potential to improve the balance between benefits and harms at the population level.

March 7th, 2013 - PhD Defence Elin Koppelaar (Woudestein, senaatszaal, 15.30-17.00)
Title thesis: Use and effect of ergonomic devices

In this thesis Elin Koppelaar focused on the use and effect of ergonomic devices in healthcare. In the first part of her thesis she estimated the effect of ergonomic devices on mechanical load and assessed the use of these devices during patient handling activities in healthcare. in the second part of her thesis the influence of individual and organisational factors on the appropriate use of ergonomic devices during patient handling activities were determined. The third part of her thesis focused on the long term effects of lifting devices use during transfer activities with patients on the occurence of low back pain among nurses in healthcare.

February 12th, 2013 - PhD Defence Jan Hontelez (Prof. Andries Queridozaal, 15:30-17:00)
Title thesis:
The impact of antiretroviral therapy on the HIV epidemic in South Africa

January 29th, 2013 - PhD Defence Melina Arnold (Prof. Andries Queridozaal, 15:30-17:00)
Title thesis:
Ethnic heterogeneity of Cancer in Europe - Lessons from registry-based studies in migrants