Purpose The SARS-CoV-2 pandemic severely disrupted society and the health care system. In addition to epidemiological changes, little is known about the pandemic's effects on the trauma care chain.... Show morePurpose The SARS-CoV-2 pandemic severely disrupted society and the health care system. In addition to epidemiological changes, little is known about the pandemic's effects on the trauma care chain. Therefore, in addition to epidemiology and aetiology, this study aims to describe the impact of the SARS-CoV-2 pandemic on prehospital times, resource use and outcome. Methods A multicentre observational cohort study based on the Dutch Nationwide Trauma Registry was performed. Characteristics, resource usage, and outcomes of trauma patients treated at all trauma-receiving hospitals during the first (W1, March 12 through May 11) and second waves (W2, May 12 through September 23), as well as the interbellum period in between (INT, September 23 through December 31), were compared with those treated from the same periods in 2018 and 2019. Results The trauma caseload was reduced by 20% during the W1 period and 11% during the W2 period. The median length of stay was significantly shortened for hip fracture and major trauma patients (ISS >= 16). A 33% and 66% increase in the prevalence of minor self-harm-related injuries was recorded during the W1 and W2 periods, respectively, and a 36% increase in violence-related injuries was recorded during the INT. Mortality was significantly higher in the W1 (2.9% vs. 2.2%) and W2 (3.2% vs. 2.7%) periods. Conclusion The imposed restrictions in response to the SARS-CoV-2 pandemic led to diminished numbers of acute trauma admissions in the Netherlands. The long-lasting pressing demand for resources, including ICU services, has negatively affected trauma care. Further caution is warranted regarding the increased incidence of injuries related to violence and self-harm. Show less
Aim: To investigate the health-related quality of life (HRQOL) of Dutch adult childhood cancer survivors (CCS) and to identify risk factors of impaired HRQOL.Methods: Adult CCS (age >18,... Show moreAim: To investigate the health-related quality of life (HRQOL) of Dutch adult childhood cancer survivors (CCS) and to identify risk factors of impaired HRQOL.Methods: Adult CCS (age >18, diagnosed <18, >= 5 years since diagnosis) from the Dutch LATER registry completed the Medical Outcome Study Short Form 36 (SF-36) to measure HRQOL and provided sociodemographic characteristics. Age-adjusted mean SF-36 scale scores of CCS were compared to the Dutch general population for men and women separately using t-tests, with effect size d. Multivariate logistic regression models were built to identify sociodemographic and cancer-related risk factors for impaired physical and mental HRQOL.Results: Both male and female CCS (N = 2301, mean age = 35.4 years, 49.6% female) reported significantly (p <= .005) worse HRQOL than the general population on almost all scales of the SF-36 (-.11 <= d <= -.56). Largest differences were found on vitality and general health perceptions. Significant risk factors (p <= .05) for impaired physical HRQOL were female sex, older age at diagnosis, not having a partner, low educational attainment, disease recurrence and exposure to radiotherapy, specifically to lower extremity radiation. Odds ratios (ORs) ranged from 1.6 to 3.7. Significant risk factors for impaired mental HRQOL were age 26-35 years, male sex, not having a partner and low educational attainment. ORs ranged from 1.3 to 2.0.Conclusion: Adult CCS had worse HRQOL than the general population. CCS most at risk were those with low educational attainment and without a partner. Adult CCS could benefit from routine surveillance of their HRQOL. Special attention for CCS' vitality and health perceptions and beliefs is warranted. (C) 2021 The Author(s). Published by Elsevier Ltd. Show less
Nies, M.; Cantineau, A.E.P.; Arts, E.G.J.M.; Berg, M.H. van den; Leeuwen, F.E. van; Kobold, A.C.M.; ... ; Links, T.P. 2020
Background: Differentiated thyroid carcinoma (DTC) during childhood is a rare disease. Its excellent survival rate requires a focus on possible long-term adverse effects. This study aimed to... Show moreBackground: Differentiated thyroid carcinoma (DTC) during childhood is a rare disease. Its excellent survival rate requires a focus on possible long-term adverse effects. This study aimed to evaluate fertility in female survivors of childhood DTC by assessing various reproductive characteristics combined with anti-Mullerian hormone (AMH) levels (a marker of ovarian reserve).Methods: Female survivors of childhood DTC, diagnosed at <= 18 years of age between 1970 and 2013, were included. Survivors were excluded when follow-up time was less than five years or if they developed other malignancies before or after diagnosis of DTC. Survivors filled out a questionnaire regarding reproductive characteristics (e.g., age at menarche and menopause, pregnancies, pregnancy outcomes, need for assisted reproductive therapy). Survivors aged Results: Fifty-six survivors with a median age of 31.0 (interquartile range, IQR, 25.1-39.6) years were evaluated after a median follow-up of 15.4 (IQR 8.3-24.7) years. The median cumulative dose of I-131 administered was 7.4 (IQR 3.7-13.0) GBq/200.0 (IQR 100.0-350.0) mCi. Twenty-five of the 55 survivors aged 18 years or older during evaluation reported 64 pregnancies, 45 of which resulted in live birth. Of these 55, 10.9% visited a fertility clinic. None of the survivors reported premature menopause. Age at AMH evaluation did not differ between DTC survivors and the comparison group (p = 0.268). Median AMH levels did not differ between DTC survivors and the comparison group [2.0 (IQR 1.0-3.7) mu g/L vs. 1.6 (IQR 0.6-3.1) mu g/L, respectively, p = 0.244]. The cumulative dose of I-131 was not associated with AMH levels in DTC survivors (r(s) = 0.210, p = 0.130).Conclusions: Female survivors of DTC who received I-131 treatment during childhood do not appear to have major abnormalities in reproductive characteristics nor in predictors of ovarian failure. Show less
Little information is available on the use of appropriate comparison groups for studies investigating late effects of childhood cancer. Two comparison groups in a nationwide study on reproductive... Show moreLittle information is available on the use of appropriate comparison groups for studies investigating late effects of childhood cancer. Two comparison groups in a nationwide study on reproductive function and ovarian reserve in female childhood cancer survivors were recruited (The Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer Cohort Study). Experiences of this process are reported. Two types of comparison groups were used: sisters of participating survivors and controls from the general population. A total of 352 out of 580 (61%) of the participating survivors who had a sister gave permission to invite them for the study. The participation rate of sisters was much higher than control participants from the general population (74% versus 21%, respectively), whereas considerably more effort was involved in recruiting controls from the general population. Participants in this group were significantly older and more highly educated than sister controls (P < 0.001 for both groups). No significant differences were observed between both types of comparison groups in several fertility-related characteristics, suggesting minimal bias owing to selective participation. Researchers setting up a study to investigate late effects among survivors of childhood cancer should carefully consider the advantages and disadvantages of using various types of comparison groups. Show less
Overbeek, A.; Berg, M.H. van den; Hukkelhoven, C.W.P.M.; Kremer, L.C.; Heuvel-Eibrink, M.M. van den; Tissing, W.J.E.; ... ; DCOG LATER VEVO Study Grp 2013
Studies on the effectiveness of information provision for patients with arthritis through the Internet are scarce. This study aimed to describe rheumatoid arthritis (RA) patients' knowledge and... Show moreStudies on the effectiveness of information provision for patients with arthritis through the Internet are scarce. This study aimed to describe rheumatoid arthritis (RA) patients' knowledge and information needs before and after launching a website providing information on regional health care services for patients with rheumatic conditions. The intervention consisted of a weekly updated website comprising practical information on regional health care services for patients with arthritis. In addition, patients were offered information leaflets and an information meeting. Before (T1) and 24 months after (T2) the website was launched, a random sample of 400 RA patients filled in a questionnaire regarding knowledge and information need (scores 0-18) about accessibility and contents of 18 regional health care services. Two hundred and fifty-one patients returned the questionnaire (response rate 63%) at T1 and 200 patients (50%) at T2, respectively, with 160 paired observations (112 females (70%), mean age 60.4 years (SD 9.9)). The total score for insufficient knowledge about contents decreased from 9.3 (SD 4.9) to 8.5 (SD 4.8; p = 0.03) and for accessibility from 8.6 (SD 4.7) to 8.4 (SD 4.9; p = 0.59). Total score for information need about contents decreased from 4.2 (SD 4.5) to 1.9 (SD 2.9; p < 0.01) and for accessibility from 3.6 (SD 4.5) to 1.4 (SD 2.4; p < 0.01) (paired t-tests).After the administration of a website comprising practical health care information, RA patients' information need and to a lesser extent their perception of having insufficient knowledge on relevant regional health care services decreased significantly. The results of this descriptive study suggest that the use of the Internet to inform patients may be effective, although controlled studies are required to evaluate and optimize web-delivered information. Show less
Berg, M.H. van den; Overbeek, A.; Pal, H.J. van der; Versluys, A.B.; Bresters, D.; Leeuwen, F.E. van; ... ; Dulmen-den Broeder, E. van 2011
Objectives. To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA. Methods. This follow-up study was a... Show moreObjectives. To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA. Methods. This follow-up study was a randomized comparison of an Internet-based individualized training (IT) and a general training (GT) programme in sedentary RA patients. Outcome measures included physical activity (meeting public health recommendations for moderate physical activity, i.e. 30 min for at least 5 days/week; or vigorous physical activity, i.e. 20 min for at least 3 days/week), functional ability and quality of life (QoL). Results. Of the 152 RA patients who completed the initial study, 110 (72%) were available at follow-up. At 24 months, the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups (19 and 24%, respectively, P < 0.05), whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group (P < 0.05) but not in the GT group. There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months. Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline, there were no significant differences within or between the programmes regarding functional ability or QoL. Conclusion. In RA patients, the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions. Show less
The aim of the thesis was to study: 1. The engagement of patients with RA in various forms of physical activity and their preferences regarding the delivery of physical activity interventions; 2.... Show moreThe aim of the thesis was to study: 1. The engagement of patients with RA in various forms of physical activity and their preferences regarding the delivery of physical activity interventions; 2. The evidence regarding the effectiveness of physical activity interventions delivered by means of the Internet in general and for patients with RA in particular; 3. Barriers and facilitators for the broader implementation of physical activity interventions in patients with arthritis. The thesis is divided into two parts. Part 1 describes the current engagement of RA patients with various types of physical activity. In Chapter 2 the results of a study comparing RA patients__ physical activity levels with those of the general Dutch population are presented. Chapter 3 describes the participation and preferences regarding various types of leisure-time physical activity in patients with RA. Part 2 focuses on a specific, innovative strategy to promote physical activity, i.e. enhancing physical activity levels by means of interventions delivered through the Internet. In Chapter 4 the results of a randomised controlled trial, comparing the effectiveness of two Internet-based physical activity interventions for patients with RA, are described. Chapter 5 describes RA patients__ engagement and satisfaction with one of these physical activity interventions. Chapter 6 presents the results of a systematic literature review concerning the effectiveness of Internet-based physical activity interventions for healthy people as well as people with chronic conditions. In Chapter 7 barriers and facilitators regarding the implementation of physical activity interventions for people with arthritis are described and illustrated by means of a case study. Finally, a summary of the results and a general discussion are given in Chapter 8. Show less
