Background: Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to... Show moreBackground: Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes. Methods: We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses. Results: In the study population of 4172 women, we identified five latent classes. The largest 'healthy and socioeconomically stable'-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes 'high care utilization' [n = 485 (11.6%)], 'socioeconomic vulnerability' [n = 395 (9.5%)] and 'psychosocial vulnerability' [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the 'multidimensional vulnerability'-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section. Conclusions: Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support. Show less
Molenaar, J.M.; Meer, L. van der; Bertens, L.C.M.; Vries, E.F. de; Waelput, A.J.M.; Knight, M.; ... ; Struijs, J.N. 2022
BackgroundEarly detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children’s development and health. We aimed to identify... Show moreBackgroundEarly detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children’s development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes.MethodsWe conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses.ResultsIn the study population of 4172 women, we identified five latent classes. The largest ‘healthy and socioeconomically stable’-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes ‘high care utilization’ [n = 485 (11.6%)], ‘socioeconomic vulnerability’ [n = 395 (9.5%)] and ‘psychosocial vulnerability’ [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the ‘multidimensional vulnerability’-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section.ConclusionsCo-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support. Show less
Ploeg, C.P.B. van der; Grevinga, M.; Eekhout, I.; Vlasblom, E.; Lanting, C.I.; Minderhout, H.M. van; ... ; Verkerk, P.H. 2021
Background: Little is known about costs and effects of vision screening strategies to detect amblyopia. Aim of this study was to compare costs and effects of conventional (optotype) vision... Show moreBackground: Little is known about costs and effects of vision screening strategies to detect amblyopia. Aim of this study was to compare costs and effects of conventional (optotype) vision screening, photoscreening or a combination in children aged 3-6 years. Methods: Population-based, cross-sectional study in preventive child health care in The Hague. Children aged 3 years (3y), 3 years and 9 months (3y9m) or 5-6 years (5/6y) received the conventional chart vision screening and a test with a photoscreener (Plusoptix 512C). Costs were based on test duration and additional costs for devices and diagnostic work-up. Results: Two thousand, one hundred and forty-four children were included. The estimated costs per child screened were (sic)17.44, (sic)20.37 and (sic)6.90 for conventional vision screening at 3y, 3y9m and 5/6y, respectively. For photoscreening, these estimates were (sic)6.61, (sic)7.52 and (sic)9.40 and for photoscreening followed by vision screening if the result was unclear (combination) (sic)9.32 (3y) and (sic)9.33 (3y9m). The number of children detected with amblyopia by age were 9, 14 and 5 (conventional screening), 6, 13 and 3 (photoscreening) and 10 (3y) and 15 (3y9m) (combination), respectively. The estimated costs per child diagnosed with amblyopia were (sic)1500, (sic)1050 and (sic)860 for conventional vision screening, (sic)860, (sic)420 and (sic)1940 for photoscreensic)ing and (sic)730 (3y) and (sic)450 (3y9m) for the combination. Conclusions: Combining photoscreening with vision screening seems promising to detect amblyopia in children aged 3y/3y9m, whereas conventional screening seems preferable at 5/6y. As the number of study children with amblyopia is small, further research on the effects of these screening alternatives in detecting children with amblyopia is recommended. Show less
Kool, R.B.; Verkerk, E.W.; Meijs, J.; Gorp, N. van; Maessen, M.; Westert, G.; ... ; Dulmen, S. van 2020
Background: There have been contributions to quantify the volume of low-value care practices in the USA, Canada and Australia but we have no knowledge about the volume in Europe. The purpose of... Show moreBackground: There have been contributions to quantify the volume of low-value care practices in the USA, Canada and Australia but we have no knowledge about the volume in Europe. The purpose of this study was to assess the volume and variation of Dutch low-value care practices. Methods: We conducted a cross-sectional study with data of a Dutch healthcare insurance company from general practioners (GP's) and hospitals in the Netherlands from 2016. We used all billing claims made by healthcare providers of 3.5 million Dutch inhabitants. We studied Choosing Wisely recommendations in order to select low-value care practices. We used the percentage low-value care practices per hospital and number of low-value care practices per GP as outcomes. Results: We assessed the volume of low-back imaging by GPs, screening of patients over 75 years for colorectal cancer and diagnosing varices with Doppler or Plethysmography. We found that 0.4% (range 0-7%) of the eligible patients received low-value screening for colorectal cancer and 8.0% (range 0-88%) of eligible patients received low-value diagnosing of varices. About 52.4% of the GPs ordered X-rays and 11.2% ordered magnetic resonance imagings of the lumbosacral spine. Most healthcare providers did not provide the measured low-value care practices. However, 1 in 12 GPs ordered at least one low-back X-ray a week. Conclusions: The three Choosing Wisely recommendations showed a lot of practice variation; many healthcare providers did not order these low-value diagnostic tests; a minor part did order a substantial amount, low-back spine radiology in particular. These healthcare providers should start reducing these activities. Show less
Wilde, J.A. de; Eilander, M.; Middelkoop, B.J.C. 2019
Background: Studies on the influence of neighbourhood socioeconomic status (N-SES) on overweight and obesity rates in children from different ethnic backgrounds are scarce. This study investigated... Show moreBackground: Studies on the influence of neighbourhood socioeconomic status (N-SES) on overweight and obesity rates in children from different ethnic backgrounds are scarce. This study investigated the differential effect of N-SES on overweight (including obesity) and obesity prevalence in different ethnic groups, and if N-SES explains ethnic differences in the prevalence of overweight and obesity. Design: A population based study of 109 766 body mass index (BMI) measurements of 86 209 children 2-15 years of Dutch, Turkish, Moroccan and South Asian descent. BMI class was determined with The International Obesity Task Force, and South Asian specific BMI cutoffs. WHO BMI criteria were applied for reference purposes. The effect of N-SES on prevalence rates was studied with generalized linear mixed models. Results: Neighbourhood SES was negatively associated with overweight and obesity. However, the effect of N-SES on overweight was stronger in Dutch children (OR 0.75, 95% CI 0.73-0.77) than in Turkish (OR 0.86, 95% CI 0.82-0.90), Moroccan (OR 0.91, 95% CI 0.86-0.97) and South Asian (OR 0.90, 95% CI 0.84-0.96) children. The influence of N-SES on obesity showed a similar pattern, except for Moroccan children in whom obesity prevalence remained stable over the whole N-SES range. At the same N-SES, overweight and obesity prevalence was significantly higher in Turkish, Moroccan and especially South Asian children compared with Dutch children. Adjusting for N-SES attenuated the ethnic differences. Conclusions: Neighbourhood SES was negatively associated with overweight and obesity rates in all ethnic groups, but only partly explained the ethnic differences in overweight and obesity prevalence. Show less
Bergen, A.P.L. van; Wolf, J.R.L.M.; Badou, M.; Wilde-Schutten, K. de; IJzelenberg, W.; Schreurs, H.; ... ; Hemert, A.M. van 2019
Background: Social exclusion (SE), or the inability to participate fully in society, is considered one of the driving forces of health inequalities. Systematic evidence on this subject is pertinent... Show moreBackground: Social exclusion (SE), or the inability to participate fully in society, is considered one of the driving forces of health inequalities. Systematic evidence on this subject is pertinent but scarce. This review aims to systematically summarise peer reviewed studies examining the association between the multidimensional concepts of SE and social inclusion (SI) and health among adults in EU and OECD countries. Methods: The protocol was registered on Prospero (CRD42017052718). Three major medical databases were searched to identify studies published before January 2018, supplemented by reference and citation tracking. Articles were included if they investigated SE or SI as a multidimensional concept with at least two out of the four dimensions of SE/SI, i.e. economic, social, political and cultural. A qualitative synthesis was conducted. Results: Twenty-two observational studies were included. In the general population, high SE/low SI was associated with adverse mental and general health. For physical health, the evidence was inconclusive. In groups at high risk of SE, support was found for the association between high SE/low SI and adverse mental health but no conclusions could be drawn for physical and general health. Conclusions: This review found evidence for the association between high SE/low SI and adverse health outcomes, particularly mental health outcomes. The evidence is mainly based on cross-sectional studies using simple and often ad hoc indicators of SE/SI. The development and use of validated measures of SE/SI and more longitudinal research is needed to further substantiate the evidence base and gain better understanding of the causal pathways. Show less
Wilde, J.A. de; Meeuwsen, R.C.; Middelkoop, B.J. 2018
Background: Objective of this study was to assess the degree to which preventive child health professionals (CHPs) identify and act upon psychosocial problems among young toddlers in the general... Show moreBackground: Objective of this study was to assess the degree to which preventive child health professionals (CHPs) identify and act upon psychosocial problems among young toddlers in the general population and to determine the concordance with parent-reported behavioural and emotional problems. Also, associations of psychosocial problems with socio-demographic factors, and (mental) health history of the toddlers were studied. Methods: CHPs examined a national sample of children aged 14 months and interviewed their parents during the routine health assessments. Identification of and action upon psychosocial problems by CHPs were registered. The Infant-Toddler Social and Emotional Assessment (ITSEA) was completed by the parents. Data were available on 701 Dutch 14-month-old toddlers. Results: In 7.6% of all toddlers, CHPs identified one or more psychosocial problems. Forty-seven percent of identified children were referred to another professional or received follow-up. Identification of psychosocial problems and subsequent action were 3-16 times more likely in children with clinical parent-reported problem behaviour according to the Dutch adapted version of the ITSEA. Also, past or current professional care for psychosocial problems was associated with the CHPs' identification or action. Associations with socio-demographic variables were weak. Conclusion: The CHPs frequently identify psychosocial problems in 14-month-old toddlers, but they miss many cases of parent-reported problems as measured by a clinical ITSEA score. This general population study shows substantial room for improvement in the early identification of psychosocial problems in young toddlers. Show less
Zwart, J.J.; Jonkers, M.D.; Richters, A.; Ory, F.; Bloemenkamp, K.W.; Duvekot, J.J.; Roosmalen, J. van 2010
BACKGROUND: There are concerns about ethnic disparity in outcome of obstetric health care in high-income countries. Our aim was to assess these differences in a large cohort of women having... Show moreBACKGROUND: There are concerns about ethnic disparity in outcome of obstetric health care in high-income countries. Our aim was to assess these differences in a large cohort of women having experienced severe acute maternal morbidity (SAMM) during pregnancy, delivery and puerperium. METHODS: All women experiencing SAMM were prospectively collected in a nationwide population-based design from August 2004 to August 2006. Women delivering in the same period served as reference cohort. Population-based risks were calculated by ethnicity and by type of morbidity. Additionally, non-Western and Western women having experienced SAMM were compared in multivariable logistic regression analysis. RESULTS: All 98 Dutch maternity units participated. There were 371 021 deliveries during the study period. A total of 2506 women with SAMM were included, 21.1% of whom were non-Western immigrants. Non-Western immigrants showed a 1.3-fold [95% confidence interval (CI) 1.2-1.5] increased risk to develop SAMM. Large differences were observed among different ethnic minority groups, ranging from a non-increased risk for Moroccan and Turkish women to a 3.5-fold (95% CI 2.8-4.3) increased risk for sub-Saharan African women. Low socio-economic status, unemployment, single household, high parity and prior caesarean were independent explanatory factors for SAMM, although they did not fully explain the differences. Immigration-related characteristics differed by ethnic background. CONCLUSIONS: Non-Western immigrants have an increased risk of developing SAMM as compared to Western women. Risks varied largely by ethnic origin. Immigration-related characteristics might partly explain the increased risk. The results suggest that there are opportunities for quality improvement by targeting specific disadvantaged groups. Show less
