In response to the shortage of nursing staff and the so-called refugee crisis in 2015, two residential homes invited first-generation immigrants with a refugee background to participate in a... Show moreIn response to the shortage of nursing staff and the so-called refugee crisis in 2015, two residential homes invited first-generation immigrants with a refugee background to participate in a project for nursing education, orientation and internships. Between 2015 and 2018, a group of ten immigrants started working in a Dutch residential home and a group of seventeen immigrants in the German home. This dissertation investigates the social processes when these newcomers start working with the established staff, as well as the extent to which their mutual interactions and values of good care influence the enactment of geriatric care. Using ethnographic observations (305 hours), in-depth interviews (44) and six focus groups (24), the established care workers and immigrants were followed in both homes. The empirical data shows that institutional constraints, such as staff shortage, the imposition of professional norms, gossip used as a ‘weapon of the weak’, mutual suspicions of indifference, and collective images of ‘us’ versus ‘them’ affected the enactment of geriatric care. Their habitus stimulated them to tinker among each other as well as with different, sometimes conflicting, values of good care. However, both groups shared the feeling of ignorance by management, a pain of not mattering. Show less
In this project we examine whether homicide ‘clusters together’ with other adverse health outcomes in the Netherlands, focusing on child mortality, suicide, sexual risk behavior, and substance... Show moreIn this project we examine whether homicide ‘clusters together’ with other adverse health outcomes in the Netherlands, focusing on child mortality, suicide, sexual risk behavior, and substance abuse. We expect moderate-to-strong correlations between homicide and the other adverse health phenomena (hypothesis 1). Further, we expect that these correlations will be reduced when social disorganization is controlled for (hypothesis 2).The study used population-level data between the years 1996 and 2019, for each of the 40 local regions of the Netherlands. We applied a multilevel correlation procedure to evaluate correlations between homicide and the other adverse health outcomes. Correlations between homicide and the other adverse health outcomes were modest. That is, we found only limited evidence for clustering between homicide and the other adverse health outcomes. The patterns of clustering that did occur, suggested that social disorganization in the region promotes risk-taking behaviors in the population, which ultimately increases rates of homicide, abuse of illegal drugs and births to adolescent parents.Project materials, syntax and supplementary information can be found on the Open Science Framework at https://osf.io/jd5yu/. Show less
Jonas, P.; Savigne, E.G.; Koster, M.; Choonara, I. 2022
Over the past ten years, seven Dutch Universities have built a sustainable exchange with seven institutes in Cuban healthcare. The exchange was initiated by the Leiden University Medical Centre and... Show moreOver the past ten years, seven Dutch Universities have built a sustainable exchange with seven institutes in Cuban healthcare. The exchange was initiated by the Leiden University Medical Centre and the University of Medical Sciences of Havana. Cooperation with Cuba was chosen as Cuba has excellent primary healthcare and has a strong focus on prevention and public health. These were considered important due to the major contribution of non-communicable diseases to morbidity and mortality in the Netherlands. Exchanges have occurred with Dutch health professionals and students visiting Cuban healthcare institutions and Cuban postgraduate students studying in the Netherlands. There has been an increased awareness of the importance of public health and prevention in Dutch professional organizations following the exchange. The exchange has also helped to break the scientific and economic US blockade of Cuba and resulted in joint publications. In this review we described the process, key aspects, results and lessons learned in this process. Collaboration between Cuba (a middle income) and the Netherlands (a high-income country) is possible. Show less
The impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires... Show moreThe impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires hospital and/or ICU admission, results in prolonged and chronic illness, or leads to premature death. We aimed to quantify the total disease burden of acute COVID-19 in the Netherlands in 2020 using the disability-adjusted life-years (DALY) measure, and to investigate how burden varies between age-groups and occupations. Using standard methods and diverse data sources (mandatory notifications, population-level seroprevalence, hospital and ICU admissions, registered COVID-19 deaths, and the literature), we estimated years of life lost (YLL), years lived with disability, DALY and DALY per 100,000 population due to COVID-19, excluding post-acute sequelae, stratified by 5-year age-group and occupation category. The total disease burden due to acute COVID-19 was 286,100 (95% CI: 281,700-290,500) DALY, and the per-capita burden was 1640 (95% CI: 1620-1670) DALY/100,000, of which 99.4% consisted of YLL. The per-capita burden increased steeply with age, starting from 60 to 64 years, with relatively little burden estimated for persons under 50 years old. SARS-CoV-2 infection and associated premature mortality was responsible for a considerable direct health burden in the Netherlands, despite extensive public health measures. DALY were much higher than for other high-burden infectious diseases, but lower than estimated for coronary heart disease. These findings are valuable for informing public health decision-makers regarding the expected COVID-19 health burden among population subgroups, and the possible gains from targeted preventative interventions. Show less
Heus, E. de; Duijts, S.F.A.; Zwan, J.M. van der; Kapiteijn, E.; Dijkum, E.J.M.N. van; Herpen, C.M.L. van; Merkx, M.A.W. 2022
Introduction: Epidemiological discrepancies exist between rare and common can-cers. The aim of this population-based study was to compare rare versus common adult solid cancers in the Netherlands,... Show moreIntroduction: Epidemiological discrepancies exist between rare and common can-cers. The aim of this population-based study was to compare rare versus common adult solid cancers in the Netherlands, by providing incidence, prevalence and survival rates, evaluating trends in survival and comparing individual entities within domains and families.Methods: All adult patients with malignant solid cancers in the Netherlands between 1995 and 2019 were identified from the Netherlands Cancer Registry. Data on patient, tumour and treatment characteristics were collected, and relative survival and survival trends were ana-lysed.Results: A total of 170,628 patients with rare adult solid cancers and 806,023 patients with common adult solid cancers were included. Rare cancers accounted for 18% of all cancer di-agnoses (mean incidence), and 15% of the total ten-year cancer prevalence during 2010-2019. Overall 5-year survival was worse for rare cancers than for common cancers (52.0% versus 68.7%). Between 1995-1999 and 2015-2019, 5-year survival rates for rare cancers increased to a lesser extent (from 46.2% to 52.6%, i.e. 6.4%) than for common cancers (56.9% Show less
Osong, B.; Masciocchi, C.; Damiani, A.; Bermejo, I.; Meldolesi, E.; Chiloiro, G.; ... ; Soest, J. van 2022
Background and Purpose: Tumor recurrence, a characteristic of malignant tumors, is the biggest concern for rectal cancer survivors. The epidemiology of the disease calls for a pressing need to... Show moreBackground and Purpose: Tumor recurrence, a characteristic of malignant tumors, is the biggest concern for rectal cancer survivors. The epidemiology of the disease calls for a pressing need to improve healthcare quality and patient outcomes. Prediction models such as Bayesian networks, which can probabilistically reason under uncertainty, could assist caregivers with patient management. However, some concerns are associated with the standard approaches to developing these structures in medicine. Therefore, this study aims to compare Bayesian network structures that stem from these two techniques. Materials and Methods: A retrospective analysis was performed on 6754 locally advanced rectal cancer (LARC) patients enrolled in 14 international clinical trials. Local tumor recurrence at 2, 3, and 5-years was defined as the endpoints of interest. Five rectal cancer treating physicians from three countries elicited the expert structure. The algorithmic structure was inferred from the data with the hill-climbing algorithm. Structural performance was assessed with calibration plots and area under the curve values. Results: The area under the curve for the expert structure on the training and validation data was above 0.9 and 0.8, respectively, for all the time points. However, the algorithmic structure had superior predictive performance over the expert structure for all time points of interest. Conclusion: We have developed and internally validated a Bayesian networks structure from experts' opinions, which can predict the risk of a LARC patient developing a tumor recurrence at 2, 3, and 5 years. Our result shows that the algorithmic-based structures are more performant and less interpretable than expert based structures. Show less
This qualitative case study uses a life-course approach to explore syndemic vulnerability in a former fishing village in the Netherlands. Building on four years of fieldwork in a low-income... Show moreThis qualitative case study uses a life-course approach to explore syndemic vulnerability in a former fishing village in the Netherlands. Building on four years of fieldwork in a low-income neighborhood, we explored salient themes between and across families and generations. Elderly community members (> 65 years) were interviewed to map village history and explore how contextual factors have affected family life, health, and wellbeing since the 1940s. We systematically traced and compared processes leading to or from syndemic vulnerability by studying seven families across three generations. Adults with at least one of clustering diseases, their parents (when possible), and their children participated in semi-structured life-course interviews. A complex interaction of endemic social conditions, sociocultural normative processes, learned health be-haviors, and disheartening life events shaped families' predispositions for a syndemic of psychological distress, cardiometabolic conditions, and musculoskeletal pain. Educational attainment, continued social support, and aspirational capabilities emerged as themes related to decreasing syndemic vulnerability. This study demonstrates that syndemic vulnerability is potentially intergenerational and reveals the need for culturally sensitive and family-focused syndemic interventions. Future longitudinal research should focus on unravelling the pathogenesis of the clustering of psychological distress, cardiometabolic conditions, and musculoskeletal pain among young people. Show less
Bertus Haverkort groeide op in een boerengezin in Slagharen. Hij genoot van modernisering op de boerderij van zijn jeugd, omdat dit het werk verlichte en de opbrengsten verbeterde. Met in zijn... Show moreBertus Haverkort groeide op in een boerengezin in Slagharen. Hij genoot van modernisering op de boerderij van zijn jeugd, omdat dit het werk verlichte en de opbrengsten verbeterde. Met in zijn bagage een dosis moderne landbouwkennis uit Wageningen, werkte hij aan programma’s in de tropen waarbij overdracht van westerse kennis het doel was. De aanpak blijkt niet te werken. Hij plaatst vraagtekens bij de toepasbaarheid van de westerse kennis in situaties waar de ecologie, economie en cultuur zoveel verschillen. In samenwerking met lokale deskundigen uit India, Bolivia en Ghana wordt onderzocht hoe lokale wereldbeelden, waarden en kennis een rol spelen. Daarvoor wordt gewerkt aan een onderwijsmethode voor endogene ontwikkeling en aan een benadering voor co-creatie van wetenschappen uit verschillende tradities en wereldstreken. De internationale ervaringen worden in verband gebracht met de huidige crisis in de landbouw in Nederland en monden uit een pleidooi voor klimaat- en natuurvriendelijke landbouw. Show less
Jongenelen, R.G.L.; Leighton, T.; Veldkamp, F. 2022
