This thesis provides an overview of the current epidemiology of neonatal NI, including CLABSI. While highlighting the importance of this complication, it has laid the foundation for the development... Show moreThis thesis provides an overview of the current epidemiology of neonatal NI, including CLABSI. While highlighting the importance of this complication, it has laid the foundation for the development and evaluation of several prevention and reduction strategies. The incidence of sepsis among certain neonatal subpopulations such as neonates with hemolytic disease of the fetus and newborn remains high, illustrating the need to re-calibrate indications for central-line placement and CLABSI prevention measures. In contrast to what was hypothesized, a significant positive effect of several interventions and changes in clinical practice, including the implementation of single-room care and a multi-modal strategy, could not be supported. On the other hand, support was found for behavioral change tools such as ‘nudges’ which seem to be a more promising avenue in the reduction of NI, providing such tools can be tailored to the clinical micro-system and context-specific needs of NICU-healthcare workers. Furthermore, nationwide CLABSI surveillance provided a unique insight into the current burden of neonatal CLABSI in The Netherlands, although the optimization of digital infrastructures, data availability and accessibility are urgently needed to perform forthcoming benchmarking initiatives. Even though much progress has been made, we are far from done in the battle against neonatal NI. Show less
This thesis showed that there appears much room for improvement in optimizing physical activity and exercise of people with axial spondyloarthritis (axSpA), both in patients using and not using... Show moreThis thesis showed that there appears much room for improvement in optimizing physical activity and exercise of people with axial spondyloarthritis (axSpA), both in patients using and not using individual physical therapy and axSpA-specific group exercise. Although recommended, only a minority engages in high-intensity aerobic physical activity and in strengthening and mobility exercise with the recommended frequency. This is also the case in people with axSpA using physical therapy. Furthermore, certain evidence-based enhancements in axSpA-specific exercise groups seem warranted. A pilot implementation of these enhancements was found to be partially successful and a number of barriers remain to be overcome in a larger-scale implementation. Because only a small minority of people with axSpA participate in such exercise groups, it is also desired to implement modifications to individual physical therapy as well as interventions in which people with axSpA can participate independently (without supervision). A number of components of such interventions were identified in this thesis. Show less
Physical activity is effective in preventing and treating many of these age-related diseases. However, two thirds of Dutch older adults do not reach the recommended level of physical activity.... Show morePhysical activity is effective in preventing and treating many of these age-related diseases. However, two thirds of Dutch older adults do not reach the recommended level of physical activity. Current efforts to increase physical activity with professional led physical activity interventions are effective during the intervention period, but do not manage to have a sustainable effect. In this thesis we studied the possibility of peer coaching to sustainably increase physical activity in older adults. We do this by studying the effectiveness, implementation and organization of peer coach physical activity intervention. The conclusion of this thesis is that older adults can effectively and sustainably increase physical activity of older adults through peer coach physical activity interventions. After a small investment for implementation, a sustainable self-organising exercise intervention can be created which exist for years. The reach of the groups can be increased through an exercise referral scheme in primary care, but the effectivity needs to be improved through research. Nationwide implementation of exercise groups for older adults is possible, but it requires effort from a large (governmental) party. Show less
Chronic kidney disease (CKD) poses a major challenge to public health. China, a middle-income country, is the largest country globally with a current population of 1.4 billion. China accounts for... Show moreChronic kidney disease (CKD) poses a major challenge to public health. China, a middle-income country, is the largest country globally with a current population of 1.4 billion. China accounts for around one fifth of the global burden of CKD. Hence, eHealth self-management interventions are a great potential to Chinese populations. An extensively studied CKD self-management eHealth intervention is the Dutch ‘Medical Dashboard (MD)’. It has been demonstrated effective in decreasing the burden of CKD. To aim of this thesis is to inform the adaptation and evaluation of a tailored CKD self-management eHealth intervention in China based on the Dutch MD intervention. Specific characteristics and needs (e.g. facilitators and barriers) in Chinese settings need to be addressed to optimize the implementation of CKD self-management eHealth intervention. Emphasis should be placed on addressing the existing paternalistic patient-HCP relationship, stakeholder involvement in the development and implementation process, adjusting eHealth design features to fit the clinical workflows, and providing the needed support and training. This thesis is a vital step towards the design and implementation of a tailored eHealth solution to improve health outcomes of patients with CKD and address the high burden of CKD in China. Show less
Ample research has shown that more household chaos is related to lower parenting quality, but it is yet unknown whether this is a causal relation. This dissertation focuses on two research... Show moreAmple research has shown that more household chaos is related to lower parenting quality, but it is yet unknown whether this is a causal relation. This dissertation focuses on two research questions. The first is whether household chaos has a causal effect on parenting. The second is whether the effect of household chaos on parenting is stronger for parents with certain characteristics, such as high sensory-processing sensitivity (SPS), low self-regulation, and more impulsivity. Two experimental studies were conducted in which household chaos was manipulated. The results show that household chaos affects both positive and negative parenting, but only in demanding parenting situations. Moderation by impulsivity was not found and moderation by SPS and by self-regulation was inconsistent. Regarding SPS, this may exacerbate the effect of household chaos on parenting in case of extreme differences between or high levels of household chaos. Regarding self-regulation, parents with low self-regulation may not have enough self-regulation capacities to simultaneously lower their levels of household chaos and refrain from harsh discipline. These results form a promising vantagepoint for further research, which could eventually lead to prevention and intervention programs to improve parenting by reducing household chaos. Show less
This dissertation aimed to contribute to the quality of foster care addressing three main objectives: The first objective was to investigate if existing parenting interventions are effective in... Show moreThis dissertation aimed to contribute to the quality of foster care addressing three main objectives: The first objective was to investigate if existing parenting interventions are effective in supporting/improving parenting and child outcomes in foster care using a meta-analytic approach. The second objective was to study the effectiveness of an adapted version of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) for foster care, i.e., VIPP-FC. The implementation of VIPP-SD in different types of families and in childcare settings was first reviewed, with special attention to VIPP-FC. Subsequently, the study protocol of the randomized controlled trial (RCT) investigating the effectiveness of VIPP-FC was described. In addition, the results of this RCT regarding the effectiveness of VIPP-FC on parenting behavior and attitudes were presented. The third objective was to examine correlates of indiscriminate friendliness (IF) displayed by foster children. To answer this question, the relations of attachment security, parental sensitivity, and child inhibitory control with IF were examined using data collected during the pretest of the VIPP-FC RCT. Results are described and discussed in different chapters, and implications for clinical practice and recommendations for future research are additionally provided. Show less
This dissertation focused on the role of attachment-based interventions in child protection cases involving young children. The results confirmed that placement decisions are impacted by subjective... Show moreThis dissertation focused on the role of attachment-based interventions in child protection cases involving young children. The results confirmed that placement decisions are impacted by subjective factors, including professionals’ own attitudes and mind-set. Because we argue that the influence of subjective factors can be reduced by inserting relevant evidence into the decision-making process, we tested the effectiveness of one procedure that might produce such information. Evidence for the notion that implementing an attachment-based intervention in parenting capacity assessments can enhance the quality of placement decisions was partially found in this dissertation: We found initial evidence for improved reliability, but not for improved validity, of placement decisions. Taking these findings together with international evidence, we do tentatively conclude that attachment-based interventions can contribute to an improved quality of placement decisions. However, more research is needed to determine what implementation would be most fruitful in the Dutch child protection context. Finally, our finding that maltreating parents with more severe levels of childhood trauma benefited less from an attachment-based intervention implicates that we need to consider families’ individual needs when conducting interventions in this setting. This way, not only more parents will benefit from these interventions, their responses to these interventions might also be a more valid source of information to support placement decisions. Show less
This dissertation highlights that people with intellectual disabilities (ID) generally have the ability and the desire to manage their affairs more independently, which can positively influence... Show moreThis dissertation highlights that people with intellectual disabilities (ID) generally have the ability and the desire to manage their affairs more independently, which can positively influence their lives. Promoting self-management in people with ID therefore deserves more attention. Whereas previous self-management interventions for people with ID mostly focused on teaching singular practical skills, we aimed to target the promotion of overall self-management. Several barriers are experienced when trying to promote this, such as a lack of time for support staff to guide people with ID, and staff and relatives taking over. What seems necessary is more time and support, next to a clear, tailored, and step-by-step approach. Fostering the transfer of learnt skills to daily life also needs to be considered in interventions, as well as involving the support network of relatives and support staff. Staff need to ensure good communication and coordination between all people involved, adopt a tailored approach, positively encourage people with ID during the learning process, and let them handle things as much as possible themselves. In our evaluations of self-management interventions for people with ID, we concluded that these are generally found to be effective. Show less
For decades children with moderate hearing loss (MHL) were “forgotten children”. Most research focused on deaf children and the needs of children with MHL were underestimated. Children with MHL... Show moreFor decades children with moderate hearing loss (MHL) were “forgotten children”. Most research focused on deaf children and the needs of children with MHL were underestimated. Children with MHL have inconsistent access to linguistic input and social-emotional experiences and that place them at risk for developmental difficulties. In the present thesis the psychosocial functioning of toddlers with moderate hearing loss was examined within the context of the caregiving environment. No risk factors were found in the parent-child affective domain: Toddlers with MHL were affected by the emotions of others, they were affectively available to their parents and their parents to them, and their parents did not feel more parental stress than parents of toddlers without hearing loss. Challenges were found in the domain of meaningful social interactions: Toddlers with MHL had more difficulties in understanding the intentions of others and exchanged fewer social-communicative signals. The episodes of joint engagement during parent-child interactions were briefer and parents used less rich language during these interactions than parents of toddlers without hearing loss. To overcome these challenges parents could ready storybooks with their children. An interactive reading program for parents of toddlers with hearing loss showed to be effective in increasing joint engagement. Show less
Childhood obesity remains a major public health concern. To successfully address the childhood obesity epidemic, intersectoral community interventions that take into account the multifactorial... Show moreChildhood obesity remains a major public health concern. To successfully address the childhood obesity epidemic, intersectoral community interventions that take into account the multifactorial aetiology of childhood obesity are needed. However, the implementation of such interventions has proved to be difficult and prone to error. This thesis therefore examines the implementation process of five EPODE-derived intersectoral community approaches targeting childhood obesity in the Netherlands. It focuses on both the level of implementation and determinants of implementation. Quantitative as well as qualitative methods are used, next to novel “in-between” methods such as Quantitative Comparative Analysis and Social Network Analysis. Recommendations are provided on how to design strategies to improve the implementation of intersectoral community approaches, and suggestion for future research initiatives are made. Show less
By first examining civil society’s recently recognized amicus curiae role in addressing the ‘broader’ public interest at stake in investor-state arbitration, this research aims to provide a... Show moreBy first examining civil society’s recently recognized amicus curiae role in addressing the ‘broader’ public interest at stake in investor-state arbitration, this research aims to provide a comprehensive understanding of civil society’s role as practiced hitherto. It then considers whether such role may be equally adequate whenever investor-state arbitrations closely relate to environmental protection, public health, human rights or other public policy issues that could potentially affect the direct interests of certain communities or groups who are third parties to arbitration proceedings. This research therefore scrutinizes civil society’s amicus role and questions whether it constitutes the most enhanced form of access within the jurisdictional ambit set by IIAs or BITs, and whether it may be expanded. It will also consider whether third party intervention necessarily equates to the joinder of an additional party to arbitration proceedings. Show less
Much of the previous work investigating the impact of honor on conflict management has focused on how people endorsing honor values respond to possibly offensive interactions. Despite the... Show moreMuch of the previous work investigating the impact of honor on conflict management has focused on how people endorsing honor values respond to possibly offensive interactions. Despite the accumulation of this research, it is yet unclear why people endorsing the ideal of honor respond more fiercely after being offended. Moreover, hardly any systematic attempts have been undertaken to identify ways in which these negative ramifications of offensive encounters can be prevented or reduced. The discoveries made in the context of this dissertation paint a more balanced picture of the effect of honor concern on conflict management and inform us on possible avenues of effective conflict intervention. Show less
This thesis describes the role of a problem solvingintervention approach in improving quality of work and well-being of healthcare employees. The promising results of a problem solving intervention... Show moreThis thesis describes the role of a problem solvingintervention approach in improving quality of work and well-being of healthcare employees. The promising results of a problem solving intervention as wellas the strength and limitations of it, point at the possible importance ofproblem solving research within the field of health care employeesinterventions. The study limitations that are described in the generaldiscussion, however, also point at the need for carefull interpretation of thestudy results. Therefor, more extensive research is needed to furtherunderstand the interventional and theory based mechanisms that underlie healthcare employees problem solving behaviors. There is stil much more to know aboutthe role of specific problem solving mechanisms in health care interventions.Implementing the results of this thesis in future problem solving studies inhealth care employees might bring the appli cation of problem solving theory inthe field of worksite health promotion up to a next level. Show less
This dissertation examines the use of the military instrument for initiating a state-building process in fragile states as a foundation for stability and basic security. This is done by analysing... Show moreThis dissertation examines the use of the military instrument for initiating a state-building process in fragile states as a foundation for stability and basic security. This is done by analysing the position of the armed intervening parties in Afghanistan in the 2001-2011 period as an empirical and qualitative single-case study. Owing to their weak governmental institutions, instability and lack of basic security, fragile state can represent serious security risks. Events taking place far from national borders of developed states governed by the rule of law can therefore affect the national security situations of those states. Whatever the motive for an armed intervention, before it commences the question must be asked as to whether the intervention force is fit-for-purpose regarding the tasks to be carried out and whether there is a large enough support base, not only for the invasion, but also for the long-term process required for the political consolidation of military results. The intervening force must be capable of kneading this harmonisation into a workable and integrated strategy, giving as much confidence as possible to the legitimate and broadly supported leadership and ownership of the fragile state that was subject of the intervention Show less
The making of commitments is often used as an intervention aimed at increasing pro-environmental behavior. Research shows that when people commit to changing their environmental behaviors, they... Show moreThe making of commitments is often used as an intervention aimed at increasing pro-environmental behavior. Research shows that when people commit to changing their environmental behaviors, they tend to adhere to their commitments. In this dissertation it is investigated whether commitment making is effective in improving agricultural nature conservation and with that, environmental quality of farm lands. Furthermore, a conceptual review is offered, as well as an experimental investigation of the conditions under which people are willing to make such commitments. Results show that commitment making combined with tailored information is indeed effective in improving farmers’ nature conservation. Several explanations of the effect of commitment making on behavior are offered. Also, it is shown that that the willingness to invest in commitment making is contingent on the interplay of dispositional trust and situational expectations. Taken together, this dissertation aims to provide the reader with a perspective on the entire process of commitment making: under which conditions people engage in it, if it is successful in altering behavior, and how it is successful. Show less
Because of the problems associated with chronic benzodiazepine use, there is impetus to prevent and reduce chronic benzodiazepine use. The overall aim was to develop a 'tailor-made' intervention in... Show moreBecause of the problems associated with chronic benzodiazepine use, there is impetus to prevent and reduce chronic benzodiazepine use. The overall aim was to develop a 'tailor-made' intervention in order to reduce chronic use. Before developing tailored patient education, it is first of all important to know which psychosocial factors predict benzodiazepine cessation. The computer-tailored intervention should target and change these determinants. The thesis showed that benzodiazepine users had a greater intention to quit and were more likely to quit their benzodiazepine intake if they perceived many positive consequences of cessation, while at the same time perceiving few negative consequences. In addition, higher self-efficacy was associated with cessation. These determinants were translated into intervention texts on the computer. The computer programme produced single-tailored letters and multiple-tailored letters. Single-tailored letters consisted of one letter of advice and multiple-tailored letters consisted of three different letters with a one-month interval. The multiple-tailored letters took into account the changes in benzodiazepine use over time. The results showed that tailored letters were twice as effective as non-tailored letters in quitting benzodiazepine use, especially in the case of patients who were already intending to quit. We found, however, no differences between single and multiple-tailored letters. Show less
The objective of the research described in this thesis was to study single and cumulative family risk in relation to early childhood externalizing problems and the effectiveness of a parenting... Show moreThe objective of the research described in this thesis was to study single and cumulative family risk in relation to early childhood externalizing problems and the effectiveness of a parenting intervention program. The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) aimed at reducing externalizing problems in 1- to 3-year-old children by enhancing parental sensitivity and adequate discipline strategies. An evaluation of the process of this intervention was also conducted. The study consisted of a screening phase in a general population sample (N = 2408) and a randomized case-control intervention phase in a selected sub-sample of children with high levels of externalizing behaviors (n = 237). The results of this thesis showed that even at an early age, family risk predicted child externalizing behaviors. Cumulative risk longitudinally predicted externalizing behaviors, but was not related to the effectiveness of the intervention. Further, first-time parents (primiparas) profited differently from the intervention than parents with more than one child (multiparas). Finally, a positive alliance between mother and intervener predicted change in positive parenting strategies. Show less
The general objective of this thesis was to test the effectiveness of an early intervention program aimed at reducing externalizing problems in 1- to 3-year-old children by enhancing parental... Show moreThe general objective of this thesis was to test the effectiveness of an early intervention program aimed at reducing externalizing problems in 1- to 3-year-old children by enhancing parental sensitivity and adequate discipline strategies. A new intervention was designed for this study: the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) The study consisted of a screening phase in a general population sample (N = 2408) and a randomized case-control intervention phase in a selected subsample of children with high levels of externalizing behavior problems (n = 237). The results of this thesis show that externalizing problems occur in children as young as 1 year of age and are moderately predictive of externalizing problems one year later. Furthermore, child temperament appears to be a moderator in the association between maternal discipline strategies and externalizing problems. Children with difficult temperaments are more susceptible to both negative discipline (i.e., showing more externalizing problems) and positive discipline (i.e., showing less externalizing problems) compared to children with relatively easy temperaments. Finally, the VIPP-SD intervention was effective in improving maternal attitudes towards sensitivity and sensitive discipline, enhancing actual maternal sensitive discipline practices, and decreasing the children's level of overactive behaviors. Show less
