The overall aim of this dissertation was to study the contribution of a syndemics framework to understanding and addressing persistent health disparities. Departing from an interdisciplinary... Show moreThe overall aim of this dissertation was to study the contribution of a syndemics framework to understanding and addressing persistent health disparities. Departing from an interdisciplinary approach, the dissertation attends to research questions on syndemics indicators, contextual drivers for syndemics, the intergenerational nature of syndemics, and possibilities for early public health interventions in Katwijk, a former fishing town in the Netherlands. An epidemiological study described the three most prevalent disease clusters in Katwijk. A qualitative life course study found a first indication that syndemic vulnerability is potentially intergenerational, and that syndemic processes can be countered. A mixed method study showed that while challenging, a family-engagement approach can elicit positive effects on families’ health and wellbeing. The ethnographic study described the hurdles for implementing family-focused health promotion for multifaceted health conditions, such as childhood obesity. This dissertation establishes that the syndemics framework provides tools to identify past and present factors on the complex pathways to persistent poor health, which in turn point at directions for breaking patterns of generational health. The findings highlight a need for multisystem approaches in which stakeholders develop a thorough understanding of a community’s history and past legacies with institutions, and professionals are equipped with the necessary knowledge, attitudes and skills for community-based and family-focused interventions. Show less
For people with chronic kidney disease (CKD), adhering to a range of self-management tasks—such as healthy eating, frequent physical activity, and non-smoking—is crucial. However, changing health... Show moreFor people with chronic kidney disease (CKD), adhering to a range of self-management tasks—such as healthy eating, frequent physical activity, and non-smoking—is crucial. However, changing health behaviors is difficult. To support patients in doing so, an eHealth care pathway was developed and evaluated. The results provide different insights into patients' priorities and care needs. Many individuals with CKD experience problems in self-management, which can be hindered by many different barriers of which a common one is psychological distress. Therefore, personalized interventions are needed with screening and treatment of both psychological distress and suboptimal self-management, tailored to the specific barriers and needs of the individual patient. The E-GOAL eHealth care pathway is an example of such a personalized intervention, combining cognitive behavioral therapy with self-management support. Patients were enthusiastic about the eHealth care pathway. However, in a randomized study, the intervention was not effective in reducing psychological distress compared with regular care only. Patients did experience improvements in areas of functioning and self-management that they prioritized themselves. These mixed results show that interventions could be implemented that are person-tailored, with personalized outcomes that reflect individually meaningful treatment goals and improvements for every patient. 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
Background: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there... Show moreBackground: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients. In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped.Methods: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status.Findings: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients.Interpretation: Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role. (C) 2021 The Author(s). Published by Elsevier Ltd. Show less
Background: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there... Show moreBackground: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients. In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped.Methods: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status.Findings: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P<0.001; 15.4%; P<0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients.Interpretation: Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role. (C) 2021 The Author(s). Published by Elsevier Ltd. Show less
Our aim was to assess the effect of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty (TKA). We searched studies on the effect of... Show moreOur aim was to assess the effect of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty (TKA). We searched studies on the effect of perioperative interventions focused on psychological distress used in conjunction with TKA on pain, function, and quality of life (QoL) on PubMed, Embase.com, PsycINFO/OVID, CENTRAL, the Cochrane Database of Systematic Reviews, Scopus, and Web of Science. We included 40 studies (22 RCTs, ten cohort studies, and eight quasi-experimental studies) with a total of 3846 patients. We graded the quality of evidence as low for pain and function and as moderate for QoL. Patients receiving music, education, cognitive behavioural therapy, guided imagery, pain coping skills training, Reiki, occupational therapy with self-monitoring, and biofeedback-assisted progressive muscles relaxing training had lower pain scores or declined opioid prescriptions after TKA. Pain coping skills training, audio recording-guided imagery scripts, video promoting self-confidence, psychological therapies by video, Reiki, music, occupational therapy with self-monitoring, education, and psychotherapy improved postoperative functional outcome. Education through an app improved QoL after TKA. The studies in our systematic review show that perioperative interventions targeting psychological distress for patients receiving TKA seem to have a positive effect on postoperative pain, function, and QoL. RCTs with strict methodological safeguards are still needed to determine if perioperative interventions focused on psychological distress should be used in conjunction with TKA. These studies should also assess which type of intervention will be most effective in improving patient-reported outcome measures and declining opioid prescriptions. Show less
The overall goal of the current dissertation is to uncover predictors and outcomes of positive parenting in ethnic minority families. Chapter 2 provides an overview of commonly used observational... Show moreThe overall goal of the current dissertation is to uncover predictors and outcomes of positive parenting in ethnic minority families. Chapter 2 provides an overview of commonly used observational instruments to measure sensitivity, showing the versatility and scientific importance of the construct. The results presented in Chapter 3 suggest that mothers of different cultural backgrounds and socioeconomic groups have a highly similar view on maternal sensitivity. In Chapter 4, the results show that both acculturation stress and general psychological distress mediated the relation between socioeconomic status and positive parenting in Turkish minority families with young children. The results of the empirical study presented in Chapter 5 suggest that family stress processes play a role in adolescents’ behavioral outcomes, whereas family investment processes play a role in adolescents’ cognitive-behavioral outcome in Turkish minority families. Overall, the studies described in this thesis have shown that parenting beliefs and behaviors in ethnic minority families can only be understood in light of factors that are often related to minority status, such as lower socioeconomic status, higher general family stress, and acculturation stress. These factors should be taken into account in research and practice regarding parenting behaviors and child development in ethnic minority families. Show less
In this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202... Show moreIn this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202 patients from different hospitals in the South-West of the Netherlands between 2007-2012. With semi-structured interviews the motives to opt for breast reconstruction were qualitatively investigated. The impact of breast reconstruction was further investigated with psychological questionnaires from baseline to the end of the breast reconstruction procedure (mean follow-up of 21 months). The psychological outcomes after breast reconstruction that were investigated were: body image, satisfaction with the partner relationship and the sexual relationship, general anxiety and depression, cancer distress, and general mental and physical health. In general, the psychological outcomes after breast reconstruction were acceptable, however a subgroup of women experienced psychological adjustment problems. A percentage of 20-30% remained having problems with changes in their body image and the impact on the intimate partner relationship. Women at risk for psychological adjustment problems were younger women, those with significant cancer distress, women who experienced complications after surgery, particularly if the breast reconstruction failed, and women who underwent bilateral prophylactic mastectomy because of an increased hereditary risk to develop breast cancer. Show less
Carlier, I.; Schulte-Van Maaren, Y.; Wardenaar, K.; Giltay, E.; Noorden, M. van; Vergeer, P.; Zitman, F. 2012
