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Development and feasibility of the prenatal video-feedback intervention to promote positive parenting for expectant fathers
Get PDFObjective: the transition period in which men become fathers might provide an important window of opportunity for parenting interventions that may produce long-term positive effects on paternal care and, consequently, child development. Existing prenatal programs traditionally focus on maternal and infant health and seldom involve the father. Study design: This paper describes an interaction-based prenatal parenting intervention program for first-time fathers using ultrasound images, the Prenatal video Feedback Intervention to promote Positive Parenting (VIPP-PRE). We randomised a group of expectant fathers (N = 73) to either the VIPP-PRE or a control condition. Results: Expectant fathers thought the VIPP-PRE was more helpful and influenced their insights into their babies to a greater extent than the control condition. Expectant fathers receiving the VIPP-PRE reported that they particularly liked seeing and interacting with their unborn children as well as receiving feedback on these interactions. The intervention was well received and was considered feasible by both expectant fathers and sonographers and midwives. Discussion: We discuss the VIPP-PRE based on the experiences and perspectives of fathers, interveners, and sonographers and midwives
Influence of sex and phenotype on cardiac outcomes in patients with Fabry disease
Get PDFObjective: This study describes the influence of sex and disease phenotype on the occurrence of cardiac events in Fabry disease (FD). Methods: Cardiac events from birth to last visit (median age 50 years) were recorded for 213 patients with FD. Patients were categorised as follows: men with classical FD (n=57), men with non-classical FD (n=26), women with classical FD (n=98) and women with non-classical FD (n=32), based on the presence of classical FD symptoms, family history (men and women), biomarkers and residual enzyme activity (men). Event rates per 1000 patient-years after the age of 15 years and median event-free survival (EVS) age were presented. Influence of disease phenotype, sex and their interaction was studied using Firth's penalised Cox regression. Results: The event rates of major cardiovascular events (combined endpoint cardiovascular death (CVD), heart failure (HF) hospitalisation, sustained ventricular arrhythmias (SVAs) and myocardial infarction) were 11.0 (95% CI 6.6 to 17.3) in men with classical FD (EVS 55 years), 4.4 (95% CI 2.5 to 7.1) in women with classical FD (EVS 70 years) and 5.9 (95% CI 2.6 to 11.6) in men with non-classical FD (EVS 70 years). None of these events occurred in women with non-classical FD. Sex and phenotype significantly influenced the risk of major adverse cardiovascular event. CVD was the leading cause of death (75%) to which HF contributed most (42%). The overall rate of SVA was low (14 events in nine patients (4%)). Conclusions: Sex and phenotype greatly influence the risk and age of onset of cardiac events in FD. This indicates the need for patient group-specific follow-up and treatment
Impact of interfractional target motion in locally advanced cervical cancer patients treated with spot scanning proton therapy using an internal target volume strategy
Get PDFBackground and purpose: The more localized dose deposition of proton therapy (PT) compared to photon therapy might allow a reduction in treatment-related side effects but induces additional challenges to address. The aim of this study was to evaluate the impact of interfractional motion on the target and organs at risk (OARs) in cervical cancer patients treated with spot scanning PT using an internal target volume (ITV) strategy. Methods and materials: For ten locally advanced cervical cancer patients, empty and full bladder planning computed tomography (pCT) as well as 25 daily cone beam CTs (CBCTs) were available. The Clinical Target Volume (CTV), the High Risk CTV (CTVHR) (gross tumor volume and whole cervix), the non-involved uterus as well as the OARs (bowel, bladder and rectum) were contoured on the daily CBCTs and transferred to the pCT through rigid bony match. Using synthetic CTs derived from pCTs, four-beam spot scanning PT plans were generated to target the patient-specific ITV with 45 Gy(RBE) in 25 fractions. This structure was defined based on pre-treatment MRI and CT to anticipate potential target motion throughout the treatment. D98% of the targets and V40Gy(RBE) of the OARs were extracted from the daily anatomies, accumulated and analyzed. In addition, the impact of bladder volume deviations from planning values on target and bowel dose was investigated. Results: The ITV strategy ensured a total accumulated dose >42.75 Gy(RBE) to the CTVHR for all ten patients. Two patients with large bladder-related uterus motion had accumulated dose to the non-involved uterus of 35.7 Gy(RBE) and 41.1 Gy(RBE). Variations in bowel V40Gy(RBE) were found to be correlated (Pearson r = −0.55; p-value <0.0001) with changes in bladder volume during treatment. Conclusion: The ITV concept ensured adequate dose to the CTVHR, but was insufficient for the non-involved uterus of patients subject to large target interfractional motion. CBCT monitoring and occasional replanning is recommended along the same lines as with photon radiotherapy in cervical cancer
Morbid Obesity: Cardiovascular consequences and safety strategies in the surgical treatment
Get PDFThis thesis focuses on the consequences of morbid obesity on cardiovascular disease on the one hand and different aspects of the surgical treatment of morbid obesity on the other hand
Romeyn de Hooghe (1645-1708) op de bres voor de burgerlijke eenheid: Het politiek-religieuze debat in de Republiek rond 1700 aan de hand van de Spiegel van Staat (1706/07)
Get PDFThis dissertation is an analysis of the political thought of Romeyn de Hooghe. His ideas as expressed in his _Spiegel van Staat_ [Mirror of State] are contextualized by the many public debate at the end of the 17th century. This research show how De Hooghe tries to find a way out of the many polemics with his new civic morality
Burden of providing informal care for patients with atrial fibrillation
Get PDFObjectives: Patients with atrial fibrillation (AF) have rapid and irregular heart rates, increasing the risk of comorbidities and
mortality. Next to formal medical care, many patients receive informal care from their social environment. The objective of
this study was to examine the well-being and economic burden of providing informal care to patients with AF in the UK, Italy,
and Germany.
Methods: Caregivers of patients with AF completed an online survey based on the iMTA Valuation of Informal Care Questionnaire, with questions about their caregiving situation, perceived burden of caregiving, and absence from work due to
health problems resulting from caregiving. Care-related quality-of-life utilities were calculated using the Care-related Quality
of Life instrument and associated tariffs. Societal costs of caregiving were calculated based on the proxy good method.
Results: A total of 585 caregivers participated in this study. On average, caregivers provided 33 hours of informal care per
week to patients (SD 29 hours). On a scale from 0 to 10, their self-rated burden was 5.4. The average Care-related Quality of
Life utility was 72. Caregivers primarily indicated problems with daily activities, mental health, and physical health. Still, the
vast majority of caregivers (87%) derived fulfillment from providing care. Weekly societal costs of caregiving were on average
V636. Comorbidities contributed substantially to the caregiver time and burden.
Conclusions: Caring for a patient with AF is associated with substantial objective and subjective burden, but also provides
fulfillment from being able to care for a loved one
Quo Vadis HTA for Medical Devices in Central and Eastern Europe? Recommendations to Address Methodological Challenges
Get PDFObjectives: Methodological challenges in the evaluation of medical devices (MDs) may be different for early and late technology adopter countries, as well as the potential health technology assessment (HTA) solutions to tackle them. This study aims to provide guidance to Central and Eastern European (CEE) countries on how to address key challenges of HTA for MDs with special focus on the transferability of scientific evidence. Methods: As part of the COMED Horizon 2020 project, a comprehensive list of issues related to MD HTA were identified based on a targeted literature review. Health technology assessment issues which pose a greater challenge or require different solutions in late technology adopter countries were selected. Draught recommendations to address these issues were developed and discussed in a focus group. The recommendations were then validated with a wider group of experts, including HTA and reimbursement decision makers from CEE countries in May and June 2020. Results: A consolidated list of 11 recommendations were developed in 3 major areas: (1) clinical value assessment, focusing on the use of joint EU work, relying on real-world evidence, use of coverage with evidence development schemes, transferring evidence from foreign countries and addressing the challenges of learning curve and centre effect; (2) economic value assessment, covering cost calculation of complex medical devices and transferability of economic evaluations of MDs; (3) HTA processes, related to the frequent product modifications and various indications of MDs. Conclusions: Central and Eastern European countries with limited resources for conducting HTA, can benefit from HTA methods and evidence generated in early technology adopter countries. Considering the appropriate reuse of international HTA materials, late technology adopter countries can still implement HTA, even for MDs, which have a more limited evidence base compared with pharmaceuticals
Environmental Exposures and Maternal and Child Health Focus on bisphenols, phthalates and smoking
Get PDFExposure to environmental exposures and its associations with maternal and child health. The specific environmental exposures we investigated are bisphenols (plastics), phthalates (impart flexibility and pliability to plastics) and smoking
First-line BRAF/MEK inhibitors versus anti-PD-1 monotherapy in BRAFV600-mutant advanced melanoma patients: a propensity-matched survival analysis
Get PDFBackground: Anti-PD-1 antibodies and BRAF/MEK inhibitors are the two main groups of systemic therapy in the treatment of BRAFV600-mutant advanced melanoma. Until now, data are inconclusive on which therapy to use as first-line treatment. The aim of this study was to use propensity score matching to compare first-line anti-PD-1 monotherapy vs. BRAF/MEK inhibitors in advanced BRAFV600-mutant melanoma patients. Methods: We selected patients diagnosed between 2014 and 2017 with advanced melanoma and a known BRAFV600-mutation treated with first-line BRAF/MEK inhibitors or anti-PD-1 antibodies, registered in the Dutch Melanoma Treatment Registry. Patients were matched based on their propensity scores using the nearest neighbour and the optimal matching method. Results: Between 2014 and 2017, a total of 330 and 254 advanced melanoma patients received BRAF/MEK inhibitors and anti-PD-1 monotherapy as first-line systemic therapy. In the matched cohort, patients receiving anti-PD-1 antibodies as a first-line treatment had a higher median and 2-year overall survival compared to patients treated with first-line BRAF/MEK inhibitors, 42.3 months (95% CI: 37.3-NE) vs. 19.8 months (95% CI: 16.7–24.3) and 85.4% (95% CI: 58.1–73.6) vs. 41.7% (95% CI: 34.2–51.0). Conclusions: Our data suggest that in the matched BRAFV600-mutant advanced melanoma patients, anti-PD-1 monotherapy is the preferred first-line treatment in patients with relatively favourable patient and tumour characteristics
Discordant Expectations of Global Intimacy: Desire and Inequality in Commercial Surrogacy
Get PDFGestational surrogacy – carrying someone else’s baby (or babies) to term and giving birth to them – is perhaps one of the most intimate acts a human being can perform for others. However, the proliferation of commercial surrogacy has drawn concern and criticism, with many scholars arguing that it both creates and exacerbates global social and economic inequalities. Commercial surrogacy thus raises both the possibility of global intimate connection and the specter of reproductive exploitation. I therefore explore the various, shifting, and often discordant desires for intimate connection between the intending parent(s), the surrogate mother, and the resulting child(ren) in commercial surrogacy. I then examine how those intimacies intersect with commercial surrogacy’s socioeconomic inequalities. Weighing commercial surrogacy’s driving desires and intimate practices against its commercialization, I end with a reconsideration of the procreative desires and intimate practices that spur current international commercial surrogacy (ICS), urging an emphasis on reproductive justice