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Examining Longitudinal Relations Between Mothers’ and Fathers’ Parenting Stress, Parenting Behaviors, and Adolescents’ Behavior Problems
Get PDFParenting stress of mothers has frequently been linked to negative child outcomes. According to Abidin’s stress model, this relationship may be explained by dysfunctional parenting behaviors. In this study, we scrutinized the effects of both mothers and fathers in the pathway from parenting stress through parenting behaviors to subsequent adolescent behavior problems. We expected the association between parenting stress and adolescent behavior problems to be partially mediated by maternal and paternal parenting behaviors. Further, we expected crossover effects, i.e., that parenting stress of one parent was related to the parenting behavior of the other parent. We applied a 3-wave longitudinal design using data from 441 adolescents (52% girls) and their parents (419 fathers; 436 mothers). Parents reported on parenting stress (adolescent age range = 10.9–16.3 years). Adolescents reported on perceived parental overreactivity and warmth (age range = 12.9–18.3) and their own internalizing and externalizing problems (age range = 15.9–21.3). Despite cross-sectional significant associations between parenting stress, parenting behavior, and adolescent behavior problems, we found no evidence of longitudinal linkages. One exception was maternal parenting stress, which positively predicted later adolescent externalizing problems. Consequently, the mediating role of parenting behaviors was not supported. We found no crossover effects in the pathway from parenting stress to parenting behaviors. The discrepancies between our longitudinal and cross-sectional findings raise questions about the actual impact that parents have on their children’s outcome. Though, targeting mothers’ parenting stress may help to reduce adolescent externalizing problems and its ramifications at least to some extent
Simulating Population-Level Effects of Colorectal Cancer Screening Policies
Get PDFThe aim of this thesis was to estimate population-level effects of colorectal cancer screening policy changes or interventions
Reducing unnecessary referrals for colposcopy in hrHPV-positive women within the Dutch cervical cancer screening programme: A modelling study
Get PDFBackground: With the implementation of primary high-risk human papillomavirus (hrHPV) screening in the Netherlands, an increase was observed in the number of unnecessary referrals (≤Cervical Intraepithelial Neoplasia (CIN) 1) to colposcopy. We aimed to investigate which alternative triage strategies safely reduce unnecessary referrals in HPV-based cervical cancer screening programmes. Methods: Microsimulation model MISCAN was used to simulate an unvaccinated cohort of ten million 30-year old Dutch women. We calculated unnecessary referrals, cervical cancer incidence, mortality, costs and QALYs for 24 triage strategies. Condition for direct referral (atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), conditional on HPV-genotype 16/18/other high risk (OHR)), type of triage test (cytology alone or combined with hrHPV) and time to triage test (6 or 12 months) was varied. Results: The 24 triage strategies had varying effects on the number of unnecessary referrals ranging from −72% to +35%. Adjusting conditions for referral to ‘HPV16/18+ and ASC-US+’ and ‘HPVOHR+ and HSIL+’ and extending the interval between tests to 12 months resulted in a reduction in unnecessary referrals of 40% (incidence +0%, mortality −1%). Reduction in unnecessary referrals without genotyping was achieved by adjusting conditions for direct referral to LSIL (12 months to repeat test) (unnecessary referrals −37%, incidence +2%, mortality +0%). Conclusions: To reduce the number of unnecessary referrals without increasing incidence and mortality by more than 2% in the Dutch cervical cancer screening programme, genotyping for HPV16 or HPV16/18 should be implemented with 12 months to repeat testing
Feasibility of onchocerciasis elimination using a “test and not treat” strategy in Loa loa co endemic areas
Get PDFBackground
Mass drug administration (MDA) with ivermectin is the main strategy for onchocerciasis elimination.
Ivermectin is generally safe but associated with serious adverse events in individuals with high Loa
loa microfilarial densities (MFD). Therefore, ivermectin MDA is not recommended in areas where
onchocerciasis is hypo-endemic and L. loa is co-endemic. To eliminate onchocerciasis in those areas,
a test-and-not-treat (TaNT) strategy has been proposed. We investigated whether onchocerciasis
elimination can be achieved using TaNT and the required duration.
Methods
We used the individual-based model ONCHOSIM to predict the impact of TaNT on onchocerciasis
microfilarial (mf) prevalence. We simulated pre-control mf prevalence levels from 2-40%. The impact
of TaNT was simulated under varying levels of participation, systematic non-participation and
exclusion from ivermectin due to high L. loa MFD. For each scenario, we assessed the time to
elimination, defined as bringing onchocerciasis mf prevalence below 1.4%.
Results
In areas with 30-40% pre-control mf prevalence, the model predicted that it would take between 14
and 16 years to bring the mf prevalence below 1.4% using conventional MDA, assuming 65%
participation. TaNT would increase the time to elimination by up to 1.5 years, depending on the level
of systematic non-participation and the exclusion rate. At lower exclusion rates (≤2.5%), the delay
would be less than six months.
Conclusions
Our model predicts that onchocerciasis can be eliminated using TaNT in L. loa co-endemic areas. The
required treatment duration using TaNT would be only slightly longer than in areas with conventional
MDA, provided that participation is good
Nationalism and the lost homeland: The case of Greece
Get PDFAs evidenced by the radical changes to state organisation, legitimacy and the international order in the past couple of centuries with the development of nationalist ideology, nationalism inherently carries a spatial dimension that translates into an assertion for control of land. This way, it transforms the land to an ancestral national homeland rightfully belonging to ‘the nation’. But what if that land was lost to another nation? Embarking from Anthony Smith's ethno-symbolist approach on the construction of national homelands, this article will attempt a theoretical approach on the construction of the lost national homelands. These are usually cases where military defeats led to mass expulsions of populations from their ancestral lands, while nationalist ideologies appropriated them as lost national homelands. The main argument is that the idea of the lost homelands has turned into a symbol of these nationalist ideologies and a constituent element of the respective national identities. Drawing from Greek perceptions of their lost homelands, this article will explore the mechanisms of the nationalisation of space process that elaborated the nationalisation of those homelands even after they became ‘lost’ for the Greek nation. This article contributes to the studies of the spatial dimensions of national identities, the effects of forced population transfers in identity politics and the creation of national myths and symbols
Health-Related Quality of Life in Patients with Multiple Endocrine Neoplasia Type 1
Get PDFIntroduction: Multiple endocrine neoplasia type 1 (MEN1) is a hereditary endocrine tumor syndrome characterized by the triad of primary hyperparathyroidism, duodenopancreatic neuroendocrine tumors (pNETs), and pituitary tumors. Patients are confronted with substantial morbidity and are consequently at risk for an impaired quality of life (QOL). Meticulous assessment of QOL and associated factors in a representative population is needed to understand the full spectrum of the burden of the disease. Patients and Methods: A cross-sectional study was performed using the national Dutch MEN1 cohort. Patients with a confirmed MEN1 mutation received the SF-36 Health Related Quality of Life questionnaire and questions regarding sociodemographic and medical history. Results: A total of 227 of 285 (80%) eligible MEN1 patients returned the questionnaires. Health-related QOL scores (HRQOL) in MEN1 patients were significantly lower for the majority of subscales of the SF-36 in comparison with the general Dutch population. The most consistent predictor for HRQOL was employment status, followed by the presence of a pituitary tumor. 16% of patients harboring a pNET and 29% of patients with a pituitary tumor according to the medical records, reported that they were unaware of such a tumor. These subgroups of patients had several significant better QOL scores than patients who were aware of their pNET or pituitary tumors. Conclusion: Patients with MEN1 have an impaired QOL in comparison with the general Dutch population warranting special attention within routine care. For daily practice, physicians should be aware of their patients' impaired QOL and of the impact of unemployment on QOL
Regulation of Medical Emergency Research legal policy and medical practice
Get PDFThis thesis focuses on the medical practice and legal regulation of medical scientific research with humans in medical emergency situations
Automated final lesion segmentation in posterior circulation acute ischemic stroke using deep learning
No full textFinal lesion volume (FLV) is a surrogate outcome measure in anterior circulation stroke (ACS). In posterior circulation stroke (PCS), this relation is plausibly understudied due to a lack of methods that automatically quantify FLV. The applicability of deep learning approaches to PCS is limited due to its lower incidence compared to ACS. We evaluated strategies to develop a convo-lutional neural network (CNN) for PCS lesion segmentation by using image data from both ACS and PCS patients. We included follow-up non-contrast computed tomography scans of 1018 patients with ACS and 107 patients with PCS. To assess whether an ACS lesion segmentation generalizes to PCS, a CNN was trained on ACS data (ACS-CNN). Second, to evaluate the performance of only including PCS patients, a CNN was trained on PCS data. Third, to evaluate the performance when combining the datasets, a CNN was trained on both datasets. Finally, to evaluate the performance of transfer learning, the ACS-CNN was fine-tuned using PCS patients. The transfer learning strategy outperformed the other strategies in volume agreement with an intra-class correlation of 0.88 (95% CI: 0.83–0.92) vs. 0.55 to 0.83 and a lesion detection rate of 87% vs. 41–77 for the other strategies. Hence, transfer learning improved the FLV quantification and detection rate of PCS lesions compared to the other strategies.</p