100 research outputs found
Koers houden in turbulentie: De rol van de rijksoverheid op het gebied van infrastructuur en milieu internationaal vergeleken
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Caspar van den Berg, Frits van der Meer, Marije van Mannekes, Danielle van Osch, Jan Porth en Arjen Schmidt hebben een omvangrijk internationaal-vergelijkend onderzoek uitgevoerd naar de veranderde rol van de overheid in België/Vlaanderen, Canada, Denemarken, Duitsland, Finland, Frankrijk en het Verenigd Koninkrijk.
De afgelopen decennia is de rol van de overheid, en de taakverdeling tussen overheid, burgers en bedrijfsleven sterk veranderd. New Public Management, joined-up government, de voorwaardenscheppende staat en de participatie samenleving zijn voorbeelden van modellen die door de tijd heen gebruikt zijn om die veranderende rol en stijl van de overheid, te duiden en legitimeren.
Maar, wat weten we nu eigenlijk over deze vernieuwing en verandering van de rol van de nationale overheid in internationaal verband? Hoe uniek is Nederland in haar uitdagingen en aanpak, of zijn de problemen en oplossingen universeel voor de landen om ons heen? In opdracht van het Ministerie van Infrastructuur en Milieu deden de bestuurskundigen onderzoek naar deze vraag in zeven relevante vergelijkingslanden.
Het boek is opgebouwd uit een korte historische en conceptuele inleiding, empirische studies naar de zeven landen, een analyse van de sectorspecifieke vernieuwing en verandering binnen de domeinen infrastructuur en milieu, en tot slot een conclusie met een duiding van de grote lijnen.
Het boek laat zien hoe dezelfde problemen zich per land in een andere gedaante in een andere context voordoen. Geslaagde en minder geslaagde experimenten uit andere landen geven inzicht en inspiratie voor de Nederlandse bestuurspraktijk. Zo wordt duidelijk dat een overheid die verantwoordelijkheden wil overhevelen naar het maatschappelijke en private domein, zonder burgers in de kou te laten staan, daarin geleidelijk moet investeren om kennis en capaciteit op te bouwen. Het afstoten van taken met alleen kostenbesparingen als oogmerk leidt vaak tot een verarming van dienstverlening, en verslechterde relaties tussen de overheid en de samenleving.
Het resultaat van het onderzoek is een omvangrijk boek, uitgegeven door het CAOP, het kennis en dienstencentrum op het gebied van arbeidszaken in het publieke domein, gevestigd in Den Haag.The politics and administration of institutional chang
Smoking and bladder cancer risk and recurrence
Get PDFSmoking has been shown to be a major modifiable risk factor for bladder cancer. However, apart from distinguishing between current smokers and former smokers, not many detailed analyses have been performed on lifetime smoking behaviour and bladder cancer risk. Furthermore, smoking cessation after diagnosis of bladder cancer could improve bladder cancer prognosis, but this has not yet been studied prospectively over a longer period yet.
In this thesis, the current evidence on the association between smoking behaviour (duration, intensity, cessation, passive smoking exposure, cigarette type) and bladder cancer incidence and prognosis has been summarised through several meta-analyses. Furthermore, a prospective study on smoking and bladder cancer recurrence is described as well as a consortium study pooling data from 15 case-control studies to further decipher the interplay between smoking duration and intensity in determining bladder cancer risk.
Considering all evidence described in the results chapters of this thesis, it is suggested that duration of exposure to cigarette smoke is most important in determining bladder cancer risk and possibly also recurrence. Also, there does not seem to be any association between exposure to environmental smoke and bladder cancer. To provide more insight in how smoking causes bladder cancer, future studies should consider the possible association between molecular subtypes and smoking behaviours
The Association between Diabetes Medication Use and Tumour Characteristics at Diagnosis in Patients with Urothelial Carcinoma: A Retrospective Registry-Based Study
No full textBACKGROUND: Observational studies indicate a potential association between diabetes medication use and aggressiveness of bladder cancer. OBJECTIVE: The objective is to exploratively study the association between diabetes medication use, as proxy for diabetes, and cancer characteristics of urothelial carcinoma at diagnosis. Furthermore, differences in associations between specific types of diabetes medication are studied. METHODS: The association between use of diabetes medication and urothelial carcinoma (UC) characteristics at diagnosis is studied. A retrospective registry-based study among UC patients in the Netherlands was performed for which two large linked registries from PHARMO and IKNL were used. Patients diagnosed with UC between 2000 and 2016 and no previous cancer were included in this study. In this study, 1,168 UC patients who were diabetes medication users were included as well as 3,609 non-users. Conditional logistic regression analysis was performed to determine odds ratios comparing cancer characteristics between different types of diabetes medication users to non-users. RESULTS: Noninsulin antidiabetic drugs (NIAD) use was associated with a muscle-invasive type of UC compared to non-users (OR = 1.31, 95% CI: 1.10-1.55 for T2+ versus Ta) as well as a poorly differentiated tumour (OR = 1.31, 95% CI: 1.07-1.59 for poorly versus well differentiated tumours). CONCLUSION: Users of diabetes medication are potentially more likely to be diagnosed with a more aggressive tumour than non-users; however, lifestyle factors could not be adjusted for
Significant role for lifetime cigarette smoking in worsening bladder cancer and upper tract urothelial carcinoma prognosis: a meta-analysis
Get PDFPURPOSE: Although cigarette smoking is a well-established risk factor for urothelial cancer (UC), its role in UC prognosis is still undetermined. This meta-analysis aimed to quantify the role of lifetime smoking history on bladder cancer recurrence, progression and survival, by pooling available data on non-muscle-invasive bladder cancer (NMIBC), muscle-invasive bladder cancer (MIBC) and upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: A total of 24 studies, comprising data from 13,114 BC and 2,259 UTUC patients, were included in this meta-analysis. Publication bias was addressed through Eggers test and the heterogeneity between studies was assessed by the I2 test statistic and subgroup analyses. RESULTS: Current smokers at diagnosis are at an increased risk of developing local recurrences in NMIBC (HR=1.27, 95% C.I. = 1.09-1.46) and smoking MIBC patients are at an increased risk of dying due to BC (HR=1.23, 95% C.I. = 1.02-1.44). In the UTUC population smokers have both an increased risk of recurrence in the operative bed (HR=1.57, 95%C.I. = 1.19-1.95) and of dying due to UTUC (HR=1.53, 95%C.I. = 1.13-1.92). We did not identify significant heterogeneity between included studies. CONCLUSIONS: The body of evidence is limited due to the absence of prospective studies. However, the results from this meta-analysis unambiguously support the hypothesis that lifetime cigarette smokers are at an increased risk of developing a more malignant type of urothelial carcinoma associated with worse prognosis
A stratified meta-analysis of the association between exposure to environmental tobacco smoke during childhood and adulthood and urothelial bladder cancer risk
Get PDFBackground: Active smoking is a major risk factor for urothelial bladder cancer (UBC). However, the evidence that exposure to environmental tobacco smoke (ETS) either in childhood or adult life is also associated with UBC risk is ambiguous. With this meta-analysis, we aim to summarise how exposure to ETS is associated with UBC risk. Methods: In total, 11 studies (3 cohort studies, 8 case-control studies) were included in this meta-analysis and summary odds ratios (SORs) for UBC risk were calculated for never smokers who were exposed to ETS during childhood at home, during adulthood at home, or during adulthood in a work environment compared to never smokers who were never exposed to ETS. Sensitivity analyses were conducted to test the robustness of findings. Results: Never smokers exposed to ETS during childhood (SOR = 1.04, 95% confidence interval (CI) = 0.82–1.26), during adulthood at work (SOR = 0.98, 95% CI = 0.78–1.18) or at home (SOR = 0.99, 95% CI = 0.83–1.15) were at a similar risk of UBC compared to never smokers who were never exposed to ETS. Results for males and females were similar. Also, when pooling all estimates during both childhood and adulthood, no effect was observed (SOR = 1.00, 95% CI = 0.89–1.10). Conclusions: Although measurement of exposure to ETS was imprecise, there does not seem to be an association between UBC risk and exposure to ETS during childhood or adulthood. However, the current body of evidence mostly overlooks the duration and intensity of exposure to ET
Assessing the influence of information on the intention to use dietary supplements: An online questionnaire study
No full textSince it is observed that the consumption of herbal dietary supplements is increasing, we aimed to research whether front-of-pack risk and benefit information influences a consumer’s intention to use (ITU) a dietary supplement.A total of 268 subjects participated in an online questionnaire, in which they were exposed to one of four different labels with risk and/or benefit information about the product, and were provided with additional risk-benefit information. Their ITU was measured at three time points: after exposure to the label, after reading the additional information and after a wash-out period.The results from our study showed that information on the label did not significantly impact the ITU. In all groups, ITU significantly increased after exposure to detailed information, and again after the wash-out period.We therefore conclude that front-of-pack information did not influence a consumer’s intention to use dietary supplements, but additional information may have influenced their intentions
Modelling the complex exposure history of smoking in predicting bladder cancer:a pooled analysis of 15 case-control studies
Get PDFBackground: Few studies have modeled smoking histories by combining smoking intensity and duration to show what profile of smoking behavior is associated with highest risk of bladder cancer. This study aims to provide insight into the association between smoking exposure history and bladder cancer risk by modeling both smoking intensity and duration in a pooled analysis.Methods: We used data from 15 case–control studies included in the BLadder cancer Epidemiology and Nutritional Determinants (BLEND) study, including a total of 6,874 cases and 17,727 controls. To jointly interpret the effects of intensity and duration of smoking, we modeled excess odds ratios (EOR) per pack–year by intensity continuously to estimate the risk difference between smokers with long duration/low intensity and short duration/high intensity.Results: The pattern observed from the pooled EOR model indicated that for a fixed number of pack–years, smoking for a longer duration at lower intensity was more deleterious for bladder cancer risk than smoking more cigarettes/day for a shorter duration. We observed similar patterns within individual study samples.Conclusions: This pooled analysis shows that long duration/low intensity smoking is associated with a greater increase in bladder cancer risk than short duration/ high intensity smoking within equal pack–year categories, thus confirming studies in other smoking-related cancers and demonstrating that reducing exposure history to a single metric such as pack–years was too restrictive
Terrorist Attacks Against Health Care Facilities, Health Care Workers, and First Responders:A Scoping Review
No full textIntroduction: Since 2001, the world has encountered an increase in terrorist attacks on civilian targets, during which conventional as well as unconventional modalities are being used. Terrorist attacks put immediate strains on health care systems, whilst they may also directly threaten the safety of first responders, health care workers, and health care facilities.Study Objective: This scoping review aimed to systematically map the existing research on terrorist attacks targeting health care facilities, health care workers, and first responders, and to identify opportunities to improve future research and health care response to terrorist attacks.Methods: A scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. A systematic search for relevant literature was conducted through electronic databases including PubMed, Cochrane, and Embase. Inclusion and exclusion criteria were applied to check eligibility. Extracted data from the articles included the title, first author, year of publication, journal, study design, number of attacks, number of injured, number of fatalities, target type, and weapon modalities. Furthermore, methodological quality assessment was performed.Results: The initial search within three major databases yielded 4,656 articles, including 2,777, 1,843, and 36 articles from PubMed, Embase, and Cochrane Library, respectively. Finally, 11 studies were included, which were all database reviews.Conclusions: This scoping review included 11 studies focusing on terrorist attacks against health care facilities, health care workers, and first responders. Nearly all studies were exclusively based on the Global Terrorism Database (GTD). An increase of attacks on health care-related targets was consistently reported by all studies in this review, but there were significant discrepancies in reported outcomes. In order to improve counter-terrorism preparedness and the future protection of health care workers, counter-terrorism medicine (CTM) research may benefit from a more standardized and transparent approach to document and analyze terrorist attacks, as well as the inclusion of additional databases other than the GTD
Internet-Based Computer Tailored Feedback on Sunscreen Use
No full textBackground: Skin cancer incidence rates signify the need for effective programs for the prevention of skin cancer and for helping skin cancer patients. Internet and computer tailored (CT) technology fosters the development of highly individualized health communication messages. Yet, reactions to Internet CT programs may differ per level of involvement and education level and remain understudied. Objective: First, we identified perceptions concerning sunscreen use in Dutch adults and assessed differences in differences between the general public and skin cancer patients, and between low and high educated respondents. Second, we assessed program evaluations of these groups about a new Dutch CT Internet-based program promoting sunscreen use, and potential differences between groups Methods: A cross-sectional research design was used. In total, 387 respondents participated and filled out an online questionnaire based on the I-Change Model assessing socio-demographics, history of skin cancer, sunscreen use, and beliefs about sunscreen use. The responses were fed into a computer program that generated personal tailored feedback on screen; next we assessed their program evaluations Results: Of the 132 patients, 92 were female (69.7%) and 40 were male (30.3%). In the general population (N = 225), 139 (54.5%) respondents were female and 116 (45.5%) were male. Men (50.9 years) were 8 years older than women (43.1 years). Most patients were diagnosed with basal cell carcinoma (N = 65; 49.2%), followed by melanoma (N = 28; 21.2%) and squamous cell carcinoma (N = 10; 7.6%); 22% (N = 29) did not remember their skin cancer type. Patients had higher knowledge levels, felt significantly more at risk, were more convinced of the pros of sunscreen, experienced more social support to use sunscreen, had higher self-efficacy, and made more plans to use sunscreen than respondents without skin cancer (N = 255; all P'
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