Future Burden and Costs of Smoking-Related Disease in the Netherlands: A Dynamic Modeling Approach

AbstractObjectivesIn this article, we explore the future health gain of different policy measures to reduce smoking prevalence: health education campaigns specifically aimed at keeping (young) people from starting to smoke, campaigns aimed at persuading smokers to quit, and tax measures.MethodsWe drew up different policy scenarios based on evaluations of several health promotion campaigns. Implementing these into the dynamic multistate models, we simulated smoking prevalence, loss of life-years, and costs for several decades into the next century.ResultsIn the short run, campaigns aimed at potential “quitters” appear to be most effective in terms of health gain. However, their effect fades away after several decades, while campaigns aimed at young “starters” or tax measures in the end yield a larger and more lasting decrease in smoking attributable disease burden.ConclusionDynamic modeling is very useful tool in calculating costs and effects of preventive public health measures

Direct observation by resonant tunneling of the B^+ level in a delta-doped silicon barrier

We observe a resonance in the conductance of silicon tunneling devices with a delta-doped barrier. The position of the resonance indicates that it arises from tunneling through the B^+ state of the boron atoms of the delta-layer. Since the emitter Fermi level in our devices is a field-independent reference energy, we are able to directly observe the diamagnetic shift of the B^+ level. This is contrary to the situation in magneto-optical spectroscopy, where the shift is absorbed in the measured ionization energy.Comment: submitted to PR

Ecologische effecten van een derde spuimiddel in de Afsluitdijk op vogels, zeezoogdieren en beschermde habitats in de westelijke Waddenzee

Momenteel worden voorbereidingen getroffen voor de bouw van nieuwe spuisluizen in de Afsluitdijk. Deze nieuwe sluizen moeten het mogelijk maken dat het overtollige zoete water uit het IJsselmeer, ook bij de verwachte stijging van de zeespiegel en een toename van de aanvoer van rivierwater vanuit de ijssel, nog tenminste tot het jaar 2050 kan worden geloosd op de Waddenzee. Na uitvoerige afwegingen is als voorlopige voorkeurslocatie voor het nieuwe spuimiddel gekozen voor een locatie in de "knik" van de Afsluitdijk, enkele kilometers westelijk van Kornwerderzand. Gebruik van een nieuw spuimiddel op deze locatie zal tot gevolg hebben dat in de Waddenzee een andere zoet-zoutverdeling zal ontstaan. Deze kan leiden tot een verandering in de samenstelling en de omvang van de bodemfaunagemeenschappen, zowel van de droogvallende wadplaten als van het permanent onder water staande deel van de Waddenzee. Als gevolg hiervan zouden ook veranderingen kunnen optreden in de aantallen, verspreiding en soortensamenstelling van wad- en watervogels en van zeezoogdieren. In dit rapport worden de resultaten van een studie naar de ecologische effecten op vogels en zeezoogdieren en op relevante habitats in de westelijke Waddenzee weergegeven. Deze resultaten zullen worden verwerkt in het Milieu-effectrapport Extra Spuicapaciteit Afsluitdijk en worden gebruikt in een toetsing van de ecologische effecten van het nieuwe spuimiddel in het licht van de Nederlandse en Europese wet- en regelgeving op het gebied van de Natuurbescherming

Psychometrics of the observational scales of the Utrecht Scale for Evaluation of Rehabilitation (USER): Content and structural validity, internal consistency and reliability: A study on psychometric properties of the USER.

Introduction: : Establish content and structural validity, internal consistency, inter-rater reliability, and measurement error of the physical and cognitive scales of the Utrecht Scale for Evaluation clinical Rehabilitation (USER) in geriatric rehabilitation. Material and methods: : First, an expert consensus-meeting (N=7) was organised for content validity wherein scale content validity index (CVI) was measured. Second, in a sample of geriatric rehabilitation patient structural validity (N=616) was assessed by confirmatory factor analyses for exploring unidimensionality. Cut-off criteria were: Root Mean Square Error of Approximation (RMSEA) 0.95. Local independence (residual correlation0.30 and Hs-coefficient >0.50) were also calculated. Cronbach alphas were calculated for internal consistency. Alpha's > 0.7 was considered adequate. T hird, two nurses independently administered the USER to 37 patients. Intraclass-correlation coefficients (ICC) were calculated for inter-rater reliability (IRR), standard error of measurement (SEM) and Smallest Detectable Change (SDC). Results: : The CVI for physical functioning was moderate (0.73) and excellent for cognitive functioning (0.97). Structural validity physical scale was acceptable (CFI;0.95, TLI;0.93, RMSEA;0.07, ECV;0.78, OmegaH;0.87; Monotonicity;(Hi;0.52-0.75 and Hs;0.63)). Cognitive scale was good (CFI;0.98, TLI;0.96, RMSEA;0.05, ECV;0.66 and OmegaH;0.90. Monotonicity;(Hi;0.30 -0.70 and Hs;0.61)). Cronbach's alpha were high: physical scale;0.92 and cognitive scale;0.94. Reliability physical scale ICC;0.94, SEM;5 and SDC;14 and cognitive scale ICC;0.88, SEM;5 and SDC;13. Conclusion: : The observational scales of the USER have shown sufficient content and structural validity, internal consistency, and interrater reliability for measuring physical and cognitive function in geriatric rehabilitation. Trial registration: : N/AGeriatrics in primary carePublic Health and primary car

Hepatitis C virus in hemophilia:Health-related quality of life after successful treatment in the sixth Hemophilia in the Netherlands study

INTRODUCTION: Persons with hemophilia and hepatitis C virus (HCV) infection have a lower health‐related quality of life (HRQoL) than those never HCV infected. However, it is unknown whether HRQoL after HCV eradication is comparable to individuals never HCV infected. We aimed to compare HRQoL between HCV‐cured and never chronically HCV‐infected persons with hemophilia. METHODS: All persons with hemophilia in the Netherlands were invited for a nationwide study conducted in 2018–2019. For the current analysis, participants born before 1992 with data on HRQoL and HCV status were included. HCV status was collected from medical records. HRQoL was measured by RAND‐36 questionnaire, with a minimally important difference set at 4.0 points. Multivariable linear regression was used to adjust for age, hemophilia severity, HIV status, and self‐reported joint impairment. RESULTS: In total, 486 persons were eligible; 180 were HCV cured and 306 never chronically HCV infected. Compared with those never HCV infected, HCV‐cured individuals were older (57 vs. 53 years), more often had severe hemophilia (67% vs. 21%), and reported more impaired joints (median 3 vs. 0). Compared with those never HCV infected, adjusted RAND‐36 domain scores of HCV‐cured individuals cured were lower on all RAND‐36 domains except Pain, ranging from a difference of 4.5 (95% CI, −8.8 to −0.3) for Physical functioning to 11.3 (95% CI, −19.4 to −3.1) for Role limitations due to physical problems. CONCLUSION: Despite effective HCV treatment, HRQoL of HCV‐cured persons with hemophilia is still lower than HRQoL of those never chronically HCV‐infected on all RAND‐36 domains. This implies that careful psychosocial follow‐up and support are indicated

Desmopressin in nonsevere hemophilia A:patient perspectives on use and efficacy

Background: Desmopressin increases plasma factor VIII and von Willebrand factor levels in persons with nonsevere hemophilia A. Patients’ perspectives on desmopressin are relevant to increase and optimize its suboptimal use. However, patients’ views on desmopressin are not reported. Objectives: To evaluate the perspectives of persons with nonsevere hemophilia A on desmopressin use, barriers for its use, side effects, and their knowledge about desmopressin's efficacy and side effects. Methods: Persons with nonsevere hemophilia A were included in a cross-sectional, national, multicenter study. Questionnaires were filled out by adult patients and children aged ≥12 years themselves. Caretakers filled out questionnaires for children aged &lt;12 years. Results:In total, 706 persons with nonsevere hemophilia A were included (544 mild, 162 moderate, [age range, 0–88 years]). Of 508 patients, 234 (50%) patients reported previous desmopressin use. Desmopressin was considered as at least moderately effective in 171 of 187 (90%) patients. Intranasal administration was the modality of choice for 138 of 182 (76%) patients. Flushing was the most reported side effect in 54 of 206 (26%) adults and 7 of 22 (32%) children. The most frequently reported advantage and disadvantage were the convenience of intranasal, out-of-hospital administration by 56% (126/227) and side effects in 18% (41/227), respectively. Patients’ self-perceived knowledge was unsatisfactory or unknown in 28% (63/225). Conclusion:Overall, desmopressin was most often used intranasally and considered effective, with flushing as the most common side effect. The most mentioned advantage was the convenience of intranasal administration and disadvantage was side effects. More information and education on desmopressin could answer unmet needs in patients with current or future desmopressin treatment.</p

Practical guidance for mismatch repair-deficiency testing in endometrial cancer

MTG8 - Moleculaire pathologie van gynecologische tumore