Ethnic Differences in Prenatal Screening for Down Syndrome: information, decision-making and participation

Pregnant women and their partners are increasingly confronted with choices whether or not to participate in prenatal screening for structural, genetic, and chromosomal disorders, such as Down syndrome. Studies in several countries have documented ethnic differences in the provision of information about prenatal screening and Down syndrome, pregnant women’s knowledge and attitude and their participation in prenatal screening for Down syndrome.1-27 This thesis addresses the question whether such differences also exist in the Netherlands, where 20% of the population currently consists of individuals from non-Dutch ethnic origin. The research as presented in this thesis reports on studies on ethnic differences in the provision of information about prenatal screening for Down syndrome, pregnant women’s knowledge about prenatal screening and Down syndrome, their decision- making process and actual (non-) participation in prenatal screening for Down syndrome. This introductory chapter fi rst provides background information on Down syndrome, prenatal screening tests, the Dutch prenatal screening practice and the multi-ethnic population in the Netherlands. The aim and outline of the thesis are presented at the end of this chapter

Postgraduate Coursework Studies handbook

2002 handbook for Postgraduate Coursework Studie

The role of health literacy in explaining the relation between educational level and decision making about colorectal cancer screening

Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in CRC screening and explores to what extent health literacy mediates the association between education and informed decision making in CRC screening. In total, 696 individuals eligible for CRC screening (55-75 years of age) were recruited from online panels and filled in an online questionnaire at T0 (n = 696), T1 (n = 407) and T2 (n = 327). A hypothetical mediation model was tested using structural equation modelling. Outcomes included CRC knowledge, CRC screening knowledge, attitude, injunctive norm, descriptive norm, risk perception, self-efficacy, decisional conflict and decisional certainty. Health literacy domains included Comprehension, Application, Numeracy and Communication. Comprehension, Application and Numeracy, were found to mediate the association between education and knowledge about CRC and CRC screening, injunctive norm, descriptive norm, decisional conflict and decisional certainty. In light of these findings, targeting multiple health literacy domains in decision-support interventions is essential for facilitating informed decision making in CRC screening.Multivariate analysis of psychological dataHealth and self-regulatio

Systematic development of materials for inviting low health-literate individuals to participate in preconception counseling

In this study we aimed to systematically analyze problems in the recruitment of women with low health literacy for preconception counseling and to adapt and evaluate written invitations for this group. In a problem analysis (stage 1) we used structured interviews (n = 72) to assess comprehension of the initial invitations, perception of perinatal risks, attitude and intention to participate in preconception counseling. These outcomes were used to adapt the invitation. The adapted flyer was pretested in interviews (n = 16) (stage 2) and evaluated in structured interviews among a new group of women (n = 67) (stage 3). Differences between women in stages 1 and 3 regarding comprehension, risk perception, attitude and intention to participate in counseling were analyzed by linear regression analysis and chi-square tests. Women in stage 3 (who read the adapted flyer) had a more positive attitude towards participation in preconception counselling and a better understanding of how to apply for a consultation than women in stage 1 (who read the initial invitations). No differences were found in intention to participate in preconception counseling and risk perception. Systematic adaptation of written invitations can improve the recruitment of low health-literate women for preconception counselling. Further research should gain insight into additional strategies to reach and inform this group

Shape coexistence in neutron-deficient Hg isotopes studied via lifetime measurements in Hg 184, 186 and two-state mixing calculations

The neutron-deficient mercury isotopes, Hg184,186, were studied with the recoil distance Doppler-shift method using the Gammasphere array and the Köln plunger device. The differential decay curve method was employed to determine the lifetimes of the yrast states in Hg184,186. An improvement on previously measured values of yrast states up to 8+ is presented as well as first values for the 93 state in Hg184 and 10+ state in Hg186. B(E2) values are calculated and compared to a two-state mixing model which utilizes the variable moment of inertia model, allowing for extraction of spin-dependent mixing strengths and amplitudes

Automated entire thrombus density measurements for robust and comprehensive thrombus characterization in patients with acute ischemic stroke

Background and Purpose: In acute ischemic stroke (AIS) management, CT-based thrombus density has been associated with treatment success. However, currently used thrombus measurements are prone to inter-observer variability and oversimplify the heterogeneous thrombus composition. Our aim was first to introduce an automated method to assess the entire thrombus density and then to compare the measured entire thrombus density with respect to current standard manual measurements. Materials and Method: In 135 AIS patients, the density distribution of the entire thrombus was determined. Density distributions were described usingmedians, interquartile ranges (IQR), kurtosis, and skewedness. Differences between themedian of entire thrombusmeasurements and commonly applied manualmeasurements using 3 regions of interest were determined using linear regression. Results: Density distributions varied considerably with medians ranging from 20.0 to 62.8 HU and IQRs ranging from 9.3 to 55.8 HU. The average median of the thrombus density distributions (43.5 ± 10.2 HU) was lower than the manual assessment (49.6 ± 8.0 HU) (p<0.05). The difference between manual measurements and median density of entire thrombus decreased with increasing density (r = 0.64; p<0.05), revealing relatively higher manual measurements for low density thrombi such that manual density measurement tend overestimates the real thrombus density. Conclusions: Automatic measurements of the full thrombus expose a wide variety of thrombi density distribution, which is not grasped with currently used manual measurement. Furthermore, d

Search formixed-symmetry states of nuclei in the vicinity of the double-magic nucleus 208Pb

In this work we present the results from two experiments dedicated to search for quadrupolecollective isovector valence-shell excitation, the states with so-called mixed proton-neutron symmetry (MSS), in nuclei around the doubly magic nucleus 208Pb. 212Po was studied in an α-transfer reaction. 204Hg was studied in an inverse kinematics Coulomb excitation reaction on a carbon target. Both experiments provide indications for existence of one-phonon MSSs. Those are the first experimentally identified MSSs in the mass A ≈ 208 region

Two-year clinical follow-up of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN): Design and statistical analysis plan of the extended follow-up study

Background: MR CLEAN was the first randomized trial to demonstrate the short-term clinical effectiveness of endovascular treatment in patients with acute ischemic stroke caused by large vessel occlusion in the anterior circulation. Several other trials confirmed that endovascular treatment improves clinical outcome at three months. However, limited data are available on long-term clinical outcome. We aimed to estimate the effect of endovascular treatment on functional outcome at two-year follow-up in patients with acute ischemic stroke. Secondly, we aimed to assess the effect of endovascular treatment on major vascular events and mortality during two years of follow-up. Methods: MR CLEAN is a multicenter clinical trial with randomized treatment allocation, open-label treatment, and blinded endpoint evaluation. Patients included were 18 years or older with acute ischemic stroke caused by a proven anterior proximal artery occlusion who could be treated within six hours after stroke onset. The intervention contrast was endovascular treatment and usual care versus no endovascular treatment and usual care. The current study extended the follow-up duration from three months to two years. The primary outcome is the score on the modified Rankin scale at two years. Secondary outcomes include all-cause mortality and the occurrence of major vascular events within two years of follow-up. Discussion: The results of our study provide information on the long-term clinical effectiveness of endovascular treatment, which may have implications for individual treatment decisions and estimates of cost-effectiveness. Trial registration:NTR1804. Registered on 7 May 2009; ISRCTN10888758. Registered on 24 July 2012 (main MR CLEAN trial); NTR5073. Registered on 26 February 2015 (extended follow-up study)