BACKGROUND: Von Willebrand disease (VWD) is the most frequent inherited bleeding disorder. Whethe... more BACKGROUND: Von Willebrand disease (VWD) is the most frequent inherited bleeding disorder. Whether VWD is associated with health-related quality of life (HR-QoL) in children is unknown. OBJECTIVES: This nationwide cross-sectional study measured HR-QoL in children with moderate or severe VWD. Our primary aim was to compare HR-QoL of VWD patients with that of reference populations. Additionally, we studied the impact
An Internet tool for monitoring, personalized feedback and referral was developed to support rout... more An Internet tool for monitoring, personalized feedback and referral was developed to support routine adolescent preventive care and was compared with usual practice using paper and pencil (P&P). A total of 1071 students (average age 15 years) from seven secondary schools were randomly assigned to the Internet or P&P group. The Internet group received a health and health-behavior assessment, tailored
Objective To explore adolescents' behaviors and opinions about exposure to loud music from MP... more Objective To explore adolescents' behaviors and opinions about exposure to loud music from MP3 players. Study design We conducted a qualitative analysis of focus-group discussions with adolescents aged 12 to 18 years from 2 large secondary schools (1 urban and 1 rural) for pre-vocational and pre-university education. The semi-structured question route was theoretically framed within the protection motivation theory. Results
Not much is known about the ethnic differences in cardiovascular risk factors during childhood in... more Not much is known about the ethnic differences in cardiovascular risk factors during childhood in European countries. We examined the ethnic differences in childhood cardiovascular risk factors in the Netherlands. In a multi-ethnic population-based prospective cohort study, we measured blood pressure, left ventricular mass, and levels of cholesterol, triglyceride and insulin at the median age of 6.2 years. As compared to Dutch children, Cape Verdean and Turkish children had a higher blood pressure, whereas Cape Verdean, Surinamese-Creole and Turkish children had higher total-cholesterol levels (p-values <0.05). Turkish children had higher triglyceride levels, but lower insulin levels than Dutch children (p-values <0.05). As compared to Dutch children, only Turkish children had an increased risk of clustering of cardiovascular risk factors (Odds Ratio: 2.45 (95 % Confidence Interval 1.18, 3.37)). Parental pre-pregnancy factors explained up to 50% of the ethnic differences in ch...
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2012
ABSTRACT Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and... more ABSTRACT Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and/or gestational diabetes are at increased risk of future cardiovascular and metabolic disease. Lifestyle intervention may help these women to effectively lower these risks.Objectives To test if offering lifestyle intervention after a complicated pregnancy significantly improves saturated fat-intake and exercise (primary objectives) and/or smoking habits (secondary objective).Methods The Pro-Active study (Postpartum Rotterdam Appraisal of Cardiovascular health and Tailored Intervention) is a feasibility study to develop and evaluate a postpartum lifestyle intervention program. In a prospective case-control setting we tested the effect of the lifestyle intervention. Women were included between April 2007 and August 2009. They were eligible if ⩾18 years old at time of inclusion, being able to understand and speak the Dutch language and not having pre-existing conditions that could interfere with the lifestyle intervention. Cases were offered lifestyle intervention by a trained counsellor between 6 and 10 months postpartum. During 3 private sessions, mainly exercise and fat-intake and to some extend smoking habits were discussed and aims were made to improve lifestyle. Controls did not receive these sessions, but were not restricted to improve lifestyle on their own. Lifestyle habits were scored at 6 and 13 months postpartum. For saturated fat-intake we used the Maastricht Fatlist. For exercise we used the International PhysicalActivity Questionnaire (IPAQ). For smoking habits we used a short version of the questionnaire of STIVORO (the Dutch anti-smoking association). We also performed a formative evaluation of the intervention program.ResultsDuring our study 1121 women gave birth after a complicated pregnancy. 490 Women were eligible for the study of which 240 women (49%) gave informed consent to participate. 56 Women (23%) were lost-to-follow-up, leaving 186 women for the analysis. Between 6 and 13 months postpartum saturated fat-intake was significantly reduced by 3.6 g/day (95% &gt; CI 1.8–5.4) in cases compared to controls. Exercise was improved in cases compared to controls, but it did not reach significance (277 MET’s (-2699–3254)). Although smoking decreased from 14.5% to 10.4% in cases, it was not significant and comparable to the decrease in controls (15.0% to 8.4%).The formative evaluation showed that the most important motivator to improve lifestyle was the increased risk of future cardiovascular and metabolic disease (70%) and the increased risk for recurrence in a next pregnancy (57%). Main barriers were an already busy life (40%), distance (35%) and duration (38%) of travelling to the hospital and to early postpartum to pay attention to lifestyle (26%).Conclusion Lifestyle intervention after complicated pregnancy may be effective in improving saturated fat-intake. Other interventions, specially aimed at postpartum women, are needed to improve exercise and smoking habits. More research is needed to develop lifestyle intervention program specifically aimed at these women. New possibilities of multimedia are promising.
Haemophilia : the official journal of the World Federation of Hemophilia, 2014
Treatment adherence in haemophilia is strongly associated with quality of life and the cost-benef... more Treatment adherence in haemophilia is strongly associated with quality of life and the cost-benefit of treatment. Therefore, it is important to quantify and monitor it. This study aimed to validate a translation of the VERITAS-Pro cross-culturally and analyse treatment adherence in a Dutch population of paediatric haemophilia patients. Children aged 1-18 years with haemophilia were included from three Haemophilia Treatment Centres, on prophylactic clotting factor replacement therapy for more than 1 year. Parents and adolescents were analysed separately. The adherence scale for prophylactic therapy (VERITAS-Pro) was translated according to international guidelines. This instrument contains a total of six subscales ('Time', 'Dose', 'Plan', 'Remember', 'Skip' and 'Communicate') each with four items. Lower scores reflect higher adherence. Overall response rate was 85%, leading to a study population of 60 children. Mean age was 10 years (SD...
A pregnancy complicated by preeclampsia (PE), intra-uterine growth restriction (IUGR) or gestatio... more A pregnancy complicated by preeclampsia (PE), intra-uterine growth restriction (IUGR) or gestation diabetes (GD) is a maternal predictor for future cardiovascular disease. Lifestyle changes may well lower this risk. The Pro-Active study was designed to evaluate a postpartum lifestyle intervention program after complicated pregnancy. From 2007 to 2012 women with PE, IUGR or GD were invited to participate. Women with known pre-existent pathology were excluded. At inclusion (6mos postpartum) and closure (13mos postpartum) measurements and lifestyle questionnaires were obtained. A non-randomized cohort (Erasmus MC, Rotterdam, n=144) was offered a web based health check and 3 counseling sessions with a behavioral expert. The control cohort (Amphia Hospital, Breda, n=62) was not. Primary outcome measure was weight reduction. The effect of lifestyle intervention was estimated, using linear regression on measurement changes, adjusted for changes in controls, measurement at inclusion and dem...
This study evaluates the appreciation, application and effects of an intervention (Your Health), ... more This study evaluates the appreciation, application and effects of an intervention (Your Health), in which adolescents received a consultation with the school nurse. A cluster randomized controlled trial with an intervention and control group (care-as-usual) was conducted among first-grade senior vocational students. Adolescents (n = 418) completed a questionnaire at baseline and 6-month follow-up assessing health and health behaviors. School absenteeism was monitored via the school registration system. After the consultation, adolescents and nurses evaluated the consultation by questionnaire. Adolescents appreciated being invited for the consultation and gave the consultation a positive mean rating of 8.78 on a 10-point scale. Adolescents rated the other nine items on the appreciation of the consultation also high. In 36.8% of the adolescents, nurses suspected problems. Most often these adolescents were given tailored advice (59.3%) or they were referred to another professional (40....
To generate knowledge about potential improvements to human papillomavirus (HPV) vaccination info... more To generate knowledge about potential improvements to human papillomavirus (HPV) vaccination information and organization strategies, we assessed how aspects of HPV vaccination are associated with parents' preferences for their daughters' uptake, and which trade-offs parents are willing to make between these aspects. A discrete choice experiment (DCE) was conducted among parents with a daughter aged 10-12 years. Panel mixed logit regression models were used to determine parents' preferences for vaccination. Trade-offs were quantified between four vaccination programme aspects: degree of protection against cervical cancer, duration of protection, risk of serious side-effects, and age of vaccination. Total response rate was 302/983 (31%). All aspects influenced respondents' preferences for HPV vaccination (p < 0.05). Respondents preferred vaccination at age 14 years instead of at a younger age. Respondents were willing to trade-off 11% of the degree of protection to...
Fetal smoke exposure may influence growth and body composition later in life. We examined the ass... more Fetal smoke exposure may influence growth and body composition later in life. We examined the associations of maternal and paternal smoking during pregnancy with total and abdominal fat distribution in school-age children. We performed a population-based prospective cohort study among 5243 children followed from early pregnancy onward in the Netherlands. Information about parental smoking was obtained by questionnaires during pregnancy. At the median age of 6.0 years (90% range: 5.7-7.4), we measured anthropometrics, total fat and android/gynoid fat ratio by dual-energy X-ray absorptiometry, and preperitoneal and subcutaneous abdominal fat were measured by ultrasound. The associations of maternal smoking during pregnancy were only present among girls (P-value for sex interaction<0.05). Compared with girls from mothers who did not smoke during pregnancy, those from mothers who smoked during the first trimester only had a higher android/gynoid fat ratio (difference 0.23 (95% confid...
There are limited data regarding the associations of both maternal and paternal anthropometrics w... more There are limited data regarding the associations of both maternal and paternal anthropometrics with longitudinally measured post-natal growth measures in early childhood. To assess the associations of maternal and paternal anthropometrics with growth characteristics and the risk of overweight in pre-school children. Population-based prospective cohort study from early foetal life onwards in the Netherlands. Maternal pre-pregnancy anthropometrics and gestational weight gain, and paternal anthropometrics were related to foetal and post-natal growth measures and the risk of overweight until the age of 4 years. Analyses were based on 5674 mothers, fathers and their children. Both pre-pregnancy maternal and paternal height, weight and body mass index were associated with corresponding foetal and post-natal anthropometric measures. Maternal body mass index had a significantly stronger effect on childhood body mass index than paternal body mass index. As compared to children from parents ...
International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity, 2011
The purpose of this study was to evaluate the effect of a school-based intervention program to re... more The purpose of this study was to evaluate the effect of a school-based intervention program to reduce overweight and improve fitness in primary school children. A cluster randomized controlled design was used over one school year with schools as unit of randomization. In total 20 schools and 2,622 children aged 6-12 years (grades 3-8) from multi-ethnic, low income inner-city neighbourhoods in Rotterdam, Netherlands, participated. The intervention, named Lekker Fit! (Enjoy being fit!) was a multi-component intervention based on behavioural and ecological models. Main components of the intervention are the implementation of three physical education (PE) sessions a week by a professional PE teacher, additional sport and play activities outside school hours and an educational program. Main primary outcome measures were weight status, body mass index (BMI), waist circumference and fitness (20 m shuttle run). Significant positive intervention effects were found for percentage overweight c...
Introduction: The Strengths and Difficulties Questionnaire (SDQ) is a relatively short instrument... more Introduction: The Strengths and Difficulties Questionnaire (SDQ) is a relatively short instrument developed to detect psychosocial problems in children aged 3-16 years. It addresses four dimensions: emotional problems, conduct problems, hyperactivity/inattention problems, peer problems that count up to the total difficulties score, and a fifth dimension; prosocial behaviour. The validity and reliability of the SDQ has not been fully investigated in younger age groups. Therefore, this study assesses the validity and reliability of the parent and teacher versions of the SDQ in children aged 5-6 years in the total sample, and in subgroups according to child gender and parental education level.
Archives of Physical Medicine and Rehabilitation, 2014
To (1) determine the long-term trajectory of health-related quality of life (HRQOL) for the dimen... more To (1) determine the long-term trajectory of health-related quality of life (HRQOL) for the dimensions of physical complaints and motor, psychological, and social functioning for groups of individuals with cerebral palsy (CP) aged 1 to 24 years; (2) assess the variability in HRQOL within individuals with CP over time; (3) assess the variability in HRQOL between individuals with CP; and (4) compare the HRQOL in individuals with CP to reference data of typically developing individuals. Multicenter prospective longitudinal study. Rehabilitation departments of 3 university medical centers and various rehabilitation centers in The Netherlands. Dutch individuals with CP (N=424; age, 1-24y). Not applicable. The HRQOL dimensions of physical complaints and motor, psychological, and social functioning. Each individual visited the rehabilitation department for 3 or 4 measurements. The time between measurements was 1 or 2 years. Individuals with CP experience an HRQOL that, on average, remains fairly stable over time. Variability in HRQOL within individuals with CP was similar to that within typically developing individuals. Variability between individuals with CP could be explained by type of CP (motor functioning), Gross Motor Function Classification System level (physical complaints and motor and social functioning), and intellectual disability (physical complaints and social functioning). Finally, individuals with CP experienced a lower HRQOL than did typically developing individuals, especially for the dimensions of motor and social functioning. Many changes take place in the psychosocial development of the individual with CP, which accordingly change their expectations and those of their caregivers, peers, and professionals. As a result, perceived physical complaints and motor, psychological, and social functioning remain fairly stable over many years.
To examine the association between socioeconomic position (SEP) and umbilical and uterine placent... more To examine the association between socioeconomic position (SEP) and umbilical and uterine placental resistance indices in the second and third trimester, and to what extent this could be explained by lifestyle-related behaviors. Prospective cohort study. Rotterdam, the Netherlands. 7,033 pregnant women of mean age (± standard deviation) 29.9 (±5.2) years. None. Uterine artery resistance index (UARI) and umbilical artery pulsatility index (UAPI) in second and third trimester measured with Doppler ultrasound. Third-trimester UARI and both second- and third-trimester UAPI were statistically significantly higher for women with lower educational levels as compared with those with higher educational levels. Educational level was strongly associated with the risk of continuously high levels of UARI and UAPI from second to third trimester of pregnancy. Notching was not associated with SEP. Smoking was a significant contributor to the association of SEP and increased placental resistance ind...
Ethnic differences in childhood and adulthood are known, but ethnic differences in preschool over... more Ethnic differences in childhood and adulthood are known, but ethnic differences in preschool overweight and associated factors are less studied. We assessed ethnic differences in pre-school age overweight, and studied the mediating role of early life factors in this association. Furthermore, we assessed body mass index (BMI) z-score development from birth to age 4 years to study ethnic-specific differences in BMI z-score trajectory. We used data on 4581 children participating in a birth cohort who were born between 2002 and 2006 in Rotterdam, the Netherlands. Child's ethnicity was defined according to country of birth of the parents. Weight and length/height was repeatedly measured between 1 and 45 months of age. Overweight at age 4 years was defined according to cut-off points for BMI from the international obesity task force. We performed logistic regression to obtain independent estimates of the association between ethnicity and preschool-age overweight, and to assess the med...
To investigate the emergence of the inverse socioeconomic gradient in body mass index (BMI) in th... more To investigate the emergence of the inverse socioeconomic gradient in body mass index (BMI) in the first 6 years of life. Furthermore, associations of socioeconomic position (SEP) with BMI and total fat mass (%) were assessed at age 6, and potential mediating factors in the pathway between SEP and children's body composition were investigated. Nearly 3,656 Dutch children participating in a prospective cohort study in Rotterdam, the Netherlands, were included from 2002 to 2006. Maternal educational level and net household income were used as indicators of SEP. BMI and fat mass were both outcome measures. Associations and mediation analyses were investigated using linear mixed models and linear regression analyses. The lowest SEP groups showed a larger increase in BMI over time as compared to the highest SEP groups (P < 0.001), which resulted in the emergence of the inverse SEP gradient around 3-4.5 years of age. In 6-year-old children, both BMI and total fat mass were signific...
To investigate whether maternal educational level is associated with gestational diabetes mellitu... more To investigate whether maternal educational level is associated with gestational diabetes mellitus (GDM), and to what extent risk factors for GDM mediate the effect of educational level. We examined data of 7,511 pregnant women participating in a population-based cohort study in Rotterdam, the Netherlands. The highest achieved education was categorized into four levels. Diagnosis of GDM was retrieved from delivery records. Odds ratios (OR) of GDM were calculated for levels of education, adjusting for confounders and potential mediators. Mediators were selected according to Baron and Kenny's causal step approach. Adjusted for ethnicity, age, family history of diabetes and parity, women in the lowest educational level were three times more likely to develop GDM than women in the highest level (OR 3.07; 95 % CI 1.37, 6.89). Selected mediators were alcohol use and body mass index (BMI). Additional adjustment for alcohol use attenuated the OR to 2.54 (95 % CI 1.11, 5.78). The individ...
BACKGROUND: Von Willebrand disease (VWD) is the most frequent inherited bleeding disorder. Whethe... more BACKGROUND: Von Willebrand disease (VWD) is the most frequent inherited bleeding disorder. Whether VWD is associated with health-related quality of life (HR-QoL) in children is unknown. OBJECTIVES: This nationwide cross-sectional study measured HR-QoL in children with moderate or severe VWD. Our primary aim was to compare HR-QoL of VWD patients with that of reference populations. Additionally, we studied the impact
An Internet tool for monitoring, personalized feedback and referral was developed to support rout... more An Internet tool for monitoring, personalized feedback and referral was developed to support routine adolescent preventive care and was compared with usual practice using paper and pencil (P&P). A total of 1071 students (average age 15 years) from seven secondary schools were randomly assigned to the Internet or P&P group. The Internet group received a health and health-behavior assessment, tailored
Objective To explore adolescents' behaviors and opinions about exposure to loud music from MP... more Objective To explore adolescents' behaviors and opinions about exposure to loud music from MP3 players. Study design We conducted a qualitative analysis of focus-group discussions with adolescents aged 12 to 18 years from 2 large secondary schools (1 urban and 1 rural) for pre-vocational and pre-university education. The semi-structured question route was theoretically framed within the protection motivation theory. Results
Not much is known about the ethnic differences in cardiovascular risk factors during childhood in... more Not much is known about the ethnic differences in cardiovascular risk factors during childhood in European countries. We examined the ethnic differences in childhood cardiovascular risk factors in the Netherlands. In a multi-ethnic population-based prospective cohort study, we measured blood pressure, left ventricular mass, and levels of cholesterol, triglyceride and insulin at the median age of 6.2 years. As compared to Dutch children, Cape Verdean and Turkish children had a higher blood pressure, whereas Cape Verdean, Surinamese-Creole and Turkish children had higher total-cholesterol levels (p-values <0.05). Turkish children had higher triglyceride levels, but lower insulin levels than Dutch children (p-values <0.05). As compared to Dutch children, only Turkish children had an increased risk of clustering of cardiovascular risk factors (Odds Ratio: 2.45 (95 % Confidence Interval 1.18, 3.37)). Parental pre-pregnancy factors explained up to 50% of the ethnic differences in ch...
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2012
ABSTRACT Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and... more ABSTRACT Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and/or gestational diabetes are at increased risk of future cardiovascular and metabolic disease. Lifestyle intervention may help these women to effectively lower these risks.Objectives To test if offering lifestyle intervention after a complicated pregnancy significantly improves saturated fat-intake and exercise (primary objectives) and/or smoking habits (secondary objective).Methods The Pro-Active study (Postpartum Rotterdam Appraisal of Cardiovascular health and Tailored Intervention) is a feasibility study to develop and evaluate a postpartum lifestyle intervention program. In a prospective case-control setting we tested the effect of the lifestyle intervention. Women were included between April 2007 and August 2009. They were eligible if ⩾18 years old at time of inclusion, being able to understand and speak the Dutch language and not having pre-existing conditions that could interfere with the lifestyle intervention. Cases were offered lifestyle intervention by a trained counsellor between 6 and 10 months postpartum. During 3 private sessions, mainly exercise and fat-intake and to some extend smoking habits were discussed and aims were made to improve lifestyle. Controls did not receive these sessions, but were not restricted to improve lifestyle on their own. Lifestyle habits were scored at 6 and 13 months postpartum. For saturated fat-intake we used the Maastricht Fatlist. For exercise we used the International PhysicalActivity Questionnaire (IPAQ). For smoking habits we used a short version of the questionnaire of STIVORO (the Dutch anti-smoking association). We also performed a formative evaluation of the intervention program.ResultsDuring our study 1121 women gave birth after a complicated pregnancy. 490 Women were eligible for the study of which 240 women (49%) gave informed consent to participate. 56 Women (23%) were lost-to-follow-up, leaving 186 women for the analysis. Between 6 and 13 months postpartum saturated fat-intake was significantly reduced by 3.6 g/day (95% &gt; CI 1.8–5.4) in cases compared to controls. Exercise was improved in cases compared to controls, but it did not reach significance (277 MET’s (-2699–3254)). Although smoking decreased from 14.5% to 10.4% in cases, it was not significant and comparable to the decrease in controls (15.0% to 8.4%).The formative evaluation showed that the most important motivator to improve lifestyle was the increased risk of future cardiovascular and metabolic disease (70%) and the increased risk for recurrence in a next pregnancy (57%). Main barriers were an already busy life (40%), distance (35%) and duration (38%) of travelling to the hospital and to early postpartum to pay attention to lifestyle (26%).Conclusion Lifestyle intervention after complicated pregnancy may be effective in improving saturated fat-intake. Other interventions, specially aimed at postpartum women, are needed to improve exercise and smoking habits. More research is needed to develop lifestyle intervention program specifically aimed at these women. New possibilities of multimedia are promising.
Haemophilia : the official journal of the World Federation of Hemophilia, 2014
Treatment adherence in haemophilia is strongly associated with quality of life and the cost-benef... more Treatment adherence in haemophilia is strongly associated with quality of life and the cost-benefit of treatment. Therefore, it is important to quantify and monitor it. This study aimed to validate a translation of the VERITAS-Pro cross-culturally and analyse treatment adherence in a Dutch population of paediatric haemophilia patients. Children aged 1-18 years with haemophilia were included from three Haemophilia Treatment Centres, on prophylactic clotting factor replacement therapy for more than 1 year. Parents and adolescents were analysed separately. The adherence scale for prophylactic therapy (VERITAS-Pro) was translated according to international guidelines. This instrument contains a total of six subscales ('Time', 'Dose', 'Plan', 'Remember', 'Skip' and 'Communicate') each with four items. Lower scores reflect higher adherence. Overall response rate was 85%, leading to a study population of 60 children. Mean age was 10 years (SD...
A pregnancy complicated by preeclampsia (PE), intra-uterine growth restriction (IUGR) or gestatio... more A pregnancy complicated by preeclampsia (PE), intra-uterine growth restriction (IUGR) or gestation diabetes (GD) is a maternal predictor for future cardiovascular disease. Lifestyle changes may well lower this risk. The Pro-Active study was designed to evaluate a postpartum lifestyle intervention program after complicated pregnancy. From 2007 to 2012 women with PE, IUGR or GD were invited to participate. Women with known pre-existent pathology were excluded. At inclusion (6mos postpartum) and closure (13mos postpartum) measurements and lifestyle questionnaires were obtained. A non-randomized cohort (Erasmus MC, Rotterdam, n=144) was offered a web based health check and 3 counseling sessions with a behavioral expert. The control cohort (Amphia Hospital, Breda, n=62) was not. Primary outcome measure was weight reduction. The effect of lifestyle intervention was estimated, using linear regression on measurement changes, adjusted for changes in controls, measurement at inclusion and dem...
This study evaluates the appreciation, application and effects of an intervention (Your Health), ... more This study evaluates the appreciation, application and effects of an intervention (Your Health), in which adolescents received a consultation with the school nurse. A cluster randomized controlled trial with an intervention and control group (care-as-usual) was conducted among first-grade senior vocational students. Adolescents (n = 418) completed a questionnaire at baseline and 6-month follow-up assessing health and health behaviors. School absenteeism was monitored via the school registration system. After the consultation, adolescents and nurses evaluated the consultation by questionnaire. Adolescents appreciated being invited for the consultation and gave the consultation a positive mean rating of 8.78 on a 10-point scale. Adolescents rated the other nine items on the appreciation of the consultation also high. In 36.8% of the adolescents, nurses suspected problems. Most often these adolescents were given tailored advice (59.3%) or they were referred to another professional (40....
To generate knowledge about potential improvements to human papillomavirus (HPV) vaccination info... more To generate knowledge about potential improvements to human papillomavirus (HPV) vaccination information and organization strategies, we assessed how aspects of HPV vaccination are associated with parents' preferences for their daughters' uptake, and which trade-offs parents are willing to make between these aspects. A discrete choice experiment (DCE) was conducted among parents with a daughter aged 10-12 years. Panel mixed logit regression models were used to determine parents' preferences for vaccination. Trade-offs were quantified between four vaccination programme aspects: degree of protection against cervical cancer, duration of protection, risk of serious side-effects, and age of vaccination. Total response rate was 302/983 (31%). All aspects influenced respondents' preferences for HPV vaccination (p < 0.05). Respondents preferred vaccination at age 14 years instead of at a younger age. Respondents were willing to trade-off 11% of the degree of protection to...
Fetal smoke exposure may influence growth and body composition later in life. We examined the ass... more Fetal smoke exposure may influence growth and body composition later in life. We examined the associations of maternal and paternal smoking during pregnancy with total and abdominal fat distribution in school-age children. We performed a population-based prospective cohort study among 5243 children followed from early pregnancy onward in the Netherlands. Information about parental smoking was obtained by questionnaires during pregnancy. At the median age of 6.0 years (90% range: 5.7-7.4), we measured anthropometrics, total fat and android/gynoid fat ratio by dual-energy X-ray absorptiometry, and preperitoneal and subcutaneous abdominal fat were measured by ultrasound. The associations of maternal smoking during pregnancy were only present among girls (P-value for sex interaction<0.05). Compared with girls from mothers who did not smoke during pregnancy, those from mothers who smoked during the first trimester only had a higher android/gynoid fat ratio (difference 0.23 (95% confid...
There are limited data regarding the associations of both maternal and paternal anthropometrics w... more There are limited data regarding the associations of both maternal and paternal anthropometrics with longitudinally measured post-natal growth measures in early childhood. To assess the associations of maternal and paternal anthropometrics with growth characteristics and the risk of overweight in pre-school children. Population-based prospective cohort study from early foetal life onwards in the Netherlands. Maternal pre-pregnancy anthropometrics and gestational weight gain, and paternal anthropometrics were related to foetal and post-natal growth measures and the risk of overweight until the age of 4 years. Analyses were based on 5674 mothers, fathers and their children. Both pre-pregnancy maternal and paternal height, weight and body mass index were associated with corresponding foetal and post-natal anthropometric measures. Maternal body mass index had a significantly stronger effect on childhood body mass index than paternal body mass index. As compared to children from parents ...
International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity, 2011
The purpose of this study was to evaluate the effect of a school-based intervention program to re... more The purpose of this study was to evaluate the effect of a school-based intervention program to reduce overweight and improve fitness in primary school children. A cluster randomized controlled design was used over one school year with schools as unit of randomization. In total 20 schools and 2,622 children aged 6-12 years (grades 3-8) from multi-ethnic, low income inner-city neighbourhoods in Rotterdam, Netherlands, participated. The intervention, named Lekker Fit! (Enjoy being fit!) was a multi-component intervention based on behavioural and ecological models. Main components of the intervention are the implementation of three physical education (PE) sessions a week by a professional PE teacher, additional sport and play activities outside school hours and an educational program. Main primary outcome measures were weight status, body mass index (BMI), waist circumference and fitness (20 m shuttle run). Significant positive intervention effects were found for percentage overweight c...
Introduction: The Strengths and Difficulties Questionnaire (SDQ) is a relatively short instrument... more Introduction: The Strengths and Difficulties Questionnaire (SDQ) is a relatively short instrument developed to detect psychosocial problems in children aged 3-16 years. It addresses four dimensions: emotional problems, conduct problems, hyperactivity/inattention problems, peer problems that count up to the total difficulties score, and a fifth dimension; prosocial behaviour. The validity and reliability of the SDQ has not been fully investigated in younger age groups. Therefore, this study assesses the validity and reliability of the parent and teacher versions of the SDQ in children aged 5-6 years in the total sample, and in subgroups according to child gender and parental education level.
Archives of Physical Medicine and Rehabilitation, 2014
To (1) determine the long-term trajectory of health-related quality of life (HRQOL) for the dimen... more To (1) determine the long-term trajectory of health-related quality of life (HRQOL) for the dimensions of physical complaints and motor, psychological, and social functioning for groups of individuals with cerebral palsy (CP) aged 1 to 24 years; (2) assess the variability in HRQOL within individuals with CP over time; (3) assess the variability in HRQOL between individuals with CP; and (4) compare the HRQOL in individuals with CP to reference data of typically developing individuals. Multicenter prospective longitudinal study. Rehabilitation departments of 3 university medical centers and various rehabilitation centers in The Netherlands. Dutch individuals with CP (N=424; age, 1-24y). Not applicable. The HRQOL dimensions of physical complaints and motor, psychological, and social functioning. Each individual visited the rehabilitation department for 3 or 4 measurements. The time between measurements was 1 or 2 years. Individuals with CP experience an HRQOL that, on average, remains fairly stable over time. Variability in HRQOL within individuals with CP was similar to that within typically developing individuals. Variability between individuals with CP could be explained by type of CP (motor functioning), Gross Motor Function Classification System level (physical complaints and motor and social functioning), and intellectual disability (physical complaints and social functioning). Finally, individuals with CP experienced a lower HRQOL than did typically developing individuals, especially for the dimensions of motor and social functioning. Many changes take place in the psychosocial development of the individual with CP, which accordingly change their expectations and those of their caregivers, peers, and professionals. As a result, perceived physical complaints and motor, psychological, and social functioning remain fairly stable over many years.
To examine the association between socioeconomic position (SEP) and umbilical and uterine placent... more To examine the association between socioeconomic position (SEP) and umbilical and uterine placental resistance indices in the second and third trimester, and to what extent this could be explained by lifestyle-related behaviors. Prospective cohort study. Rotterdam, the Netherlands. 7,033 pregnant women of mean age (± standard deviation) 29.9 (±5.2) years. None. Uterine artery resistance index (UARI) and umbilical artery pulsatility index (UAPI) in second and third trimester measured with Doppler ultrasound. Third-trimester UARI and both second- and third-trimester UAPI were statistically significantly higher for women with lower educational levels as compared with those with higher educational levels. Educational level was strongly associated with the risk of continuously high levels of UARI and UAPI from second to third trimester of pregnancy. Notching was not associated with SEP. Smoking was a significant contributor to the association of SEP and increased placental resistance ind...
Ethnic differences in childhood and adulthood are known, but ethnic differences in preschool over... more Ethnic differences in childhood and adulthood are known, but ethnic differences in preschool overweight and associated factors are less studied. We assessed ethnic differences in pre-school age overweight, and studied the mediating role of early life factors in this association. Furthermore, we assessed body mass index (BMI) z-score development from birth to age 4 years to study ethnic-specific differences in BMI z-score trajectory. We used data on 4581 children participating in a birth cohort who were born between 2002 and 2006 in Rotterdam, the Netherlands. Child's ethnicity was defined according to country of birth of the parents. Weight and length/height was repeatedly measured between 1 and 45 months of age. Overweight at age 4 years was defined according to cut-off points for BMI from the international obesity task force. We performed logistic regression to obtain independent estimates of the association between ethnicity and preschool-age overweight, and to assess the med...
To investigate the emergence of the inverse socioeconomic gradient in body mass index (BMI) in th... more To investigate the emergence of the inverse socioeconomic gradient in body mass index (BMI) in the first 6 years of life. Furthermore, associations of socioeconomic position (SEP) with BMI and total fat mass (%) were assessed at age 6, and potential mediating factors in the pathway between SEP and children's body composition were investigated. Nearly 3,656 Dutch children participating in a prospective cohort study in Rotterdam, the Netherlands, were included from 2002 to 2006. Maternal educational level and net household income were used as indicators of SEP. BMI and fat mass were both outcome measures. Associations and mediation analyses were investigated using linear mixed models and linear regression analyses. The lowest SEP groups showed a larger increase in BMI over time as compared to the highest SEP groups (P < 0.001), which resulted in the emergence of the inverse SEP gradient around 3-4.5 years of age. In 6-year-old children, both BMI and total fat mass were signific...
To investigate whether maternal educational level is associated with gestational diabetes mellitu... more To investigate whether maternal educational level is associated with gestational diabetes mellitus (GDM), and to what extent risk factors for GDM mediate the effect of educational level. We examined data of 7,511 pregnant women participating in a population-based cohort study in Rotterdam, the Netherlands. The highest achieved education was categorized into four levels. Diagnosis of GDM was retrieved from delivery records. Odds ratios (OR) of GDM were calculated for levels of education, adjusting for confounders and potential mediators. Mediators were selected according to Baron and Kenny's causal step approach. Adjusted for ethnicity, age, family history of diabetes and parity, women in the lowest educational level were three times more likely to develop GDM than women in the highest level (OR 3.07; 95 % CI 1.37, 6.89). Selected mediators were alcohol use and body mass index (BMI). Additional adjustment for alcohol use attenuated the OR to 2.54 (95 % CI 1.11, 5.78). The individ...
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Papers by Hein Raat