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EUSUHM-congres: kennisdelen voor en samenwerken aan een gezonde jeugd! Changing contexts—influencing youth and their surroundings. Het thema van het congres was ‘Changing contexts – influencing youth and their surroundings’. Met dit thema komt tot uiting dat gezondheid meer is dan lichaam en geest en dat lichaam en geest worden beïnvloed door de context waarin zij zich bevinden. Dit is waar publieke gezondheid over gaat.

Previous studies showed that missing data in multi-item scales can best be handled by multiple imputation of item scores. However, when many scales are used, the number of items will become too large for the imputation model to reliably estimate imputations. A solution is to use passive imputation or a parcel summary score that combine and consequently reduce the number of variables in the imputation model. The performance of these methods was evaluated in a simulation study and illustrated in an example. Passive imputation, which updated scale scores from imputed items, and parcel summary scores that use the average over available item scores were compared to using all items simultaneously, imputing total scores of scales and complete-case analysis. Scale scores and coefficient estimates from linear regression were compared to "true" parameters on bias and precision. Passive imputation and using parcel summaries showed smaller bias and more precision than imputing total scores and complete-case analyses. Passive imputation or using parcel summary scores are valid missing data solutions in studies that include many multi-item scales.

Objective: The concept of specific agreement (SA) has been proposed for dichotomous outcomes for two or more raters. We aim to extend this concept for variables with more than two ordinal or nominal categories and more than two raters. Study Design and Setting: We used two data sets: four plastic surgeons classifying photographs after breast reconstruction on a 5-point ordinal scale and six raters classifying psychiatric patients into five diagnostic categories. For m raters, all (i.e., m(m−1)/2) pairwise agreement tables were summed to calculate the observed agreement (OA), SA and conditional probabilities. The 95% confidence intervals were obtained by bootstrapping. Results: SA was calculated for each ordinal or nominal category to examine when one of the raters scored in a specific category, what is the probability that the other raters scored in that same category. And suppose one of the raters scored X1, what is the probability that the other raters scored X1 or any of the other categories (conditional probability). It appeared, for example, that among the psychiatric disorders, depression and personality disorders were often mixed up, whereas neurosis was rarely mixed up with schizophrenia. Conclusion: The concept of SA for variables with ordinal and multiple nominal categories provides relevant clinical information. The extension to conditional probabilities of alternative categories broadens the clinical application with examining which categories are most often mixed up. © 2017 Elsevier Inc.

In dit rapport wordt verslag uitgebracht van de evaluatie van de neonatale hielprikscreening (NHS) op adrenogenitaal syndroom (AGS), congenitale hypothyreoïdie (CH), 13 metabole ziekten (MZ), hemoglobinopathie (HbP)1 en cystische fibrose (CF ofwel taaislijmziekte) bij kinderen uit Europees Nederland geboren in 2017. Er wordt een aparte monitor uitgebracht over de NHS in Caribisch Nederland. De landelijke regie, waaronder ook de verantwoordelijkheid voor de monitor en evaluatie van het programma neonatale hielprikscreening, is in handen van het Centrum voor Bevolkingsonderzoek (CvB) van het RIVM. In opdracht van het CvB voert TNO jaarlijks een monitoring en evaluatie uit. Doel hiervan is de kwaliteit van het screeningsprogramma te bewaken en waar mogelijk verder te verbeteren.

This report examines barriers to and drivers of workplace psychosocial risk management, and how this is influenced by different national and organisational contexts. The exposure of workers to psychosocial risks is increasing. However, the level of risk and the effectiveness of management vary across sectors and countries. Based on the findings of a quantitative analysis of ESENER-2 data combined with other country-specific data, it shows that the national context — culture, economy and occupational safety and health initiatives by social partners — is related to the level of psychosocial risk management in the workplace. It also reveals that management commitment and worker involvement are likely to be most effective organisational drivers of managing psychosocial risks, regardless of the national context. The practical implications of these findings are also discussed. Including summary.

van het Mind the gap! Building bridges to better health for all young people, EUSUHM (European Union for School and University Health and Medicine) congres 2017, Leuven.

Background: In 2010, the human papillomavirus (HPV) vaccination was introduced in the Dutch National Immunization Program for 12-year-old girls, aiming to reduce the incidence of cervical cancer in women. HPV vaccination uptake turned out to be lower than expected: 61% versus 70%, respectively. Mothers were shown to play the most important role in the immunization decision about this vaccination. They had also expressed their need for interactive personal information about the HPV vaccination over and above the existing universal general information. To improve the effectiveness of the existing education about the HPV vaccination, we systematically developed a Web-based tailored intervention with virtual assistants providing mothers of girls to be invited with tailored feedback on their decision making about the HPV vaccination. Objective: The aim of this study was to evaluate the effectiveness of the Web-based tailored intervention for promoting HPV vaccination acceptance by means of a randomized controlled trial (RCT). Methods: Mothers were recruited via the Dutch vaccination register (Praeventis) (n=36,000) and three Web-based panels (n=2483). Those who gave informed consent (N=8062) were randomly assigned to the control (n=4067) or intervention condition (n=3995). HPV vaccination uptake, as registered by Praeventis once the HPV vaccination round was completed, was used as the primary outcome. Secondary outcomes were differential scores across conditions between baseline (before the provided access to the new tailored intervention) and follow-up (just before the first vaccination) regarding the mothers’ degree of informed decision making (IDM), decisional conflict, and critical determinants of HPV vaccination uptake among which are intention, attitude, risk perception, and outcome beliefs. Results: Intention-to-treat analysis (N=8062) showed a significant positive effect of the intervention on IDM, decisional conflict, and nearly all determinants of HPV vaccination uptake (P

Om de meer dan 217 miljoen werkenden in de Europese Unie (EU) beter te beschermen tegen werkgerelateerde ongevallen en ziekten heeft de Europese Commissie in 2014 het strategisch EU-kader voor gezondheid en veiligheid op het werk 2014-2020 (1) aangenomen. Daarin stelt zij belangrijke uitdagingen en strategische doelstellingen vast in de context van gezondheid en veiligheid op het werk. Het strategisch kader heeft allereerst tot doel ervoor te zorgen dat de EU een vooraanstaande rol blijft spelen bij het bevorderen van hoge normen voor arbeidsomstandigheden. Ten tweede moet de tenuitvoerlegging van de bestaande regelgeving op het gebied van veiligheid en gezondheid worden verbeterd, met name door kleine en micro-ondernemingen beter in staat te stellen effectieve en efficiënte strategieën voor risicopreventie uit te voeren. De derde doelstelling is de preventie van werkgerelateerde ziekten te verbeteren door nieuwe en opkomende risico’s aan te pakken zonder bestaande risico’s te veronachtzamen. Om deze uitdagingen het hoofd te bieden, worden in het strategisch kader diverse maatregelen voorgesteld, zoals het verbeteren van de wijze waarop statistieken worden verzameld om beter bewijs te genereren en de gegevens adequater te gebruiken, en het verder verbeteren van monitoringinstrumenten.

Background. Multiple imputation is a recommended method to handle missing data. For significance testing after multiple imputation, Rubin’s Rules (RR) are easily applied to pool parameter estimates. In a logistic regression model, to consider whether a categorical covariate with more than two levels significantly contributes to the model, different methods are available. For example pooling chi-square tests with multiple degrees of freedom, pooling likelihood ratio test statistics, and pooling based on the covariance matrix of the regression model. These methods are more complex than RR and are not available in all mainstream statistical software packages. In addition, they do not always obtain optimal power levels. We argue that the median of the p-values from the overall significance tests from the analyses on the imputed datasets can be used as an alternative pooling rule for categorical variables. The aim of the current study is to compare different methods to test a categorical variable for significance after multiple imputation on applicability and power. Methods. In a large simulation study, we demonstrated the control of the type I error and power levels of different pooling methods for categorical variables. Results. This simulation study showed that for non-significant categorical covariates the type I error is controlled and the statistical power of the median pooling rule was at least equal to current multiple parameter tests. An empirical data example showed similar results. Conclusions. It can therefore be concluded that using the median of the p-values from the imputed data analyses is an attractive and easy to use alternative method for significance testing of categorical variables.

In order to better protect the more than 217 million workers in the European Union (EU) from work-related accidents and diseases, in 2014 the European Commission adopted the Strategic Framework on Health and Safety at Work 2014-2020 (1), which identifies key challenges and strategic objectives for health and safety at work. The Strategic Framework aims to ensure that the EU continues to play a leading role in the promotion of high standards for working conditions, to improve implementation of existing safety and health rules, in particular by enhancing the capacity of micro- and small enterprises to implement effective and efficient risk prevention strategies and to improve the prevention of work-related diseases by tackling new and emerging risks, without neglecting existing risks. This Framework proposes to address these challenges with a range of actions, including the improvement of statistical data collection to generate better evidence and to make more appropriate use of the data, as well as further improvements in monitoring tools.