Annual Report. Julius Center for Health Sciences and Primary Care

Transcription

1 Annual Report Julius Center for Health Sciences and Primary Care

2 Annual Report 2007 Julius Center for Health Sciences and Primary Care UMC Utrecht

3 The Julius Center for Health Sciences and Primary Care is one of the twelve divisions of the University Medical Center Utrecht (UMC Utrecht). It carries out scientific research, provides education, and offers expertise and facilities in the clinical health sciences field. The Center aims for a leading and acquisitive position in the enlargement and dissemination of knowledge, especially in the field of health sciences. This is done by means of groundbreaking research on four disease-related themes and research methodology, by offering courses for (bio)medical students, researchers and clinicians, and by providing academic primary care. Disciplines represented in the Center are general practice, (clinical) epidemiology, nursing science, medical technology assessment, public health, medical ethics, and nutritional sciences. In this annual report the reader will find information on activities, output and finances in Contact information M. Kluijtmans, PhD Executive Secretary Management Team & Coordinator Master s Programme Epidemiology Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Visitors: Heidelberglaan 100, Utrecht, The Netherlands Correspondence: Str , P.O. Box 85500, 3508 GA Utrecht, The Netherlands URL: [email protected] Contents Introduction 7 Organization 17 Brief History 19 Organizational Structure 19 Research 21 Research Organization 23 Research Themes 26 IRAS 43 International Collaboration 45 External Assessment of Past Performance 50 Education 55 Educational Organization 56 General Practice 59 Epidemiology 67 Public Health 78 Medical Humanities 81 Nursing Science 83 Nutritional Science 87 Patient Care 91 Nutritional Sciences and Dietetics 93 Julius Center Health Care Leidsche Rijn 98 Unit Health Care Innovations Annual Report

4 Operational Support 103 Management Support 105 Clinical Trial Services Unit 106 Data Management 108 Personnel and Finances 111 Personnel, Figures 113 Personnel, Listing 114 Financial Report 127 Research Projects Cardiovascular Diseases 135 Infectious Diseases 143 Cancer 148 Mental Health 150 Theoretical Epidemiology and Biostatistics 154 Miscellaneous 157 Clinical Trial Services Unit 161 Vasculair Imaging Center (VIC) 166 Data Management 167 Publications PhD Theses 173 International Refereed Publications 174 Professional Publications 201 Books and Book Chapters 205 Nederlandse Samenvatting 209 Colophon Annual Report

5 Introduction This year s report again lists the many ational scientific publications by staff members and fellows of the Julius Center which underlines the Center s continued success at the forefront of ational research. (Rick Grobbee)

6 The year 2007 started with a new management team. For a number of reasons, not in the least the continuous growth of the Julius Center and its activities, the team was expanded from three to four members. In addition, the responsibilities of the members were rearranged. Professor Diederick E. Grobbee remains the chairman of the division, with Margot van der Starre, MSc, remaining director of business administration. Professor Theo Verheij decided to leave the management team after having served as the director of education for eight years. His position was taken over by Professor Yolanda van der Graaf, while Professor Arno Hoes was appointed as director of research, a position that was previously combined with the position of chairman. The management team is supported by the executive secretary, Dr Manon Kluijtmans. In the past years, several investments were made in the research support and infrastructure. The research management information system was further optimized and a start was made to upgrade the education management information system. In January a highly innovative in-house developed data capture and management system was launched for use in research projects : Research Online: research without borders. Research Online is fully et based, flexible and modular and can be applied for projects of any size without any geographic or linguistic restriction. Also in other domains, the impact of information technology could be felt. The Dietetics section of the Julius Center was the first UMC Utrecht care department to work fully digitally. Since January 2007 all patients have an electronic file, the EPD, which can never go missing and is accessible form any location within the hospital. As UMU pioneers in comprehensive patient and workflow records, of course initial challenges and difficulties were encountered. Many were solved satisfactorily and other departments will likely benefit from these initial experiences. Introduction 9

7 The Julius Center values education very highly and continues to invest in the development of new teaching activities and improvements in existing programmes. One of the major developments in 2007 was the start of the AsiaLink programme. In collaboration with academic departments in the United Kingdom (Oxford), Indonesia (Jakarta) and Malaysia (Kuala Lumpur), and with support from the European Union, the Julius Center aims to strengthen training and application of Evidence Based Medicine in Asia. AsiaLink has resulted from long existing ties between the participating institutions and a history of annual teaching courses in Asia by staff members of the Julius Center. Apart from stimulating evidence based medicine, AsiaLink will promote teaching in clinical epidemiology by incorporating courses developed in Utrecht and Oxford in the medical curricula in Kuala Lumpur and Jakarta. Closely related to these activities, but more orientated towards collaborative research, a local Julius Center KL has opened at the University of Malaya Medical Center in Kuala Lumpur in November We cherish our stimulating and productive ational collaborations. As a reflection, the Julius Center has one of the highest travel budgets in the UMC Utrecht. A more important reflection is, however, an increasing number of high level affiliations of staff members of the Julius Center with prestigious academic institutions abroad. A prime example was the appointment of Dr Petra Peeters as a professor in Chronic Disease Epidemiology at the Faculty of Medicine, Imperial College London in London, UK in October She will combine this position with her activities as director of cancer epidemiology at the Julius Center. Importantly, the appointment will further reinforce the existing collaboration between these two institutes. In addition to her scientific work and commitment to high quality teaching, the Julius Center is also active in patient care. In 2007, the Julius Health Care Centers in Leidsche Rijn (a residential area southwest of Utrecht) opened a fifth health center in t Zand, and the building of a new health care center in Vleuterweide was commissioned. In its health care centers, the Julius Center aims at setting new standards of care. With regard to quality of care it is noteworthy that the managing director of the Julius Health Care Centers, Rob van Damme, received the first ECB certificate in the Netherlands. The ECB is a certification programme in which the clients judge on the provided care. It is an initiative of the Dutch Patients and Consumers Federation. With an average client satisfaction of 8 the Julius Health Care Centers can be very proud of their performance. This year s report again lists the many ational scientific publications by staff members and fellows of the Julius Center which underlines the Center s continued success at the forefront of ational research. In 2007 the Julius Center again showed a good coverage in the major high ranking and established medical journals; the JAMA, the New England Journal of Medicine, and the Lancet. Senior staff members Michiel L. Bots and Diederick E. Grobbee even managed to publish in all three of these journals in one single year, a major achievement. Among others they published two papers on the effects of lipid modifying drugs on the development (progression) of atherosclerosis. Next to a good representation in the aforementioned general journals, the Julius Center had key methodological publications in major epidemiological journals, as well as papers with immediate practice relevance in leading journals in primary care. 10 Annual Report 2007 Introduction 11

8 In addition to the excellent research output, Julius staff members received awards and other expressions of appreciation of their research. Two prizes deserve special attention: Bert Brunekreef, professor of Environmental Epidemiology at the Julius Center and director of the interfaculty Institute for Risk Assessment Sciences in Utrecht, received two ational awards in the month of September. In Mexico City he received the John Goldsmith Award from the International Society of Environmental Epidemiology (ISEE). This award for Outstanding Contributions to Environmental Epidemiology is granted once a year to someone who has made an exceptional effort in the area of environmental care and health. Professor Brunekreef is the first Dutch recipient of this award. Only a few days later, on 15th of September he received the European Lung Foundation Award in Stockholm. The ELF Award is granted once a year to someone who has made an exceptional effort to improve public health. Following intense evaluation of the structure and organization of the Julius Center in 2006, a number of high impact decisions were made about the way the Julius Center is organized and managed that influence both its research and educational profile. After a long process of discussion and consultation the decision was made to terminate the department of Nursing Sciences in it present form. There appeared to be insufficient basis and prospects to continue the research activities in the area of nursing science. The successful teaching programme in Nursing Science will be continued in another format in close collaboration with the Utrecht School of Professional Education. On a more positive note, Utrecht University decided that as of mid 2008 the University Center for Biostatistics will become part of the Julius Center. It will continue its campus wide statistical consultation services, but strategic investments will be made to foster original biostatistical research with a special emphasis on epidemiologic and genetic statistical problems. With regard to public health, a Unit Health Care Innovation was established directed by Professor Guus Schrijvers to concentrate the advisory and evaluative work done on health care innovation. Over the years, the Julius Center has introduced and refined a matrix model to direct and monitor its research and teaching. In this matrix, education is being organized by scientific discipline and research by disease oriented research theme. To monitor the performance of the structure, a planning and control system was initiated in 2007 with increased responsibility for the educational and research coordinators. This system will be further improved and implemented in To support their new role, several of the coordinating staff members involved enrolled in personal and management development programmes. In addition, staff development in general received attention, the acquisition of educational qualifications was stimulated and the board of the UMC Utrecht granted no less than five female staff members of the Julius Center a Steyn Parvé personal development award. The Steyn Parvé programme comprises training and coaching and aims to support talented female researchers in reaching academic top positions was a year of evaluation. In two external research assessments by ational review committee s the scientific performance of the Julius Center s was judged to be excellent. The committees also were very positive about the future prospects, and applauded the societal impact of the Center. Although it is impossible to capture the full range of the Julius center s activities in a short introduction, we can safely conclude that 2007 was a very productive and successful year, in education and research as well as 12 Annual Report 2007 Introduction 13

9 in patient care. The Center received excellent scores in external assessments of past research performance, and made important steps towards securing these results for the future. Medical care in Leidsche Rijn expanded with a high ambition in quality and patient satisfaction. Last, but certainly not least, the educational activities remained of high quality, and attracted students from first year medical and biomedical bachelors to health care professionals. The assessment of 2007 is positive and rewarding. But none of this would have been possible without the people that together make up the Julius Center. They are to be complemented for their creativity, hard work, inspiration and devotion of many. Either being in support, care, education, research or administration: thank you all for your commitment and I sincerely hope that this annual report will make you feel proud and satisfied with the continued success of the Julius Center. Professor Diederick E. Grobbee, MD, PhD Chairman 14 Annual Report 2007 Introduction 15

10 Organization The Julius Center is and remains succesfull thanks to the huge capacity of its researchers to acquire funds, and the flexibility of all who support both acquisition, administration and conduct of the research projects. (Margot van der Starre)

11 Brief History The Julius Center for patient-oriented research was established on 16 December 1996, founded upon the previous departments of epidemiology and public health, and on the hospital unit of clinical epidemiology. Both scope and size have since then markedly increased, as is reflected by the Julius Center s subdivisions; former departments that have been integrated in the current center. In 1999 the department of General Practice merged with the department of patient-oriented research to become the Julius Center for Patient-Oriented Research and General Practice. In 2002 the department of Nursing Science and the Nutritional Sciences group joined the Center to become the current Julius Center for Health Sciences and Primary Care. In 2007 it was decided that Nursing Sciences will be terminated in its present form in the division. As per mid 2008, the Utrecht University Center for Biostatistics will become part of the Julius Center. Organizational Structure The organizational structure can be found on the inside of the cover. Organization 19

12 Research We often gain more by improving timely diagnosis, than by adding therapeutic interventions. (Arno Hoes) Research 21

13 Research Organization The University Medical Center Utrecht has formulated seven main research themes. These fit into a matrix with four disease-related themes on the horizontal and three methodological themes on the vertical axis. The Julius Center s main contribution to the total body of research of the UMC Utrecht is through the research theme Epidemiology. With rare exceptions, all of the Center s research activities can be classified as clinical epidemiological research, i.e. etiologic, diagnostic, prognostic and intervention research with relevance for patient care. Building upon this, the Julius Center contributes to all four disease-related areas of research: cardiovascular disease, infection & immunity, cancer, and mental health. In addition, there are strong links with the other two methodological research themes of the UMC Utrecht: Imaging sciences and Genetics. The Julius Center s research activities focused on 5 research themes, i.e. the same 4 disease-related areas as the UMC Utrecht (Cardiovascular Disease, Infection & Immunity, Cancer, and Mental Health) and one methodological theme (Theoretical Epidemiology & Biostatistics). Within these themes, there is further focus on subfields, as for example research on (etiology and prognosis of) diabetes mellitus as part of the cardiovascular disease theme or on the effects of vaccinations within the infection & immunity theme. All 5 research themes are headed by one (or two for the largest theme, cardiovascular disease) research coordinator. Importantly, the research activities of the (clinical or methodological) disciplines represented in the Julius Center (Clinical Epidemiology, General Practice/Primary Care, Public Health/Medical Technology Assessment/Medical Ethics, Nursing Science, and Nutritional Sciences) are also incorporated in Research 23

14 these 5 research themes and not in separate research organizations. The research methods for all of these disciplines can be broadly categorized as (clinical) epidemiological, which was one of the main reasons for these disciplines to be combined within the Julius Center. The research activities can, thus, be represented by a matrix structure, in which the vertical axis comprises the five research themes and the disciplines are depicted in the horizontal axis. The Center s policy is to concentrate its research as much as possible on the matrix s overlapping areas so that each of its disciplines benefit most from the Center s scientific and clinical expertise and the UMC Utrecht s scientific themes as a whole are strengthened. of Prof. Bert Brunekreef and honorary appointee Prof. Dick Heederik. There is also collaboration with other epidemiological research groups at Utrecht University, in particular with the Pharmaco-epidemiology group (from the Pharmacy Department) and Veterinary Epidemiology groups. In addition to the acquisition and conduct of its own research projects, either independently as an institute or in collaboration with other research groups, a major responsibility of the Center is to provide methodological advice and to support clinical research in virtually all departments of the University Medical Center. Staff members act as consultants for research methods on a range of clinical investigations within as well as outside the UMC Utrecht. The Center also plays a pivotal and formal role in quality assurance of randomized trials performed in the UMC Utrecht. These are important and growing activities for the Julius Center. For many clinical departments the intense and continuous interaction with epidemiology has resulted in joint appointments of staff, including the departments of anesthesiology, neurology, cardiology, cardio-thoracic surgery, al medicine, psychiatry, radiology and pediatrics. The Julius Center has a formalized link with the interfacultary Institute for Risk Assessment Sciences (IRAS), environmental and occupational epidemiology at UU. This has been embodied by the joint appointment 24 Annual Report 2007 Research 25

15 Research Themes Cardiovascular Diseases The disease-based research line Heart and Vascular Disease is the largest research line in the Julius Center. A considerable part of the research carried out within this research line focuses on the causes, diagnosis, prognosis and therapy of cardiovascular diseases. The approaches include the full range of epidemiological research methods, including multi-centered randomized controlled trials to study the effects of preventive and therapeutic interventions. Within the research line focus is on atherosclerosis progression as this underlies the occurrence of ischemic vascular disease. In 2007 results from several large ational multicenter trials conducted by the Julius Center on the effect of lipid modifying drugs were published. In the METEOR study statin treatment slowed progression of atherosclerosis, assesses as carotid intima-media thickness, in a population of healthy men and women, free from previous vascular disease and diabetes and with a low Framingham risk score (JAMA. 2007;297: ). A multicenter ational trial among familial hypercholesterolemia patients (RADIAN I) on the effect of increasing HDL cholesterol levels by cholesteryl ester transfer protein inhibitor on atherosclerosis progression showed no benefit of the intervention (N Engl J Med. 2007;356: ). Similar results were found in RADIAN II among patients mixed dyslipidemia (Lancet 2007;370:153-60). Findings from a large national trial on the effect of folic acid supplementation on carotid atherosclerosis progression in expected in With respect to large population based cohort studies several initiatives were completed in A large, population based cohort study was started in Utrecht in 1993, as part of the European Prospective Investigation into Cancer and nutrition (EPIC). Women participating in the national breast cancer screening programme and living in Utrecht and surroundings were invited to participate between 1993 and 1997, and 17,357 could be enrolled in Prospect-EPIC. Extensive information on lifestyle behavior, such as smoking, alcohol consumption, physical activity, and dietary habits were collected at baseline. Also a brief physical examination was done, for collecting information on anthropometry and blood pressure. Serum, plasma, erythrocyte and DNA samples were collected and stored locally as well as centrally in Lyon, France. Information on cardiovascular, cancer and diabetes morbidity and mortality is collected through linkage with registries, such as the Cause of Death registration at the Central Bureau of Statistics, the cancer registries from the Comprehensive Cancer Centres, and the national hospital discharge diagnosis registry, and through follow-up questionnaires to participants. Information on type 2 diabetes was verified through general practitioners and pharmacies. The National Institute for Public Health and the Environment also contributes a cohort to EPIC, the Morgen- EPIC-cohort. Since there has always been close collaboration between the Dutch investigators, and baseline measurements are identical for both cohorts, it was decided that the cohorts would be combined into the EPIC-NL cohort. This major enterprise started in 2006, and was successfully finalized in The EPIC-NL cohort now consists of 40,000 men and women aged between 20 and 70 years, with 10 years of followup, 2000 cardiovascular disease cases, 2000 cancer cases, and 750 diabetics. In 2008 cardiovascular risk factors will be measured in the cardiovascular and diabetes cases, and a random sample of the cohort, in order to have a set ready for extensive analysis and exciting papers. Information can be found at 26 Annual Report 2007 Research 27

16 A second large population based cohort of within the Julius Center is the Utrecht Health Project. All new inhabitants in the newly developed large residential area Leidsche Rijn, part of the city of Utrecht, are invited by their general practitioner to participate in the Utrecht Health Project (UHP). Informed consent is obtained and an individual health profile (IHP) is recorded by dedicated research nurses. The IHP is the starting point for the UHP research database as well as for the primary care electronic medical records. Follow-up data are collected through continuous linkage with the computerized medical files recorded by the general practitioners. UHP staff in each practice takes care of quality management of registration as well as data handling. Currently, over 50% of invited new residents in the area have given informed consent with participation steadily increasing. At present over 10,000 inhabitants are participating in Utrecht Health Project. Information is available at Using the infrastructure of the Utrecht Health Project, a weight reduction programme was initiated and finished in The aim was to reduce weight and subsequently reduce cardiovascular risk in 180 overweight subjects (BMI 28-35). The project involved efforts and intense collaboration of various health care workers: general practitioners, physiotherapists, dieticians. In addition to weight and risk reduction, the process of the programme was carefully evaluated. A factor that was related to success of weight reduction in particular was the direct contact of the patient by the general practitioners outside his regular appointments. The weight reduction programme was designated as being very innovative by the Dutch Minister of Health. Also making use of the infrastructure of the Utrecht Health Study, a study started into the early roots of cardiovascular disease in the young, in which indicators of vascular damage are being studied in 6 year old children. Using state-of-the-art ultrasound techniques information on the thickness of the arterial wall and on the stiffness of the arterial wall is collected. Furthermore, with in the research line, studies are being conducted on genetic information and the interplay between genes and environment in, for example, studies on genetic and non-genetic factors that determine the occurrence of type 2 diabetes. The studies are conducted in close collaboration with partners within and outside the UMC Utrecht and abroad. In addition, the Center is involved in the setting up and scientific evaluation of both diagnostic and therapeutic heart failure outpatient departments in the broader Utrecht region. The purpose of this is to gain a better understanding of the nature and causes of heart failure and to improve early detection and adequate treatment and follow-up of this syndrome, which constitutes an increasing burden on our ageing society. Other studies include the etiology and prognostic role of coronary collateral formation, and the risk-benefit ratio of anticoagulation in patients at a high risk of stroke. In addition, the Julius Center is increasingly involved in the execution of large-scale diagnostic studies, aimed at improving the early detection of cardiovascular diseases, both in the population at large and in patients requiring the hospital s primary care unit. These include studies on the added value of, e.g., various diagnostic imaging techniques and early (bed-side) biomarkers in recognizing atherosclerotic disease (such as stroke, coronary artery disease, peripheral arterial disease) as well as heart failure, deep venous thrombosis and pulmonary embolism. 28 Annual Report 2007 Research 29

17 Infectious Diseases Infectious diseases research at the Julius Center is centered around five topics: 1 Prevention, diagnosis and prognosis of respiratory tract infections. This research is mainly positioned within the primary care and Ear Nose and Throat area and, as an example, it is investigated to what extent certain patient characteristics predict an abnormal and serious clinical progression of bronchial infections, and what the consequences for treatment and patient advice are. In addition, antibiotic use and indications for prescribing in general practice are being studied. This research has been expanded to the development of asthma and allergy, in relation to exposure to infectious agents and other environmental determinants, both in young children and in occupationally exposed subjects. 2 Efficacy (and cost-efficacy) of vaccination strategies. In collaboration with the department of Pediatric Immunology, the National Vaccine Institute and pharmaceutical industries an increasing number of vaccination studies have been executed and are ongoing. Apart from these studies, the role of confounding in determining vaccination efficacy is investigated. 3 Mathematical modeling of infectious diseases. In collaboration with the Mathematical Institute of the University Utrecht and the National Institute of Health and Environment, the dynamics (and prevention of acquisition) of multi-resistant bacteria and influenza within hospitals and the community at large is being investigated, as well as potential effects of intervention. In 2007 a collaboration between the National Institute of Health and Environment, the Mathematical Institute, the Veterinary Faculty and the Julius Center resulted in the Utrecht Epicenter for the study of Infectious Disease Dynamics. 4 Infections in patients with diabetes mellitus. The project Development and evaluation of an educational programme on the prevention of complicated infections in patients with diabetes is currently being carried out. It focuses on respiratory and urinary tract infections. New research topics include the treatment of urinary tract infections and the relationship between onychomycosis and the diabetic foot. 5 The effects of nosocomial infections and transmission of antibioticresistant bacteria on patient outcome. The attributable mortality of ventilator-associate pneumonia is investigated and the Julius center coordinates a ational clusterrandomized trial in European ICUs to determine the efficacy of several approaches to reduce the transmission of antibiotic-resistant bacteria. Cancer Cancer research at the Julius Center focuses on the etiology, early diagnosis and prognosis of hormone dependant cancer, predominantly in women. With approximately 30,000 new cases a year amongst Dutch women, cancer is a serious health threat. However, the known causes can explain barely 30% of the cases encountered. An explanation for this rather low percentage may be sought in the fact that environmental and hormonal factors are predominantly studied without any consideration to genetic predisposition. Cancer etiological research within the Julius Center strongly focuses on the interaction between genes, hormones and the environment (or lifestyle habits). For the study of genetic determinants or gene-environmental interactions, the Julius Center has access to biological material originating from two large-scale on-going population-based cohorts, DOM and EPIC-NL, which is a merger of the two 30 Annual Report 2007 Research 31

18 Dutch cohorts participating in the European Prospective Investigation into Cancer and Nutrition: Prospect-EPIC and Morgen-EPIC. For studies of the optimal (early) diagnostic and (clinical) follow-up procedures in cancer patients, collaboration has been established with clinicians from other departments of the University Medical Center in Utrecht. Examples are the COBRA and MONET studies, both assessing optimal diagnostic and therapeutic procedures in women with non-palpable breast diseases. Studies to assess quality of life and evaluate nurse practitioners in the daily care of cancer patients also fall in the domain of the oncology research at the Julius Center. In 2007, Petra Peeters, the head of the cancer research group, was appointed Professor of Chronic Disease Epidemiology at the Faculty of Medicine of Imperial College London in London, UK. 1 The presentation of depression in primary care, and its association with somatic disease such as dementia, diabetes, gastro-enterological and vascular disease. 2 Functional disease and somatoform disorders: presentation, determinants and treatment in primary care 3 Psychiatric morbidity in relation to socio-demographic context and consultation patterns The common background hypothesis is that somatic and psychiatric disorders share an overlapping etiology and that this overlap has social and psychological as well as physiological components. Our assessments typically aim to characterize individuals on several levels (psychological, physical and physiological). Mental Health The Julius Center s psychiatric epidemiology section studies psychiatric disease and related co-morbidity in primary care and the general population. Mental illness represents a sizeable proportion of the global burden of disease in the general population, but is only partly presented to health care professionals. Major psychiatric disease represents 5% of the prevalent morbidity in primary care, with an annual prevalence of 125 per 1000 patients. A substantial part of minor psychiatric morbidity is presented in relation to somatic disease or functional syndromes or expressed through excessive consultation frequency of unexplained functional syndromes. Mental illness is - though closely linked to somatic ill-health - traditionally studied in isolation. The psychiatric epidemiology section focuses on the study of somatic - psychiatric comorbidity, with the following themes: These themes are studied on the various levels at which disorders manifest themselves: - The general population, by using existing and developing sampling frames such as LRGP (Leidsche Rijn Gezondheidsproject), NEMESIS (Netherlands Mental Health Survey and Incidence Study), AGIS health database and others. - Primary health care, in primary care networks such as HNU (Huisartsen Netwerk Utrecht), PREDICT, the Julius Gezondheidscentra in Leidsche Rijn and the database of Emergency Primary Care service in the Gelderse Vallei area. - Populations of people with reported mental illness like those registered in our psychiatric case registry (RIPAG). - Populations of people with reported somatic illness, such as samples of cardiovascular compromised patients (SMART), (pre)diabetic patients (UDES), and medication-using people (PHARMO). 32 Annual Report 2007 Research 33

19 This approach of studying the phenomenon of somatic psychiatric comorbidity on various levels of the health care system is unique. From a clinical point of view it will yield information on the etiology and prognosis of somatic-psychiatric co-morbidity, and allow preventive interventions. It will also facilitate evaluation of the patient flow through the mental health care system, and its effectiveness - Investigating innovative methods for meta-analysis and individual patient data-analysis of therapeutic studies. - Development of models to combine data from randomized and observational studies including genetic information, for estimating (long term) prognosis according to specific patient characteristics in addition to treatment effects. Most research projects are carried out in collaboration with partners within primary or secondary care health care: primary care physicians, secondary care centers for psychiatry, neurology and gastro-enterology, often in cooperation with other (ational) academic centers. Theoretical Epidemiology and Biostatistics Besides more applied studies on improving insights in the etiology, diagnosis, prognosis and therapy of specific disorders, the Julius Center also aims to further develop the theory and methodology of the discipline itself. The section Methodology conducts studies aiming to improve existing methods and to develop innovative methods for design and analysis of (clinical) epidemiological studies. The section focuses on the following themes: - Developing innovative designs for diagnostic and prognostic (prediction) research. - Developing innovative methods for quantifying the true value or contribution of (new) diagnostic and prognostic tests in a multivariable clinical context. - Developing innovative methods for the validation and updating of socalled clinical prediction rules. - Testing and improving sophisticated methods for dealing with missing values in epidemiologic research. Notably the improvement of methods for design and analysis of multivariable diagnostic and prognostic research is unique. Most research in this field focuses on single test evaluations rather than evaluations in a clinical context, accounting for other test results. But also the methodology for modeling data from randomized and non-randomized studies combined, is in its infancy. This type of research is situated at the crossroad of clinical epidemiology and medical technology assessment. All above methodological themes are not only studied on a purely theoretical level, but are also applied by using empirical data from various medical disciplines, notably from the four disease-oriented sections of the Julius Center. For example, data are used from the above-mentioned LRGP (Leidsche Rijn Gezondheidsproject), the Predict study and the AMUSE study, and from other large ongoing studies in the UMC Utrecht. It may be obvious that the results of our methodological studies do not only serve the clinical domains studied, but may serve all medical domains in which e.g. diagnosis, prognosis and therapy are at issue. Most methodological projects are carried out in close collaboration with other clinical departments from the UMC Utrecht. Other epidemiological and (bio)statistical departments from national an ational academic centers are also consulted, such as the Utrecht University, Academic Medical Center Amsterdam, Erasmus Medical Center 34 Annual Report 2007 Research 35

20 Rotterdam, Dutch National Institute for Health and the Environment, Vanderbilt University (USA), Harvard University (USA) and Oxford University (UK). Cohorts The Julius Center coordinates and participates in several large research cohorts. These cohorts are an important base for research and provide ample opportunities for obtaining financial research support. Moreover, the projects of the GP-network Utrecht and the Utrecht Health Project have the intention to create an infrastructure in which research questions on efficacy and effectiveness of health care, and effects of (local) health care policy, can be answered. The latter is of major importance for increasing the expertise in the areas of health care improvement, extramural health care, and general practice. The major cohorts are: AGIS Health database The AGIS Health database is a registry of all health care procedures of 1.7 million health insured persons. It contains data on health care procedures by all contracted health care providers such as general practitioners, specialists, physiotherapists, pharmacists, midwives and hospitals. Besides data on health care procedures in primary (consultations, referrals, prescriptions) and secondary care (consultations, prescriptions and procedures), a number of personal characteristics are documented, such as date of birth and gender. The insured persons are representative of the Dutch population. The purpose of the database is to improve knowledge on health care consumption, interaction between primary, secondary care and public health, and to provide data to support health care management and to improve quality of care. 36 Annual Report 2007 Research 37

21 ARYA The Atherosclerosis Risk in Young Adults (ARYA) study is an unselected birth cohort of 750 persons born in between 1970 and 1973 in and around the city of Utrecht. Its research focus is on early life determinants of later life cardiovascular disease. At birth, participants had elaborate registered birth data available at the Municipal Health Service in Utrecht and they were followed up into young adulthood. In 1999, participants underwent elaborate cardiovascular disease risk profiling, including classical cardiovascular disease risk factors as well as elaborate non-invasive arterial wall measurements. DOM The DOM cohort (Doorlopend Onderzoek Morbiditeit en Mortaliteit = Ongoing Study on Morbidity and Mortality) is a cohort of 50,000 healthy women, living in Utrecht and surroundings. They were recruited from among breast cancer screening participants, years at recruitment in The purpose of the DOM study is to identify risk factors for several chronic diseases, especially (breast) cancer and cardiovascular diseases. Baseline measurements included a short medical examination, and extensive lifestyle and medical questionnaires. Overnight urine samples were collected and stored at -20 C. EPIC-NL EPIC-NL is the Dutch contribution to European Prospective Investigation into Cancer and Nutrition. EPIC-NL ( is a merger of the Prospect cohort (coordinated by the Julius Center) and the MORGEN-EPIC cohort (coordinated by the National Institute of Public Health and the Environment (RIVM), Bilthoven). It is a cohort of over 40,000 men and women from Amsterdam, Doetinchem, Maastricht and Utrecht and surroundings, aged years at recruitment in The purpose of this study is to assess the relation between nutrition and cancer and other chronic diseases. Participants filled out lifestyle and medical questionnaires and extensive food frequency questionnaires. From all participants blood samples were drawn, fractionated and stored at -196 C. HNU The HNU (Huisartsen Netwerk Utrecht = Utrecht General Practice Network) was funded in 1989 and is a collaboration between the General Practice department of the Julius Center and around 35 general practitioners working in six primary health care centers in the Utrecht area. Approximately 60,000 patients are enlisted with these centers. Data on all primary care consultations (including the ICPC coded diagnosis), prescriptions and referrals in these patients are encoded in the database. GP s were trained to ensure high quality coding. The primary goal was to set up a network of practices that could provide valid and detailed routine care data on a primary care cohort for observational studies. Nowadays, the HNU has a large centralized database with observational data on the patients enlisted from 1995 up until PIAMA The PIAMA (Prevention and Incidence of Asthma and Mite Allergy) birth cohort includes circa 4,000 children who have been followed for 8 years since birth. It is a multi-centre study including IRAS/Julius Center, National Institute of Public Health and the Environment (RIVM), Erasmus University Medical Center Rotterdam, University Medical Center Groningen and Sanquin/CLB Amsterdam. The study was started in 1996 and its purpose is to investigate the occurrence of asthma and allergy in young children, as well as lifestyle and environmental risk factors for these diseases. At several points in time, data were collected on exposure and health status. Blood samples were collected in a sub sample of the children 38 Annual Report 2007 Research 39

22 PREDICT This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months for the prevalence of depression. The Dutch part is coordinated by the Julius Center. Its purpose is to develop a risk score for use by general practitioners to predict the onset and maintenance of depression. Recruitment was started in 2003 and participants were years old. Over 10,000 participants were included, among which over 1,000 participants in the Netherlands. PROVIDI PROVIDI is a cohort of ca. 16,000 patients who have undergone a chest multislice Computed Tomography (msct) scan for diagnostic reasons. The purpose of the cohort is to investigate the extent to which unrequested imaging findings are of prognostic relevance for the occurrence of several relevant diseases, other than the diagnostic CT was originally indicated for. RIPAG RIPAG-MWU (Regionaal Informatiesysteem Patiënten Geestelijke Gezondheidszorg Midden-Westelijk Utrecht) is an anonymous psychiatric case registry that contains information on people who have been treated in a regional mental health care center. It is one of the four regional psychiatric registries that are supported by the Ministry of Health. The primary aim of the database is to provide and analyse epidemiological data on mental health care, to provide management support and to improve quality of care. All major institutions for mental health care in the central region of the Netherlands participate in the registry. From 1999 onwards data (patient characteristics, DSM IV diagnosis, referring centre, type of care and prescriptions on 2.7 million episodes of 60,000 patients who were treated for mental health problems have been included in the database. SMART The SMART (Second Manifestations of ARTerial diseases) cohort started in It is an ongoing prospective single-center cohort study of patients with cardiovascular risk factors or clinically manifest arterial disease. The purpose is to screen these patients for vascular problems elsewhere in the body. Consecutive patients aged 18 to 80 years, referred to the University Medical Center Utrecht (UMCU), with manifest arterial disease or a cardiovascular risk factor underwent vascular screening including questionnaire, blood chemistry, and ultrasonography. After this screening, all patients biannually fill out a questionnaire in order to collect information on cardiovascular morbidity and mortality as well as diabetes mellitus endpoints. SMART includes over 7,500 patients with more than 10 years of follow-up. Utrecht Health Project (LRGP) The Utrecht Health Project (or Leidse Rijn GezondheidsProject (LRGP)) is a cohort of over 10,000 residents of the Leidsche Rijn, Utrecht area, who have been included through their general practitioners. The purpose of this study is to enable research on the impact of changes in health care policy, developments in community and public health and determinants of health and disease during lifetime, as well as quality management of (primary) health care itself. Individual health profiles have been made at recruitment and follow-up data are collected through continuous linkage with computerized medical files recorded by the general practitioners. Blood samples were collected as well. Whistler Whistler (Wheezing Illnesses Study in LEidsche Rijn) is a satellite cohort of the Utrecht Health Project. Participants are newborns to inhabitants of Leidsche Rijn. Whistler was originally initiated to study early life predictors of (lower tract) respiratory disease in childhood. The focus is now expanded 40 Annual Report 2007 Research 41

23 to cardiovascular disease research questions as well. Currently, some 1,800 newborns are included in Whistler. The ultimate purpose is to follow participants up until adulthood. Extensive descriptions of cohorts and related websites can be found at: IRAS IRAS, the Institute for Risk Assessment Sciences (IRAS), is an interfaculty research institute within the Utrecht University faculties of Veterinary Medicine, Medicine and the faculty of Science. The institute has a dual, complementary mission. It performs interdisciplinary research that concentrates on risk assessment of chemical, physical and biological agents on man and the environment. It also provides education and training of graduate and postgraduate (PhD) students in the disciplines of toxicology, environmental and occupational health and epidemiology. The research is performed in three divisions: Environmental Epidemiology, Toxicology, and Veterinary Public Health. Research within the Environmental Epidemiology and Veterinary Public Health Divisions is determinant-oriented epidemiological research, which in most cases is conducted in close collaboration with groups from UMC Utrecht (Julius Center, Heart and Lung Institute, Wilhelmina Children s Hospital). The IRAS input to collaborative projects involves exposure assessment methodology and advanced exposure response modeling. Specific areas of research are cancer and exposure to airborne particulate matter, polycyclic aromatic compounds, dioxin, and organic solvents, asthma and allergen exposure, immune modulation by exposure to Microbial Associated Molecular Patterns (MAMPs). There is a particular interest in exposure to infectious agents and in veterinary public health issues including zoonoses and exposure to microbial agents through the food chain. The IRAS research performance over was evaluated by an ational site visit in late The report issued in March 2006 gave IRAS research the highest possible mark for quality, productivity, relevance and viability. IRAS as a whole produced about 140 peer-reviewed 42 Annual Report 2007 Research 43

24 journal articles in 2007, some 40 of which were co-authored by Juliuscenter affiliated professors Brunekreef and Heederik. In 2007 the Utrecht Center of Molecular Epidemiology (UCME) was established. This center is a collaboration between IRAS and the Julius center and provides core lab-facilities to facilitate specimen handling, DNA extraction and a diverse range of analytical techniques specifically targeted to large scale epidemiological research. In addition, to the establishment of the center plans have been developed to enhance the education curriculum on molecular and genetic epidemiology Research collaborations with RIVM have been strengthened. Infectious disease epidemiology has become more prominent, and active collaboration with other colleagues in the Julius Center is being developed. International Collaboration By nature of its scientific and educational activities, the Julius Center s playing field is the world. Research is conducted in collaboration with research institutes and universities in many different countries. In addition to the inspiring and productive contacts between staff members and fellows with peers all over the world, the Center aims to establish more extensive long-term structural partnerships with strategically selected high-quality Academic institutions. These contacts will play an important role in the Julius Center s ambition to stay at the forefront of ational health scientific research and to disseminate knowledge to an ational audience of students and health professionals With the specific aim to expand its activities in major outcome trials, an ational alliance was created in collaboration with the George Institute for International Health in Sydney, Australia, and the Berman Center for Outcomes and Clinical Research, at the University of Minnesota, Minneapolis, USA. The Academic Alliance for Clinical Trials ( is an academic research contract organization with a focus on interaction between the pharmaceutical industry and academic investigators to promote high-quality innovative phase III and phase IV clinical trials. The Alliance builds upon an existing network of clinics and health care centers in five continents. Besides designing and conducting research, the Alliance invests in improving the methodology and efficiency of research with ample attention to studies in the developing world. In 2007 first major study was contracted. In ational education most important development in 2007 was the start of the European Committee funded AsiaLink project. The Julius Center, the Malaysian Ministry of Health and the University of Malaya 44 Annual Report 2007 Research 45

25 Medical Center (UMMC) in Kuala Lumpur, Malaysia are nurturing a growing collaboration. Until now the collaboration was predominantly based on short intensive courses on clinical epidemiology and evidencebased medicine, delivered by the Julius faculty in collaboration with local staff in Kuala Lumpur. The AsiaLink project aims to extend this collaboration to cover three domains: a) Collaborative research for clinical trials and cohort studies, b) Development and creation of a regional research infrastructure, c) Expansion of educational programmes that also focus on the South Asian region. With the project the ational educational collaboration was extended to also include the University of Indonesia in Jakarta, Indonesia, and the University of Oxford, United Kingdom. With regard to clinical trials, Southeast Asia and Malaysia in particular offers an excellent competitive environment for innovative pharmaceutical companies and large-scale-studies. It also has a growing burden of chronic diseases that require attention. The shared interests and combined forces of the Julius Center and its Malaysian partners creates unique research opportunities. The Ministry of Health s department of Medical technology has very good connections with all major hospitals in the country and a keen interest in improving the quality and efficiency medical care. The partners have jointly created a Julius-KL research infrastructure in Kuala Lumpur that reflects the Julius Center philosophy. In order to foster high quality research, a robust research-support section is needed in which project managers, research nurses, data managers, computer experts, trial monitors, and administrative personnel have their basis. In cooperation with local staff, the Julius Center will continue and broaden the programme of short courses on methods of clinical research. These courses are targeted at medical doctors and clinical investigators in the Southeast Asian region. Eventually, these courses will be largely conducted by local staff. An important purpose of these courses is also the scouting and selection of bright young medical doctors for PhD fellowships. These PhD fellowships will be supervised by the Julius staff and imbedded in the research lines of both the UMC Utrecht and the UMMC. During the fellowship, candidates will follow part of their education in the Netherlands, notably in the Epidemiology prestige master s programme. Depending on the subject, research will be carried out at the Julius Center or in their home country. In addition to clinical trials, the Julius Center is also participating in the largest ongoing observational study on nutrition and health in Europe, the EPIC Study. The European Prospective Investigation into Cancer and Nutrition started with the collection of extensive dietary questionnaires, anthropometric measurements and blood samples in 10 European countries between 1992 and The Julius Center recruited over 17,000 women. In addition to cancer, (healthy) longevity (EPIC- Elderly), cardiovascular diseases (EPIC-heart), and diabetes have been included as major focal points. There is a strong cooperation with 23 research centers of oncology and public health institutes and universities across Europe. A new collaborative project called EPIC-Heart provides breakthrough epidemiologic research on causes and consequences of cardiovascular disease using data and biologic material obtained from 520,000 subjects. A major development in the expansion of ational research contacts, and a spin-off of the collaboration in the EPIC project, is the appointment in October 2007 of Petra Peeters as professor in Chronic Disease Epidemiology at the Faculty of Medicine, Imperial College London in London, UK. Petra Peeters is senior staff member of the Julius Center and coordinator of the cancer research theme. Her parttime chair at the renown Imperial College London will reinforce the 46 Annual Report 2007 Research 47

26 existing collaboration between the two institutes and stimulate both research and educational collaboration. The above initiatives are necessarily a selection of examples of ational collaboration. Collaborations exist, among others, with the following institutions: - Berman Center for Outcomes and Clinical Research, University of Minnesota, Minneapolis, USA - Department of Clinical Epidemiology, University of Pretoria, South Africa. - Clinical Trial Services Unit and Department of General Practice, University of Oxford, Oxford, UK. - Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, USA. - Department of Cancer Epidemiology, Imperial College London, London, UK. - Department of Epidemiology, Karolinska Institute, Stockholm, Sweden. - Department of Epidemiology, UCSF, San Francisco, USA. - Department of Food Science and Nutrition, University of Minnesota, USA. - Department of Health Evaluation Sciences, University of Virginia Medical School, Charlottesville, Virginia, USA. - Department of Neurology, University of Western Ontario, Ontario, Canada. - Department of Public Health, Wake Forest University, Winston Salem, USA. - Departments of Nutrition and Cancer, Hormones and Nutrition, International Agency for Research on Cancer, IARC, Lyon, France. - Framingham Heart Study, NHLBI, Boston University Medical Center, Boston, USA. - George Institute for International Health, Sydney, Australia. - Medical Research Council London, UK. - Medical Research Council, Dunn, Cambridge, UK. - University of Indonesia, Jakarta, Indonesia. - University of Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia. - University of Tokai, Isehara, Japan. - Wallenberg Laboratory, Sahlgrenska Hospital, Gothenburg, Sweden. 48 Annual Report 2007 Research 49

27 External Assessment of Past Performance In 2007, the research performance of the Julius center was assessed by two independent external review committees. The first assessment was part of a review of all research groups of the UMC Utrecht; the second assessment was part of a review of all research groups involved in the Netherlands Institute of Health Science (Nihes), because of a renewed accreditation of this graduate school by the Royal Dutch Academy of Sciences (KNWA). Both ational committees judged both past performance and future perspectives as excellent. The next paragraphs will provide more detail on their findings. In 2007 the University Medical Center Utrecht had its research assessed by an ational external review committee, according to the Standard Evaluation Protocol (accepted in 2002 by the eight University Medical Centers in the Netherlands). The overall conclusion of the committee was that the UMC Utrecht as a whole combines a unique spectrum of preclinical, translational and clinical research. The research programme of the Julius Center, one of the twelve divisions of the UMC Utrecht, received extremely high rates, both in absolute scores as well as relative to the other divisions of the UMC Utrecht. On a score scale of one to five, the research was judged as: - Quality 5 (excellent: ationally leading) - Productivity 4/5 (very good/excellent: ationally competitive/leading and nationally leading) - Relevance 5 (excellent: ationally leading) - Vitality 4 (very good: ationally competitive, nationally leading) A quote from the conclusion of the committee: The Julius Center is a world renowned center for clinical epidemiology. It engages in all kinds of epidemiological research, from observational studies and surveys to clinical trials and screening programmes. On clinical epidemiology, there are a few other centers in Europe that can compete with this division. In general this division, with its very high publication output, is one of the pace setters for the UMC Utrecht. Within the UMC Utrecht matrix, clinical epidemiology figures as a horizontal line, crossing through neurosciences, cardiovascular sciences, immunology and infectious diseases and oncology. The research focus is predominantly on cardiovascular diseases, but there is a growing emphasis on immunology and infectious diseases. The collaboration with oncology and neurosciences is developing. The relevance of clinical epidemiology for both the research within the UMC Utrecht and the public at large is great indeed. The future of this division is very good. Also in 2007, the research performance of the Julius center was assessed by an International Review and Advisory Committee, because of a renewal of the accreditation of the Netherlands Institute for Health Sciences (Nihes). The assessment concerned the three research themes that participate in Nihes (Cardiovascular epidemiology, Cancer epidemiology and Theoretical epidemiology) and the research theme that will part of Nihes from 2008 onwards: Epidemiology of infectious diseases). The research themes Cardiovascular epidemiology, Cancer epidemiology and Theoretical epidemiology all received the maximum score of 5 (excellent) on a scale of one to five. To quote the assessment committee: The research at this department is excellent and ationally leading. The committee very much appreciates the ambition of the department to raise the level of clinical research in daily practice by investing 50 Annual Report 2007 Research 51

28 in prognostic and diagnostic research. The committee favours the view of the department that it is important to have a strong research line on theoretical epidemiology next to the applied epidemiological research. The committee was impressed by the societal impact of the department. For the newly participating research theme, Epidemiology of infectious diseases, received a score of 4 (very good). To quote the committee: The committee values the research line of infectious disease epidemiology as very good. Together with the research in this field by the department of theoretical epidemiology of the faculty of Veterinary Medicine, and the affiliation with the Center for Infectious Disease Control of National Institute of Public Health and the Environment in the near future, this research line is growing to be a strong infectious disease area of research. 52 Annual Report 2007 Research 53

29 Education Education is what survives when what has been learned has been forgotten. (B.F. Skinner, New scientist, May 21, Aangeleverd door Yolanda van der Graaf) Education 55

30 Educational Organization The Julius Center participates in numerous educational programmes covering a broad range of health sciences and primary care. The Center actively participates in new educational developments such as the UMC Utrecht s ambitious undergraduate medicine programme (CRU 99), which started in 1999 and is based on interdisciplinary problem-oriented learning, and SUMMA, a new 4-year medical grade programme that started in The majority of educational programmes are provided in co-operation with other divisions within or outside the University Medical Center Utrecht. The Center is home to the only Dutch graduate programme for nursing science. The Center is, among other things, responsible for the specialist training of medical doctors as general practitioners in a three-year vocational training programme. Notably, a new training programme for a master s degree in epidemiology was started in 2004 together with other faculties of Utrecht University. Education for the benefit of researchers at the Julius Center takes place by means of participation in recognized graduate schools such as the Netherlands Institute for Health Sciences (NIHES) ( Infection & Immunity ( Psychology and Health ( pandh.fss.uu.nl), and ImagO ( Agreements with the management of NIHES led to more intensive collaboration on marketing and recruitment of master s students and a proposal for a joint website for the Master s in Epidemiology programme. The number of educational programmes is growing each year. This year a new course for the medical curriculum has been developed (Medical Humanities) and will be implemented in the curriculum in September Medical Humanities stands for an interdisciplinary field in which the ethics, health law, history and philosophy of medicine, social sciences and art converge. Education at the Julius Center is typically organised by discipline. Each discipline has its own co-ordinator who tunes the different teaching programmes within that particular discipline. The Center supports training of lecturers and 2 co-workers of the Julius Center got their SKO and 1 the BKO certificate. In the scheme on the next page the programmes (original names of the courses) are summarized that are coordinated by staff-members of the Julius Center. A more detailed description can be found in the particular chapters. 56 Annual Report 2007 Education 57

31 Continuous Professional Education Bachelor Master Graduate Epidemiology Keuze cursus clinical trials (CRU) Wetenschappelijke vorming II (SUMMA) Research Master Clinical Epidemiology Architectuur van Klinisch Weten- START (CRU + SUMMA) Epidemiology for Internists schappelijk onderzoek (CRU) Master Epidemiology Discipline Over- Clinical Epidemiology nals Wetenschappelijke stages Wetenschappelijke stages (CRU + stijgend Onder- and EBM for professio- wijs SUMMA) Post-Academisch Onderwijs voor Huisartsen (PAO-H) General Practice Vocational Training Praktijk van de zorg (SUMMA) Co-assistentschap huisartsgeneeskunde (SUMMA + CRU) Oriëntatie geneeskunde (CRU) Patiënten volgprogramma (CRU) Klinisch lijnonderwijs (CRU) General Practice ASAS (SUMMA + CRU) Wetenschappelijke stages (SUMMA + CRU) Integrated Care Master Geneeskunde en Maatschappij (CRU) Public Health Oriëntatie geneeskunde (CRU) classes TLO (CRU) Keuzecursus Gezondheidsrecht START (CRU + SUMMA) (CRU) BSAS (CRU) Keuzecursus Zorgmanagement Co-schappen (4 weken), keuzestages (6 weken), BSAS (12 (CRU) Keuzecursus Diversiteit weken), wetenschappelijke stages (12 weken) zowel in binnen- als buitenland Keuzecursus Forensische geneeskunde Geneeskunde en Maatschappij (CRU) START (CRU + SUMMA) Medical Humanities Nutritional Science Keuzecursus: voeding in de geneeskunde (CRU) Nursing Science Master Nursing Science Lezen en beoordelen van (verplegings-) wetenschappelijk onderzoek General Practice Introduction In the Netherlands, General Practice is an important specialisation in the medical domain. In the basic medical education (bachelor, master s) the General Practice staff of the Julius Center participates in various ongoing educational programmes and provides courses at several levels in the medical curriculum. Besides these activities there is a vocational training programme and continuous medical education. - Bachelor - Master s - Post-Graduate / Vocational training programme - Continuing Professional Education The major purpose of all of these courses is to teach students the principles and methods of general practice and for the trainees in the vocational training programme to become a adequate general practitioner, and for the general practitioner to keep his competencies on a standard level. Bachelor Description The basic medical education starts generally after secondary school at the age of 18 at the university medical school. A three year period of acquisition of knowledge and skills is followed by three years of ships, where people gain their basic medical experience in teaching hospitals and (for 6 weeks) in general practice. During the last decade however in our university the period of practical experience in ships is partially put forward to the first years of training. That step is motivated 58 Annual Report 2007 Education 59

32 by the evidence that theoretical education in combination with practical experience allows students to construct their own knowledgebase more efficiently and more efficaciously. One could also say it gives a student more opportunities for learning within the context of his future work. Motivation of students and professional behaviour is stimulated when students are confronted with patient care in an early stage of their education. The bachelor programme caters to about 900 students. Course Information We teach 312 students in every class-year. The department of general practice is responsible for the introduction course for new medical students. This course lasts for five weeks. In the last two weeks of the course most students gain experience in clinical practice during a nursing apprenticeship, whereas a small part of them (24 students) have the possibility to participate in an observational apprenticeship in general practice. Since the educational programmes are problem-oriented and no longer discipline-oriented our department has no courses on its own. Together with other clinical disciplines we teach our specific knowledge and skills to the students. Courses we contribute to are: - students following patients programme, first year - clinical reasoning programme, first year - students following patients programme, second year - clinical reasoning programme, second year - metabolism - sensory organs, brain and movement - acute medicine - patient care in the Netherlands for foreign physicians Master s CRU Description Two trends are visible in the undergraduate teaching, one is early ships and the second is to realize a better link up between the undergraduate and the post graduate teaching to make the sixth year more a transition year between the undergraduate teaching and the specialization. In the postgraduate teaching we have to realize that these changes have occurred. Course Information General practice contributes to the following courses: - eye-diseases - medicine and society - determinants of disease - practical electives - scientific electives We offer the six week ship in General Practice to 360 students every year in the second year of the master s programme. In the third year of the master s programme we supervise 40 selected students during an ship that lasts 12 weeks. Summa Description The department of general practice is responsible for several parts of the curriculum of the Summa-master s. In the first and the second year all students (40 students yearly) are trained in clinical reasoning by GP staff members. In addition most students gain experience in clinical practice 60 Annual Report 2007 Education 61

33 during a nursing apprenticeship in their first year, whereas five students yearly have the possibility to participate in an observational apprenticeship in general practice. In the third year all students have a six week ship in general practice, while two or three students are supervised annually in a longer ship of 12 weeks in their fourth year. General Practice Vocational Training (Postgraduate) Description The postgraduate training is carried out by 8 Institutes for Postgraduate Training. They have a total of about 1300 trainees. The Julius Center is home to one of the eight General Practice Vocational Training Courses in the Netherlands. In Utrecht there are 216 trainees in our programme; 72 trainees a year. It is a three-year course and consists of two years of training in general practices and one year in hospitals, health care institutes and nursing homes. In order to serve the needs of the course, there is close cooperation with 213 general practitioners, 7 peripheral hospitals, 22 nursing homes and 18 regional institutes for outpatient mental health care. The trainees attend the department of general practice for reflection and training one day a week. Each training institute is linked to departments of general practice of university medical centres. In Utrecht we are embedded in the Julius Centre with epidemiologists. On a national level a close cooperation exists between the training departments of all participating University centres and the Dutch College of General Practitioners. In that perspective a number of products have seen light: for example a core competency oriented curriculum has been constructed, educational tools, all kind of assessment tools and ICT management tools are developed. We have determined the competencies of trainers and teachers, and there is a teach the teacher programme a teach the trainer programme and an assessment protocol. Too much to address all these issues here. A main advantage of this cooperation is the exchange of experience on a national level: we learn from each other and we are stimulated to improve our own results. The cooperation in the Julius Centre is especially relevant to the topic of EBM education. As already stated the curriculum of GP training is 3 years full time according to EU agreements. There are however considerable differences within Europe caused by the different local organisation of health care and the different historical background of primary care in Europe. We do recognise and certify previous postgraduate experience in teaching hospitals. That causes in half the cases a mean reduction of the training period of 6 months. Besides learning and teaching of the medical expertise, it is more and more important and accepted by the Board of General practitioners to teach seven competencies. We are very happy that not only for the training of general practitioners but also for all specialists these seven competencies (Canmeds skills for the new millennium) are formulated that will form the basis for the education for the trainees in the different competencies in a competency oriented curriculum: medical expertise, doctor patient communication, collaboration, management, social accountability, science and education and professionalism. 62 Annual Report 2007 Education 63

34 In a competency oriented curriculum you need an adequate assessment programme. On the basis of the assessment the trainee adjusts his or her individual learning and development plan. In that perspective in Utrecht, but also at the other departments in the Netherlands, we developed an extensive assessment programme. At the end of the first year there is a Go/No Go decision. A Go means that the trainee is supposed to be able to complete the whole training period successfully to become an adequate general practitioner. Course Information Each of the three training years has different characteristics. In the first year the emphasis is on obtaining and sharpening skills in general practice. In the second year, particular attention is paid to the cooperation between the GP and specialists and training in special skills by doing ships in hospitals and Regional Institutes for Outpatient Mental Health Care and Nursing Homes. In the third-year, the acquisition and integration of in-depth knowledge takes center stage. Every effort is made to increase the expertise and quality of future GPs. In 2006 we started with a more competency oriented curriculum. As a consequence of the health care reform trends of change can be foreseen which are coming up now and will be reality in the near future. As a teaching department we must be able to accommodate these changes. Or, even better, as an university department we should be in the frontline of change with experiments and educational reform. Networks of general practices are coming up momentarily, with franchising formulas and central management. They tend to organise own facilitating services for groups of GP practices to gain more efficiency and more competing power. Within general practice one can perceive a trend of differentiation between GP s and within GP groups. That means that new tasks are taken up by more or less specialised GP s within a group in that way creating opportunities to distribute tasks between the GP s. By doing so one can reach together in cooperation a higher level of care. That s why there are possibilities for differentiation in the new curriculum. Course Titles - First year: four days of general practice training in medical practice and one day release course with different topics. - Second year: ship in emergency department general hospital, mental health and nursing home. - Third year: four days of general practice training in medical practice, differentiation on management/ education/ science/ special interest like diabetes, asthma, COPD, cardiovascular risk management. Output 2007 Number of students In only a few years the capacity has been increased to 216 trainees in Number of students who started their GP training in 2007: 74 - Number of students who finished their GP training in 2007: 71 Advanced Training in General Practice (Continuing Professional Education) Description Post-academic training for general practitioners (Post Academisch Onderwijs voor Huisartsen, PAOH-Utrecht). The focus is on up-to-date information for GPs, evidence based and relevant to general practice. 64 Annual Report 2007 Education 65

35 The courses are interactive by using an interactive voting system. All Epidemiology speakers are experts on their topic. Course Information In 2007 the Julius Center organized 9 days (6 accreditation points) and 2 afternoons (PAOH EXTRA, 3 accreditation points) for GPs in the Netherlands. Course AKWO Course dates 12 courses between Aug 2006 July 2007 Number participants % passed exam Evaluation marks % 7.0 Course Titles (Dutch) Dermatologie Sport en beweging Nierziekten en urologie Kanker Zwangerschap en erfelijkheidsvoorlichting Infectieziekten Reizigersgeneeskunde 10e Diabetesdag Kindergeneeskunde Kinderallergie (EXTRA) EHBO (EXTRA) Output GPs attended each course (with a total of around 1300 GPs) SUMMA February May % 6.5 Start Block EBM module 6 courses between Aug % July 2007 EBM DOO December 14 in 2006 and January 25 in % 6.5 NIV 15 Feb and 10 Oct % 6.9 Introduction to 4 15 sep % 7.4 Epidemiology Study Design 18 Sep. 6 Oct % 7.7 Clinical Epidemiology 16 Oct. 10 Nov % 7.2 Presentation and writing of research proposal Advanced Diagnostic Research Jan % March % 7.9 Prognostic Research March % 7.7 Clinical Trials and Drug Risk Assessment Apr % 6.8 Evaluation The courses are evaluated consistently as very good. Basics of advanced mathematical modeling of infectious diseases Advanced mathematical modeling of infectious diseases 29 May 1 June % June % Annual Report 2007 Education 67

36 Medical Bachelor AKWO (Architectuur van Klinisch Wetenschappelijk Onderzoek) - Architecture of Clinical Scientific Research - Course leader: Maroeska M. Rovers, PhD Brief Course Description In modern medicine, physicians ask themselves continuously to what extent their medical decisions (diagnostic, therapeutic, prediction of prognosis) are based on solid scientific evidence. This 6-week full time course will equip medical student with the basic knowledge and skills of clinical epidemiology. In order to be able to value and interpret scientific reports, students will need to acquire their own research experience. During this course students will learn how scientific knowledge is generated. We give the students a taste of the various aspects of clinical scientific research by simulating the entire process of a scientific research project. They will learn how to define a research question, select the appropriate study design to answer this question prepare a research protocol, collect data, and analyze, interpret results, report and present the findings. At the end of this course students will be able to differentiate between the different study designs, methods and analytic techniques of etiological, diagnostic, prognostic and therapeutic research. Students work in small teaching groups, with practical assignments, workshops and meet the expert meetings. This course runs 12 times a year for groups of 25 students. Each time the course is constructed around a(nother) clinical problem, for example chest pain or neurological deficits; each year approximately 6 clinical problems will be discussed. The selection of clinical problems is based on the frequency of occurrence of the problem and the clinical and research expertise of the supervisors. Thereby, although this is not the main objective of the course, students will improve their knowledge on the incidence, etiology, diagnosis, prognosis and therapy of the clinical problem chosen. Staff Involved A. Algra, J. Beulens, M.J.M. Bonten, M.L. Bots, K. Fischer, M.I. Geerlings, C.H. van Gils, Y. van der Graaf, E. Hak, A.W. Hoes, K.G.M. Moons, P.H.M. Peeters, M.M. Rovers, A.P.E. Sachs, Y.T. van der Schouw, S.S. Soedamah-Muthu, C.S.P.M. Uiterwaal, Y. Vergouwe, F.L.J. Visseren, and our PhD students. Medical Master s of Science Evidence Based Medicine Course leader G.J.M.G. van der Heijden START Block and Return Days (in Dutch Startblok en Terugkomdagen ) Brief Description of Course Content In modern medicine, physicians ask themselves continuously to what extent their medical decisions (diagnostic, therapeutic, prediction of prognosis) are based on solid scientific evidence. This 6-week half time course at the final 6th year of medical school will equip medical student with the principles of evidence based medicine and applied knowledge and skills of medical evidence management. This course builds on the skills and knowledge acquired during the AKWO course at the 3rd year of medical school. In order to be able to apply best available evidence in patient care, students will need to acquire their own experience with medical evidence 68 Annual Report 2007 Education 69

37 management. During this course students will learn how to write a case report: a 1200 words comprehensive summary best available evidence on questions concerning the management of a particular patient. These are focused on a foreground question, i.e. an applied problem of diagnostic, prognostic and therapeutic patient management rather than on a theoretical or conceptual scientific background problem. For this we learn them to adequately translate the problem in an adequately phrased search question, efficiently retrieve and select the best available evidence, tabulate and translate it in terms of clinical patient management. We use of small teaching groups, with practical assignments, workshops and meet the expert meetings. During their subsequent 24 weeks ship at the clinical ward students get the assignment to write the 3 case reports per couple. Each student reviews and grades 6 case reports of other students. Staff Involved M.L. Bots, K. Fischer, K.G.M. Moons, M.M. Rovers, A.P.E. Sachs, S.S. Soedamah-Muthu, E.M. Monninkhof, and our PhD students. Scientific Education 2 (in Dutch: Wetenschappelijke Vorming) During this course, students of the Selective Utrecht Medical Master s (SUMMA) Programme learn will learn in plenary lectures and moderated small student groups about the theory of risk, and the epidemiologic design of diagnostic, prognostic, and experimental research. At the end of this course students will be able to differentiate between the different study designs, methods and analytic techniques of etiological, diagnostic, prognostic and therapeutic research, and have learned how to value and interpret scientific reports, as well as how to define a research question, select the appropriate study design to answer this question prepare a research protocol. This course runs once a year for groups of 40 students. Staff Involved Cuno Uiterwaal, Yolanda van der Graaf Biomedical Master s of Sciences Epidemiology Research Master s Programme Brief Description of Programme Content The Utrecht University Graduate School of Life Sciences offers two Epidemiology Master s programmes which are organised by research groups at UMC Utrecht (Julius Center) and Utrecht University (IRAS, Veterinary Epidemiology, and Pharmaco-epidemiology): - a 2-year regular Research Master s programme; this programme is aimed at students holding a Bachelor of Science degree in Biomedical Sciences, (Veterinary) Medicine or Pharmaceutical Sciences. - an 18-month postgraduate Research Master s programme; this programme is aimed at professionals, e.g. PhD students or health professionals involved in clinical research, holding a Master s of Science degree in Life Sciences or (Bio-)Medical Sciences, for example in Medicine (MD), Pharmaceutical Sciences (PharmD). In close collaboration with these Epidemiology Prestige Master s Epidemiology programmes, Utrecht University offers a postgraduate research master s programme in Veterinary Epidemiology and Economics for professionals holding a Doctoral degree in Veterinarian Medicine (DVM). 70 Annual Report 2007 Education 71

38 The two main components of the programmes are: - comprehensive theoretical education in the principles and methods of epidemiological research (over 6 months of courses), - a practical research project in which the theory can be applied. This research project is finished by the writing of a scientific paper, and an oral presentation. These 2 programme components provide students with extensive knowledge and practical skills in patient-oriented research design, implementation, quantitative analysis and its application to human or veterinary medicine and public health. The knowledge and skills gained form a solid basis for health research and disease control programmes, including application in developing countries. The programmes provide the possibility for specialisation in Clinical Epidemiology, Epidemiology of Infectious Diseases, Pharmaco-epidemiology, Environmental and Occupational Epidemiology, and Veterinary Epidemiology (as from 2008 labeled: Epidemiology of Animal Diseases). In December 2005 Utrecht University awarded the Epidemiology master s programme with the exclusive label Prestige Master s. For more information go to Staff Involved Programme coordination: M. Kluijtmans, J.E. Brussee, Programme committee: D.E. Grobbee (Chair), A.W. Hoes, M.J.M. Bonten, Y.T. van der Schouw, K.G.M. Moons, G.J.M.G. van der Heijden Course leaders, teaching staff: A. Algra, M.L. Bots, E. Buskens, J.J.M. van Delden, M. van den Donk, K. Fischer, M.I. Geerlings, C.H. van Gils, Y. van der Graaf, E. Hak, E.M. Monninkhof, P.A.H. van Noord, P.H.M. Peeters, M.M. Rovers, S.S. Soedamah-Muthu, I. van der Tweel, C.S.P.M. Uiterwaal, Y. Vergouwe, PhD Continuing Professional Education Clinical Epidemiology Course leader: M.L Bots Brief Description of Programme Content This 2-day course on the principles of Epidemiology and Evidence Based Medicine for members of the Dutch Society of Internal Medicine (NIV), in particular for residents and registrars, includes plenary lectures on methods of applied research and evidence based medicine and small moderated student groups. At the end of this course participants are familiar with the principles of epidemiological study design for diagnostic, prognostic and intervention research, are able to critically appraise clinical medical research papers and clinical guidelines. Staff Involved D.E. Grobbee, A.W. Hoes, A. Algra, M.L. Bots, M.I. Geerlings, C.H. van Gils, Prof. Y. van der Graaf, P.H.M. Peeters, C.S.P.M. Uiterwaal Evidence Based Medicine (Discipline Overstijgend Onderwijs) Brief Description of Programme Content This 2-day course on the principles of Epidemiology and Evidence Based Medicine for clerks and residents at UMC Utrecht and collaborating teaching hospitals, includes plenary lectures on methods of applied research and evidence based medicine, small moderated student groups, with additional lectures external speakers for the plenary sessions. At the end of this course participants are familiar with the principles of epidemiological study design for etiologic, diagnostic, prognostic and 72 Annual Report 2007 Education 73

39 intervention research, are able to coherently formulate a clinical question, search and critical appraisal clinical research papers, clearly summarise available evidence and critically consume clinical guidelines. Staff Involved Marie-Louise Bartelink, Geert van der Heijden, Maroeska Rovers, Peter Jacobs, Frank Visseren, Kathelijn Fischer, Evelyn Monninkhof Clinical Epidemiology & Evidence Based Medicine in Asia November 1, 2007 was the official start of the EU financed AsiaLink project. This project, initiated by the Julius Center is a collaboration between the University Hospital Cipto Mangunkusomo in Jakarta (Indonesia), the University of Malaya in Kuala Lumpur (Malaysia), the University of Oxford (UK) and the University Medical Centre Utrecht (the Netherlands) to establish the necessary platform for a durable improvement in clinical epidemiological teaching and research in Indonesia and Malaysia. The specific actions planned include: 1 Teaching Mission Aim: to establish common and sustainable knowledge and capacities in the participating centres in evidence based medicine and clinical epidemiology by organizing teaching missions aimed at defined target groups at undergraduate and postgraduate level. 2 PhD Fellowships Aim: To enable the most talented young medical doctors of University of Malaya and Cipto Mangunkusumo Hospital Indonesia to deepen their knowledge and expertise in specialized areas of clinical epidemiology on an ational level. Course Target group Teaching staff UNDERGRADUATE 6 week introductory course in applied clinical epidemiology POSTGRADUATE Basic course clinical epidemiology and evidence based medicine Advanced courses clinical epidemiology and evidence based medicine 400 3rd year medical students of University of Malaya and University of Indonesia per year 480 Medical doctors (practicing doctors, post graduate researchers, management staff) of the University of Malaya and University of Indonesia and affiliated hospitals. Healthcare policy makers of Ministries of Health. Staff from the University Medical Centre Utrecht and University of Oxford (first teaching, then supervisory). Staff from University of Malaya and University of Indonesia (teaching). PhD fellows (assisting in practicum) Staff from the University Medical Centre Utrecht and University of Oxford (first teaching, then supervisory). Staff from University of Malaya and University of Indonesia (teaching). Ten PhD fellows (six from each country) will be recruited (six in year one and six in year two). The PhD fellows will be supported and mentored by expert scientists of the University of Oxford and the University Medical Centre Utrecht. In addition, they will be receiving supervised teaching experience by teaching graduate and postgraduate students. 74 Annual Report 2007 Education 75

40 3 Development of Clinical Epidemiology & Evidence Based Medicine Units Aim: to develop regional collaborative (support) units at the premises of Malaya University and Cipto Mangunkusomo Hospital to assure continuity of the educational programmes beyond the duration of the programme. These units will be coordinating, facilitating and supporting future structural collaboration for educational and research projects between Asia and Europe in Clinical Epidemiology and Evidence Based Medicine. The following activities took place in 2007: - Project launch In November 2007, AsiaLink Clinical Epidemiology and Evidence Based Medicine ( & EBM) was officially launched at the University of Malaya (Kuala Lumpur), in the presence of University and Hospital officials, European and Malaysian AsiaLink partners, students and press. - Postgraduate courses In the same period, a first advanced postgraduate course on Diagnostic Research at the University of Malaya (Kuala Lumpur) was offered, which was attended by 76 participants. - Implementation of undergraduate module At the University of Malaya (Kuala Lumpur) and the University of Indonesia (Jakarta), we are in the process of, and making good progress with, the implementation of the undergraduate module. All relevant officials (Deans, Vice-Deans, Educational Managers etc.) are on board and have agreed to have implemented the module by July PhD fellowships A Call for PhD fellowships has been circulated and announced on our website. In November 2007 in Jakarta, Dutch Professors, in close collaboration with their Indonesian counterparts, have selected two PhD candidates. In Kuala Lumpur, two candidates will be selected in April These fellows will start their training in the Netherlands in September Clinical Epidemiology Units We have hired two local co-ordinators, who will be manning the Clinical Epidemiology Units in Kuala Lumpur and Jakarta. In both cities, accommodation has been made available by the local institutions. - Communication / Visibility We have built a project website, and sent out our first newsletter (ALliance). 76 Annual Report 2007 Education 77

41 Public Health On different levels throughout the whole medical educational programme, different courses related to the field of Public Health are being offered. The educational programme of Public Health defines as main focus the principles and methods of healthcare research, structure, quality, finance en functioning of healthcare systems, with a focus on Social Medicine and Public Health interventions. When it comes to these matters there is a constant centre of attention around the updating of the educational material within the Public Health division. Bachelor In the first year of the bachelor phase, the course Orientation to Medicine ( Orientatie Geneeskunde ) is offered. In this course the main outlines of the organization of healthcare are the focus point. An ship in a nursing home or a care institution of a different kind is part of this course. Last year the average result of the evaluation by students was a 7. - Diversity in prevention, illness and care ( Diversiteit in preventie, ziekte en zorg ). This course is set up to create and stimulate the awareness of the presence and influence of diversity in the medical profession. The average result of last year was a Forensic Medicine ( Forensische geneeskunde ). This course is being developed. Master s In year 5 the course Medicine and Society is offered. Matters that are being discussed within this course are aspects of health and healthcare, the grey area between curative forces and society. Connected to this course are obligatory ships in social medicine for a period of 4 weeks. Past year the average result was a 6.9. In year 5 the course TLO is also offered. In this course themes like avian influenza, prostate cancer screening and prevention projects in large cities were being studied. This course had an average result of 6.4. This last year a different approach is chosen with a new theme: patient safety. In the second year 4 optional courses of 5 weeks each are offered, namely: - Disease Management ( Zorgmanagement ). The main objectives of this course are the improvement of competence on the area of knowledge of care management, co-operating within a multidisciplinary context and the communication with different kinds of professionals. The average result of this course last year was an 8. - Law and Medicine ( Gezondheidsrecht ). This course is centred around the legal and regulatory framework of the Dutch health care system, with a focus on the professional competence of doctors. The average result of last year was a 8.1. Year 6 has it s focus points on the decision making processes in healthcare in emergency situations, and the organization, quality and finance of healthcare. Optional ships of 6 weeks are part of the possibilities in the 4th, 5th and 6th year. In year 6 it is possible to do a BSAS, a scientific ship or an educational ship within the division of Public Health. It is possible to do these ships and optional ships abroad. For these matters one should contact R.W. Haneveld, head of Public Health Education. Due to computer problems there are no evaluation records on the different ships available. 78 Annual Report 2007 Education 79

42 Postgraduate The division post graduate education provides additional and refresher courses like symposia and conferences for graduated doctors. All of the courses are accredited. Turn to Prof. A.J.P. Schrijvers via Mrs. G.M.C. Hageman, Manager Post Graduate Education for additional information. Phone: Continuing Professional Education In cooperation with many foreign and non-foreign guest teachers, the division Public health provides additional courses for professionals in healthcare, set up in the form of conferences, courses, workshops and study trips. For an overview on the different activities go via nascholing to Contact Head of Public Health Education R.W. Haneveld, MD, PHS, MPH Phone: Medical Humanities Overview Medical humanities is a term which we use for a interdisciplinary field in which the humanities, sociology and arts come together. The humanities are medical ethics, health law history of medicine, and philosophy of medicine. Sociology is medical anthropology and medical sociology and with arts we mean literature, theatre and movies. The aim of this course is to help the student become a better physician. By providing insight into the human condition, complementary to his or her biomedical knowledge. By providing a better understanding of the responsibilities and duties physicians have for their patients and society. By showing that the art of medicine is performed within a cultural and societal context which is characterized by diversity and by showing that this context also shapes the experience of being ill and the way medicine is performed. By further developing the student s competence for observing, analyzing, empathy and self-reflection. Secretariat Mrs. M.C. van Straaten Phone: Bachelor In the third year of the curriculum CRU2006, starting in September 2008, two courses of four weeks each will be devoted to Medical Humanities. All students will have to take both courses. Since this course has not been given yet, evaluations cannot be given at this moment. Master s In the master s phase of CRU2006 no integrated courses in medical humanities are given. Nonetheless, some of the disciplines of medical 80 Annual Report 2007 Education 81

43 humanities, especially health law and medical ethics will contribute to courses, e.g. the starting course in the sixth year. Postgraduate Not applicable. Continuing Professional Education Not applicable. Nursing Science Overview In 2000, a Master s of Science degree for the Health Sciences programme was established at Utrecht University (UU). Nursing Science was the first major field of study to be offered within the Health Sciences programme. Physiotherapy Science was added as a second major field of study in 2002 and Speech Therapy Science as the third field in However, a new curriculum for the Health Sciences programme was necessary in order to comply with the European regulations for university education and to conform to the ational Bachelor-Master s structure in higher education. This resulted in the development of a two year part-time master s programme (60 ects) for graduates of a BSc-university degree programme or a premaster s programme (see description Bachelor below). The MSc programme in Nursing Science started in September In July 2006 accreditation of the master s programme was given by the External Accreditation Committee (EAC) - a committee appointed by the Ministry of Education and responsible for accrediting all university programmes. The accreditation is valid till July The Department of Nursing Science within the Julius Center for Health Sciences and Primary Care is responsible for the development and coordination of the Nursing Science field of study. Bachelor Description At this time, Utrecht University does not offer a bachelor programme Health Sciences. Instead, a one year part-time premaster s programme (30 ects) was developed for graduates of a non-university bachelor programme. This programme enables students to qualify for admission to a 82 Annual Report 2007 Education 83

44 university level master s programme. A certificate is awarded upon successful completion of the premaster s programme. Premaster s Nursing Science Programme Information Courses EC Project and Academic Skills 7.5 Philosophy, Science and Ethics 7.5 Research Methods 7.5 Statistics 7.5 All coursework 30 MSc Nursing Science Programme Information Courses EC Nursing innovation policy 6.5 Innovation development and implementation 6.5 Advanced Statistics 2 Systematic Literature Review 7.5 Science and Nursing Practice 6.5 Elective course 6 Master s thesis: proposal and preparation 8 Master s thesis: conduct and reporting 15 Portfolio 2 All coursework 60 Output Premaster s 2007 Started: 72 new students in addition to 6 already enrolled Completed with success: 42 students Evaluation The average grade (on a 0-10 scale) of the students for the premaster s programme is 7.35 Master s Description The MSc in Nursing Science is a two year part time programme offered by Utrecht University. Students are educated and trained in four roles: academic professional, researcher, innovator and educator/coach. Consequently, the student is able to combine the world of science with that of nursing practice and to contribute to the development and scientific foundation of nursing. For more detailed information (in Dutch) concerning the MSc programme, check the website of Nursing Science: Output MSc Nursing 2007 Started: 50 new students in addition to 40 already enrolled Graduated: 55 master s students. Evaluation The average grade (on a 0-10 scale) of the students in the master s programme is Postgraduate Not applicable. 84 Annual Report 2007 Education 85

45 Continuing Professional Education Description In collaboration with the Education Center of the University Medical Center Utrecht a 2.5-day course is offered annually for nurses who want to develop basic competencies in reading and critically appraising scientific research (particularly in nursing). The content of the course focuses on research methods and concepts, searching in scientific databases such as PubMed, reading and appraising quantitative and qualitative research, and finally the use of research findings and evidence in practice. Output participants. Evaluation The course was rated with an average score of 7.5 (on a 0-10 scale). Nutritional Science Overview There are many misconceptions about the effect of nutrition on health. Most consumers, patients and doctors are uncertain whether a prudent diet can prevent diseases and whether clinical nutrition can help cure disease. The Division of Nutritional Sciences strives to enhance the professional knowledge and the understanding of nutritional problems, depletion and metabolic needs in relation to disease. Our target consists of medical students because nutrition education is fragmentary in their medical courses. We teach them to acknowledge nutritional problems and malnutrition, and to decide which patients should be referred to a dietician. The facultative course Nutrition and Medicine ( Voeding in de Geneeskunde ) takes a collaborative and interdisciplinary approach to nutritional problems in the clinical setting. An evidence-based approach is encouraged. Bachelor GNK facultative course Voeding in de Geneeskunde : twice a year, 4-week course for 3rd year bachelors. The course consists of (guest) lectures and group work. Topics include: - Methodology: how to read scientific papers about nutrition and health - Practice: how to assess nutritional status (malnutrition) - Prevention of chronic diseases - Therapeutic diets - Nutritional supplements and functional foods - Management of treatment side effects - Management of specialized feeding regimens like tube feedings - The effect of life style modification 86 Annual Report 2007 Education 87

46 The course is assessed by means of an individual multiple choice test and group poster presentations about a concise research project. In 2007, 47 students took the course of whom 46 passed their examinations. The course was graded 6,4 (March) and 7,1 (October). The course will be changed into a 5-weeks course within the CRU2006 programme. Master s Not applicable. Postgraduate Not applicable. Continuing Professional Education Not applicable. 88 Annual Report 2007 Education 89

47 Patient Care Leidsche Rijn offers us a unique opportunity to deliver academic and integrated primary health care. The challenge is how to do that in a real client centered way. In daily practice this is much more difficult than theory suggests. (Rob van Damme) Patient care 91

48 Nutritional Sciences and Dietetics Nutritional Sciences and Dietetics are two groups which form one section. Education and research are the core activities of Nutritional Sciences while the Dietetics core activity is providing patient care at UMC Utrecht and at rehabilitation center De Hoogstraat. The section Dietetics is nationwide leading in evidence based dietetics and standardized processes for dietetics professionals. Electronic Dietetics Patient File The implementation of an electronic dietetics patient file was the most important project in This file will replace all paper files. All new patients and most of the chronic patients have been imported in the new system. All personnel were trained to work with the file. During 2007 the section developed several improvements to the system and files. Connections with other electronic files in the UMC Utrecht were made. Dietetics is the first section within UMC Utrecht that is working with the electronic patient file. The implementation was successful. In the near future the electronic files offer more and new possibilities for research. Evidence-based Guidelines The development of evidence-based guidelines and product descriptions (short practical guidelines) is still making progress. As always several guidelines and product descriptions provided topics for concise (student) projects, such as cystic fibrosis related diabetes, growth and lung capacity, iodine restricted diet, patient satisfaction in food allergy treatment and treatment during radiotherapy, etc. One student project, on the relationship between sulphur intake and exacerbations of Colitis Patient Care 93

49 Ulcerosa, won 3 awards; the NVVL award, Novartis dietetics award and the prof. dr. W. van Mechelen award. Educational and Scientific Contributions In students from Wageningen University and from the various Dietetics Academies performed student projects and worked on practical skills. The dieticians gave several lectures, workshops and poster presentations for health care professionals on topics such as Cystic Fibrosis related Diabetes, ketogenic diet in the Netherlands and other European countries. A 5-week course on nutrition was provided 7 times to food service assistants nutrition aids in the hospital. Education on several subjects was provided to several specialist nursing groups, the nursing training school in Utrecht and dieticians. The section hosted a TODU workshop on regional cooperation workshop and the 3-yearly gathering of all Dutch academic hospital dieticians. The dietetic section co-operated in the facultative course on Nutrition and Medicine. A few scientific articles were published and several articles and book chapters are in progress. Training was provided to the dieticians in the form of external courses, meetings, and conferences (30 individual activities and 4 group activities for all dieticians). These activities took place in the Netherlands and other European countries. External (International, National and Regional) Projects The Dietetics section contributed to several external projects. The most important are: - The CBO guidelines Peri-operative nutrition and Cystic Fibrosis were finished. Guideline implementation is in progress. - The national project Ketogenic nutrition guidelines, including evidence-based guidelines. - Chairing and vice-chairing a regional oncology group - Chairing the national academic dieticians working groups - Rehabilitation Centre De Hoogstraat policy plan, due to the renewed co-operation goals on development and care provided by dieticians were set clear - Member scientific advisory committee of the PKU association Besides these projects, our staff participated in a wide range of (national) consultation groups. Internal Projects Within the UMC Utrecht, the Dietetics sections participated in the following al projects and work groups: - hosting the UMC Utrecht Clinical Nutrition Advice Board, this enables us to discuss nutrition problems and new insights in dietetics in a broader clinical context. Advice on screening malnutrition, and Weight plan was given. The tube feeding plan and UMC Utrecht food policy plan are forthcoming. - indicator malnutrition, delivering figures to the board of directors - development of a website on PKU in children - Better eating project in the Wilhelmina Children s Hospital - HOOP study (evidence-based treatment for obese patients) - participation in clinical multicenter studies (ALS study, propatria) - introduction of a new tube feedings system - participation in a hospital food distribution project 94 Annual Report 2007 Patient Care 95

50 Dieticians participated besides these projects in several al multidisciplinary groups to develop, improve and implement evidence-based and best practice guidelines Personnel In 2007 no personnel left the section. There were no vacancies. There was 1 formal complaint. Care provided by the Dietetics section in st visit Follow-up visits DME* Team 1 Outpatients Hospitalized No-show Team 2 Outpatients Hospitalized No-show Team 3 Outpatients Hospitalized No-show 9 49 Rehabilitation centre De Hoogstraat No-show 1 1 DME *= 30-minute time units Academic primary care One of the ambitions of the Julius Center is to create an academic environment in primary care, in which research and medical education are combined with high quality, innovative patient care. To materialize this ambition the Julius Center joined in the development of the primary health facilities in Leidsche Rijn, the VINEX area of Utrecht, and took over management responsibility of the health centers in After a period of stabilization and development the five of what are presently called - Julius Health Centers are now ready for the next phase in their academic development. In 2007 an ambitious academic development plan was written, in which the key features of academic patient care and the required infrastructure and time frame to develop an integrated research/education/patient care environment are described in detail. The process will require close cooperation with other primary care partners, hospital colleagues, patients and other stakeholders. This development plan, which covers a time period of 5 years, was discussed with the academic staff and the professionals involved, and adopted by the management team of the Julius Center end of As a result in 2008 the first phase of this academic development in the Julius Health Centers will be implemented, starting off with the assignment and training of academic staff for four different clinical fields (cardiovascular disease, COPD, mental health and diabetes) as well as for education and research. The academic patient care programmes that they will develop will be integrated in daily clinical care in 2008/2009. In 2009 and 2010 the programme will be extended to eight other clinical fields, resulting in full implementation of the academic infrastructure in Annual Report 2007 Patient Care 97

51 Julius Center Health Care Leidsche Rijn As of January 2004, the Julius Center has been hosting a network for academic patient care, located in the newly developed Utrecht district of Leidsche Rijn. In the next few years, Leidsche Rijn will expand to a large suburban area, with approximately 80,000 inhabitants. Six health centers will provide general practice services, physiotherapy, mental health care, mother and child health services, pharmacies and social workers. In the underlying health care concept for Leidsche Rijn, these curative services are closely related to preventive, social and educational activities in the area. This concept is being developed together with municipal health authorities, the University Medical Center, the Mesos hospital and the regional general practitioners organization. The new Mesos hospital will be built in the center of Leidsche Rijn, offering excellent opportunities for continuity of care and cooperation between general practitioners and consultants (secondary care specialists). Five health centers were operating in 2007: Parkwijk, which offers health care services for 10,000 inhabitants; Veldhuizen, with 9,000 listed patients; Terwijde, with 4,500 registered patients and rapidly expanding; Vleuterweide, which began in March 2006 in a highly competitive environment. At the end of 2007, Vleuterweide had approximately 1,600 listed patients. Health Center number five: t Zand, started in September The centers offer primary medical care (19 general practitioners, 10.4 full-time equivalencies), physiotherapy (10 physiotherapists, approximately 7 fte), and additional dietary services, obstetrics, social work, pharmacy etc. GP s, assistants and nurses provide medical services that cover the full spectrum of family medicine, with curative care, chronic disease management for hypertension, diabetes and lung disease and preventive services involving e.g. cardiovascular disease. The Julius Center directs the health centers management. The next few years another center will be developed in the Leidsche Rijn s Central Zone district. Health care services for new inhabitants in those areas will be provided in the meantime by the existing health centers nearby. The Leidsche Rijn Network offers an excellent opportunity for the Julius Center to fulfill its ambition of providing academic health care services in primary care. This involves high quality patient care, closely integrated with (vocational) training and research. In order to facilitate this, training facilities will be incorporated into the health centers at Leidsche Rijn, enabling on-location training of medical students, general practitioners and other health care professionals. Electronic recording of all aspects of medical care as well as dedicated support staff will provide the basis for an excellent research environment in the Leidsche Rijn health centers. Most new inhabitants of Leidsche Rijn are already participating in the Leidsche Rijn Health project (LRGP), which records their basic health characteristics and offers instant medical assessments. In future this health profile will be related to updated primary medical care data at the health centers. Medical follow-up of the Leidsche Rijn population combined with academic research will enable us to develop evidencebased multidisciplinary patient-centered health care programmes. 98 Annual Report 2007 Patient Care 99

52 Unit Health Care Innovations In February 2007 the Board of Trustees of the UMC Utrecht and the management team of the Julius Center founded the Unit Health Care Innovations. Mission is to evaluate organizational innovations, to design instruments to work in innovations and to disseminate knowledge by courses, congresses and lectures. The Unit is strongly involved with public health education for the medical students of the UMC Utrecht. Leader of the unit is Guus Schrijvers, professor of public health. The unit is positioned within the Julius Center. The focus of the unit is the study of 1. integrated care and disease management and 2. emergency services. The first theme consists of three sub themes: a. the epidemiology of chronic care b. the evaluation of innovative interventions and c. the validation of assessment instruments and procedures to select patients with a chronic condition for early interventions. The theme emergency services has three comparable sub themes: a. the epidemiology of emergency services provided by GP cooperatives, emergency departments and ambulance services b. evaluation of innovative emergency interventions and c. validation of assessment instruments and procedures to triage patient with acute needs. In 2007 the unit worked with 17 fte professional staff. They profiled themselves on the two mentioned themes. Six research grants were acquired from scientific funds, social funds, and Ministry of health, social insurance agencies and health care providers. Eight congress and four courses took place. Seven scientific publications and may reports were published. Often, the group was asked to give guest lectures on scientific and professional congresses. In 2007 the Unit had a positive financial result. 100 Annual Report 2007 Patient Care 101

53 Operational Support My taste is simple: I am satisfied with the best. (Thijs Bekkers) Operational support 103

54 Management Support The Julius Center s core activities of research, education and patient care are supported by a number of services. Management is supported by a central finance department, a personnel & organization (P&O) department and an ICT department. The finance department handles all contracts and other financial matters. The Julius Center is highly dependant on external funding, such as the European Counsel funds or Dutch research funds, such as ZonMw. Because the administration of these funds is very complex, the center devoted much attention in 2007 to professionalization and staff development. This professionalization takes shape in a renewed planning and control cycle which makes it possible to manage all financial aspects of the organization. Keyword in this planning is prognostication. The P&O department deals with management development, vacancies and all procedural matters involving employment. The ICT Department is responsible for the development and maintenance of an infrastructure that supports both office automation and scientific research. It provides user support and Internet development services. The Julius Center website was renewed and updated in The ICT Department is certified by KEMA (ISO 9001:2000). Operational Support 105

55 Clinical Trial Services Unit / Research Services Research Services is available for al (Julius Center) and external sponsors. External sponsors can be other divisions of the UMC Utrecht or pharmaceutical companies. Our services include - Project Management including the organization, conduct and monitoring of clinical trials from initial design to final publication - Clinical trial co-ordination - Site monitoring - Site management - Endpoint adjudication management - Adverse event reporting - Clinical Trial Monitoring of mono- and multi-center trials based in The Netherlands and other European countries - Research Clinic: an out-patient research center fully equipped with state of the art clinical and diagnostic facilities for carrying out clinical trials - Vascular Imaging Center: a center of expertise in vascular ultrasound imaging and retinal vascular measurements About 60 persons are working for Research Services, including 10 CRA s home-based in other European countries. They are involved in about 40 different projects. The CTSU has been certified according to ISO 9001:2000 since January The Julius Center is responsible for the Quality Assurance System for clinical drug trials performed in the UMC Utrecht. Activities include compulsory quality intake check before starting the study, helpdesk service for questions regarding quality issues, training and audits. Since its inception in July intakes were performed within 18 months. The 1-year evaluation showed positive feedback from investigators and in general improvement in quality consciousness. In 2007: - The name CTSU (Clinical Trial Services Unit) was introduced for external communication. A brochure was developed with fact sheets covering the services of the CTSU for both Research Services and Data Management. - Within the Academic Alliance for Clinical Trials (AACT) the first ational study was acquired. - Together with scientists of the Julius Center and the Wilhelmina Children s Hospital, several vaccination studies were performed. For this type of research, specialized logistical knowledge is required. - Within the UMC Utrecht Research Services is responsible for monitoring of about 40 investigator-driven studies. - At the research clinic, we were involved in 11 studies. Seven of them were new (drug) intervention studies, among which a complicated phase II study. - After successful completion of two large studies at the Vascular Imaging Center, we could not realize immediate continuation of the activities and staff had to decrease accordingly. - Fifteen multicenter studies were managed and monitored by Research Services. These studies were performed in up to 16 European countries. 106 Annual Report 2007 Operational Support 107

56 Data Management Data Management provides a technical infrastructure for the collection, processing and analysis of epidemiological data. The department provides these services for the Julius Center s research, but also for other UMC Utrecht divisions, as well as external parties. implementing Accolade. The project management is carried out by Data Management and the CTSU. The Data management department consists of 13.3 FTE s (15 employees in absolute numbers), it has been certified according to ISO 9001:2000 since January This year Data Management participated in about 90 studies. These studies include 21 new ones and eight cohorts (pertaining to mental health care, oncology and general practice). There were 30 projects were closed in 2007, at the end of the year the department had 10 prospects. In 2006 the department successfully implemented a web-based research system (Research Online Platform) in collaboration with Mediportaal. The system has been put to use for the first time for GRA, the first pan-european primary care research network focusing on the challenge of treating respiratory tract infections in an era of emerging antibiotic resistance. In 2007 new projects have been implemented on the platform. The major projects are summarized: DESC (Dexamethason usage in heart surgery), MOSAR, an EU-funded research programme pertaining to antimicrobial resistance of bacteria responsible for major and emerging nosocomial infections in hospitals and the Leidsche Rijn Health care Project. In 2007 the implementation of the Accolade application has started, which aims to provide management information in the context of the activities of Quality Assurance System for clinical drug trials. The ambition is to identify all clinical trials in the UMCU as a whole. The Division DIGD is the first that participates in the project and is now 108 Annual Report 2007 Operational Support 109

57 Personnel and Finances Working with pleasure, active aging. (Coby Molenaar) Personnel and finances 111

58 Personnel, Figures ( ) Scientific Support Care Total Absolute numbers Male Female TOTAL FTE Male Female TOTAL Average FTE Male Female TOTAL Personnel and Finances 113

59 Personnel, Listing 2007 S Ouchan TC Loffeld TC van der Weerd WG Bobbink CTSU WS Heddema AAA Huisman-Bak AB Marks AC Krediet AM Bos Datamanagement AMH Suiker BWPM Sies AC Geerts BD Dijker CAJ Tims-Polderman CBGH van de Pas BJ Slotboom D ter Doest CCW Brugman A Tacke EHJ Spithoven-van Leeuwen FR Leus CGEM Groot CH van Everdingen J Zwerver JJ Schotsman CTM Nollen DA Rozie-Maalderink JW Maaskant LM Heuveling DB Mooiweer-Boogaerdt EA Wijnia-Lemstra ML van den Haak-van Mourik N Boekema-Bakker EAM Ram EM Bollaert-Vendrig NPA Zuithoff R van Lom EM Hertogh G Haars RB van Petersen RER Veen GB van Hemert GEPM Meijers S Brinkman GP Makhanlal H Wisse I Noorman I Vissers ICT IE Zwartsenberg-Kowal IEM Sikking HC Frens J de Jonge JA Zuidema JAG Stooker-Brouwer JC Harkema KP Dieleman JJ van de Brink JJM Stern-van den Heuvel MS Vos R Nelissen JWM van Eck K Koppenol RER Veen S Bouabdellaoui-Abahai KE Menninga KM Muller-Nijssen L Romkes-van Urk L van der Vlist MTA/Kea LD Izeboud LM Zwart BA Borkent-Raven BA van Hout M Bolkenbaas M de Leeuw H Koffijberg IL de Kruif M Verblaauw MC Hafkamp K Fischer MP Janssen MCT Ehrencron MHGH Wildenborg MJ van der Meer-Poelwijk MJG Scholten Cardiovascular Diseases MTA van Beijnen MW Kuiper A Algra AF Baas ON van Hall P Holleman AG Pijl ALM Vlek PH Barkel RCM Wilken AW Hoes B Gramsma 114 Annual Report 2007 Personnel and Finances 115

60 BG Brouwer CH Vaartjes JP Trapman KY Tsoi CSPM Uiterwaal DJ Duits-Kroon L Grigoryan L Koopman DJ Piersma DJW van Noppen-Pinkaarts LMAJ Muller ME Numans EA Molenaar FGW Cleveringa MEL Bartelink MJ Warnier FH Rutten GEHM Rutten MJP van Avendonk MK van Dijk-Okla GJ Geersing I Sluijs MM Kuyvenhoven MM Rovers JP Greving JWJ Beulens PGH Janssen PM van Eden KJ Gorter KJM Janssen RHH Groenwold SF van Vugt LEM Perales-Hijman LG Exalto SJ Damman WG Melsen LT Bakker M Bloemendaal M de Weerd M Djuanda-Ojemann Managementteam M Edlinger M van den Donk AW Hoes DE Grobbee MF de Beus MH Kamphuis M Kluijtmans Y van der Graaf MH van der Hoorn-van Kempen MJ Knol M van der Starre MJA Gondrie ML Bots MM Monteban PCA Jacobs Secretariat S Dogan SS Muthu-Soedamah A Koopmans AI van den Hoeven-van Vriesland T Scheltens TWJ Rikkers Maekelbergh T de Bruin US Dasrath Y Plantinga EM Blijleven GMC Hageman-Raatgever Y van der Graaf YT van der Schouw H Meegdes-Kuiperij HA Braun IC Laurens JC Kusters-Ritman Infectious Diseases MA den Hartog MC van Straaten AE Schep-Akkerman AN van Gorcum M van Eck ML van der Linde-Hablous APE Sachs AW van der Velden N Linnebank-Hillebrand R de Vries BDL Broekhuizen C van den Dool TLTM Haks-Schoonderwoerd CW Helsper E Hak EJ Groen EJ Pijpers Management support EM Blijleven GA van Essen A Slimani EP Plomp J Bont JAR van Bruggen GHM Horstink HGB van Kesteren JJ Groenendijk JMI Vos JC Griffioen JH ter Keurs 116 Annual Report 2007 Personnel and Finances 117

61 JJ Molenaar JLM Tuithof LJ van Veenendaal M Meier K Blom-Klein K Booden MA Smit-Kam MA van Dijk LJC Kolste M Perdon MB Berk MC Kuyvenhoven MH Bekkers MME van der Werff MCA Smit ME van Baar WD Baars MF Engel MMJE Makkinga MS Poeschmann MS Schrijvers Cancer MYV Homs NM Glerum A Vrieling AM May-de Groot O Visser PHA Bours AWJ van Winden CH van Gils R Brandenburg RAJM Bierings EM Monninkhof FJB van Duijnhoven RG van der Meulen S van Erp JJ Metselaar-van den Bos JJMM Drijvers SA de Bruin SK Kwee M Verheus PAH van Noord VJM Baggen ZAY Braam PHM Peeters SG Elias Mental Health Unit Health Care Innovations AJG Knoops AW Braam ABM Simkens AJP Schrijvers CJ Bijkerk EE Beem APP Janssen BC ten Tusscher HM Smeets IS van den Hengel-Koot E Verweij EGJ Ensink J Neeleman L Gerritsen EML Verschuur EVH van Velzen MI Geerlings NJ de Wit F Hamdaoui El FF Berkhof W Laan FL Oosterwijk GH de Weert-van Oene GHJ Rosken GW Westendorp Medical Ethics H Belkadi HA van Oers FG Huisman GJMW van Thiel HF van Stel I van der Wulp JJM van Delden KN Lanting IFM Schweitzer-Janssen IJEM Swaans MC Stuifbergen R van der Graaf-Verhave IL van den Herik J Sinke J Thiesen JCA Trappenburg Education Epidemiology JJN Urbanus-van Laar KA de Rooij A Algra AAHM Weel-van de Heijden L Catoen L Rietveld AMC Raat AW Hoes L van Hensbergen LAJ van Egmond B Gramsma CH van Gils 118 Annual Report 2007 Personnel and Finances 119

62 CLM Appelman DE Grobbee E Hak GMG van der Heijden HE Hart I Noorman JM Houthuysen KGM Moons M Bosman M Perdon MC de Knegt-Schmidt MHGH Wildenborg ML Bots MM Rovers P Timmen-Jobse PHM Peeters SSL Mol VR Rambharose Y van der Graaf Education General Practice A Belgraver AO Quartero AR Maille C Nusse C Vernooij CJ Mutsaers E van Bruggen EJ van der Jagt HM Jordan-Carels CSPM Uiterwaal DJ Piersma EAE Scheele HAE Vreugdenhil HM Verkooijen IE Wesselink-van Meerten JWJ Beulens LHM Rikken M Kluijtmans M van den Donk MEL Bartelink MI Geerlings MM Kuyvenhoven MM van Eenige PAH van Noord PMA Dudok van Heel V Coenen Y Groeneveld YT van der Schouw AJ van Leeuwen AP de Graaf ARJ van Lennep-Sanders C van Beek CF Dagnelie DLM Zwart EFHM Hendrickx HHG de Jong HM Pieters IH Barels J Maaijen JE Konings JJ Molenaar JJS Tjin A Ton JLM Tuithof L Truijens LGM van Berkestijn LJ de Boer M Bogaards-Godschalk M Schouten M Terluin M Zwijnenburg MA Mathot MCGA Albert MED Filippo MEV Ledoux MH Bekkers MI van der Cingel MI Vermeulen MJFM Suijs-Schellekens MJG de Wilt MKE Feijen MLC van Voorst-Vader MM Kuyvenhoven MMH van Hemert MS van den Dool-Mulder NG de Grunt PJ Kruithof R Hirsch S van den Hoeven S Vossen S Zwart SK Kwee SM van Honk TWPM Wolf-Verschuure W Mertens W van der Kraan WM van Stempvoort Education Public Health MCIH Biesaart O Visser RG van der Meulen Leidsche Rijn Health Care Project DJ Duits-Kroon K Koppenol KN Lanting 120 Annual Report 2007 Personnel and Finances 121

63 Julius Health Care Centers AG Pijl RAE van Damme Nursing Science A Akoudad AH Horenberg AL van Dillen AM May-de Groot AM van Straalen B van Garden BKG van Meijel CAM Goverde CJ Gamel DG Zwiers EL Meerwijk F de Boer G van der Hooft-Leemans GEJ Weustink-Mathu GH Tuijtel H Moes HEM Morselt J van Sonsbeek JI Dijkstra JJ van der Bijl JM van Vuuren-Rozendaal JRJ de Leeuw LGC Bouter M Engel M Oosterom MC de Korte-Verhoef MC Kars ME Wigboldus MHF Janssens-Grypdonck MJ van Vliet MJ van den Berg MM Bosman MM van Halm-Walters RH van Linge WJG Ros Theoretical Epidemiology & Biostatistics DB Toll JAH de Groot KGM Moons LM Peelen R Oudega Y Vergouwe Nutritional Sciences & Dietetics A Gil AD Michelsen-Huisman AL Zuur C Timmer CME van Marissing D Schregardus DJ van den Berg E Steenhagen EC Carbasius Weber EH de Jongh-Kampherbeek FM Hollander-Kraaijeveld GK Hiemstra J Dopheide J Hiemstra JA Iestra JCM Schreurs JM van Maarseveen-Hendriks JMP Leermakers-Vermeer JNN van Harten JW Woestenenk JWH van der Luyt JWM Renken-Terhaerdt K van Halen-Kemp M de Bruin M Los M Somer N Broekman-Peters N Lamarche NM de Roos PD van Heest-Cooman S Chevalier-Runia SCG van Alst TAM van den Hurk Adjunct faculty (in Dutch nul-aanstelling ) Cancer H Besson HB Bueno de Mesquita HGM Peters MJ Velthuis RCH Vermeulen Cardiovascular Diseases A Mosterd AM Baart BG Brouwer BI Idris CL Verheugt E Peterfai EJC van Ameijden F Travert 122 Annual Report 2007 Personnel and Finances 123

64 H Burger H Nakhai Pour RP Venekamp HJ van Duijn HM Smeets I Arts I Oudejans-Mooijaart ICT JF Hoekstra K Williamson C van den Broeck M Lensink LE Vos LJ Bax LJM Boonman-de Winter M Edlinger Infectious Diseases M Jager-Geurts M Lengyel CW Helsper EJM van Gils M Rietveld-Ernst MH Zafarmand FAM van Balen I Looijmans MHE Bruins Slot N van Geloven KM van Asselt LMAJ Muller OP van der Spoel PB van Bemmelen LPG Derde MEE de Roos-Kretzschmar RGA Ettema RP Stolk MJ Warnier MW Marcus S Sabour SECA de Jong W Opstelten CTSU Mental Health AJ van Hoek CA Mulder HL Keijer CGEM Groot E Chalachanova JJM Stern-van de Heuvel JL de Bruin MTA/Kea LD Izeboud M Dirven BMS Heeg CL van der Poel MJF Bastiaansen P Novotny E Buskens GJ Bonsel PA van Meurs V Puzej M Verschuuren MJ Meijboom V Ruda Z Bielicka Nursing Science Datamanagement BKG van Meijel E van Swieten-Duifjes RJT Wit FAJ Fluttert JAM Winnubst L Noorland-Schoonhoven MHF Janssens-Grypdonck Education Epidemiology MJ Schuurmans S Mujakovic JE Brussee YS Tjang Nutritional Sciences & Dietetics General Practice B Pottinga CME van Marissing A Hendrix AM Mathot E de Bruin E Stravers 124 Annual Report 2007 Personnel and Finances 125

65 EJ Sinnige EK Makkink I Oude Groeniger I Wijers J van Riemsdijk K de Jong ME Berkenpas RM van Oversteeg SE Zwolsman Other BE de Galan EE Wineke F Linnebank G Jongebreur G Wolfslag HA Smit J Tiebesl JA Zuidema JAG Stooker-Brouwer JC Kelder JJ Noordzij-van Willigen ME Avezaath MK Van Dijk-Okla MW Kuiper R Dettingmeijer R Tan-Paap S Rampal TJ Huizenga Theoretical Epidemiology and Biostatistics I van der Tweel Financial report Financial overview 2007 Personnel costs Income UMC UMC Projects External GPVT Projects Investments Computers Running costs Traveling & Lodging Post & Phone Other UMC Central Unit Health Care Innovations AH Peters H Kraijo IFM Schweitzer-Janssen JH Schaaf MSA Hady RW Haneveld G Powell Davies HJ van der Steeg IIE van de Woestijne-Staal JMD Boot RJP Coenen Overhead VAT reimbursement Grand Total Annual Report 2007 Personnel and Finances 127

66 Organizations and companies providing funding ADIR AGIS Zorgverzekeringen nv Akzo Nobel N.V. Astmafonds Astra Zeneca Bayer HealthCare Bowling Pfizer Centrum Maliebaan College van Zorgverzekeraars Diabetes Fonds Districts Huisartsen Vereniging DGV Nederlands Instituut voor Verantwoord Medicijngebruik Eli-Lilly bv European Union Gemeente Amsterdam George Institute for International Health GlaxoSmithKline Imperial College London Internationale Stichting Alzheimer Onderzoek Koningin Wilhelminafonds (Nederlandse Kankerbestrijding) Lipid Nutrition bv Landelijk Centrum Verpleging & Verzorging Landelijke Stichting Beheer Kruiswerk Merck Sharp en Dohme Ministerie van Volksgezondheid, Welzijn en Sport Nederlandse Hartstichting Nederlandse Organisatie voor Wetenschappelijk onderzoek (ZonMW) Nederlandse Vaccin Instituut Novartis Pharma bv Novo Nordisk Farma bv Nutricia Organon nederland bv Pfizer Pharmanet RIVM Sanofi-Aventis SBOH Servier Schering Plough Sticares Stichting centraal fonds Reserves Voormalig Vrijwillige Ziekenfondsverzekering Stichting Egris Stichting Interactie Stichting Koningsheide Stichting RIPAG Stichting Vascular Research Netwerk Stichting Vecozo Stichting tot steun VCVGZ Strangeways Research The Icelandic Heart Association The Stanley Medical Research Institute TNO-voeding UMC Utrecht University of Durham University of Oxford VU Medical Centre Wyeth World Cancer Research Fund 128 Annual Report 2007 Personnel and Finances 129

67 World Health Organization Zorgonderzoek Nederland Zorggroep Almere 130 Annual Report 2007 Personnel and Finances 131

68 Research Projects (2007) The theme-oriented organisation of our research contributes to the high quality of the output. (Manon Kluijtmans) Research projects 133

69 Cardiovascular Diseases PhD projects, finished 2007 Name Title JC Discipl Janssen, K.J.M. Improvements in clinical prediction (see also Theor. Epi.) research Nakhai Pour, Androgens and selected cardiovascular H.R. risk factors in aging men Sabour, S. Calcification of the coronary arteries. Reproducibility, risk factors and risk Thoolen, B.J. Venmans- Muller, L.M.A.J. (see also Infectious diseases) Beyond good intentions. The effectivenes of a proactive selfmanagement intervention in patients with screen-detected type 2 diabetes Diabetes and infections: towards an optimal treatment strategy in primary care extern GP, Psych. GP PhD projects, ongoing Name Title JC Discipl vacature Cardiovascular effects of severe caloric joint restriction: Dutch hongerwinter cohort collaboration Appelman, A.P.A. (see also Mental Health) Early cerebral damage in patients with manifest vascular disease joint Arts, I. Avendonk, M.J.P. van Bauer, F. Determinants of disability in older persons Insulin therapy in diabetes type 2 patients in general practice IOP Genomics project: The role of inflammation in obesity-induced type 2 diabetes joint GP Research Projects 135

70 Beelen, R.M.J. Berg, M.J. van den Long-term effects of traffic-related air pollution on respiratory and cardiovascular mortality. Expert patients as a coach in a selfmanagement programme for newly diagnosed patients with diabetes type 2 extern joint GP, NS Beus, M.F. de Sudden death in sportsman, SPORTCOR Bijker, J. Boonman-de Winter, L.J.M. Borkent-Raven, B.A. Bozkurt, O. (see also Mental Health) Brouwer, B.G. Bruggen, J.A.R. van Bruggink- André de la porte, P.W.F. Bruins Slot, M.H.E. Cleveringa, F.G.W. Dogan, S. Intra-operative hypotension and extern adverse outcome after surgery Heart failure in diabetes extern GP The relationship between the costeffectiveness of blood safety measures and the distribution of patients receiving blood; the PROTON study MTA UDES project pharmacy joint Evaluation of multidisciplinary care in cardiovascular disease IMPETUS: Implementation of shared care guidelines for people with type 2 diabetes Value of doctor- and nurse directed multidisciplinary interventions in heart failure Improving the early diagnosis of myocardial infarction in primary care: the added value of a rapid assay to detect heart-type FABP, a novel marker of myocardial injury - PhD project 2. Diabetes care Inplementation Study (DIS) Methodological aspects of carotid intima-media-thickness measurements in observational and intervention studies extern GP, GP, GP, MTA, GP Eck, J.W.M. van Complications in first year after pacemaker implants El Fakiri, F. Preventive cardiovascular care in deprived neighbourhoods Elbers, C.C. Role of inflammation in obesity-induced type 2 diabetes, Phd study Emmelot-Vonk, M.H. Engelsen, C. den Gast, G.C.M. Geersing, G.J. Geerts, C.C. Gerritsen, L. (see also Mental Health) Effects of testosterone suppl. on functional mobility, quality of life, body composition, cognitive function, vasc. ageing, and bone mineral density in testosterone deficient men, PhD project 1 The IJsselstein screening for central obesity to detect metabolic syndrome A net preventive benefit of postmenopausal hormone therapy in peri-menopausal women Generalizability of the Wells rule for excluding pulmonary embolism to primary care: The AMUSE 2 study The relation between early childhood obesity and arterial disease Psychological stress and depression as risk factors for cognitive decline and Alzheimer s disease Gondrie, M.J.A. PROVIDI: Prognostic value of unrequested information in diagnostic imaging Gorter, P.M. Insulin resistance and adipose tissue in the development of vascular diseases in high-risk patients Hajer, G.R. Vascular risk factors and adipocyte dysfunction in metabolic syndrome Halkes, P.H.A. Minor and major vascular diseases of the brain extern joint joint joint extern extern GP, GP, GP 136 Annual Report 2007 Research Projects 137

71 Jacobs, P.C.A. The prognostic value of incidental findings in diagnostic imaging (PROVIDI) joint Pruissen, M. Genetic determinants for new vascular events in patients with cerebral ischaemia extern Janssen, P.G.H. The Dutch ADDITION Study; As part of the Anglo-Danish-Dutch study of intensive treatment in people with screen detected diabetes in primary care, GP Regieli, J.J. Prognosis in ischemic heart disease. Impact and molecular determinants of collateral circulation - the SMART study and REGRESS trial cohorts joint Jong, S.E.C.A. de (DREAM)on: Dutch Randomised Endovascular Aneurysm Management Trial - 2nd part. extern Rutten, A. Multi-detector row CT of the heart: methodological evaluation and application in high-risk patients extern Jongen, L.M. Cerebral perfusion and cerebral vascular morphology in patients with symptomatic carotid artery stenosis Kelder, J.C. Diagnostic strategies in patients, GP suspected of heart failure Knol, M.J. (see Psychiatric comorbidity in diabetes joint also Mental Health) (UDES-project JC) Knoops, A.J.G. The etiology of Alzheimer disease: an (see also Mental Health) innovative hypothesis of depression, vulnerability an biological interaction Koffijberg, H. Modeling complex disease processes: MTA subarachnoid hemorrhage and frailty Laar, F. van de Nutritional and pharmaceutical extern GP treatment aspects in newly diagnosed type 2 diabetes patients in general practice Lebrun, C.E.I. Determinants of physical aging among extern healthy postmenopausal women and their relation with serum hormone levels Maessen, M. Determinants of end-of-life decisions in extern ALS: prospective study Meijs, M.F.L. Non invasive cardiac imaging joint Nijdam, M.E. Elevated blood pressure in young adults Oudejans- Mooijaart, I. Heart failure in the very old extern Scheltens, T. Sluijs, I.S. Spoel, O.P. van der Svircevic, V. Toll, D.B. (see also Methodology) Uijl, I.E.M. den Uijl, S. Vaartjes, C.H. Verheugt, C.L. Prevention of cardiovascular diseases in primary care The effect of environmental as well as genetic factors on selected biomarkers of pathophysiological pathways thusfar known to be involved in the ethiology of type 2 diabetes Improving the early diagnosis of myocardial infarction in primary care: the added value of a rapid assay to detect heart-type FABP, a novel marker of myocardial injury - PhD project 1. Optimal technique in cardiac anestesia recovery Diagnosing deep vein thrombosis in primary care Long term outcome of mild and moderate haemophilea Optimal diagnostic routing to determine the indication of surgery in epilepsy patients Cerebrovascular disease and peripheral arterial disease in the Netherlands: incidence and prognosis Prognosis of adults with congenital heart disease in the CONCOR national registry extern extern, GP, GP, MTA, GP 138 Annual Report 2007 Research Projects 139

72 Vlak, M. Vlek, A.L.M. Vos, A.M. de Weerd, M. de Wermer, M. Westerhuis, M.E.M.H. (see also Theor. Epi.) Zaane, B. van Zafarmand, M.H. Triggers for rupture of intracranial aneurysms Parameters of cardiovascular diseasethe SMART study (definitive title to be decided) Cardiac imaging in patients with peripheral arterial disease. Chronic renal insufficiency in the Netherlands, incidence and prevalence + Is screening of asymptomatic carotid stenosis to prevent stroke risk cost effective Aneurysm Screening after surgical Treatment in Ruptured Aneurysms (ASTRA) The cost-effectiveness of ST-analysis of the fetal electrocardiogram as compared to fetal blood sampling for intrapartum monitoring: a randomised controlled trial Diagnostic value of an innovative noninvasive diagnostic to determine the grade of atherosclerosis before sternotmy in patients scheduled for cardiac surgery Genetic risk factors in cardiovascular disease extern extern extern extern extern, MTA Other projects, finished 2007 Name Title JC Discipl Kruif, I.L. de Prevention of cardiovascular disease MTA Other projects, ongoing Name Title JC Discipl Bak, A.A.A., Bots, M.L. Effects of increased convective clearance by online hemodiafiltration on all cause mortality in chronic hemodialysis patients Berg, M.J. van den Beulens, J.W.J. Bots, M.L. Bots, M.L. Bots, M.L. Donk, M. van den Donk, M. van den Graaf, Y. van der, Soedamah- Muthu, S.S. Greving, J.P. Expectations and preferences of people with type 2 diabetes mellitus with regard to changes in primary diabetes care Nutrition, Type 2 Diabetes and Cardiovasular Disease Optimal risk factor management in CRI patients and risk of CVD events: MASTERPLAN Cardiac imaging and risk of CVD PAD patients: GROUND study Carotid intima-media thickness measurement (CIMT): Is it useful for clinical practice? Quality of life in screen detected type 2 DM patients Cognition in screen/detected patients with type 2 diabetes mellitus in primary care± two and five years follow/up after randomisation towards intensive or standard treatment SMART: Second Manifestations of ARTerial disease Balancing the risks and benefits in primary prevention. Development of an individualised approach., GP, DT, GP, GP 140 Annual Report 2007 Research Projects 141

73 Grobbee, D.E., Soedamah- Muthu, S.S. Hees, Y. van Kluijtmans, M. Onland-Moret, N.C. Peeters, P.H.M. (see also Cancer) Rutten, G.E.H.M. Schouw, Y.T. van der ADVAN: Action in Diabetes and Vascular Disease, an ational multicenter clinical trial on the effects of Perindopril-Indapamide and Glicazide on cardiovascular disease in patients with diabetes mellitus type 2 Outcomes after aortic valve replacement. A prognostic cohort study on survival, quality of life and costs IPD analysis of on- versus off pump coronary bypass surgery Role of inflammation in obesity-induced type 2 diabetes PROSPECT: European prospective investigation into cancer and nutrition NAVIGATOR: Efficacy and safety of long term administration of nateglinide and valsartan in the prevention of diabetes and cardiovascular outcome European Prospective Investigation into Cardiovascular diseases (EPIC-Heart) joint Klep GP Infectious Diseases PhD projects, finished 2007 Name Title JC Discipl Boldin, B. Mathematical aspects of infectious extern disease dynamics Jansen, Extending recommendations for GP A.G.S.C. respiratory vaccines: experimental and non-experimental studies Leavis, H.L. Evolutionary insights into CC17 extern Enterococcus faecium Top, J. Molecular epidemiology Enferococcus faecium from commensal to hospital adapted pathogen extern Venmans- Muller, L.M.A.J. (see also Cardiovascular diseases) Diabetes and infections: towards an optimal treatment strategy in primary care GP Shahin, G Outcomes after mitral valve replacement. A prognostic cohort study Sonsma, A.C.M. Application of nurse practitioners at the vascular center Peelen, L.M. (see Theoretical epidemiology in also Theor. Epi.) cardiovascular surgery Vergouwe, Y. Diagnostic prediction rules: innovative (see also Theor. Epi.) methods to improve their applicability - Postdoc project Verheus, M. Does equol-producer capacity determine beneficial effect of soy? Wamsteker, E.W. HOOP-study: Baseline expectations and the effect of weight reduction therapy. Does changing baseline expectations prevent undesired weight gain within the first two years after treatment? Klep DT PhD projects, ongoing Name Title JC Discipl Aardweg, Effectiveness of adenoidectomy in extern M.T.A. van den children with recurrent upper respiratory tract infections Ammerlaan, MRSA, clinical epidemiologie extern H.S.M. Bolkenbaas, M. 13-valent pneumococcal conjugate vaccin efficacy in prevention in prevention of pneumococcal CAP and IPD Bont, J. Lower respiratory tract infections in the elderly: Prognostic studies in primary care GP 142 Annual Report 2007 Research Projects 143

74 Boonacker, C.W.B. Broekhuizen, B.D.L. Derde, L.P.G. Dool, C. van den Ermers, M.J.J. Gils, E.J.M. van Groenwold, R.H.H. Helsper, C.W. Hendrickx, A.P.A. Houben, M.L. Optimizing the transferability and applicability of trial results to other countries FRESCO study: Diagnostic Strategies for COPD in coughing patients in general practice Mastering hospital Antibiotic Resistance (MOSAR); ICU trial (WP3) Mathematical modeling as an alternative for clinical trials in predicting effectiveness of preventive measures for influenza in healthcare settings Local anti-inflammatory treatment in the prevention of long-term airway morbidity following hospitalisation for respiratory syncytial virus infection: clinical efficacy and immunological correlates. Effect of 2 versus 3 pneumococcal conjugate vaccinations Prevnar on nasopharyngeal carriage, transmission and herd immunity; a randomized, controlled study Control and Quantification of confounding by indication in nonrandomised studies: Methodological inquiry using an example of vaccine effectiveness Improving diagnosis in Hepatitis C in General Practice Vaccine Development to combat NEF infections Perinatal determinants, including amniotic fluid inflammation and innative immunity, of infant wheeze and RSV lower respiratory infection. extern joint extern extern, GP, GP, GP, GP GP Jong, B.M. de Jongerden, I.P. Kempen, E.E.M.M. van Lemjahdi, H. Looijmans-van den Akker, I. Whistler: Wheezing illness study in Leidsche Rijn, study dejong Endotracheal suctioning in ICU patients: towards an evidence based guideline Transportation noise exposure and children s health and cognition Clinical and molecular epidemiology of pseudomonas aeruginos in cystic fibrosis patients Evaluation of influenza vaccinations in healthy adults joint extern extern joint, GP, NS, GP Meijboom, M.J. Cost-effectiveness (A/CUA) of extern, GP influenza vaccination programmes during interpandemic & pandemic years Melsen, W.G. Nosocomial infections and Mortality Pijpers, E.J. CHAMP - Changing behaviour of Health GP care professionals And the general public towards a More Prudent use of anti-microbial agents & Arti-4 Ruskamp, J.M. Upper respiratory tract infections in extern children; the role of atopy, environmental and life style factors, and genetic polymorphisms in a prospective birth cohort study Scholtens, S. Breastfeeding in relation to growth, extern childhood overweight and asthma in Dutch children. The PIAMA birth cohort study. Soares da Silva, Air pollution study in São Paulo extern A. Steenhof, M. Risk evaluation of ultrafine (nanosize) extern ambient particular matter Suarthana, E. Development of diagnostic models for occupational asthma in the framework of a health monitoring system joint Vervoort, S.C.J.M. Factors influencing therapy-fidelity in the view of HIV infected patients extern NS 144 Annual Report 2007 Research Projects 145

75 Visscher, S. Predicting VAP extern Vos, J.M.I. Prestudy optimizing diagnosis of extern Community Acquired Pneumonia (CAP) Vugt, S.F. van GRA (WP ), GP Warnier, M.J. Optimising COPD care: going for silver GP or for gold Willers, S.M. Environmental and life style determinants of childhood asthma and allergy in birth cohort extern Other projects, finished 2007 Trapman, J.P. Velden, A.W. van der Verhoeff, M. Mathematical modelling of infection diseases Implementation of a multiple intervention aimed at optimising prescription of antibiotics for respiratory tract infections, embedded within the new practice accreditation of the Dutch College of General Practitioners; a randomised controlled trial The effectiveness of treatment with cotrimoxazol in children with chronic otitis media joint extern GP Name Title JC Discipl Niesink, A. COPD care in general practice; evaluation of the copd-astma care protocol PH Other projects, ongoing Name Title JC Discipl Grigoryan, L. European project: Mastering hospital antimicrobial resistance and its spread into the community Hak, E. Utrecht GP Network (HNU) GP Hooven, E.C. van den Quantification of confounding by indication GP Rovers, M.M. Which children with acute otitis media benefit from treatment with antibitics? An individual patients data metaanalysis, GP Smeets, H.M. Optimalising antibiotic prescribing in respiratory tract infections in general practice implementation in the Middle region of the Netherlands. GP Strijp, J. van In-vitro study of anti-inflammatory activity of Zithromax GP 146 Annual Report 2007 Research Projects 147

76 Cancer PhD projects, finished 2007 Name Title JC Discipl Verheus, M. Endocrine determinants of breast density and breast cancer risk PhD projects, ongoing Name Title JC Discipl Braunius, W. Diagnostic management in patients extern with head and neck malignancies Haars, G. Influences on mammographic tissues and patterns Horrée, N. Molecular biology in endometrial extern carcinogenesis Kars, M.C. PRESEN study: The experiences, NS needs, coping strategies and professional support of parents caring at home for a child with cancer during the palliative phase Klerkx, W. MR imaging: the efficacy of noninvasive joint techniques to detect lymph node involvement in gynecologic malignancies May, A.M. (see Rehabilitation in cancer: Training and NS also Mental Health) talking? Effects of physical training versus physical training combined with cognitive-behavioural therapy Oosterom, M. NUCAI: The effect of comprehensive NS (see also Mental Health) counseling by a specialized nurse on depressive symptoms and quality of life: a prospective randomised study. Peters, H.G.M. MR in non-palpable breast tumors joint Velthuis, M. Vernooij, F. Winden, A.W.J. van PACT-Study: The influence of physical activity, weight changes and hormone levels on (breast) cancer risk and cancer survival Ovarian cancer treatment in The Netherlands. The effect of care provider on the outcomes of treatment between 1996 and 2003 The use of proteomics in the etiologic epidemiology of breast cancer extern extern, MTA Other projects, ongoing Name Title JC Discipl Duijnhoven, SOR project: fruit and vegetables in extern F.J.B. van relation to colonrectal cancer in epic. Elias, S.G. KWf project Harvard disease risk model Gamel, C.J. Care for (relatives of) patients with NS cancer Gils, C.H. van Carotenoids, vitamin C and risk of joint breast cancer in the european prospective investigation into cancer and nutrition Huitema, M.C. Effectiveness of oncological follow-up by specialized nurses joint NS Monninkhof, E.M. Noord, P.A.H. van Peeters, P.H.M. Vrieling, A. Physical activity and breast cancer risk: a trial in postmenopausal women DOM project: diagnostic investigation mamma carcinoma PROSPECT: European prospective investigation into cancer and nutrition SOR project: fruit and vegetables in relation to pancreatic cancer in EPIC extern 148 Annual Report 2007 Research Projects 149

77 Mental Health PhD projects, finished 2007 Name Title JC Discipl Mujakovic, S. Genetic and psychological determinants, GP of dyspepsia and implications for treatment Gerritsen, L. (see also Cardiovascular diseases) Heeg, B.M.S. Houtjes, W. Psychological stress and depression as risk factors for cognitive decline and Alzheimer s disease Health economic modeling of complex systems; the case of schizophrenia Development of protocol for the assesment of needs and the application of individualized nursing interventions in depressed elderly extern extern NS PhD projects, ongoing Name Title JC Discipl Aanen, M van Determinants of diagnostic in reflux extern GP disease Appelman, A.P.A. Early cerebral damage in patients with manifest vascular disease joint Joosten, G. Knol, M.J. (see also Cardiovascular diseases) Deciding Together : A research into the effectiveness of making a standardised treatment agreement in the addiction treatment care Psychiatric comorbidity in diabetes (UDES-project JC) extern joint PH Bijkerk, C.J. Irritable bowel syndrome in primary GP care Boonstra, G. Quiting-study antipsychotic medicine extern Bosman, M. Prevention of self-harm in psychiatric extern NS inpatients Bozkurt, O. (see UDES project pharmacy joint also Cardiovascular diseases) Breetveld, E.J. Building blocks project: prospective study on development of psychopathology within the normal population extern, GP Clignet, F.G.H.M. Dieleman, J.M. Fluttert, F.A.J. Physical excercise in depressed elderly: The development of a nursing intervention Prophylactic corticosteroids in cardiac surgery Prevention of violence in forensic psychiatry extern extern extern NS NS Knook, L.M.E. Knoops, A.J.G. (see also Cardiovascular diseases) Koekkoek, B. Laan, W. Lee-Kwon, S. Leeuw, M.G.C. de Prognosis of children referred for unexplained chronic pain: the PUC (Pediatric Unexplained Chronic pain) study The etiology of Alzheimer disease: an innovative hypothesis of depression, vulnerability an biological interaction The development and testing of a bestpractice programme for nursing care for chronically depressed patients Acetylsalicylic acid as an adjuvant therapy for schizophrenia Primary Caregivers perception of a long term care facility for their demented elders in Korea and intervening factors of those perceptions Quality of the working alliance in Assertive Community Treatment extern joint extern extern NS NS NS 150 Annual Report 2007 Research Projects 151

78 May, A.M. (see also Cancer) Meijer, B Oberndorff Klein Wolthuis, A. Oosterom, M. (see also Cancer) Pruijssers, A.C. Reincke, C. Smeets, H.M. Velden, A.W. van der Verkaik, R. Visscher, A.J.M. Zegwaard, M.I. Zuithoff, N.P.A. Rehabilitation in cancer: Training and talking? Effects of physical training versus physical training combined with cognitive-behavioural therapy Determinants of cognitive decay in the HALE project Effectiveness of mebeverine in IBS in primary care NUCAI: The effect of comprehensive counseling by a specialized nurse on depressive symptoms and quality of life: a prospective randomised study. Multidisciplinary diagnostics of anxiety related behavioural disorders in patients with intellectual disabilities A clinical prospective cross-sectional diagnostic study on the referral for screening for epilepsy surgery ARAMIS: analysis of the effectiveness of a PPI reduction programme ELISE: placebo determinants of PPI dependancy. Nursing care for depressed elderly with dementia in nursing homes: A multi centre intervention study into the effects of a nursing guideline Prevention of violent behaviour in patients with Acquired Brain Injury. Family care of elder persons with chronic psychiatric problems and difficult behaviour Early decision of depression in primary care: application and theory extern extern joint extern extern extern extern extern NS, GP NS NS GP GP, MTA NS NS NS, GP Other projects, finished 2007 Name Title JC Discipl Meerwijk, E.L. Development and testing of an evidence based practice guideline for nurses to effectively handle suicidality in patients with schizofrenia or associated psychotic disorders NS Other projects, ongoing Name Title JC Discipl Beem, E.E. Regional case registry of psychiatric disturbances in the West and Central Netherlands Boter, H. The european first episode extern schizophrenia trial Hage, S. Self-management strategies for extern NS adolescents with violent behaviour Matthijs, W. Treatment of children with functional extern MTA disorders or behaviour disorders Nuboer, V.S.P. Prevention of suicide in patients with extern NS schizophrenia Peijnenburg, R. The development of a nursing extern NS guideline aimed at the reduction of agitated behaviors in patients with dementia Stel, H.F. van, Early diagnosis in child health centers PH Swaans, I.J.E.M., Weertvan Oene, G.H. de of boisterous behavior in children of 0-4 years Villevoye, D.P.J. Out of school prevention of alcohol and drugs in the European countries extern PH Weert-van Oene, G.H. de Demand driven mental health care in Utrecht: baseline measurement with respect to care programming in mental health facilities in the region Utrecht PH 152 Annual Report 2007 Research Projects 153

79 Theoretical Epidemiology and Biostatistics PhD projects, finished 2007 Name Title JC Discipl Janssen, K.J.M. (see also Cardiovascular diseases) Improvements in clinical prediction research Roosbroeck, S.A.H. van Validation of traffic related air pollution exposure estimates for long-term studies extern PhD projects, ongoing Name Title JC Discipl Baart, A.M. Prediction of future hemoglobin levels in whole blood and plasma donors extern, MTA Bax, L.J. Synthesis of clinical research data: innovations in methods and applications extern Boonacker, C.W.B. Bruins Slot, M.H.E. Optimizing the transferability and applicability of trial results to other countries Improving the early diagnosis of myocardial infarction in primary care: the added value of a rapid assay to detect heart-type FABP, a novel marker of myocardial injury - PhD project 2., GP, MTA Dieleman, J.M. Postoperative cognitive decline extern Ettema, R. Improving outcomes of cardiac surgery extern in elderly patients Gondrie, M.J.A. PROVIDI: Prognostic value of unrequested information in diagnostic imaging Graaf-Verhave, R. van der Justice in research ethics Med. Ethics Groenwold, R.H.H. Groot, J.A.H. de Heeg, B.M.S. Control and Quantification of confounding by indication in nonrandomised studies: Methodological inquiry using an example of vaccine effectiveness Diagnostic research in the absence of a gold standard. Health economic modeling of complex systems; the case of schizophrenia joint extern, GP Idris, B.I. Long-term outcomes in cardiac surgery extern Janssen, M.P. Transfusion Technology Assessment MTA collaboration with Sanquin Blood Supply Foundation Kappen, T. IMplementation of a Prediction rule in extern Anesthesia practice to improve Costeffectiveness of Treatment of postoperative nausea and vomiting: the IMPACT trial Koopman, L. Pooling of individual patient data from clinical trials. Improvement of analyses of subgroups Molenaar, E.A. Research and Development Utrecht, GP Health Project Spoel, O.P. van der Improving the early diagnosis of myocardial infarction in primary care: the added value of a rapid assay to detect heart-type FABP, a novel marker of myocardial injury - PhD project 1., GP, MTA Thiel, G.J.M.W. van Toll, D.B. (see also Cardiovascular diseases) Evidence-based ethics: reflective equilibrium as a method for combining empirical and ethical elements. Diagnosing deep vein thrombosis in primary care Med. Ethics, GP 154 Annual Report 2007 Research Projects 155

80 Westerhuis, M.E.M.H. (see also Cardiovascular diseases) The cost-effectiveness of ST-analysis of the fetal electrocardiogram as compared to fetal blood sampling for intrapartum monitoring: a randomised controlled trial extern Other projects, ongoing Name Title JC Discipl Hooven, E.C. Quantification of confounding by GP van den indication Rovers, M.M. Methodological challenges of subgroup analyses in IPD meta-analyses Peelen, L.M. Theoretical epidemiology in (see also Cardiovascular diseases) cardiovascular surgery Vergouwe, Y. (see also Cardiovascular diseases) Diagnostic prediction rules: innovative methods to improve their applicability - Postdoc project Miscellaneous PhD projects, finished 2007 Name Title JC Discipl Berg, B. van den Physical symptoms that are frequently unexplained among survivors of the Enschede fireworks disaster extern Os- Medendorp, H. van Vlimmeren, L.A. van Coping with itch, a nurse-led intervention Asymmetry in infancy - The effect of paediatric physical therapy on the course of deformational plagiocephaly and subsequent developmental delay extern extern PhD projects, ongoing Name Title JC Discipl Berk, M.B. Evaluation patient organisations PH Boelhouwer- Jacobsen, D.E. Efficacy of tibolone and raloxine on the maintenance of muscle strength, bone mineral density and cognitive function in late postmenopausal women. extern Boogaard, J.M.C. Bruijn, C. de Bruns- Neumann, E.E. Integrated assessment of health risks of environmental stressors in Europe (INTARESE) Cognitive behavioural treatment for sub-acute shoulder disorders Support of parents of premature children extern extern extern Buiting, H. Evaluation of the law on euthanasia extern MTA Dijkstra- Prevention of pressure ulcers in home extern NS Chaves, L.M. care Eland-Kok, P. A patient portal for patients with constitutional eczema: feasibility and effectiveness extern NS NS NS 156 Annual Report 2007 Research Projects 157

81 Emmrich, D. Promotieproject Emmrich, extern NS Verplegingswetenschap Engel, M. Palliative care and presence NS Grul, Y.M. Attention, care and professionalism in extern NS care for the elderly Hofhuis, J. Quality of life in relation to ICU extern PH treatment Hoogerduijn, J. Prevention of complications in elderly joint NS after hospital admission Jansen, A.J.M. Differences in health perception extern between physician and patient in chronically ill children Jong, S.W. de Population based study on Amyotrophic extern Lateral Sclerosis Netherlands PAN Jukema, J.S. Presence in caring relationships joint NS Klijn, A. Efficacy of home-uroflowmetry in children with dysfunctional voiding (UFO) extern Luiking-Martin, M-L. Moes, H. Implementation of evidence based practice Development and testing of innovation/ implementation measurement instruments Piepers, S. Effectiveness of non-invasive artificial respiration at home in patients with ALS Polet, J.C. Development and validation of a multidisciplinary protocol for withdrawal of artificial breathing on IC units Rademakers, K. Additional value of MRI in prediction of psychomotorical development in premature children: a cost benefit analysis Simkens, A.B.M. Evaluation of Physician Assistant trainees in Dutch general practices. extern extern joint extern NS NS NS PH Stuifbergen, M. Sutedja, N.A. Trappenburg, J.C.A. Vallenga, D. Wassenberg, M.W.M. Zuurbier, M.M.M. Changing familiy ties and caretaking of the elderly MTA Environmental and genetic risk factors extern for amyotrophic lateral sclerosis (ALS) Disease management in patients with PH COPD; New stratiegies to improve selfmanagement skills and early detection of exacerbations Risk management in care of mentally extern NS retarded patients with epilepsy Rapid diagnostics of MRSA extern TRAVEL: Transport Related Air pollution, Variance in commuting, Exposure and Lungfunction extern Other projects, ongoing Name Title JC Discipl Belkadi, H. Beheer kwaliteitsmonitor voor Centrum extern PH Maliebaan Bie-de Waal, Stop the care-stops PH M.N.A. de Bie-de Waal, Reduction of care-delay for multi PH M.N.A. de trauma patients Buskens, E. PATMAN: Patient workflow MTA management systems Lemmens, L. Implementation of POS clinics in Dutch hospitals extern Linden, B.A. van der Meaning of American integrated care programmes to Dutch chronically ill patients extern Niesink, A. Telemonitoring of COPD patients PH Rietveld, L.A. Evaluation of Physician in general extern PH practice PH 158 Annual Report 2007 Research Projects 159

82 Rooij, S. Schrijvers, A.J.P. Urbanus-van Laar, J.J.N. Veenendaal, L.J. van Weert-van Oene, G.H. de Weldam, S.D.W. Wulp, I. van der Zweers-de Groot, J.A.M. Early recognition in elderly hospital patients who are at risk for functional impairments extern NS Evaluation of periodical indicators of PH youth health care in child health centers Evaluation Sylvia Toth Center PH CIZ extern PH IMC benchmarking. Routine Outcome Monitoring of patients in impatient motivation centers in substance dependence care extern PH Guideline development to stimulate extern NS fluid intake Comparative study of triage systems in PH the Netherlands Implementation of care homes extern NS Other projects, finished Meier, M. Organisation of acute care. Demand and supply of emergency care in the region of Utrecht PH Clinical Trial Services Unit / Research Services Projects 2007 finished Project Title Activity Aspirin/ Schizophrenia Acetylsalicylic acid as an adjuvant therapy for schizophrenia M/DM CIRA Study on chronic hepatits-c treatment M/DM with interferon alpha, ribavirin and amantadine DEPRESSIE Pharmacological Treatment of Psychotic M/DM Depression. Comparance of efficacy at 7 weeks after treatment with venlafaxine, imipramine, venlafaxine + imipramine. DIS Diabeteszorg Implementatie Studie Adm./ DM Epi-flu An observational study to investigate Site the incidence of influenza-related complications in adults between years and elderly adults 65 years and over vaccinated with GSK biologicals influenza vaccine (Fluarix ) administered intramuscularly. EUFEST The EUropean First Episode M/DM Schizophrenia Trial ILLUMINATE Phase 3 multi-center, double-blind, Site randomized, parallel group evaluation of the fixed combination torcetrapib/ atorvastatin, administered orally, once dai ly (QD), compared with atorvastatin alone, on the occurence of major cardiovascular events in subjects with coronary heart disease or risk equivalents Other CT CT Other CT CT CT 160 Annual Report 2007 Research Projects 161

83 PDY Randomized, double-blind, placebocontrolled, multinational study evaluating the safety and pharmacokinetics of 5 and 10 µg AVE0010 single doses and the efficacy, safety and pharmacokinetics of AVE0010 administered for 6 or 6 weeks, either once or twice daily, following dose escalation from 5 to 30 µg in Japanese and Caucasian type 2 diabetic patients not adequately controlled with sulfonylurea and metformin. Telmisartan Telmisartan and simvastatin in hyperlipidemia and hypertension. UHFO-DD Utrecht Heart Failure Study Diagnostics Zolip Randomized clinical trial on the efficacy and safety of combination fenofibrate/ simvastatin compared to simvastatin monotherapy in patients with mixed dyslipidemia Projects, ongoing Project Title ADVAN Action in Diabetes and Vascular disease; pretax and Diamicron MR Controlled Evaluation Altitude A randomized, double-blind, placebocontrolled, parallel-group study to determine whether, in patients with type 2 diabetes at high risk for cardiovascular and renal events, aliskiren, on top of conventional treatment, reduces cardiovascular and renal morbidity and mortality. Site Site M/DM Site M M CT CT Other CT CT CT Ascertain Assesment of everolimus in addition to calcineurin inhibitors reduction in maintenance renal transplant recipients Site (CIMT only) AUDITOR Atherosclerosis underlying development Site CT assessed by intima-media thickness in patients on Rimonabant CLA Possible effects of supplementation Site/DM CT with cis-9, 11 conjugated linoleic acid on markers of atherosclerosis CONTRAST The Dutch Convective Transport Study M/DM CT Diasulin Falen van metformine en Site/DM CT sulfonylureumderivaat combinatietherapie: stoppen of doorgaan met een sulfonylureumderivaat in combinatie met insuline glargine bij diabetes type 2 patiënten in de huisartspraktijk. DREAM Dutch Randomised Endovascular M/DM CT Aneurysm Management Trial FAME Heart-type Fatty Acid binding protein Site/DM Other for early Myocardial infarction Exclusion FOLLOW-PA Complications in first year after DM Other pacemaker implants Grace Genomics to combat resistance against PM/DM Other antibiotics in community-acquired LRTI in Europe Interact Validering van de EPIC-vragenlijst over Site Other lichamelijke activiteit (InterAct-studie). Interaction A phase 3, randomized, double-blind trial evaluate the safety, tolerability, and immunogenicity of a 13-valent pneumococcal conjugate vaccine when administered concomitantly with trivalent inactivated influenza vaccine in healty adults 65 years of age or older who are naïve to 23-valent pneumococcal polysaccharide vaccine Site CT A CT 162 Annual Report 2007 Research Projects 163

84 JUPITER LRGP MASTERPLAN Justification for the use of statins in primary prevention: an intervention trial evaluating Rosuvastatin Utrecht Health Monitoring Study Leidsche Rijn Multifactorial Approach and Superior Treatment Efficacy in renal patients with the aid of nurse practitioners Site Site/DM M/DM CT Other CT 067 lipids A multicenter, randomized, doubleblind, parallel group, 12-week study to evaluate the efficacy and safety of extended-release (ER) niacin/ laropiprant. added to statin versus doubling the dose of statin in patients with primary hypercholesterolemia of mixed dyslipidemia. Site CT+ MINOES Invloed van 2 en 3 Prevenar vaccinaties in het RVP pneumokokken neusdragerschap, transmissie en herdimmunity : een gerandomiseerd, gecontroleerd onderzoek. M/DM CT CT = Clinical Trial M = Monitoring & Projectmanagement PM = Projectmanagement DM = Datamanagement NAVIGATOR Efficacy and safety of long term administration of nateglinide and valsartan in the prevention of diabetes and cardiovascular outcome. Site CT Perform Prevention of cerabrovascular and cardiovascular events if ischaemic origin with te rutroban in patients with a history of ischaemic stroke or transient ischaemic attack Site (IMT s) CT CAPITA s Pilots Community Acquired Pneumonia Immunization trial in adults-pilot studies Site/DM Other SHARP Study on Heart And Renal Protection M CT The Dutch ADDITION Study As part of the Anglo-Danish-Dutch study of intensive treatment in people with screen detected diabetes in primary care Site/DM CT Zoster A study to determine the acceptability of the Zostavax vaccine when simultaneously offered with the influenza vaccination in patients of 65 year and above in the general practice Site/DM Other 164 Annual Report 2007 Research Projects 165

85 Vascular Imaging Center (VIC) Projects 2007 finished AdRem ADVAN Retinal Measurements, a large sub-study of ADVAN on diabetic retinopathy and vascular retinal changes Retinal A Measurement of carotid intima-media CIMT thickness in a multi centre randomised controlled trial on lipid lowering (CP- 529,414/Atorvastatin, Administered Orally, Once daily (QD) for 24 months, Compared with Atorvastatin alone) on progression of carotid intima-media thickness in patients with Heterozygous Familial Hypercholesterolaemia:1003 FH A Measurement of carotid intima-media CIMT thickness in a multi centre randomised controlled trial on lipid lowering (CP- 529,414/Atorvastatin, Administered Orally, Once daily (QD) for 24 months, Compared with Atorvastatin alone) on progression of carotid intima-media thickness in subjects with Mixed Hyperlipidemia: 1004MH Projects, ongoing Organisation Title Measurement Contrast The Dutch Convective Transport Study - IMT measurements CIMT CIMT = Carotid intima-media thickness CT = Clinical Trial For all studies datamanagement is performed by the Julius Center. CT CT CT CT Data Management without participation of Research Services or VIC Projects, ongoing AED Projects Online vragenlijst bij plotselinge dood other BLOEDBANK Datamining gegevens van bloedbanken other CHECK Reuma-onderzoek DIGD cohort COCO Onderzoek naar BLWI bij kinderen CT CRINE Onderzoek naar de prevalentie en incidentie van other chronische nierinsufficiëntie in Nederland DECS Dexamethason gebruik bij hartoperaties CT DIASULIN Trial bij diabetes type 2 patienten in Breda e.o. CT DOM Utrechts cohort t.b.v. opsporing risicofactoren cohort voor onstaan van borstkanker EBCR Website voor onderwijs Evidence Based Medicine other EPIC-NL Combineren van de cohorten PROSPECT (JC) en cohort MORGEN (RIVM) FAME Evaluatie van hartschade test in huisartsen CT praktijk. FIBRE Dieet interventies bij Prikkelbare Darm CT Syndroom: oplosbaar, onoplosbaar of geen vezels? GRA WP2 IT/datamanagement workpackage binnen other GRA. (Europees onderzoek naar antibiotica resistentie) GROUND Multicenter trial bij patienten met perifeer CT vaatlijden, waarbij gekeken wordt of imaging en vervolgbehandeling gevolgen heeft voor cardiovasculairrisico binnen 5 jaar. GGD 18 Vergelijking tussen consultatiebureaubezoek of other maanden thuisbezoek bij kinderen van 18 maanden bij GGD Zeeland Hemofilie Zweden Vragenlijsten bij hemofilie patiënten in Zweden other 166 Annual Report 2007 Research Projects 167

86 HNU Huisartsen Netwerk Utrecht, database gevuld cohort met gegevens van 6 huisartsenpraktijken in regio Utrecht IMPACT Onderzoek naar het gebruik van een CT predictieregel voor anesthesist op misselijkheid bij geopereerde patiënten IMPETUS Implementatie en evaluatie van transmurale CT werkafspraken diabets mellitus KEMA Verwerking vragenlijsten other LEUKO Leukemie-studie bij WKZ other NS-2 Nationale Studie 2, database gevuld met cohort gegevens van 195 huisartsen verspreid over Nederland NUCAI Trial waarbij patienten met kanker in hoofdhalsgebeid CT op reguliere wijze wordt behandeld t.o.v. inzet van counseling ODIN Ontspanning door Inspanning other ONCOREV Effectiviteit van oncoligische revalidatie op CT kwaliteit van leven OPTICA Optimising Circulating blood Volume After Subarachnoid Haemorrhage OVARIUM- Database met patiënten met ovariumcarcinoom cohort CARCINOOM PANTER PAncreatitis, Necrosectomie versus minimaal invasieve step up benadering CT PATIENT- VEILIGHEID PEDNET Onderzoek naar patiëntveiligheid binnen UMC Utrecht European paediatric network for Haemophilia management Other Cohort PGO-O Pilot preventief gezondheidsonderzoek ouderen other PROSPECT Utrechts cohort t.b.v. leefgewoonten en kanker Cohort en hart-en vaatziekten QUOFUN Vragenlijsten bij kaakkankerpatiënten Other REACTIE Vergelijking therapietrouw bij verschillende manieren van risico-omschrijving Other RODIN Internationaal Internet based dataverzameling Cohort bij hemofilie patiënten. SPIN UTI Trial mbt wel/niet preventief geven van CT antibiotica bij kinderen met spina bifida SPIEGEL Patiëntveiligheid in de huisartsenpraktijk Other STEM VAN DE PATIENT ST. QUADRAET ST. RIPAG Onderzoek naar beleving kwaliteit van zorg bij diabetespatiënten Database gevuld met gegevens alle 20 huisartsenpraktijken in Almere Datamanagement van een psychiatrisch cohort in de regio Utrecht Other Cohort Cohort VAN PELT Kinderen met reuma Other CT = Clinical Trial 168 Annual Report 2007 Research Projects 169

87 Publications 2007 A 12 month trial to study the effect of lipid modifying drugs on carotid intimamedia thickness progression should precede the launch of a morbidity and mortality trial. (Michiel Bots) Publications 171

88 PhD Theses 1 Berg, B. van den (2007, april 05). Physical symptoms that are frequently unexplained among survivors of the Enschede fireworks disaster. Utrecht University (165 pag.). Prom./coprom.: prof.dr.ir. B. Brunekreef, L. Grievink, E. Lebret & dr. C.J. Yzermans. 2 Boldin, B. (2007, september 05). Mathematical aspects of infectious disease dynamics. Utrecht University (169 pag.). Prom./coprom.: prof. dr. O. Diekmann & prof. dr. M.J.M. Bonten. 3 Jansen, A.G.S.C. (2007, september 20). Extending recommendations for respiratory vaccines: experimental and non-experimental studies. Utrecht University. Prom./coprom.: prof.dr. E.A.M. Sanders, prof. dr. A.W. Hoes & dr. E. Hak. 4 Janssen, K.J.M. (2007, december 06). Improvements in clinical prediction research. Utrecht University (159 pag.). Prom./coprom.: prof.dr. K.G.M. Moons, prof.dr. D.E. Grobbee & dr. Y. Vergouwe. 5 Leavis, H.L. (2007, december 06). Evolutionary insights into CC17 Enterococcus faecium. Utrecht University (208 pag.). Prom./coprom.: prof.dr. M.J.M. Bonten & dr. R.J.L. Willems. 6 Mujakovic, S. (2007, december 18). Genetic and psychological determinants of dyspepsia and implications for treatment. Utrecht University (170 pag.) (Utrecht). Prom./coprom.: prof.dr. D.E. Grobbee, prof.dr. M. Samsom, dr. N.J. de Wit & dr. M.E. Numans. 7 Nakhai Pour, H.R. (2007, juli 12). Androgens and selected cardiovascular risk factors in aging men. Utrecht University (152 pag.). Prom./coprom.: prof.dr. D.E. Grobbee, dr. Y.T. van der Schouw & dr. H.J.J. Verhaar. 8 Nieuwenhoven, C. van (2007, april 27). Prevention of ventilator-associated pneumonia: Making a difference?! Utrecht University. Prom.coprom.: prof.dr. G. Ramsay, prof.dr. C.A. Bruggeman, prof.dr. M. Bonten & dr. F. van Tiel. 9 Os-Medendorp, H. van (2007, november 22). Coping with itch, a nurse-led intervention. Utrecht University. Prom./coprom.: prof.dr. M.H.F. Grypdonck, prof.dr. C.A.F.M. Bruijnzeel-Koomen & dr. W.J.G. Ros. 10 Roosbroeck, S.A.H. van (2007, juni 04). Validation of traffic-related air pollution exposure estimates for long term studies. Utrecht University (139 pag.). Prom./coprom.: prof.dr.ir. B. Brunekreef, G. Hoek & N.A.H. Janssen. 11 Sabour, S. (2007, juli 12). Calcification of the coronary arteries. Reproducibility, risk factors and risk. Utrecht University (121 pag.). Prom./coprom.: prof.dr. D.E. Grobbee & dr. M.L. Bots. 12 Thoolen, B.J. (2007, oktober 24). Beyond good intentions. The effectiveness of a proactive selfmanagement intervention in patients with screen-detected type 2 diabetes. Utrecht University. Prom./ coprom.: prof. dr. D.T.D. de Ridder, prof. dr. J. Bensing & prof.dr. G.E.H.M. Rutten. 13 Top, J. (2007, mei 10). Molecular Epidemiology of Enterococcus faecium from commensal to hospital adapted pathogen. Utrecht University (175 pag.). Prom./coprom.: prof.dr. M.J.M. Bonten & dr. R.J.L. Willems. 14 Venmans-Muller, L.M.A.J. (2007, september 11). Diabetes and Infections. Towards an optimal treatment strategy in primary care. Utrecht University (189 pag.). Prom./coprom.: prof.dr. G.E.H.M. Rutten, dr. K.J. Gorter & dr. E. Hak. 15 Verheus, M. (2007, mei 23). Endocrine determinants of breast density and breast cancer risk. Utrecht University (163 pag.). Prom./coprom.: prof.dr. D.E. Grobbee, dr. C.H. van Gils & dr. P.H.M. Peeters. 16 Vlimmeren, L.A. van (2007, april 24). Asymmetry in infancy - The effect of paediatric physical therapy on the course of deformational plagiocephaly and subsequent developmental delay. Utrecht University. Prom./coprom.: prof.dr. P.J.M. Helders, prof.dr. Y. van der Graaf, dr. R.H.H. Engelbert & L.N.A. van Adrichem. Publications 173

89 International Refereed Publications 1 Akkerman, A.E., Kuyvenhoven, M.M., Verheij, T.J.M. & Dijk, L. van. Antibiotics in Dutch general practice: nationwide electronic GP database and national reimbursement rates. Pharmocoepidemiol Drug Saf. 2007; doi: /pds Al-Zoughool, M., Dossus, L., Kaaks, R., Clavel-Chapelon, F., Tjonneland, A., Olsen, A., Overvad, K., Boutron-Ruault, M.C., Gaulthier, E., Linseisen, J., Chang-Claude, J., Boeing, H., Schulz, M., Trichopoulou, A., Chryssa, T., Trichopoulos, D., Berrino, F., Palli, D., Mattiello, A., Tumino, R., Sacerdote, C., Bueno de Mesquita, H.B., Boshuizen, H.C., Peeters, P.H.M., Gram, I.T., Braaten, T., Lund, E., Chirlaque, M.D., Ardanaz, E., Agudo, A, Larranaga, N., Quiros, J.R., Berglund, G., Manjer, J., Lundin, E., Hallmans, G., Khaw, K.T., Bingham, S, Allen, N., Key, T.J., Jenab, M., Cust, A., Rinaldi, S. & Riboli, E. (2007). Risk of endometrial cancer in relationship to cigarette smoking: Results from the EPIC study. International Journal of Cancer, 121(12), Annesi-Maesano, I., Forastiere, F., Kunzli, N. & Brunekreef, B. (2007). Particulate matter, science and EU policy. European Respiratory Journal, 29(3), Arslan, F., Kaya, M.G., Heijden, G.J.M.G. van der & Cengel, A. (2007). Hypertension as a predictor of adverse cardiac events in patients with borderline fractional flow reserve. Acta Cardiologica, 62(4), Baas, A.F., Grobbee, D.E. & Blankensteijn, J.D. (2007). Impact of randomized trials comparing conventional and endovascular abdominal aortic aneurysm repair on clinical practice. Journal of Endovascular Therapy, 14(4), Bakker, A.M., Mees, S.M., Algra, A. & Rinkel, G.J.E. (2007). Extent of acute hydrocephalus after aneurysmal subarachnoid hemorrhage as a risk factor for delayed cerebral infarction. Stroke, 38(9), Bamia, C., Trichopoulos, D., Ferrari, P., Overvad, K., Bjerregaard, L., Tjonneland, A., Halkjaer, J., Clavel-Chapelon, F., Kesse, E., Boutron-Ruault, M.C., Boffetta, P., Nagel, G., Linseisen, J., Boeing, H., Hoffmann, K., Kasapa, C., Orfanou, A., Travezea, C., Slimani, N., Norat, T., Palli, D., Pala, V., Panico, S., Tumino, R., Sacerdote, C., Bueno de Mesquita, H.B., Waijers, P.M., Peeters, P.H.M., Schouw, Y.T. van der, Berenguer, A., Martinez-Garcia, C., Navarro, C., Barricarte, A., Dorronsoro, M., Berglund, G., Wirfalt, E., Johansson, I., Johansson, G., Bingham, S, Khaw, K.T., Spencer, E.A., Key, T.J., Riboli, E. & Trichopoulou, A. (2007). Dietary patterns and survival of older Europeans: The EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition). Public Health Nutrition, 10(6), Bax, L.J., Yu, L.M., Ikeda, N. & Moons, K.G.M. (2007). A systematic comparison of software dedicated to meta-analysis of causal studies. BMC Medical Research Methodology [E], 7, Beelen, R.M.J., Hoek, G., Fischer, P., Brandt, P.A. v.d. & Brunekreef, B. (2007). Estimated longterm outdoor air pollution concentrations in a cohort study. Atmospheric Environment, 41(7), Bendermacher, B.L.W., Teijink, J.A., Willigendael, E.M. van, Bartelink, M.E.L., Peters, R.J., Bie, R.A. de, Büller, H.R., Boiten, J., Langenberg, M & Prins, M.H. (2007). A clinical prediction model for the presence of peripheral arterial disease - the benefit of screening individuals before initiation of measurement of the ankle-brachial index: an observational study. Vascular Medicine, 12(1), Benders, M.J.N.L., Groenendaal, F., Uiterwaal, C.S.P.M., Nikkels, P.G.J., Bruinse, H.W., Nievelstein, R.A.J. & Vries, L.S. de (2007). Maternal and Infant Characteristics Associated With Perinatal Arterial Stroke in the Preterm Infant. Stroke, 38(6), Berg, H.M. van den, Groot, Ph.G. de & Fischer, K. (2007). Phenotypic heterogeneity in severe hemophilia. Journal of Thrombosis and Haemostasis, 5(suppl 1), Bernal, M., Haro, J.M., Bernert, S., Brugha, T., Graaf, R.M. de, Bruffaerts, R., Lepine, J.P., Girolamo, G., Vilagut, G., Gasquet, I., Torres, J.V., Kovess, V., Heider, D., Neeleman, J., Kessler, R. & Alonso, J. (2007). Risk factors for suicidality in Europe: results from the ESEMED study. Journal of Affective Disorders, 101(1-3), Besselink, M.G.H., Verwer, T.J., Schoenmaeckers, E.J., Buskens, E., Ridwan, B.U., Visser, M.R., Nieuwenhuijs, V.B. & Gooszen, H.G. (2007). Timing of surgical intervention in necrotizing pancreatitis. Archives of Surgery, 142(12), Beulens, J.W.J., Bruijne, L.M. de, Stolk, R.P., Peeters, P.H.M., Bots, M.L., Grobbee, D.E. & Schouw, Y.T. van der (2007). High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study. Journal of the American College of Cardiology, 50(1), Beus, M.F. de & Mosterd, A. (2007). The SPORTCOR registry: a national databank for sports cardiology. Netherlands Heart Journal, 15(6), Beus, M.F. de, Mosterd, A. & Grobbee, D.E. (2007). Sudden cardiac death in athletes: An overview. Current Cardiovascular Risk Reports, 1, Bijker, J.B., Klei, W.A. van, Kappen, T.H., Wolfswinkel, L. van, Moons, K.G.M. & Kalkman, C.J. (2007). Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology, 107, Bleeker, S.E., Derksen-Lubsen, G., Grobbee, D.E., Donders, A.R.T., Moons, K.G.M. & Moll, H. (2007). Validating and updating a prediction rule for serious bacterial infection in patiens with fever without source. Acta Paediatrica, 96, Bobbink, W.G., Gorter, K.J., Rutten, G.E.H.M., Wens, J., Claramunt, X.C., Topsever, P. & Khunti, K. (2007). The EUCCLID study: Proposed European study on care and complications in people with type 2 diabetes in primary care. Primary Care Diabetes, 1(3), Boelens, J.J., Wynn, R.F., O meara, A., Veys, P., Bertrand, Y., Souillet, G., Wraith, J.E., Fischer, A, Cavazanna-Calvo, M., Sykora, K., Sedlacek, P., Rovelli, A., Uiterwaal, C.S.P.M. & Wulffraat, N.M. (2007). Outcomes of hematopoietic stem cell transplantation for Hurler s syndrome in Europe: a risk factor analysis for graft failure. Bone Marrow Transplantation, 40(3), Boldin, B., Bonten, M.J.M. & Diekmann, O. (2007). Relative effects of barrier precautions and topical antibiotics on nosocomial bacterial transmission: results of multi-compartment models. Bulletin of Mathematical Biology, 69(7), Bollen, C.W., Uiterwaal, C.S.P.M. & Vught, A.J. van (2007). Meta-regression analysis of highfrequency ventilation vs conventional ventilation in infant respiratory distress syndrome. Intensive Care Medicine, 33(4), Bom, J.G. van der, Gouw, S.C. & Berg, H.M. van den (2007). Response: Immunogenicity of factor VIII concentrates in patients with hemophilia: a randomized clinical trial is warranted. Blood, 110(8), Bom, J.G. van der, Gouw, S.C. & Berg, H.M. van den (2007). Response: Plasma-derived or recombinant factor VIII products and inhibitors in previously untreated patients with severe hemophilia. Blood, 110(3), Bont, J., Hak, E., Birkhoff, C.E., Hoes, A.W. & Verheij, Th.J.M. (2007). Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations? Family Practice, 24(4), Bont, J., Hak, E., Hoes, A.W., Schipper, M, Schellevis, F.G. & Verheij, Th.J.M. (2007). A prediction rule for elderly primary-care patients with lower respiratory tract infections. European Respiratory Journal, 29(5), Bootsma, M.C., Bonten, M.J.M., Nijssen, S., Fluit, A.C. & Diekmann, O. (2007). An algorithm to estimate the importance of bacterial acquisition routes in hospital settings. American Journal of Epidemiology, 166(7), Annual Report 2007 Publications 175

90 29 Borggreve, S.E., Hillege, H.L., Dallinga-Thie, G., Jong, P.E. de, Wolffenbuttel, B.H., Grobbee, D.E. & Dullaart, R.P.F. (2007). High plasma cholesteryl ester transfer protein levels may favour reduced incidence of cardiovascular events in men with low triglycerides. European Heart Journal, 28(8), Bots, M.L., Baldasarre, D., Simon, A., Groot, E. de, O Leary, D.H., Riley, W., Kastelein, J.J. & Grobbee, D.E. (2007). Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations? European Heart Journal, 28(4), Bots, M.L., Remme, W.J., Luscher, T.F., Fox, K.M., Bertrand, M., Ferrari, R., Simoons, M.L. & Grobbee, D.E. (2007). A inhibition and endothelial function: main findings of PERFECT, a substudy of the EUROPA trial. Cardiovascular Drugs and Therapy, 21(4), Bots, M.L., Visseren, F.L.J., Evans, G.W., Riley, W.A., Revkin, J.H., Tegeler, C.H., Shear, C.L., Duggan, W.T., Vicari, R.M., Grobbee, D.E. & Kastelein, J.J. (2007). Torcetrapib and carotid intima-media thickness in mixed dyslipidaemia (RADIAN 2 study): a randomised, double-blind trial. Lancet, 370(9582), Bozkurt, O., Boer, A. de, Grobbee, D.E., Heerdink, E.R., Burger, H. & Klungel, O.H. (2007). Pharmacogenetics of glucose-lowering drug treatment: a systematic review. Molecular Diagnosis & Therapy, 11(8), Brands, A.M.A., Biessels, G.J., Kappelle, L.J., Haan, E.H.F. de, Valk, H.W. de, Algra, A. & Kessels, R.P.C. (2007). Cognitive Functioning and Brain MRI in Patients with Type 1 and Type 2 Diabetes Mellitus: A Comparative Study. Dementia and Geriatric Cognitive Disorders, 23(5), Brauer, M., Hoek, G., Jongste, J.C. de, Gerritsen, J., Postma, D.S., Kerkhof, M. & Brunekreef, B. (2007). Air pollution and development of asthma, allergy and infections in a birth cohort. European Respiratory Journal, 29(5), Braun, K.P.J., Rafay, M.F., Uiterwaal, C.S.P.M., Pontigon, A.M. & Deveber, G. (2007). Mode of onset predicts etiological diagnosis of arterial ischemic stroke in children. Stroke, 38(2), Bree, L. van, Fudge, N., Tuomisto, J.T. & Brunekreef, B. (2007). Closing the gap between science and policy on air pollution and health. Journal of Toxicology and Environmental Health A, 70(3-4), Breekveldt-Postma, N.S., Koerselman, J., Erkens, J.A., Lammers, J.W.J. & Herings, R.M.C. (2007). Enhanced persistence with tiotropium compared with other respiratory drugs in COPD. Respiratory Medicine, 101(7), Brouha, X.D.R., Tromp, D.M., Koole, R., Hordijk, G.J., Winnubst, J.A.M. & Leeuw, J.R.J. de (2007). Professional delay in head and neck cancer patiënts: Analysis of the diagnostic pathway. Oral Oncology, 43(6), Brouwer, B.G., Visseren, F.L.J. & Graaf, Y. van der (2007). The effect of leisure-time physical activity on the presence of metabolic syndrome in patients with manifest arterial disease. The SMART study. American Heart Journal, 154(6), Brouwer, B.G., Visseren, F.L.J., Stolk, R.P. & Graaf, Y. van der (2007). Abdominal Fat and Risk of Coronary Heart Disease in Patients with Peripheral Arterial Disease. Obesity (Silver Spring), 15(6), Brouwer, C.N.M., Schilder, A.G.M., Stel, H.F. van, Rovers, M.M., Veenhoven, R.H., Grobbee, D.E., Sanders, E.A.M. & Maille, A.R. (2007). Reliability and validity of functional health status and healthrelated quality of life questionnaires in children with recurrent acute otitis media. Quality of Life Research, 16(8), Bruggen, J.A.R. van, Gorter, K.J., Stolk, R.P. & Rutten, G.E.H.M. (2007). Shared and delegated systems are not quick remedies for improving diabetes care: A systematic review. Primary Care Diabetes, 1(2), Bruggink-André de la Porte, P.W.F., Lok, DJ, Veldhuisen, D.J. van, Wijngaarden, J. van, Cornel, J.H., Zuithoff, N.P.A., Badings, E. & Hoes, A.W. (2007). 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93 108 Gouw, S.C., Berg, H.M. van den, Cessie, S. le & Bom, J.G. van der (2007). Treatment characteristics and the risk of inhibitor development: a multicenter cohort study among previously untreated patients with severe hemophilia A. Journal of Thrombosis and Haemostasis, 5, Gouw, S.C., Bom, J.G. van der & Berg, H.M. van den (2007). Treatment-related risk factors of inhibitor development in previously untreated patients with hemophilia A: the CANAL cohort study. Blood, 109(11), Gouw, S.C., Bom, J.G. van der, Auerswald, G., Ettinghausen, C.E., Tedgard, U. & Berg, H.M. van den (2007). Recombinant versus plasma-derived factor VIII products and the development of inhibitors in previously untreated patients with severe hemophilia A: the CANAL cohort study. Blood, 109(11), Groenwold, R.H.H., Hoes, A.W. & Hak, E. (2007). Confounding in publications of observational intervention studies. European Journal of Epidemiology, 22(7), Groot, M.H. de, Keijser, J. de, Neeleman, J., Kerkhof, A.C., Nolen, W.A. & Burger, H. (2007). Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: cluster randomised controlled trial. BMJ - British Medical Journal, 334(7601), Haeck, I.M., Timmer-de Mik, L., Lentjes, E.G.W.M., Buskens, E., Hijnen, D.J., Guikers, C.L.H., Bruijnzeel - Koomen, C.A.F.M. & Bruin-Weller, M.S. de (2007). Low basal serum cortisol in patients with severe atopic dermatitis: potent topical corticosteroids wrongfully accused. British Journal of Dermatology, 156(5), Hafsteinsdottir, T.B., Kappelle, L.J., Grypdonck, M.H.F. & Algra, A. (2007). Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke. Journal of Rehabilitation Medicine, 39(8), Hafsteinsdottir, T.B., Kruitwagen, C.L.J.J., Strijker, H., Wee, K. & Grypdonck, M.H.F. (2007). Assessing quality of nursing care as a confounding variable in an outcome study on neurodevelopmental treatment. Journal of nursing care quality, 22, Haiman, C.A., Dossus, L., Setiawan, V.W., Stram, D.O., Dunning, A.M., Thomas, G., Thun, M.J., Albanes, D., Altshuler, D., Ardanaz, E., Boeing, H., Buring, J.E., Burtt, N.P., Calle, E.E., Chanock, S., Clavel-Chapelon, F., Colditz, G., Cox, D.G., Feigelson, H.S., Hankinson, S.E., Hayes, R.B., Henderson, B.E., Hirschhorn, J.N., Hoover, R., Hunter, D., Kaaks, R., Kolonel, L.N., LeMarchand, L., Lenner, P., Lund, E., Panico, S., Peeters, P.H.M., Pike, M.C., Riboli, E., Tjonneland, A., Travis, R.C., Trichopoulos, D., Wacholder, S. & Ziegler, R. (2007). Genetic variation at the CYP19A1 locus predicts circulating estrogen levels but not breast cancer risk in postmenopausal women. Cancer Research, 67(5), Hajer, G.R., Graaf, Y. van der, Olijhoek, J.K., Edlinger, M. & Visseren, F.L.J. (2007). Low plasma levels of adiponectin are associated with low risk for future cardiovascular events in patients with clinical evident vascular disease. American Heart Journal, 154(4), 750.e1-750.e Hajer, G.R., Graaf, Y. van der, Olijhoek, J.K., Verhaar, M.C. & Visseren, F.L.J. (2007). Levels of homocysteine are increased in metabolic syndrome patients but are not associated with an increased cardiovascular risk, in contrast to patients without the metabolic syndrome. Heart, 93(2), Halkes, P.H.A. & Algra, A. (2007). Anticoagulants, aspirin and dipyridamole in the secondary prevention of cerebral ischemia; which is the best for which patient? Cerebrovascular Diseases, 24, Hankey, G.J., Baker, R.I., Algra, A., Song, S. & e.a., - (2007). VITATOPs, the VITAmins TO Prevent Stroke Trial: Rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke (NCT ) (ISRCTN ). International Journal of Stroke, 2(2), Happo, M.S., Salonen, R.O., Halinen, A.I., Jalava, P.I., Pennanen, A.S., Kosma, V.M., Sillanpaa, M., Hillamo, R., Brunekreef, B., Katsouyanni, K., Sunyer, J. & Hirvonen, M.R. (2007). Dose and time dependency of inflammatory responses in the mouse lung to urban air coarse, fine, and ultrafine particles from six European cities. Inhalation toxicology, 19(3), Heide, A. van der, Onwuteaka-Philipsen, B.D., Rurup, M.L., Buiting, H.M., Delden, J.J.M. van, Hanssen-de Wolf, J.E., Janssen, A.G., Pasman, H.R., Rietjens, J.A.C., Prins, C.J., Deerenberg, I.M., Gevers, J.K.M., Maas, P.J. van der & Wal, G. van der (2007). End-of-life practices in the Netherlands under the Euthanasia Act. New England Journal of Medicine, 356(19), Heijstek, M.W., Pileggi, G.C., Zonneveld-Huijssoon, E., Armbrust, W., Hoppenreijs, E.P.A.H., Uiterwaal, C.S.P.M., Kuis, W. & Wulffraat, N.M. (2007). Safety of measles, mumps and rubella vaccination in juvenile idiopathic arthritis. Annals of the Rheumatic Diseases, 66(10), Heikens, E., Bonten, M.J.M. & Willems, R.J.L. (2007). Enterococcal surface protein Esp is important for biofilm formation of Enterococcus faecium E1162. Journal of Bacteriology, 189(22), Hellingman, C.A., Bergh, W.M. van den, Beijer, I.S., Dijk, G.W. van, Algra, A., Gijn, J. van & Rinkel, G.J.E. (2007). Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage. Stroke, 38(1), Hendrickx, A.P.A., Wamel, W.J.B. van, Posthuma, G., Bonten, M.J.M. & Willems, R.J.L. (2007). Five genes encoding surface-exposed LPXTG proteins are enriched in hospital-adapted Enterococcus faecium clonal complex 17 isolates. Journal of Bacteriology, 189(22), Henskens, L.H., Kroon, A.A., Schouw, Y.T. van der, Schiffers, P.M., Grobbee, D.E., Leeuw, P.W. de & Bots, M.L. (2007). Renin-angiotensin system and nutric oxide synthase gene polymorphisms in relation to stroke. American Journal of Hypertension, 20(7), Hjortnaes, J., Algra, A., Olijhoek, J.K., Huisman, A.M., Jacobs, J.W.G., Graaf, Y. van der & Visseren, F.L.J. (2007). Serum Uric Acid Levels and Risk for Vascular Diseases in Patients with Metabolic Syndrome. Journal of Rheumatology, 34(9), Hofhuis, J.G., Spronk, P., Stel, H.F. van, Schrijvers, A.J.P. & Bakker, J. (2007). Quality of life before intensive care unit admission is a predictor of survival. Critical Care [E], 11(4), R Hofmeijer, J., Amelink, G.J., Hertog, H. den, Algra, A., Kappelle, L.J., Worp, H.B. van der & Hamlet- Pais, Investigators (2007). Appreciation of the informed consent procedure in a randomised trial of decompressive surgery for space occupying hemispheric infaction. Journal of Neurology, Neurosurgery and Psychiatry, 78(10), Hogenhuis, J., Voors, A.A., Jaarsma, T., Hoes, A.W., Hillege, H.L., Kragten, J.A. & Veldhuisen, D.J. van (2007). Anaemia and renal dysfunction are independently associated with BNP and NT-proBNP levels in patientswith heart failure. European Journal of Heart Failure, 9(8), Hoogerduijn, J.G., Schuurmans, M.J., Duijnstee, M.S.H., Rooij, S.E. & Grypdonck, M.H.F. (2007). A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. Journal of clinical nursing, 16(1), Hopmans, T.E.M., Blok, H.E.M., Troelstra, A. & Bonten, M.J.M. (2007). Prevalence of hospitalacquired infections during successive surveillance surveys conducted at a university hospital in the Netherlands. Infection control and hospital epidemiology, 28(4), Howard, S.C., Algra, A. & Rothwell, P.M. (2007). Effect of age and glycaemic control on the association between fibrinogen and risk of acute coronary events after transient ischaemic attack or stroke. Cerebrovascular Diseases, 25, Huddleston Slater, J.J., Lobbezoo, F., Onland-Moret, N.C. & Naeije, M. (2007). Anterior disc displacement with reduction and symptomatic hypermobility in the human temporomandibular joint: prevalence rates and risk factors in children and teenagers. Journal of orofacial pain, 21(1), Huijbregts, H.J.T.A.M., Bots, M.L., Moll, F.L. & Blankestijn, P.J. (2007). Accelerated increase of arteriovenous fistula use in haemodialysis centres: results of the multicentre CIMINO initiative. Nephrology Dialysis Transplantation, 22(9), Huijbregts, H.J.T.A.M., Bots, M.L., Moll, F.L. & Blankestijn, P.J. (2007). Hospital specific aspects predominantly determine primary failure of hemodialysis arteriovenous fistulas. Journal of Vascular Surgery, 45(5), Annual Report 2007 Publications 183

94 138 Ista, E., Dijk, M. van, Gamel, C.J., Tibboel, D. & Hoog, M. (2007). Withdrawal symptoms in children after a long-term administration of sedatives and/or analgesics: a literature review. Assessment remains troublesome. Intensive Care Medicine, 33(8), Jacobs, J.W.G., Nijs, R.N.J.T.L. de, Lems, W.F., Geusens, P.P., Laan, R.F., Huisman, A.M., Algra, A., Buskens, E., Hofbauer, L.C., Oostveen, A.C.M., bruyn, G.A., Dijkmans, B.A. & Bijlsma, J.W.J. (2007). Prevention of glucocorticoid indiced osteoporosis with alendronate or alfacalcidol: relations of change in bone mineral density, bone markers, and calcium homeostasis. Journal of Rheumatology, 34(5), Jacobs, M.A., Wijga, A.H., Brunekreef, B., Jongste, J.C. de, Baan, C.A., Kerkhof, M. & Smit, H.A. (2007). Do parents who smoke underutilize health care services for their children? A cross sectional study within the longitudianl PIAMA study. BMC Health Services Research, 7(83). 141 Jalava, P.I., Salonen, R.O., Pennanen, A.S., Halinen, A.I., Happo, M.S., Hillamo, R., Brunekreef, B., Katsouyanni, K., Sunyer, J. & Hirvonen, M.R. (2007). Heterogeneities in inflammatory and cytotoxic responses of RAW macrophage cell line to urban air coarse, fine, and ultrafine particles from six European sampling campaigns. Inhalation toxicology, 19(3), Jansen, A.G.S.C., Sanders, E.A.M., Hoes, A.W., Loon, A.M. van & Hak, E. (2007). Influenza- and respiratory syncytial virus-asscociated mortality and hospitalisations. European Respiratory Journal, Dec;30(6), Jansen, F.E., Huffelen, A.C. van, Algra, A. & Nieuwenhuizen, O. van (2007). Epilepsy surgery in tuberous sclerosis: a systematic review. Epilepsia, 48(8), Janssen, P.G.H., Gorter, K.J., Davis, K., Wang, J & Girach, A. (2007). Screen detected subjects with type 2 diabetes and impaired glucose tolerance have more adverse cardiovascular risk than subjects with impaired fasting glucose especially when they are obese: The Addition Netherlands Study. Primary Care Diabetes, 1(2), Janssen, P.G.H., Gorter, K.J., Stolk, R.P. & Rutten, G.E.H.M. (2007). Low yield of population-based screening for Type 2 diabetes in the Netherlands: the ADDITION Netherlands study. Family Practice, 24(6), Jenab, M., Riboli, E., Cleveland, R.J., Norat, T., Rinaldi, S., Nieters, A., Biessy, C., Tjonneland, A., Olsen, A., Overvad, K., Gronbaek, H., Clavel-Chapelon, F., Boutron-Ruault, M.C., Linseisen, J., Boeing, H., Pischon, T., Trichopoulos, D., Oikonomou, E., Trichopoulou, A., Panico, S., Vineis, P., Berrino, F., Tumino, R., Masala, G., Peeters, P.H.M., Gils, C.H. van, Bueno de Mesquita, H.B., Ocke, M.C., Lund, E., Mendez, M., Tormo, M.J., Barricarte, A., Martinez-Garcia, C., Dorronsoro, M., Quiros, J.R., Hallmans, G., Palmqvist, R., Berglund, G., Manjer, J., Key, T.J., Allen, N.E., Bingham, S, Khaw, K.T., Cust, A. & Kaaks, R. (2007). Serum C-peptide, IGFBP-1 and IGFBP-2 and risk of colon and rectal cancers in the European Prospective Investigation into Cancer and Nutrition. International Journal of Cancer, 121(2), Johansson, M., McKay, J.D., Wiklund, F., Rinaldi, S., Verheus, M., Gils, C.H. van, Hallmans, G., Balter, K., Adami, H.O., Gronberg, H., Stattin, P. & Kaaks, R. (2007). Implications for prostate cancer of IGF1 genetic variation and circulating IGF1 levels. Journal of Clinical Endocrinology and Metabolism, 92(12), Jong, B.M. de, Ent, C.K. van der, Putte-Katier, N., Zalm, M.M. van der, Verheij, Th.J.M., Kimpen, J.L.L., Numans, M.E. & Uiterwaal, C.S.P.M. (2007). Determinants of health care utilization for respiratory symptoms in the first year of life. Medical Care, 45(8), Jongerden, I.P., Rovers, M.M., Grypdonck, M.H.F. & Bonten, M.J.M. (2007). Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Critical Care Medicine, 35(1), Kamphuis, M.H., Geerlings, M.I., Dekker, J.M., Giampaoli, S., Nissinen, A.M., Grobbee, D.E. & Kromhout, D. (2007). Autonomic dysfunction: a link between depression and cardiovascular mortality? The FINE Study. European Journal of Cardiovascular Prevention and Rehabilitation, 14(6), Kamphuis, M.H., Geerlings, M.I., Tijhuis, M.A., Giampaoli, S., Nissinen, A.M., Grobbee, D.E. & Kromhout, D. (2007). Physical inactivity, depression, and risk of cardiovascular mortality. Medicine and science ini sports exercise, 39(10), Karadag, B., Ege, M.J., Scheynius, A., Waser, M., Schram-Bijkerk, D., Hage, M. van, Pershagen, G., Brunekreef, B., Riedler, J., Braun-Fahrlander, C. & Mutius, E. von (2007). Environmental determinants of atopic eczema phenotypes in relation to asthma and atopic sensitization. Allergy, 62(12), Kastelein, J.J., Leuven, S.I. van, Burgess, L., Evans, G.W., Kuivenhoven, J.A., Barter, P.J., Revkin, J.H., Grobbee, D.E., Riley, W.A., Shear, C.L., Duggan, W.T. & Bots, M.L. (2007). Effect of torcetrapib on carotid atherosclerosis in familial hypercholesterolemia. New England Journal of Medicine, 356(16), Kastelein, J.J., Leuven, S.I. van, Evans, G.W., Riley, W.A., Revkin, J.H., Shear, C.L. & Bots, M.L. (2007). Designs of RADIAN 1 and 2: carotid ultrasound studies comparing the effects of tocetrapib/ atorvastatin with atorvastatin alone on atherosclerosis. Current Medical Research and Opinion, 23(4), Kaya, M.G., Arslan, F., Abaci, A., Heijden, G.J.M.G. van der, Timurkay - Nak, T. & Cengel, A. (2007). Myocardial blush grade: a predictor for major adverse cardiac events after primary PTCA with stent implantation for acute myocardial infarction. Acta Cardiologica, 62(5), Keulen, J.K. van, Kleijn, D.P.V. de, Oude Nijhuis, M.M., Busser, E., Velema, E., Fijnheer, R., Graaf, Y. van der, Moll, F.L., Vries, J.P.P.M. de & Pasterkamp, G. (2007). Levels of extra domain A containing fibronectin in human atherosclerotic plaques are associated with a stable plaque phenotype. Atherosclerosis, 195(1), Kim, J.Y., Burnett, R.T., Neas, L., Thurston, G.D., Schwartz, J., Tolbert, P.E., Brunekreef, B., Goldberg, M.S. & Romieu, I. (2007). Panel discussion review: session two - interpretation of observed associations between multiple ambient air pollutants and health effects in epidemiologic analyses. Journal of Exposure Science and Environmental Epidemiology, 17(S2), S83-S Klazen, C.A.H., Verhaar, H.J.J., Lampmann, L.E.H., Juttmann, J.R., Blonk, M.C., Jansen, F.H., Tielbeek, A.V., Schoemaker, M.C., Buskens, E., Graaf, Y. van der, Janssens, X., Fransen, H., Everdingen, K.J. van, Muller, A.F., Mali, W.P.T.M. & Lohle, P.N.M. (2007). VERTOS II: Percutaneous vertebroplasty versus conservative therapy in patients with painful osteoporotic vertebral compression fractures; rationale, objective and design of a multicenter randomized controlled trial. Trials [E], 8(1), Klijn, P.H., Baan-Slootweg, O.H. van der & Stel, H.F. van (2007). Aerobic exercise in adolescents with obesity: preliminary evaluation of a modular training program and the modified shuttle test. BMC Pediatrics, 7(19). 160 Knol, M.J., Geerlings, M.I., Egberts, A.C.G., Gorter, K.J., Grobbee, D.E. & Heerdink, E.R. (2007). No increased incidence of diabetes in antidepressant users. International Clinical Psychopharmacology, 22(6), Knol, M.J., Heerdink, E.R., Egberts, A.C.G., Geerlings, M.I., Gorter, K.J., Numans, M.E., Grobbee, D.E., Klungel, O.H. & Burger, H (2007). Depressive symptoms in subjects with diagnosed and undiagnosed Type 2 diabetes. Psychosomatic Medicine: Journal of the American Psychosomatic Society, 69(4), Knol, M.J., Tweel, I. van der, Grobbee, D.E., Numans, M.E. & Geerlings, M.I. (2007). Estimating interaction on an additive scale between continuous determinants in a logistic regression model. International journal of epidemiology, 36(5), Koek, H.L., Kardaum, J.W., Gevers, E., Bruin, A. de, Reitsma, J.B., Grobbee, D.E. & Bots, M.L. (2007). Acute myocardial infarction incidence and hospital mortality: routinely collected national data versus linkage of national registers. European Journal of Epidemiology, 22(11), Annual Report 2007 Publications 185

95 164 Koek, H.L., Soedamah - Muthu, S.S., Kardaun, J.W., Gevers, E., Bruin, A. de, Reitsma, J.B., Bots, M.L. & Grobbee, D.E. (2007). Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus. European Journal of Epidemiology, 22(12), Koerselman, J., Jaegere, P.P.T. de, Verhaar, M.C., Grobbee, D.E. & Graaf, Y. van der (2007). Coronary collateral circulation: The effects of smoking and alcohol. Atherosclerosis, 191(1), Koopman, L., Heijden, G.J.M.G. van der, Glasziou, P.P., Grobbee, D.E. & Rovers, M.M. (2007). A systematic review of analytical methods used to study subgroups in (individual patient data) metaanalyses. Journal of Clinical Epidemiology, 60(10), Kreijkamp-Kaspers, S., Kok, L., Grobbee, D.E., Haan, E.H.F. de, Aleman, A. & Schouw, Y.T. van der (2007). Dietary phytoestrogen intake and cognitive function in older women. Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 62(5), Krom, M. de, Schouw, Y.T. van der, Hendriks, J.C.J.M., Ophoff, R.A., Gils, C.H. van, Stolk, R.P., Grobbee, D.E. & Adan, R.A.H. (2007). Common genetic variations in CCK, leptin, and leptin receptor genes are associated with specific human eating patterns. Diabetes, 56(1), Kroneman, M. & Essen, G.A. van (2007). Stagnating influenza vaccine coverage rates among high-risk groups in Poland and Sweden in 2003/4 and 2004/5. Euro surveillance, 12(4), E1-E Kroneman, M.W. & Essen, G.A. van (2007). Variations in influenza vaccination coverage among the high-risk population in Sweden in 2003/4 and 2004/5: a population survey. BMC Public Health [E], 14(7), Kuijpers, T., Heijden, G.J.M.G. van der, Vergouwe, Y., Twisk, J.W. & Boeke, A.J.P. (2007). Good generalizability of a prediction rule for prediction of persistent shoulder pain in the sort term. Journal of Clinical Epidemiology, 60(9), Kuijpers, T., Vergouwe, Y., Heijden, G.J.M.G. van der, Bot, S.D., Twisk, J.W., Windt, D.A. van der & Bouter, L.M. (2007). Generalizability of a prediction rule for sick leave due to shoulder pain. Scand J Work Environ Health 2007, 33(6): Kuijpers, T., Windt, D.A.W.M. van der, Heijden, G.J.M.G. van der, Twisk, J & Vergouwe, Y. (2007). A prediction rule for shoulder pain related sick leave: a prospective cohort study. BMC Musculoskeletal Disorders [E], 7, Kwee, A., Bots, M.L., Visser, G.H.A. & Bruinse, H.W. (2007). Obstetric management and outcome of pregnancy in women with a history of caesarean section in the Netherlands. European Journal of Obstetrics, Gynecology and Reproductive Biology, 132(2), Laan, W., Selten, J.P.C.J., Grobbee, D.E., Smeets, H., Kahn, R.S. & Burger, H. (2007). Non-steroidal anti-inflammatory drugs and the risk of psychosis. European Neuropsychopharmacology, 17(4), Laat, E de, Schoonhoven, L., Grypdonck, M.H.F., Verbeek, A., Graaf, R. de, Pickers, P. van & Achterberg, T. van (2007). Early postoperative 30 degrees lateral positionering after coronary artery surgery: influence on cardiac output. Journal of clinical nursing, 16(4), Laat, M.W.M. de, Alderen, E.D. van, Franx, A., Visser, G.H.A., Bots, M.L. & Nikkels, P.G.J. (2007). The umbilical coiling index in complicated pregnancy. European Journal of Obstetrics, Gynecology and Reproductive Biology, 130(1), Lahmann, P.H., Friedenreich, C.M., Schuit, A.J., Salvini, S., Allen, N.E., Key, T.J., Khaw, K.T., Bingham, S, Peeters, P.H.M., Monninkhof, E.M., Bueno de Mesquita, H.B., Wirfalt, E., Manjer, J., Gonzalez, C.A., Ardanaz, E., Amiano, P., Quiros, J.R., Navarro, C., Martinez, C., Berrino, F., Palli, D., Tumino, R., Panico, S., Trichopoulou, A., Bamia, C., Trichopoulos, D., Boeing, H., Schulz, M., Linseisen, J., Chang- Claude, J., Chapelon, F.C., Fournier, A., Boutron-Ruault, M.C., Tjonneland, A., Fons Johnson, N., Overvad, K., Kaaks, R. & Riboli, E. (2007). Physical activity and breast cancer risk: the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiology, Biomarkers & Prevention, 16(1), In 2007, dr M.L. Bots managed to publish results from his research on the effect of lipid modifying drugs on atherosclerosis progression in three major journals: TheNew England Journal of Medicine, JAMA, and the Lancet. In addition, he had also publication in the other top cardiovascular journal such as Circulation, JACC, and Eur Heart Journal. In the METEOR study statin treatment slowed progression of atherosclerosis, assesses as carotid intima-media thickness, in a population of healthy men and women, free from previous vascular disease and diabetes and with a low Framingham risk score (JAMA. 2007;297: ). A multicenter ational trial among familial hypercholesterolemia patients (RADIAN I) on the effect of increasing HDL cholesterol levels by cholesteryl ester transfer protein inhibitor on atherosclerosis progression showed no benefit of the intervention (N Engl J Med. 2007;356: ). Similar results were found in RADIAN II among patients mixed dyslipidemia (Lancet 2007;370:153-60). 186 Annual Report 2007 Publications 187

96 179 Lanki, T., Ahokas, A., Alm, S., Janssen, N.A.H., Hoek, G., Hartog, J.J. de, Brunekreef, B. & Pekkanen, J. (2007). Determinants of personal and indoor PM(2.5) and absorbance among elderly subjects with coronary heart disease. Journal of Exposure Science and Environmental Epidemiology, 17(2), Le, T., Rovers, M.M., Veenhoven, R.H., Sanders, E.A.M. & Schilder, A.G.M. (2007). Effect of pneumococcal vaccination on otitis media with effusion in children older than 1 year. European Journal of Pediatrics, 166, Le, T.M., Rovers, M.M., Staaij, B.K. van, Akker, E.H. van den & Schilder, A.G.M. (2007). Alterations of the oropharyngeal microbial flora after adenotonsillectomy in children: a randomized controlled trial. Archives of Otolaryngology - Head & Neck Surgery, 133(10), Leavis, H.L., Willems, R.J.L., Wamel, W.J.B. van, Schuren, F.H., Caspers, M.P. & Bonten, M.J.M. (2007). 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104 51 Rutten, A., Vos, A.M. de, Bots, M.L., Rensing, B.J., Cramer, M.J.M. & Prokop, W.M. (2007). Multidetector computer tomografie van het hart. Gamma, 57(1), Rutten, G.E.H.M., Grauw, W.J.C. de, Bouma, M. & Goudswaard, A.N. (2007). Beperkte plaats voor pioglitazon bij de behandeling van diabetes mellitus type 2. Huisarts en Wetenschap, 50(3), Sachs, A.P.E. & Grol, M.H. (2007). Samenvatting allergische en niet-allergische rhinitis. Nederlands Tijdschrift voor Allergie, 2, Sachs, A.P.E. (2007). Kunnen inhalatiecorticosteroïden worden gebruikt in de zwangerschap? Vademecum voor de huisarts, 25(13). 55 Sachs, A.P.E. (2007). Onderzoeksresultaten optimale behandeling COPD in de huisartspraktijk. Huisarts en Wetenschap, 50(12), Sachs, A.P.E. & Hoes, T. (2007). Rokers voor rokers. Het solidariteitsprincipe terug in de ziektekostenverzekering. Medisch Contact, 27, Schrijvers, A.J.P. (2007). Californisch zorgmodel schoolvoorbeeld preventie. MedNet Magazine, 15(4), Schrijvers, A.J.P. (2007). 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Patiëntenparticipatie in de GGZ. Een literatuuronderzoek naar de mogelijkheden van verpleegkundigen. Maandblad Geestelijke Volksgezondheid, 62(4), Thiel, G.J.M.W. van & Uniken Venema, M.M.A.T. (2007). Kind is geen volwassene. Niet therapeutisch onderzoek schaadt de kleintjes. Medisch Contact, 62(29-30), Vaartjes, C.H., Peters, R.J.G., Dis, SJ van & Bots, M.L. (2007). Aangeboren hartafwijkingen. Cijfers en feiten. Hart Bulletin, 38(6), Vaartjes, C.H., Peters, R.J.G., Dis, SJ van & Bots, M.L. (2007). Hartinfarct. Cijfers en feiten. Hart Bulletin, 38(4), Vaartjes, C.H., Peters, R.J.G., Dis, SJ van & Bots, M.L. (2007). Sterfte aan hart- en vaatziekten en kanker anno Cijfers en feiten. Hart Bulletin, 38(1), Vaartjes, C.H., Peters, R.J.G., Dis, SJ van & Bots, M.L. (2007). Ziekenhuisopnamen voor hart- en vaatziekten. Feiten en cijfers. Hart Bulletin, 38(3), Ven, S.M.W.Y. van de, Elias, S.G., Luijten, P.R. & Mali, W.P.T.M. (2007). Optische beeldvorming van de borst. Nederlands Tijdschrift voor Oncologie, 4(7), Vergouwen, A.C., Burger, H., Verheij, Th.J.M. & Koerselman, G.F. (2007). How can the results of primary-care treatment for depression be improved? Tijdschrift voor Psychiatrie, 49(8), Vergouwen, A.C.M., Burger, H., Verheij, Th.J.M. & Koerselman, G.F. (2007). Hoe kunnen de resultaten van de eerstelijnsbehandeling van depressie worden verbeterd? Tijdschrift voor Psychiatrie, 49, Verheij, Th.J.M. (2007). The practice guideline Hearing impairment (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice. Nederlands Tijdschrift voor Geneeskunde, 151(8), Verheus, M., Gils, C.H. van & Peeters, P.H.M. (2007). Fyto-oestrogenen en borstkanker. Tijdschrift Kanker, 5, Verhoeven, M., Meijel, B. van, Winter, C.P. & Kars, M.C. (2007). Als de dood voor het leven: over verpleegkundige zorg aan suïcidale patiënten. 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105 16 Moons, K.G.M. & Burger, H. (2007). Designs voor observationeel onderzoek. In T. Plochg, R.E. Juttmann, N.S. Klazinga & J.P. Mackenbach (Eds.), Handboek Gezondheidszorgonderzoek (pp. ---). Houten: Bohn Stafleu van Loghum. 17 Neeleman, J. (2007). Epidemiologie van suïcidaal gedrag. In Handboek Suïcidaal gedrag (pp ). Utrecht: de Tijdstroom. 18 Numans, M.E. & Smout, A.J.P.M. (2007). Dyspepsie. In J.W.M. Muris, E.M.H. Mathus-Vliegen & Th.B. Voorn (Eds.), Gastroenterologie (Praktische Huisartsgeneeskunde) (pp ). Houten: Bohn Stafleu Van Loghum. 19 Otten, M.H., Opstelten, W. & Asbeck, F.W.A. van (2007). Obstipatie bij neurologische aandoeningen. In M.H. Otten (Ed.), De huisarts en het achterpoortje. Het spectrum van obstipatie (pp ). Alphen a/d Rijn: Van Zuiden Communicaties BV. 20 Sachs, A.P.E. (2007). Astma en COPD handboek. Utrecht: Academic Pharmaceutical Productions. 21 Schrijvers, A.J.P., Baar, M.E. van, Ravelli, D P, Rosendal, H., Stel, H.F. van, Vrijhoef, H.J.M. & Weertvan Oene, G.H. de (2007). Onderzoek naar geïntegreerde zorg. In Juttmann.RE Klazinga NS Plochg T (Ed.), Handboek gezondheidszorgonderzoek (pp. 296). 2007: Bohn Stafleu Van Loghum. 22 Thomas-Holtus, M.H.M., Klaassen, P.W.J. & Carbasius Weber, E.C. (2007). Eetstoornissen bij jonge kinderen. In M. Former, G.A.E.G. van Asseldonk, J.J. van Duinen & R. van Nuland (Eds.), Dieetleer (Informatorium voor Voeding en dietetiek, 67) (pp. XIVa-1-XIVa-14). Houten/Antwerpen: Bohn Stafleu Van Loghum. 23 Vaartjes, C.H., Bakker, M.K. & Bots, M.L. (2007). Hart- en vaatziekten bij kinderen. In C.H. Vaartjes, R.J.G. Peters, S.J. van Dis & M.L. Bots (Eds.), Hart- en vaatziekten in Nederland. Cijfers over leefstijlen risicofactoren, ziekte en sterfte (pp ). Den Haag: Nederlandse Hartstichting. 24 Vaartjes, C.H., Peters, R.J.G., Dis, SJ van & Bots, M.L. (2007). Hart- en vaatziekten in Nederland. Cijfers over leefstijl- en risicofactoren, ziekte en sterfte. Den Haag: Nederlandse Hartstichting. 25 Vaartjes, C.H., Peters, R.J.G., Dis, SJ van & Bots, M.L. (2007). Hart- en vaatziekten in Nederland. In C.H. Vaartjes, R.J.G. Peters, S.J. van Dis & M.L. Bots (Eds.), Hart- en vaatziekten in Nederland 2007, cijfers over ziekte en sterfte (pp. 9-36). Den Haag: Nederlandse Hartstichting. 26 Vaartjes, C.H., Reitsma, J.B., Bruin, A. de & Bots, M.L. (2007). Kans op overlijden na een ziekenhuisopname vanwege perifere arteriële vaatziekten. In C.H. Vaartjes, R.J.G. Peters, S.J. van Dis & M.L. Bots (Eds.), Hart- en vaatziekten in Nederland 2007, cijfers over ziekte en sterfte (pp ). Den Haag: Nederlandse Hartstichting. 27 Vaartjes, C.H., Reitsma, J.B., Bruin, A. de & Bots, M.L. (2007). Vergelijking van prognose van patiënten met een eerste ziekenhuisopname wegens een acuut hartinfarct, een herseninfarct of claudication intermittens in Nederland. In C.H. Vaartjes, R.J.G. Peters, S.J. van Dis & M.L. Bots (Eds.), Hart- en vaatziekten in Nederland. Cijfers over leefstijl- en risicofactoren, ziekte en sterfte (pp ). Den Haag: Nederlandse Hartstichting. 28 Wit, N.J. de & Matthus Vliegen, E.M.H. (2007). Obstipatie. In Praktische Huisartsgeneeskunde, deel gastroenterologie. Houten: Bohn Stafleu en Loghum. 29 Wit, N.J. de, Rubin, G.D. & Jones, R. (2007). Irritable bowel syndrome. In Clinical evidence. BMJ. 206 Annual Report 2007 Publications 207

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107 Organisatie Vanaf het ontstaan in 1996 is het Julius Centrum gegroeid zowel qua grootte als qua werkgebied. Het Centrum is opgericht door het samenvoegen van de afdelingen Epidemiologie en Public Health en de verpleegafdeling van Klinische Epidemiologie. In 1999 werden de afdelingen Huisartsgeneeskunde en Patiënt-gericht Onderzoek toegevoegd. De uiteindelijke toevoeging van de afdelingen Verplegingswetenschap en Voedingswetenschappen in 2002 werd het huidige Julius Center for Health Sciences and Primary Care. Twee ontwikkelingen hebben plaatsgevonden binnen de organisatie in Er is een besluit genomen om te stoppen met Verplegingswetenschap in de huidige vorm binnen de divisie. Daarnaast zal vanaf medio 2008 het Centrum voor Biostatistiek van de Universiteit Utrecht worden toegevoegd aan het Julius Centrum. Onderzoek Het onderzoek van het Julius Centrum valt binnen het UMC programma Epidemiologie. Binnen dit programma valt de voornaamste bijdrage aan het totale onderzoek van het UMC Utrecht. Daarnaast draagt het Julius Centrum bij aan de vier ziekte-gerelateerde onderzoeksgebieden van het UMC Utrecht: hart- en vaatziekten, infectieziekten en immunologie, kanker en hersenen. Tot slot is het Julius Centrum ook betrokken bij de twee andere methodologische onderzoeksthema s van het UMC Utrecht, te weten beeldwetenschappen en genomics. Nederlandse Samenvatting 211

108 Onderzoek binnen het Julius Centrum is georganiseerd volgens een matrixstructuur zoals die van het UMC Utrecht. Langs de horizontale as de wetenschappelijke disciplines; Klinische Epidemiologie, Huisartsgeneeskunde, MTA/Public Health/Medische Ethiek, Verplegingswetenschap en Voedingswetenschappen. Langs de verticale as staan de hierboven genoemde vier ziekte-gerelateerde onderzoekslijnen met daaraan toegevoegd een methodologische onderzoekslijn. multi-center trials, uitgevoerd door het Julius Centrum, onder andere over het effect van lipid modifying drugs. Het Julius Centrum is verantwoordelijk voor verschillende grote patiëntgebaseerde cohort onderzoeken zoals EPIC-NL en het Utrecht Health Project. Daarnaast is het Julius Centrum betrokken bij de uitvoering van grootschalige diagnostische onderzoeken die erop gericht zijn een vroege ontdekking van hart- en vaatziekten te verbeteren. Het Julius Centrum heeft formele banden met de volgende afdelingen/ groepen binnen de Universiteit Utrecht: het interfacultaire Institute for Risk Assessment Sciences (IRAS), Environmental and Occupational Epidemiology, farmaco-epidemiologie and veterinaire epidemiologie. Het Julius Centrum geeft methodologisch advies en ondersteuning voor klinisch onderzoek aan vrijwel alle afdelingen van het UMC. Stafleden worden ingezet als adviseurs voor onderzoeksmethoden zowel binnen als buiten het UMC Utrecht. Onderzoeksthema s Hart- en Vaatziekten Dit is de meest omvangrijke onderzoekslijn binnen het Julius Centrum. Het meeste onderzoek richt zich op oorzaken, diagnose, prognose en behandeling van hart- en vaatziekten. Epidemiologische onderzoeksmethoden, inclusief multi-centered randomized controlled trials, worden toegepast om de effecten van preventief en therapeutisch ingrijpen te onderzoeken. De nadruk ligt op atherosclerose progressie als onderliggende oorzaak van ischemische vaatziekte. In 2007 verschenen er publicaties in vooraanstaande publicaties zoals JAMA en The Lancet over de resultaten van diverse grote ationale Infectieziekten Onderzoek naar infectieziekten kan worden onderverdeeld in vijf gebieden: 1 Voorkomen, diagnose en prognose van infecties van de ademhalingswegen 2 Doeltreffendheid van vaccinatiestrategieën 3 Mathematische modellen van infectieziekten 4 Infecties bij patiënten met diabetus mellitus 5 Effecten van ziekenhuisinfecties en de overdracht van antibioticaresistente bacterieën op patiënten Kanker Het kankeronderzoek binnen het Julius Centrum richt zich op de oorzaak, vroege diagnose en prognose van hormoon-gerelateerde kanker, met name bij vrouwen. Het onderzoek naar de oorzaken richt zich met name op de interactie tussen genen, hormonen en het milieu. In 2007 werd Petra Peeters, hoofd van de kanker onderzoeksgroep, benoemd tot Professor of Chronic Disease Epidemiology aan de medische faculteit van het Imperial College London in Londen, Verenigd Koninkrijk. 212 Annual Report 2007 Nederlandse Samenvatting 213

109 Geestelijke Gezondheid Het onderdeel psychiatrische epidemiologie van het Julius Centrum bestudeert psychiatrische ziekten en de daaraan gerelateerde comorbiditeit in eerstelijns zorg en de bevolking. Het onderzoek omvat de volgende drie gebieden; 1 Presentatie van depressie in eerstelijns zorg en de relatie met lichamelijke ziekten zoals dementie, diabetes, maag-darmziekten en 2 Functionele ziekten en somatoforme aandoeningen 3 Psychiatrische morbiditeit gerelateerd aan sociodemografische context en consultatie patronen. De benadering van het bestuderen van het fenomeen somatische psychiatrische co-morbiditeit op verschillende niveau s van het systeem van de gezondheidszorg is uniek. De meeste onderzoeksprojecten worden uitgevoerd in samenwerking met partners in de eerstelijns- of tweedelijns gezondheidszorg, en vaak in samenwerking met andere (ationale) academische centra. Theoretische Epidemiologie en Biostatistiek Het Julius Centrum richt zich op het ontwikkelen van de theorie en methodologie van epidemisch onderzoek. Theoretische epidemiologie houdt zich bezig met onderzoek naar het verbeteren van bestaande methoden en ontwikkelt innovatieve methoden voor de opzet en analyse van epidemiologische studies. IRAS Het Institute for Risk Assessment Sciences (IRAS) is een interfacultair onderzoeksinstituut binnen de Universiteit Utrecht dat zich bezighoudt met interdisciplinair onderzoek dat zich richt op het vaststellen van risico s van chemische, natuurlijke en biologische middelen op de gezondheid. Dit onderzoek wordt uitgevoerd binnen drie divisies: Environmental Epidemiology, Toxicology en Veterinary Public Health. In 2007 werd het Utrecht Center of Molecular Epidemiology (UCME) opgericht. Het centrum is een samenwerkingsverband tussen het IRAS en het Julius Centrum en stelt core lab-faciliteiten ter beschikking voor het faciliteren van handling van monsters, afname van DNA en een grote diversiteit aan analytische technieken specifiek gericht op grootschalig epidemiologisch onderzoek. Internationale samenwerking Onderzoek in het Julius Centrum wordt uitgevoerd in samenwerking met onderzoeksinstituten en universiteiten in veel landen. Het centrum richt zich met name op het ontwikkelen van intensieve structurele lange termijn partnerships met strategisch geselecteerde vooraanstaande en hoogwaardige academische instituten. Deze partnerships zijn van groot belang bij het verwezenlijken van de ambitie van het Julius Centrum: voorop blijven lopen in het ationaal gezondheidswetenschappelijk onderzoek en het verspreiden van kennis onder een ationaal publiek van studenten en gezondheidsprofessionals. De Academic Alliance for Clinical Trials is een academische onderzoekscontract organisatie die zich met name richt op de interactie tussen de farmaceutische industrie en academische onderzoekers om zo innovatieve hoogwaardige fase III en fase IV clinical trials te stimuleren. Deze alliantie is samengesteld uit een bestaand netwerk van klinieken en gezondheidscentra verdeeld over vijf continenten. De belangrijkste ontwikkeling in 2007 op het gebied van ationaal onderwijs was de start van het AsiaLink project, gesubsidieerd door de Europese Commissie. Het Julius Centrum, het Ministerie van 214 Annual Report 2007 Nederlandse Samenvatting 215

110 Volksgezondheid in Maleisië en de University of Malaya Medical Center (UMMC) in Kuala Lumpur, Maleisië ontwikkelen een steeds intensievere samenwerking. Naast participatie in clinical trials neemt het Julius Centrum ook deel aan het grootste lopende waarnemingsonderzoek op het gebied van voeding en gezondheid in Europa, het EPIC onderzoek. Er is een nauwe samenwerking tussen 23 kankeronderzoekscentra en public health instituten en universiteiten in heel Europa. Het nieuwe samenwerkingsproject EPIC-Heart levert baanbrekend epidemiologisch onderzoek naar de oorzaken en gevolgen van hart- en vaatziekten waarbij gebruik wordt gemaakt van gegevens en biologisch materiaal van personen. Externe beoordeling van onderzoeksresultaten In 2007 werden de onderzoeksresultaten van het Julius Centrum beoordeeld door twee onafhankelijke externe beoordelingscommissies. De eerste beoordeling maakte onderdeel uit van een waardering van alle onderzoeksgroepen binnen het UMC Utrecht; de tweede beoordeling maakte onderdeel uit van een waardering van alle onderzoeksgroepen die betrokken waren bij het Nihes (Netherlands Institute of Health Science). Deze tweede beoordeling vond plaats vanwege een hernieuwde accreditatie van deze hogeschool door de Koninklijke Nederlandse Academie van Wetenschappen (KNWA). Beide ationale commissies beoordeelden zowel de resultaten in het verleden als het toekomstperspectief als uitstekend. Onderwijs Het Julius Centrum neemt deel aan een grote hoeveelheid onderwijsprogramma s in een breed scala aan gezondheidswetenschappen en eerstelijns zorg. Het centrum neemt actief deel aan nieuwe ontwikkelingen op het gebied van onderwijs zoals het ambitieuze undergraduate medicine program (CRU 99) van het UMC Utrecht, gestart in 1999 en gebaseerd op interdisciplinair probleem-georiënteerd leren en aan SUMMA, een nieuw 4-jarig master programma dat startte in Het merendeel van de onderwijsprogramma s wordt gegeven samen met andere divisies binnen of buiten het UMC Utrecht. Het centrum is de basis van het enige Nederlandse universitaire masterprogramma voor verplegingswetenschap. Het centrum is onder andere ook verantwoordelijk voor de specialistenopleiding tot huisarts voor artsen in een driejarige vakopleiding. Speciaal is ook het nieuwe opleidingsprogramma voor een master titel in de epidemiologie dat in 2004 werd opgestart samen met andere faculteiten van de Universiteit Utrecht. Onderwijs voor onderzoekers van het Julius Centrum vindt plaats door middel van deelname aan erkende graduate schools zoals het Nihes (Netherlands Institute of Health Science). Contracten met het management van het Nihes leidden tot een intensievere samenwerking op het gebied van marketing en werving van master studenten en een voorstel voor een gezamenlijke website voor de Masteropleiding in Epidemiologie programma. Elk jaar groeit het aantal onderwijsprogramma s en dit jaar is een nieuw programma ontwikkeld voor het medisch curriculum (Medical Humanities) dat zal worden opgenomen in het curriculum vanaf september Huisartsgeneeskunde is een belangrijke specialisatie in Nederland. De medewerkers van Huisartsgeneeskunde in het Julius Centrum nemen deel aan diverse onderwijsprogramma s en geven cursussen op verschil- 216 Annual Report 2007 Nederlandse Samenvatting 217

111 lende niveau s in de basis van het medisch curriculum (Bachelor, Master). Daarnaast is er een vakopleiding en doorlopend medisch onderwijs. Evenzo neemt het Julius Centrum actief deel aan de Bachelor, Master, Post-Graduate/vakopleiding (waar van toepassing) en vervolgopleidingen op het gebied van Epidemiologie, Public Health, Medical Humanities, Verplegingswetenschap en Voedingswetenschappen. Patiëntenzorg Diëtetiek De groepen Voedingswetenschap en Diëtetiek vormen één unit. Voedingswetenschappen richt zich op onderwijs en onderzoek, terwijl de hoofdactiviteit van Diëtetiek bestaat uit het verschaffen van patiëntenzorg in het UMC Utrecht en het revalidatiecentrum De Hoogstraat. Diëtetiek is landelijk koploper op het gebied van evidence-based diëtetiek en gestandaardiseerde processen voor diëtetiek professionals. Het belangrijkste project van 2007 was de invoering van een elektronisch patiëntendossier. Diëtetiek is het eerste onderdeel van het UMC Utrecht dat werkt met het elektronisch patiëntendossier. De Diëtetiekgroep nam deel aan een groot aantal externe (ationaal, nationaal en regionaal) en e projecten, workshops, presentaties en cursussen in Leidsche Rijn Sinds januari 2004 heeft het Julius Centrum een netwerk voor academische patiëntenzorg, gesitueerd in het recent ontwikkelde Utrechtse district Leidsche Rijn. In de komende paar jaar zal Leidsche Rijn uitbreiden naar een groter voorstedelijk gebied met ongeveer inwoners. Zes gezondheidscentra zullen zorgdragen voor huisartsendienstverlening, fysiotherapie, geestelijke gezondheidszorg, moeder en kind gezondheidszorg, apotheken en maatschappelijk werk. In het onderliggende gezondheidszorgconcept voor Leidsche Rijn zijn deze curatieve diensten nauw verbonden met preventieve, sociale en onderwijs activiteiten in het gebied. In 2007 waren vijf gezondheidscentra operationeel: Parkwijk, dat gezondheidsdienstverlener is voor inwoners; Veldhuizen, met 218 Annual Report 2007 Nederlandse Samenvatting 219

112 9.000 geregistreerde patiënten; Terwijde, met geregistreerde patiënten dat sterk groeit; Vleuterweide, dat startte in 2006 in een zeer concurrerende omgeving. Eind 2007 had Vleuterweide ongeveer geregistreerde patiënten. Het vijfde gezondheidscentrum t Zand startte in september Het Julius Centrum stuurt het management van de gezondheidscentra aan. Het Leidsche Rijn netwerk biedt een uitstekende mogelijkheid aan het Julius Centrum om haar ambities vorm te geven op het gebied van het bieden van eerstelijns academische gezondheidszorg. Unit Health Care Innovations In februari 2007 heeft de Raad van Bestuur van het UMC Utrecht en het Management Team van het Julius Centrum de Unit Health Care Innovations opgericht. De missie van deze unit is het evalueren van innovaties in organisaties, het ontwikkelen van instrumenten om aan deze innovaties te werken en de distributie van kennis via cursussen, congressen en lezingen. De unit richt zich op onderzoek naar 1. Geïntegreerde zorg en ziektebeheer en 2. Hulpdiensten. In 2007 werkten er een equivalent van 17 full time professionele medewerkers. Operationele Ondersteuning Management Support De kernactiviteiten van het Julius Centrum, onderzoek, onderwijs en patiëntenzorg, worden ondersteund door een aantal diensten. Het management wordt ondersteund door een centrale financiële afdeling, een P&O afdeling en een ICT afdeling. In 2007 is de Julius Centrum website compleet vernieuwd. Subsidies Het Julius Centrum is in hoge mate afhankelijk van externe fondsen zoals die van de European Counsel en van Nederlandse onderzoeksfondsen zoals ZonMw. Research Services Research Services is beschikbaar voor e (Julius Centrum) en externe sponsors. Externe sponsors kunnen andere divisies van het UMC Utrecht zijn, of farmaceutische bedrijven. De diensten bestaan uit project management, coördinatie van clinical trials, site monitoring, site management, endpoint adjudication management, melding van medische fouten (adverse event reporting), clinical trial monitoring van mono- en multi-center trials in Nederland en andere Europese landen, een onderzoekskliniek en een Vascular Imaging Center. In 2007 werd de naam CTSU (Clinical Trial Services Unit) geïntroduceerd om in de externe communicatie te verwijzen naar Research Services. 220 Annual Report 2007 Nederlandse Samenvatting 221

113 Data Management Data Management verzorgt de technische infrastructuur voor het verzamelen, verwerken en analyseren van epidemiologische gegevens. De afdeling verleent deze diensten aan de onderzoekers van het Julius Centrum, maar ook aan andere divisies van het UMC Utrecht, en aan andere externe partijen. Tot slot De overeenkomstige onderdelen van het jaarverslag gaan dieper in op de bovengenoemde onderwerpen. Daarnaast geeft het jaarverslag informatie over de medewerkers van het Julius Centrum, de financiële stand van zaken, lopende onderzoeksprojecten en niet te vergeten de publicaties van Annual Report 2007 Nederlandse Samenvatting 223

114 Colophon Editor: Manon Kluijtmans Production: Hellen Braun Concept: Marlice van der Werff / Gea Wolfslag Design cover: Atelier Van Gog, Amsterdam Design and lay out: Frank Boesveld, Multimedia, UMC Utrecht Photography: Jacqueline Bosman, Multimedia, UMC Utrecht Printing: ZuidamUithof drukkerijen, Utrecht Circulation: 1000 University Medical Center Utrecht Julius Center for Health Sciences and Primary Care 224 Annual Report 2007

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116 University Medical Center Utrecht Julius Center for Health Sciences and Primary Care Address: Heidelberglaan CX Utrecht The Netherlands Correspondence: P.O. Box GA Utrecht The Netherlands Phone +31 (0) Fax +31 (0)