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Het doel van dit onderzoek was de mondgezondheid van volwassenen, uitgedrukt in cariëservaring en parodontale behandelbehoefte te beschrijven. Het onderzoek bestond uit een klinisch mondonderzoek en het invullen van een vragenlijst en werd uitgevoerd onder 25- tot 74-jarigen die woonachtig waren in Den Bosch, gestratificeerd naar leeftijd en opleidingsniveau. De groep met een lage sociaal-economische status (SES) had meer door cariës aangedane gebitselementen, onderging minder uitgebreide tandheelkundige behandelingen en had meer parodontale behandelbehoefte dan de hoge SES-groep. Hiermee kan worden geconcludeerd dat ook in 2013 SES negatief was gecorreleerd aan diverse mondgezondheidsvariabelen. Men dient in overweging te nemen of dit geschetste beeld aan de verwachtingen voldoet die de Nederlandse samenleving voor ogen heeft.

Background Physical activity is linked to benefits such as increased physical fitness, cognition, emotional and social functioning, general health and well-being in older people. Some evidence suggests that this also applies to people living with dementia. However, it can be harder for them to perform physical activities, due to several barriers, such as issues with orientation and balance problems. A relatively new type of physical activity called exergaming may help them overcome these barriers. Exergaming is “physical exercise interactively combined with cognitive stimulation in a gaming environment”. The aim of our study is to evaluate the effectiveness and cost-effectiveness of exergaming compared to regular activities in people living with dementia, who attend day-care centres. Additionally, we want to investigate whether the exergaming activity for the person living with dementia, also (indirectly) affects the informal caregiver, as well as which facilitators and barriers to implementation of exergames for this target group exist. Methods A cluster Randomized Controlled Trial (RCT), with economic and process evaluations alongside will be carried out. In the Netherlands, 24 day-care centres are randomized in the experimental or control group. The study group will consist of 224 dyads (community-dwelling participants with dementia and their informal caregivers), who are interviewed at baseline, and at 3 and 6 months of follow-up. The participant with dementia has to visit the day-care centre for at least two days per week, have a diagnosis of mild to moderate dementia and have an informal caregiver present, who is willing to participate. Societal cost data will be collected during interviews, using healthcare utilization diaries, and from day-care centres. The process evaluation will only involve the experimental group, and will include an online survey, qualitative interviews and focus groups. Discussion This study will contribute to the evidence base that more effective exercise among people with dementia will result in positive effects on their wellbeing and quality of life. This will motivate people with dementia to be physically active. We also envision that there might be a positive effect on the burden of care experienced by their informal caregivers.

De richtlijn “Astma” en de wetenschappelijke verantwoording zijn in 2019 geactualiseerd ten opzichte van de eerste versie van de richtlijn die is verschenen in 2011. Directe aanleiding voor de herziening was de verouderde informatie over borstvoeding en roken in de eerste versie en het verschijnen van de derde herziening van de Standaard ‘Astma bij kinderen’ van het Nederlands Huisarts Genootschap (NHG).

Om ervoor te zorgen dat alle kinderen gezond, veilig en kans rijk opgroeien, zijn de komende tijd nog forse stappen nodig. De zorg is nog onvoldoende integraal en op maat. Preventie gericht op het versterken van eigen regie gaat helpen, evenals het permanent op peil houden van de benodigde vaardig heden door professionals. Digitalisering biedt kansen, maar ook landelijke en regionale samenwerking. Er komen dankzij onderzoek voortdurend nieuwe inzichten waar professionals en ouders en kinderen zelf hun voordeel mee kunnen doen.

Vroeggeboorte blijkt in veel gevallen de ontwikkeling levenslang te beïnvloeden. Met name de laatste jaren komt hier steeds meer kennis over beschikbaar. “Ongeveer de helft van de te vroeg geboren kinderen kampt op volwassen leeftijd met lichamelijk of maatschappelijke problemen”, vertelt dr. Sylvia van der Pal. Er is wel een lichtpuntje. “De nieuwe inzichten bieden diverse aangrijpingspunten om de nazorg te verbeteren.”

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

De ALPHA-NL is een korte papieren vragenlijst over allerlei niet-medische onderwerpen, die de zwangere invult en bespreekt met de verloskundige. De vragenlijst is ontwikkeld door TNO, samen met professionals1, op basis van de Canadese ALPHA (Antenatal Psychosocial Health Assessment).

Bij één op de drie kinderen is er sprake van een onveilige band tussen ouder en kind. Met het voorkomen van een verstoorde gehechtheidsrelatie is dan ook veel ontwikkelingswinst te behalen. TNO-onderzoek toont aan dat het door kinderpsycholoog Paulien Kuipers ontwikkelde ‘Eéngespreksmodel’ zich goed leent voor het creëren van een veilige band tussen baby en ouders.

Background The Models of Child Health Appraised (MOCHA) project – www.childhealthservicemodels.eu – is a Horizon 2020 Research Project which aims to describe and appraise various models of primary child health care in Europe – including well child clinics and school and adolescent health services - and make recommendations as to optimal features of provision of child health care. Aims To provide insight in the structure, process and outcomes of systems of primary child health care in EU countries To review the primary child health care systems from the perspective of children, adults (parents) and expert stakeholders. Program Four short presentation (about 40 minutes) Young people: children’s experiences with primary child health care collected through narrative in-depth interviews (Manna Alma). Communication and relationships with health care professionals play a pivotal role for children in terms of what is good about primary care and what they felt needs to be improved. Adults: a survey of public experiences and priorities with regard to primary care for children (Magda Boere-Boonekamp/Janine van Til/Karin Groothuis-Oudshoorn). Between countries, significant differences exist in the citizens’ perceived quality of primary care and priorities. Country experts: data provided by country agents on school and adolescent health services (Danielle Jansen). This presentation will address the challenges experienced by the country experts in answering questions about national policies regarding primary care. Stakeholders: views of policy makers, health care professionals, scientist and end-users (Eline Vlasblom/Paul Kocken/Menno Reijneveld). Improvements to the child primary healthcare system can be made, but perceived barriers are the current healthcare system and service provision in the EU countries. Plenary discussion (about 50 minutes) Statements that exemplify the conditions for good system components of child primary care will be the center of the plenary discussion. The audience will be asked to form an opinion on the following questions: What is your opinion on changing the primary child healthcare system in your country? What has to be changed in order to optimize the primary child healthcare system? What are quick wins? We will conclude with recommendations for future models of primary child health care.

Om ervoor te zorgen dat alle kinderen gezond, veilig en kans rijk opgroeien, zijn de komende tijd nog forse stappen nodig. De zorg is nog onvoldoende integraal en op maat. Preventie gericht op het versterken van eigen regie gaat helpen, evenals het permanent op peil houden van de benodigde vaardig heden door professionals. Digitalisering biedt kansen, maar ook landelijke en regionale samenwerking. Er komen dankzij onderzoek voortdurend nieuwe inzichten waar professionals en ouders en kinderen zelf hun voordeel mee kunnen doen.

Dental caries has significant negative impacts on the lives of children and young people. Whilst the impacts on children’s oral health-related quality of life (OHRQoL) have been increasingly investigated, the effect on children’s overall wellbeing remains largely unknown. Data were obtained from a survey conducted across four cities in the Netherlands. Children and their parents completed a series of questionnaires, which included Dutch versions of a caries-specific pediatric measure of OHRQoL (CARIES-QC-NL) and a generic pediatric health utility measure (CHU9D-NL). The participating children underwent dental examinations to determine their caries status. A total of 486 11-year-old children participated in the study, of which 184 had caries experience (38%). The mean number of decayed, missing and filled teeth (DMFT) was 0.71. The CARIES-QC-NL was found to have statistically significant correlations with the DMFT and CHU9D-NL. There were no statistically significant correlations between the CHU9D and the clinical variables. The CARIES-QC-NL had acceptable internal consistency and construct validity in this population despite the low prevalence of active caries. A relationship was demonstrated between OHRQoL and generic wellbeing in this population. Despite this, the CHU9D did not show any correlation with the clinical data, which may limit its application in studies of the impact of dental caries.

Background and aims Asthma is a chronic respiratory disease affecting 12% of children > 6 years in the Netherlands. Asthma is characterized by variable symptoms of wheeze, shortness of breath, chest tightness an cough, and by variable expiratory airflow limitation. Atopy is present in the majority of children with asthma. Youth Health Care (YHC) professionals have an important role in the prevention of (symptoms of) asthma and in case-finding. The aim of the project was to develop an update of the web-based clinical guideline on the subject for YHC professionals. Methods A working group of various disciplines involved in the screening and treatment of asthma, patients’ representatives, researchers and guideline developers updated the guideline according to the principles of evidence-based medicine. Results The guideline provides YHC professionals with background information on asthma and its treatment, and recommendations regarding case-finding and non-pharmacological strategies to control symptoms. Asthma often begins in early childhood. However wheezing in young children is a heterogeneous condition and not all wheezing children will develop asthma. Some viral infections are associated with recurrent wheezing during childhood. Asthma is more likely if wheezing occurs in the absence of a viral infection, or when it is related to an allergic trigger. A major risk factor is a family history of asthma or allergic disease (eczema or allergic rhinitis). Primary prevention of asthma consists of allergen avoidance (multifaceted) and avoidance of pre- and postnatal exposure to environmental tobacco smoke. Breastfeeding is advised for its general health benefits, not necessarily for asthma prevention. Exposure to outdoor pollutants is also associated with an increased risk of asthma. The guideline is based on a literature review, together with experiences of professionals (YHC, GPs, pediatricians) and of youth and their caregivers. Conclusions An updated, web-based guideline for early detection and prevention of asthma symptoms was developed. This guideline will contribute to better quality of healthcare, as it supports evidence-based practice. Statement or main question Prevention of asthma by YHC professionals requires case-finding according to the clinical guideline and appropriate advice (avoidance of pre- and postnatal exposure to environmental tobacco smoke!) towards youth and their caregivers.

Professionals in de jeugdgezondheidszorg (JGZ) kunnen vanaf nu gebruik maken van de nieuwe JGZ-richtlijn Lengtegroei. De richtlijn geeft vernieuwde en uitgebreide informatie over het monitoren van groei en over signaleren van afwijkende lengtegroei: snelle of trage groei. De richtlijn ‘Signalering en verwijscriteria bij kleine lichaamslengte’ vervalt daarmee. Inclusief beslisschema's kleine, trage, grote en snelle groei.

Background Newborn screening for cystic fibrosis (NBSCF) was introduced in the Dutch NBS program in 2011 with a novel strategy. Methods Dutch NBSCF consisted of four steps: immuno-reactive trypsin (IRT), Pancreatitis-associated Protein (PAP), DNA analysis by Inno-LiPa (35 mutations), extended gene analysis (EGA) as fourth step and as safety net. Only samples with two CFTR-variants were considered screen-positive, but samples with one disease-causing variant were considered also screen-positive from April 2013. The first 5 years of NBSCF were evaluated during a follow-up ranging from 2 to 6.8 years for sensitivity, specificity, positive predictive value (PPV), ratio of CF/Cystic Fibrosis Screen Positive infants with an Inconclusive Diagnosis (CFSPID) and median age at diagnosis, and were compared to other novel strategies for NBSCF and European Cystic Fibrosis Society (ECFS) Best Practice Standards of Care. Results NBSCF achieved a sensitivity of 90% (95% CI 82%–94%), specificity of 99.991% (95% CI 99.989%–99.993%), PPV of 63% (95% CI 55%–69%), CF/CFSPID ratio of 4/1, and median age at diagnosis of 22 days, if samples with two variants as well as samples with one disease-causing variant were considered screen-positive. Conclusion The program achieved the goal to minimize the number of false positives and showed a favourable performance but sensitivity and CF/CFSPID ratio did not meet criteria of EFCS Best Standards of Care. Changed cut-off values for PAP and IRT and classification of R117H-7T/9T to non-pathogenic may improve sensitivity to ≥95% and CF/CFSPID ratio to 10/1. PPV is estimated to be around 60%.

Door middel van een korte online-enquête met daarin 12 stellingen over de organisatie, kwaliteit en impact van de mondzorg in Nederland werden lezers van het Nederlands Tijdschrift Voor Tandheelkunde gevraagd naar hun mening over een aantal belangrijke thema’s binnen de Nederlandse mondzorg met betrekking tot gezondheidseconomische kwesties. Een totaal van 237 lezers vulden de online-vragenlijst in (61% man, 39% vrouw). Hiervan werkte 70% als tandarts en was tussen de 31 en 40 jaar werkzaam in de praktijk. Geconstateerd werd dat een verschuiving van curatie naar preventie in de mondzorg nodig werd geacht. Ook waren de respondenten veelal van mening dat de ongelijkheid in mondgezondheid in Nederland toeneemt en dat mensen een bezoek aan de tandarts mijden vanwege de daarmee samenhangende kosten. Concluderend kan worden gesteld dat de meeste mondzorgverleners redelijk positief lijken te zijn over de Nederlandse mondzorg. Aandacht voor preventie, de waardering van mondgezondheid en het tegengaan van ongelijkheid in de mondzorg blijft nodig.

Om ervoor te zorgen dat alle kinderen gezond, veilig en kans rijk opgroeien, zijn de komende tijd nog forse stappen nodig. De zorg is nog onvoldoende integraal en op maat. Preventie gericht op het versterken van eigen regie gaat helpen, evenals het permanent op peil houden van de benodigde vaardig heden door professionals. Digitalisering biedt kansen, maar ook landelijke en regionale samenwerking. Er komen dankzij onderzoek voortdurend nieuwe inzichten waar professionals en ouders en kinderen zelf hun voordeel mee kunnen doen.

De Strengths and Difficulties Questionnaire (SDQ) is een korte vragenlijst waarmee psychosociale problemen bij jeugdigen gemeten kunnen worden. De SDQ wordt gebruikt door de JGZ bij verschillende leeftijden, en kan door jongeren zelf of ouders ingevuld worden. Uit recent onderzoek blijkt dat de SDQ een betrouwbaar en valide instrument is voor adolescenten. Deze factsheet heeft betrekking op het gebruik van de SDQ bij jongeren tussen 12 en 17 jaar oud: er zijn nieuwe afkapwaarden, nieuwe aanbevelingen, en tips voor de afname. In de vernieuwde SDQ handleiding wordt deze informatie uitgebreider beschreven.

Background Childhood development is a maturational and interactive process, resulting in progression of perceptual, motor, cognitive, language, socio-emotional, and self-regulation skills, which can be assessed by the attainment ages of various milestones. The developments of these various domains are inextricably intertwined. Together with growth a child’s development determines (future) physical, intellectual, emotional and social wellbeing, and its possibility to fully integrate into society. Early intervention is vital because a child learns and develops at the fastest rate during the first few years. Therefore, early detection is needed. Early detection requires tools with excellent test characteristics. It has been recommended to realize this through periodic screening, which offers, unlike a single assessment, the opportunity to detect problems within the dynamic process of child development. In the Netherlands, preventive child healthcare professionals (physicians and nurses) provide periodic developmental screening between ages 0 and 4 years using the Dutch Developmental Screening test (DDST, ‘Van Wiechen scheme’). However, developmental screening is often considered time-consuming and the basis for medical decision making is often motivated by professional’s judgment rather than scientific insights. Several initiatives have been undertaken to optimize developmental screening. Examples regard using additional parental information (e.g. via the ASQ), and improving the predictive value of risk factors and the milestones themselves. Specifically, for the DDST, computing a continuous composite score at each visit, the Developmental Score (D-score), could add. Aims of the workshop. The aim of the workshop is to present and discuss innovative approaches in the monitoring of the development in children with a focus on (a) cost-effectiveness of longitudinal monitoring e.g. by including the involvement of parents in monitoring a child’s development; (b) identifying children at risk on the basis of risk factors and the developed D-score. Program of the workshop. The workshop consists of several short presentations and an interactive session: Opening (Menno Reijneveld) Short overview of existing screening instruments, known risk factors of developmental problems and the possibility to intervene early (Marlou de Kroon). Study on the comparison of the DDST and the ASQ, an instrument which is filled in by parents (Ingrid Staal). Study on the improved communication with parents by eHealth-applications in preterm children, a high risk group of developmental problems (Marlou de Kroon). nnovative approaches in the identification of children at risk, and the demonstration of the D-score, including an interactive session in practicing and discussing the D-score (Stef van Buuren). Overall discussion; summary and conclusions of the workshop (Menno Reijneveld)

In dit tweede artikel in een reeks van 5 naar aanleiding van het Kies-voor-Tandenonderzoek 2017, worden de resultaten van de 5-jarigen gepresenteerd. Het onderzoek werd uitgevoerd onder 5-jarigen die woonden in Alphen aan den Rijn, Gouda, Breda of Den Bosch en bestond uit het invullen van een vragenlijst en het ondergaan van een klinisch mondonderzoek. Van de 5-jarigen had 76% een gaaf melkgebit. Dit percentage was toegenomen ten opzichte van eerdere metingen. Bij kinderen met cariëservaring werd geen verandering gezien. Er waren in 2017 nog steeds mondgezondheidsverschillen tussen de sociaaleconomische groepen waarbij de hoge sociaal-economische groep in het voordeel was. Conclusie: de mondgezondheid van de 5-jarigen lijkt de goede kant op te gaan maar er is nog steeds een sociale gradiënt aanwezig en er is nog steeds ruimte voor verbetering. Interventies om het gebit gaaf te houden dienen bij risicogroepen vooral gericht te zijn op het verbeteren van gedrag en zelfzorg om cariës te voorkomen.

De eerste 1000 dagen van een kind zijn cruciaal voor een gezonde ontwikkeling èn de ontplooiing en kansen op latere leeftijd. Door ouders zo vroeg mogelijk van de juiste adviezen te voorzien en bijvoorbeeld snel in te grijpen bij beginnende problematiek, kan de ontwikkeling van een kind bijgestuurd worden. Zo wordt voorkomen dat zwaardere zorg nodig is. De eerste 1000 dagen staan volop op de nationale en lokale agenda. Met het actieprogramma Kansrijke Start heeft het kabinet extra geld vrijgemaakt om de ontwikkeling van kinderen in de eerste 1000 dagen te ondersteunen. Het gaat hierbij met name om kinderen die opgroeien in kwetsbare gezinnen. Met de extra financiering worden prachtige doelen nagestreefd zoals een betere voorbereiding op de zwangerschap, minder onbedoelde zwangerschappen, een betere voorbereiding op het ouderschap en meer steun voor (aanstaande) kwetsbare ouders. Op lokaal niveau moeten deze doelen concreet vorm krijgen in het verbeteren van samenwerkingsafspraken en het verbeteren van het preventieve aanbod van gemeenten. Deze literatuurverkenning biedt een up-to-date overzicht van de kennis rond de 1e 1000 dagen. Wat weten we over de vroege ontwikkeling van kinderen, wat zijn risico- en beschermende factoren en welke interventies en programma’s zijn beschikbaar in Nederland. Met dit overzicht beogen we beleidsmakers op diverse niveaus te ondersteunen bij het maken van belangrijke keuzes met betrekking tot samenwerking en het aanbieden van interventies die de vroege ontwikkeling in de eerste 1000 dagen versterken.

Background: Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time. MethodsS: We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 (n = 708) and 2003-2006 (n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR-), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG-). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts. Results: In the 2003-2006 cohort, less children had early-life GR. In both cohorts, SGA CUG- subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β -6.5, 95% confidence interval (CI) -9.8; -3.2, P

Smoking during pregnancy is associated with a multitude of health behaviors and with the psychosocial and socio-economic circumstances of pregnant women. Limited research has so far been conducted on the clustering of these characteristics and on their effect on pregnancy outcomes. This study aimed to identify different groups of pregnant women based on their behavioral, psychosocial and socio-economic characteristics and their pregnancy outcomes. In total, 2455 women who were 12 weeks pregnant completed a questionnaire on smoking behavior, health behaviors and psychosocial and socio-economic characteristics. Neonatal and maternal outcomes were extracted from the Dutch perinatal registration. Subgroups were identified with latent class analysis and adverse pregnancy outcomes were compared between subgroups with logistic regression. Women were classified into four latent classes. Two classes represented the healthy higher-educated pregnant women who did not smoke: one group of multigravida women and one of primigravida women, also characterized by less pregnancy-specific knowledge and more pregnancy-related stress. The remaining women were grouped into two less healthy groups. One group frequently quit smoking, reported less healthy eating, less physical activity and comparable stress levels as the healthy higher-educated groups. The last group contained the most smokers, had the highest scores on psychosocial and pregnancy-related stress and the most adverse socio-economic circumstances. This group had an increased risk of adverse maternal outcomes, in particular developing diabetes during pregnancy. A comprehensive and integrated approach is needed to improve outcomes in pregnancies with a combination of adverse health, psychosocial, and socio-economic conditions.

Background and aims. Developmental Dysplasia of the Hip (DDH) is a condition caused by genetic and environmental factors. DDH affects 1-4% of all Dutch children 0-6 months of age. If left untreated, DDH can lead to arthrosis of the hip joint, pain and invalidity. Early detection and treatment are therefore important. Youth Health Care (YHC) professionals have an important role in the early detection of DDH. The aim of the project was to systematically develop a web-based clinical guideline on DDH for YHC professionals. Methods. A working group of various disciplines involved in the screening and treatment of DDH, patients’ representatives, researchers and guideline developers composed the guideline according to the principles of evidence-based medicine. The guideline was piloted in several YHC organizations and implemented nationally in 2017. Results. The guideline provides background information on DDH and its treatment, and statements regarding screening (identification of risk factors, physical examination), referral, communication with caregivers, and cooperation between healthcare providers. The guideline is based on a literature review and practice experience. The following risk factors were identified as indications for diagnostic ultrasound of the hip: positive family history for DDH or hip arthrosis (first or second-degree relatives, below 50 years of age), and breech position during pregnancy or at birth. Anamnesis of swaddling with straight hips and knees, also a risk factor for DDH, is followed by safe swaddling advice by the YHC professional. The YHC physician should perform examination of the hips (abduction, knee height) at least three times in the first 7 months. After the age of 7 months, the YHC physician performs a hip examination in case of caregivers’ report of signals and complaints of their child (case-finding). Conclusions. In 2017, a systematically developed web-based guideline on DDH was implemented for Dutch YHC professionals. It is expected that this guideline contributes to better quality of healthcare, as it supports evidence-based practice, uniform working procedures, communication with caregivers and cooperation between healthcare providers. Statement or main question. Early treatment of DDH requires screening according to the clinical guideline and appropriate communication with caregivers and between professionals.

The aim of this cross-sectional study was to assess differences in caries experience according to socio-economic status (SES) in a health-care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries-free dentitions were lower and mean caries experience were higher in low-SES than in high-SES participants. In 5-yr-old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23-yr-old participants, these estimates were 6.8 and 4.4, respectively (P < 0.05). Low-SES children have a greater risk of more caries experience than high-SES children. Thus, in a system with full free paediatric dental coverage, socio-economic inequality in caries experience still exists. Dental health professionals, well-child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low-SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate-rich foods, with particular attention for low-SES families.

Vroege opsporing van aan-doeningen die invloed hebben op de lengtegroei biedt zicht op vroege behandeling. Maar wat zijn signalen van achterblijvende lengtegroei? Of andersom, wanneer de groei te snel gaat? En welke rol speelt de JGZ-professional hierin?

In 2002, a nationwide screening for congenital adrenal hyperplasia (CAH) was introduced in the Netherlands. The aim of our study is to evaluate the validity of the neonatal screening for CAH and to assess how many newborns with salt-wasting (SW) CAH have already been clinically diagnosed before the screening result was known. Retrospective, descriptive study. The following data of patients with positive screening results since implementation of the screening programme were collected (1 January 2002 up until 31 December 2013): gestational age, sex, diagnosis, clinical presentation and contribution of screening to the diagnosis. In the evaluated period, 2 235 931 newborns were screened. 479 children had an abnormal screening result, 133 children were diagnosed with CAH (114 SW, 14 simple virilizing (SV)), five non-classic CAH. During this period, no patients with SW CAH were missed by neonatal screening (sensitivity was 100%). After exclusion of 17 cases with missing information on diagnosis, specificity was 99.98% and positive predictive value was 24.7%. Most false positives (30%) were attributable to prematurity. Of patients with SW CAH, 68% (71/104) patients were detected by neonatal screening and 33 (33/104) were clinically diagnosed. Of girls with SW CAH, 38% (14/37) were detected by neonatal screening and 62% (23/37) were clinically diagnosed. The Dutch neonatal screening has an excellent sensitivity and high specificity. Both boys and girls can benefit from neonatal screening.

Objectives The aim of this study was to learn more about levels of knowledge relating to erosive tooth wear and about the most desirable way of disseminating dental information among young adults. Methods The research was a cross-sectional study of 331 young adults (20–25 years old) attending 25 dental care practices. Participants were asked to fill out a questionnaire with questions about their background, knowledge relating to erosive tooth wear and the preferred way of acquiring information about erosive tooth wear. Results The results showed that there are gaps in the knowledge of young adults about erosive tooth wear. The knowledge score depended on educational level and dental information received in the past. The preferred way of acquiring information was chair side information from an oral health care professional complemented by tailored information in writing. Conclusion There is a lack of knowledge among young adults about erosive tooth wear. They prefer to receive information from the oral health care professionals accompanied by tailored information in writing. Further research should focus on developing this tailored information in line with the advice given by the oral health care professional.

De neonatale gehoorscreening is in 2018 goed uitgevoerd door de jeugdgezondheidszorg (JGZ). De deelname is landelijk zeer hoog, namelijk 99,6-99,7% per screeningsronde. Screeningen worden bij 98-99% van de kinderen tijdig uitgevoerd.

In 2017 heeft TNO in opdracht van Zorginstituut Nederland onderzoek uitgevoerd met als doel het schetsen van een actueel en representatief beeld van de mondgezondheid en het preventief tandheelkundig gedrag van 5-, 11-, 17- en 23-jarigen in Nederland en het vaststellen van eventuele veranderingen daarin sinds eerdere metingen. Omdat aanleiding, achtergrond, onderzoeksopzet, materiaal en methode identiek waren voor de 4 leeftijden en er in de beschouwing van de artikelen deels dezelfde punten aan de orde dienen te komen, worden in dit eerste van de serie van 5 artikelen, deze identieke en generieke zaken beschreven. Aangezien er in Nederland geen systeem bestaat om mondgezondheid structureel te bewaken zijn deze Kies-voor-Tandenonderzoeken van eminent belang om trends in mondgezondheid en preventief tandheelkundig gedrag bij jeugdigen te kunnen volgen gedurende een langere tijd. Zulke gegevens zijn onontbeerlijk om zinvol beleid omtrent mondgezondheid te kunnen formuleren. Voortgang van monitoringsonderzoek wordt daarom ten zeerste aanbevolen.

Severe combined immunodeficiency (SCID) is a condition that often results in severe infections and death at young age. Early detection shortly after birth, followed by treatment before infections occur, largely increases the chances of survival. As the incidence of SCID is low, assessing cost-effectiveness of adding screening for SCID to the newborn screening program is relevant for decision making. Lifetime costs and effects of newborn screening for SCID were compared to a situation without screening in the Netherlands in a decision analysis model. Model parameters were based on literature and expert opinions. Sensitivity analyses were performed. Due to earlier detection, the number of deaths due to SCID per 100,000 children was assessed to decrease from 0.57 to 0.23 and a number of 11.7 quality adjusted life-years (QALYs) gained was expected. Total yearly healthcare costs, including costs of screening, diagnostics, and treatment, were €390,800 higher in a situation with screening compared to a situation without screening, resulting in a cost-utility ratio of €33,400 per QALY gained. Conclusion: Newborn screening for SCID might be cost-effective. However, there is still a lot of uncertainty around the cost-effectiveness estimate. Pilot screening projects are warranted to obtain more accurate estimates for the European situation.

Background: The aim of this study is to understand the determinants of adherence to wrap-around care (WAC) by professional care providers working in child and family services. WAC is a care coordination method targeting families with complex needs. The core components of WAC involve activating family members and the social network, integrating the care provider network, and assessing, planning and evaluating the care process. WAC was introduced in the Netherlands using two approaches: the network approach (NA) and the team approach (TA). Methods: A cross-sectional study was conducted using a digital questionnaire targeted at care providers. After imputation of missing data, univariate and multilevel regression analyses were conducted to study the associations between adherence to the core components of WAC, the determinants of adherence and background characteristics. Results: In total 145 out of 275 care providers (52.7%) responded to the questionnaire. Multilevel regression analysis showed that self-efficacy of the care providers and the way WAC is organised (NA versus TA region) were significantly associated with adherence to core components of WAC. Self-efficacy was significantly associated with all WAC core components (activating family members and the social network: β (95% confidence interval, CI) =.27(.04-.50), integrating the network of care providers: β (95% CI) =.27(.05-.50) and assessing, planning and evaluating the care process: β (95% CI) =.30(.08-.52)). The way WAC is organised was significantly associated to two core components (activating family members and the social network: β (95% CI) =.18(0.1-.37) and integrating the network of care providers: β (95% CI) =.25(.09-.42)). Conclusion: The way WAC is organised and the self-efficacy of care providers who use WAC are factors that are relevant for the redesign of the strategy for introducing WAC. Longitudinal research into the predictive value of determinants of adherence to WAC is advised. © 2019 The Author(s).

3rd Congress of Joint European Neonatal Societies (jENS 2019), 17–21 September 2019 in Maastricht, the Netherlands.

Het doel van de (JGZ)-richtlijn 'Gezonde slaap en slaapproblemen bij kinderen' is zorgprofessionals te ondersteunen bij het bevorderen van gezond slaapgedrag en het verminderen van slaapproblemen bij kinderen van O tot 18 jaar.

De Nederlandse mondzorg is een belangrijke sector. In de eerste plaats draagt mondzorg direct bij aan de gezondheid van burgers. Weinig zaken zijn belangrijker en waardevoller voor mensen dan hun gezondheid, waarvan mondgezondheid een wezenlijk onderdeel is. Daarnaast biedt de mondzorg aan veel mensen werk, zowel direct als indirect, en gaat er in deze sector veel geld om. De uitgaven binnen de mondzorg bedragen jaarlijks zo’n 3,5 miljard euro en worden betaald uit de collectieve basisverzekering, aanvullende verzekeringen en directe betalingen. In dit bedrag zijn directe uitgaven door burgers aan tandpasta’s, tandenborstels en andere benodigdheden overigens nog niet eens meegerekend. De mondzorg is in veel opzichten derhalve een sector van betekenis.

Verleden. Ik kom uit een familie van ingenieurs, advocaten en vrouwen die ‘homemakers’ zijn. Ik was zes jaar en geïnspireerd door de gynaecologe die mijn zusje ter wereld bracht. Ik wilde graag een zusje en zij was voor mij als kind een echte tovenaar. Dit was mijn eerste kennismaking met een dokter binnen de familie, de gynaecologe werd later mijn oma. Ze was de eerste vrouw in de familie die buitenhuis werkte, en ik luisterde gefascineerd naar haar ervaringen als Indiase consultant voor Wereldgezondheidsorganisatie WHO.Heden. Ruim twintig jaar geleden, als praktiserend jeugdarts, leerde ik een screeningsmethode die door orthoptisten wordt gebruikt. Daarmee kon ik slechtziendheid bij jonge kinderen vroegtijdig opsporen. Wanneer ik van een moeder kreeg te horen dat ze niet had geweten dat haar dreumes minder goed zag (hij wilde met zijn bril op naar bed) was ik blij verrast. Een wonder dat ik als arts zoveel impact had op het zien van dit kind. Ik deed onderzoek hiernaar en vorig jaar werd ik vanwege mijn passie om vermijdbare slechtziendheid bij de jeugd te verminderen, benoemd tot ‘AJN-ambassadeur Visus Inzicht’ van mijn beroepsvereniging. Toekomst. Samen met professionals van verschillende achtergronden ben ik bezig om de toename van bijziendheid bij de jeugd aan te pakken. De huidige digitale leefomgeving, meer binnenshuis zijn, dit alles heeft grote gevolgen voor de kinderogen. Op korte termijn is misschien alles met een bril op te lossen, op de langere termijn kan hoge bijziendheid zelfs leiden tot blindheid. De Wereldgezondheidsorganisatie heeft adviezen uitgebracht in april dit jaar over het aantal uren achter een beeldscherm. Mijn passie voor gezonde kinderogen houdt mij geboeid en wie weet, kan ik ook op wereldniveau de maatschappelijke gezondheid beïnvloeden.

Background: Adverse Childhood Experiences (ACEs) may have a life-long impact on mental health and risk behavior and are related to physical diseases in adults, such as diabetes and heart diseases. Research on ACEs suffers from recall bias when performed with adults. Objective: Our aim was to estimate the prevalence ACEs as reported by children and to determine the impact of these ACEs on their self-reported quality of life (QoL). Method: In 2016 we conducted a cross-sectional study using a child version of the ACE-Questionnaire. This questionnaire assesses parental separation or divorce, physical and emotional child abuse and neglect, sexual violence, violence against the (step)mother, household substance abuse, incarceration of a household member, suicide or psychological issues with a household member. QoL was measured with the Kidscreen-10. Participants and setting: The questionnaire was completed by 644 children at a median age of 12 years (range 9 – 13 years) in the two last grades of regular elementary schools recruited throughout the Netherlands. Results: Data were weighted by ethnicity to obtain a representative sample of children in Dutch elementary education. We found that 26.4% of the children had experienced one or more forms of child maltreatment, and 45.3% had one or more out of ten ACEs. ACEs often co-occurred. A higher number of ACEs correlated with a lower mean level of QoL (p < 0.001). Mean QoL was 8.5 points lower (Cohen’s d = 0.8) in children who experienced child maltreatment. Conclusion: Our research stresses the need for prevention and trauma-focus in schools.

De richtlijn “Astma” en de wetenschappelijke verantwoording zijn in 2019 geactualiseerd ten opzichte van de eerste versie van de richtlijn die is verschenen in 2011. Directe aanleiding voor de herziening was de verouderde informatie over borstvoeding en roken in de eerste versie en het verschijnen van de derde herziening van de Standaard ‘Astma bij kinderen’ van het Nederlands Huisarts Genootschap (NHG).

Background Childhood development is a maturational and interactive process, resulting in progression of perceptual, motor, cognitive, language, socio-emotional, and self-regulation skills, which can be assessed by the attainment ages of various milestones. The developments of these various domains are inextricably intertwined. Together with growth a child’s development determines (future) physical, intellectual, emotional and social wellbeing, and its possibility to fully integrate into society. Early intervention is vital because a child learns and develops at the fastest rate during the first few years. Therefore, early detection is needed. Early detection requires tools with excellent test characteristics. It has been recommended to realize this through periodic screening, which offers, unlike a single assessment, the opportunity to detect problems within the dynamic process of child development. In the Netherlands, preventive child healthcare professionals (physicians and nurses) provide periodic developmental screening between ages 0 and 4 years using the Dutch Developmental Screening test (DDST, ‘Van Wiechen scheme’). However, developmental screening is often considered time-consuming and the basis for medical decision making is often motivated by professional’s judgment rather than scientific insights. Several initiatives have been undertaken to optimize developmental screening. Examples regard using additional parental information (e.g. via the ASQ), and improving the predictive value of risk factors and the milestones themselves. Specifically, for the DDST, computing a continuous composite score at each visit, the Developmental Score (D-score), could add. Aims of the workshop. The aim of the workshop is to present and discuss innovative approaches in the monitoring of the development in children with a focus on (a) cost-effectiveness of longitudinal monitoring e.g. by including the involvement of parents in monitoring a child’s development; (b) identifying children at risk on the basis of risk factors and the developed D-score. Program of the workshop. The workshop consists of several short presentations and an interactive session: Opening (Menno Reijneveld) Short overview of existing screening instruments, known risk factors of developmental problems and the possibility to intervene early (Marlou de Kroon). Study on the comparison of the DDST and the ASQ, an instrument which is filled in by parents (Ingrid Staal). Study on the improved communication with parents by eHealth-applications in preterm children, a high risk group of developmental problems (Marlou de Kroon). nnovative approaches in the identification of children at risk, and the demonstration of the D-score, including an interactive session in practicing and discussing the D-score (Stef van Buuren). Overall discussion; summary and conclusions of the workshop (Menno Reijneveld)

In de adolescentie, de leeftijdsperiode tussen de kinderjaren en de volwassenheid, nemen psychosociale problemen vaak toe. Dat kunnen emotionele problemen zijn zoals somberheid, maar ook gedragsproblemen of sociale problemen met leeftijdgenoten. Emotionele problemen zoals somberheid, zich terugtrekken of piekeren komen tijdens de adolescentie vaker bij meisjes voor dan bij jongens. Wat is de Strengths and Difficulties Questionnaire (SDQ)? De Strengths and Difficulties Questionnaire (SDQ) is een korte vragenlijst waarmee psychosociale problemen bij jeugdigen gemeten kunnen worden. De SDQ kan gebruikt worden door de Jeugdgezondheidszorg (JGZ) voor jeugdigen in de leeftijd van 3-17 jaar. De SDQ kent verschillende versies, namelijk een voor leerkrachten, een voor ouders en een voor de jeugdige zelf. Deze verschillende versies van de SDQ zijn te vinden op de website www.sdqinfo.com

Background. A triage approach to routine health assessments was recently introduced to improve the efficiency of Preventive Child Healthcare (PCH) in the Netherlands: PCH assistants carry out pre-assessments of all children and send the children with suspected health problems to follow-up assessments conducted by a physician or nurse. This two-step approach differs from the usual approach, in which physicians or nurses assess all children. Previously, each PCH service that employs a triage method used their own criteria (i.e. protocol) to determine whether a follow-up assessment is needed. Health themes such as visuals disorders, sleeping problems and psychosocial problems are generally included in the protocol. This study aimed to improve the quality of detection of health problems in primary school children by PCH by developing a standardized triage protocol, and by investigating the quality of detection of health problems of this novel protocol. Methods. A systematic approach was used to develop the standardized triage protocol, e.g. by making use of an assessment framework and an expert group. Data was gathered by PCH services, using both parent-reported child problems and PCH registry data. After each routine assessment PCH professionals reported whether they had identified any problems in the child and carried out additional actions (e.g., additional assessments, referral). We will assess the validity of the protocol (sensitivity and specificity), with problems identified by PCH professionals as well as additional actions by the professional as criteria (gold standard). Next, the satisfaction with the novel protocol will be investigated among parents and PCH professionals; the answers of parents on a questionnaire will be analyzed and PCH professionals will be interviewed. Results. We included 670 primary school children undergoing routine health assessments in 4 PCH services across the Netherlands. Validity of the protocol and satisfaction with the novel protocol of parents and PCH professionals will be assessed in the spring, and presented at the EUSUHM congress. Conclusions. Conclusions will be drawn about whether the novel triage protocol is a valid method to identify health problems in a PCH setting. Recommendations about necessary adaptations of the protocol and the need of future research will be made.

Background: Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time. MethodsS: We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 (n = 708) and 2003-2006 (n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR-), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG-). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts. Results: In the 2003-2006 cohort, less children had early-life GR. In both cohorts, SGA CUG- subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β -6.5, 95% confidence interval (CI) -9.8; -3.2, P

Deze richtlijn is bedoeld voor JGZ-professionals (dit zijn jeugdartsen, verpleegkundig specialisten , 1 jeugdverpleegkundigen, doktersassistenten) en beoogt richtinggevend te zijn bij het handelen tijdens contacten met individuele 0-18 jarigen en hun ouders/verzorgers. De richtlijn ‘Ondergewicht’ beschrijft het normale gewichtsverloop en de begrippen ondergewicht en ondervoeding en geeft handelingsaanbevelingen ten behoeve van: 1. het monitoren van het gewicht en het signaleren van ondergewicht en ondervoeding; 2. het verwijzen bij ondergewicht en/of een afbuigende gewichtscurve; 3. de advisering bij ondergewicht.

De eerste 1000 dagen van een kind zijn cruciaal voor een gezonde ontwikkeling èn de ontplooiing en kansen op latere leeftijd. Door ouders zo vroeg mogelijk van de juiste adviezen te voorzien en bijvoorbeeld snel in te grijpen bij beginnende problematiek, kan de ontwikkeling van een kind bijgestuurd worden. Zo wordt voorkomen dat zwaardere zorg nodig is. De eerste 1000 dagen staan volop op de nationale en lokale agenda. Met het actieprogramma Kansrijke Start heeft het kabinet extra geld vrijgemaakt om de ontwikkeling van kinderen in de eerste 1000 dagen te ondersteunen. Het gaat hierbij met name om kinderen die opgroeien in kwetsbare gezinnen. Met de extra financiering worden prachtige doelen nagestreefd zoals een betere voorbereiding op de zwangerschap, minder onbedoelde zwangerschappen, een betere voorbereiding op het ouderschap en meer steun voor (aanstaande) kwetsbare ouders. Op lokaal niveau moeten deze doelen concreet vorm krijgen in het verbeteren van samenwerkingsafspraken en het verbeteren van het preventieve aanbod van gemeenten. Deze literatuurverkenning biedt een up-to-date overzicht van de kennis rond de 1e 1000 dagen. Wat weten we over de vroege ontwikkeling van kinderen, wat zijn risico- en beschermende factoren en welke interventies en programma’s zijn beschikbaar in Nederland. Met dit overzicht beogen we beleidsmakers op diverse niveaus te ondersteunen bij het maken van belangrijke keuzes met betrekking tot samenwerking en het aanbieden van interventies die de vroege ontwikkeling in de eerste 1000 dagen versterken.

Background: Community pediatric services typically use short questionnaires to identify children with emotional and behavioral problems (EBP) . The psychometric properties of such questionnaires are mostly not sufficient for an accurate distinction between children with and without problems. We aimed to assess whether a short Computerized Adaptive Test (CAT) can overcome the weaknesses of short written questionnaires to identify children with EBP. Method: We used a dataset obtained from parents of Dutch children aged 7 to 12 years invited for a routine health examination by Preventive Child Healthcare with 205 items on behavioral and emotional problems (n = 2,041,response 84%). In a random subsample (n=1,650) we determined which items met the requirements of an Item Response Theory (IRT) model to a sufficient degree. We used those items to calculate the item parameters necessary for a CAT and defined a cut-off point to identify EBP, for the resulting latent score . We determined the validity and efficiency of this CAT using simulation techniques in the remaining subsample (n=391). A clinical score on the Child Behavior Checklist was used as criterion. Results: The median number of items needed to identify EBP was 14. Sensitivity and specificity of general EBP with CBCL as a criterion were 0.75 and 0.92, respectively. High sensitivity and specificity indices were found for the subscale internalizing problems both 0.92 for externalizing problems 0.96 and 0.91, and for hyperactivity 0.88 and 0.90 respectively. Conclusion: An IRT-based CAT is a very promising tool to screen for EBP in children, as it can lead to an efficient, yet high-quality identification. A pilot study will be conducted to use the CAT as a standard instrument in routine health examinations by Preventive Child Healthcare and an extension of the CAT is developed to identify EBP in children aged 2 to 4 years old. Statement: An IRT-based Computerized Adaptive test procedure is an efficient and valid tool for the identification of emotional and behavioral problems among children.

Objective: Validated questionnaires help community pediatric services to identify emotional and behavioral problems (EBPs). This study assesses the psychometric properties of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) for the identification of EBPs in adolescents (13 to 14 years old) and the added value of the SDQ parent-form version. Methods: We obtained data on 500 adolescents (mean age 13.5 years) from community well-child services and schools. Adolescents completed the SDQ self-report and the Youth Self-Report (YSR). Parents completed the SDQ parent-form and the Child Behavior Checklist (CBCL) for their children. We assessed the internal consistency and validity using the YSR and CBCL as the criteria, and the degree to which the SDQ parent-form provides additional information by comparison with the self-report. Results: The internal consistency of the SDQ total score was good (Cronbach's alpha, 0.75). Sensitivity and specificity using the YSR as the criterion were 0.75 and 0.91, respectively. When the CBCL was adopted as the criterion, these validity indices were lower. The SDQ parent-form does not provide additional information by comparison with self-reporting only when the YSR score is used as the criterion (odds ratio, 0.48; 95% confidence interval, 0.14-1.65); however, it does do so when the CBCL is the criterion (odds ratio, 10.9; 95% confidence interval, 4.23-27.9). Conclusions: The SDQ self-report is valid for the detection of EBPs in adolescents, and the SDQ parent-form provides additional information by comparison with the self-report. This indicates that it is useful to involve adolescents and their parents as informants for the identification of EBPs in adolescents. © 2019

BACKGROUND: Logistic regression is often used for mediation analysis with a dichotomous outcome. However, previous studies showed that the indirect effect and proportion mediated are often affected by a change of scales in logistic regression models. To circumvent this, standardization has been proposed. The aim of this study was to show the relative performance of the unstandardized and standardized estimates of the indirect effect and proportion mediated based on multiple regression, structural equation modeling, and the potential outcomes framework for mediation models with a dichotomous outcome. METHODS: We compared the performance of the effect estimates yielded by the three methods using a simulation study and two real-life data examples from an observational cohort study (n = 360). RESULTS: Lowest bias and highest efficiency were observed for the estimates from the potential outcomes framework and for the crude indirect effect ab and the proportion mediated ab/(ab + c') based on multiple regression and SEM. CONCLUSIONS: We advise the use of either the potential outcomes framework estimates or the ab estimate of the indirect effect and the ab/(ab + c') estimate of the proportion mediated based on multiple regression and SEM when mediation analysis is based on logistic regression. Standardization of the coefficients prior to estimating the indirect effect and the proportion mediated may not increase the performance of these estimates.

Dental caries has significant negative impacts on the lives of children and young people. Whilst the impacts on children’s oral health-related quality of life (OHRQoL) have been increasingly investigated, the effect on children’s overall wellbeing remains largely unknown. Data were obtained from a survey conducted across four cities in the Netherlands. Children and their parents completed a series of questionnaires, which included Dutch versions of a caries-specific pediatric measure of OHRQoL (CARIES-QC-NL) and a generic pediatric health utility measure (CHU9D-NL). The participating children underwent dental examinations to determine their caries status. A total of 486 11-year-old children participated in the study, of which 184 had caries experience (38%). The mean number of decayed, missing and filled teeth (DMFT) was 0.71. The CARIES-QC-NL was found to have statistically significant correlations with the DMFT and CHU9D-NL. There were no statistically significant correlations between the CHU9D and the clinical variables. The CARIES-QC-NL had acceptable internal consistency and construct validity in this population despite the low prevalence of active caries. A relationship was demonstrated between OHRQoL and generic wellbeing in this population. Despite this, the CHU9D did not show any correlation with the clinical data, which may limit its application in studies of the impact of dental caries.

Door middel van een korte online-enquête met daarin 12 stellingen over de organisatie, kwaliteit en impact van de mondzorg in Nederland werden lezers van het Nederlands Tijdschrift Voor Tandheelkunde gevraagd naar hun mening over een aantal belangrijke thema’s binnen de Nederlandse mondzorg met betrekking tot gezondheidseconomische kwesties. Een totaal van 237 lezers vulden de online-vragenlijst in (61% man, 39% vrouw). Hiervan werkte 70% als tandarts en was tussen de 31 en 40 jaar werkzaam in de praktijk. Geconstateerd werd dat een verschuiving van curatie naar preventie in de mondzorg nodig werd geacht. Ook waren de respondenten veelal van mening dat de ongelijkheid in mondgezondheid in Nederland toeneemt en dat mensen een bezoek aan de tandarts mijden vanwege de daarmee samenhangende kosten. Concluderend kan worden gesteld dat de meeste mondzorgverleners redelijk positief lijken te zijn over de Nederlandse mondzorg. Aandacht voor preventie, de waardering van mondgezondheid en het tegengaan van ongelijkheid in de mondzorg blijft nodig.

Het doel van de neonatale hielprikscreening is het vroegtijdig opsporen van een aantal zeldzame, ernstige aangeboren ziektes bij pasgeborenen. Voor deze ziektes zijn vroegtijdige interventies, zoals medicatie of een dieet, belangrijk voor de pasgeborene, omdat hiermee onherstelbare schade voorkomen of beperkt kan worden. De neonatale hielprikscreening is op 1 januari 2015 op Bonaire ingevoerd en in oktober 2015 op St. Eustatius en Saba. De verschillende GGD’en in Caribisch Nederland (van Bonaire, St. Eustatius en Saba) coördineren de NHS op de drie eilanden en werken nauw samen met verloskundigen, huisartsen en artsen uit ziekenhuizen. Ook wordt nauw samengewerkt met professionals op het eiland St. Maarten, omdat vrouwen uit Saba en St. Eustatius hier meestal bevallen. De regie van de NHS ligt bij het RIVM-Centrum voor Bevolkingsonderzoek (CvB). De Dienst Vaccinvoorziening en Preventie-programma’s (DVP) van het RIVM zorgt voor een professionele uitvoering van de NHS.

De ALPHA-NL is een korte papieren vragenlijst over allerlei niet-medische onderwerpen, die de zwangere invult en bespreekt met de verloskundige. De vragenlijst is ontwikkeld door TNO, samen met professionals1, op basis van de Canadese ALPHA (Antenatal Psychosocial Health Assessment).