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Papers by Bellis van den Berg

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TVZ - Verpleegkunde in praktijk en wetenschap, 2022

PTSD = post-traumatic stress disorder TAP = targeted agenda program Web publication: 27 August 20... more PTSD = post-traumatic stress disorder TAP = targeted agenda program Web publication: 27 August 2008 A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters. During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment? A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by

Research article Are physical symptoms among survivors of a disaster presented to the general pra... more Research article Are physical symptoms among survivors of a disaster presented to the general practitioner? A comparison between self-reports and GP data

BMC Health Services Research, 2021

Background This study aims to describe the validation and optimization of a new instrument design... more Background This study aims to describe the validation and optimization of a new instrument designed to comprehensively measure and evaluate the quality of care in nursing homes; the Quality Evaluation Questionnaires for Nursing Homes (QEQ-NH). This instrument comprises several questionnaires on the perceived quality of care for various perspectives (e.g. clients, family and professional caregivers) and covers eight themes of the national quality framework for nursing home care in the Netherlands. Methods Data were collected in six nursing homes between September 2017 and June 2018, among 359 residents, 48 family caregivers and 648 professional caregivers who completed a subgroup-specific questionnaire of the QEQ-NH. Construct and criterion validity of the three questionnaires were tested with item- and scale analyses. Content validity of the questionnaires was tested in cognitive interviews with 20 participants (7 residents, 5 family caregivers and 8 professional caregivers). Result...

Background This study aims to describe the validation and optimization of a new instrument specif... more Background This study aims to describe the validation and optimization of a new instrument specifically designed to measure and improve the quality of care in nursing homes; the Quality Improvement Questionnaires for Nursing Homes (QIQ-NH). This instrument comprises several questionnaires on the perceived quality of care for various perspectives (e.g. clients, family and professional caregivers) and covers eight themes of the national quality framework for nursing home care in the Netherlands. Methods Data was collected in six nursing homes between September 2017 and June 2018, among 359 residents, 48 family caregivers and 648 professional caregivers who completed a subgroup-specific questionnaire of the QIQ-NH. The construct and criterion validity of the three questionnaires were tested with item- and scale analyses. The content validity of the questionnaires was tested in cognitive interviews with 20 participants (7 residents, 5 family caregivers, 8 professional caregivers). Resul...

Prehospital and Disaster Medicine, 2008

A broad range of health problems are related to disasters. Insight into these health problems is ... more A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters.During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment?A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by a disaster. Different methods can be used to examine these health problems such as: (1) rapid assessment of health needs; (2) (longitudinal) epidemiological studi...

Most studies after disasters have focused on mental health problems such as post-traumatic stress... more Most studies after disasters have focused on mental health problems such as post-traumatic stress disorder (PTSD), depression and anxiety among survivors. Besides mental health problems, survivors may develop physical health symptoms that are frequently unexplained such as headache, fatigue and stomachache as a result of the traumatic event. To date, these symptoms have not often been studied after disasters. The studies described in this thesis examine symptoms that are frequently medically unexplained among residents affected by the Enschede fireworks disaster. As a result of the explosion of a fireworks depot in a residential area in Enschede, the Netherlands, 23 persons were killed, more than 900 people were injured and about 1200 people were forced to relocate because their houses were destroyed or severely damaged. After this disaster, a longitudinal study of the health consequences of the disaster was started. The study consisted of a 3-wave longitudinal health survey that was performed three weeks (wave 1), 18 months (wave 2) and almost 4 years (wave 3) after the disaster. In addition to this longitudinal health survey, the electronic medical records (EMRs) of general practitioners (GPs) were used to study changes in health problems among survivors. The main objectives of this thesis were 1) to examine the prevalence of symptoms among survivors of disasters, 2) to explore risk factors for these symptoms among survivors and 3) to investigate whether self-reported symptoms show similarities with medically unexplained symptoms (MUS) that are presented to the GP. A review of the literature showed that the prevalence rate of self-reported symptoms was elevated among survivors of different kinds of disasters. Among the survivors of the fireworks disaster, the level of self-reported symptoms was higher compared to controls up to four years after the disaster. Besides this, the mean number of symptoms presented to the GP was higher in the two years after the disaster compared to the year prior to the disaster. We identified several important risk factors for symptoms among survivors such as female gender, immigrant status and psychological problems. The risk factors for physical symptoms among survivors were comparable with the risk factors for MUS in the general population. In addition, the results showed several similarities between the self-reported symptoms and MUS presented to the GP such as associated functional impairment and a higer level of illness behavior. Several methodological issues, such as the design, selective response and possible bias are discussed. Besides this, the advantages and disadvantages of the use of questionnaires and EMRs in epidemiological studies after disasters are discussed. The findings indicate that elevation of physical symptoms are part of the distress reaction following traumatic exposure. For that reason, it is recommended to measure these symptoms in studies after disasters. Also, since the self-reported symptoms showed several similarities with MUS, it can be concluded that questionnaires can be used to measure physical symptoms that are frequently unexplained.

BMC medical research methodology, 2007

Little is known about the response mechanisms among survivors of disasters. We studied the select... more Little is known about the response mechanisms among survivors of disasters. We studied the selective attrition and possible bias in a longitudinal study among survivors of a fireworks disaster. Survivors completed a questionnaire three weeks (wave 1), 18 months (wave 2) and four years post-disaster (wave 3). Demographic characteristics, disaster-related factors and health problems at wave 1 were compared between respondents and non-respondents at the follow-up surveys. Possible bias as a result of selective response was examined by comparing prevalence estimates resulting from multiple imputation and from complete case analysis. Analysis were stratified according to ethnic background (native Dutch and immigrant survivors). Among both native Dutch and immigrant survivors, female survivors and survivors in the age categories 25-44 and 45-64 years old were more likely to respond to the follow-up surveys. In general, disasters exposure did not differ between respondents and non-responde...

Tijdschrift voor gezondheidswetenschappen, 2010

ResumenHet ministerie van VWS heeft een proefimplementatie uit laten voeren om beter zicht te kri... more ResumenHet ministerie van VWS heeft een proefimplementatie uit laten voeren om beter zicht te krijgen op het gebruik van ondersteuning bij het stoppen met roken indien dit zou worden vergoed. In deze proef konden verzekerden van Agis Zorgverzekeringen, een halfjaar gebruikmaken van effectief gebleken stopondersteuning zonder dat daar voor hen kosten aan waren verbonden. Parallel aan deze proefimplementatie heeft Regioplan Beleidsonderzoek een onderzoek uitgevoerd naar het gebruik van stopondersteuning in de proef en de effecten ervan. Deelnemers aan de proef zijn op twee tijdstippen gevraagd een vragenlijst in te vullen. In totaal hebben 2398 rokers deelgenomen aan de proef. Uit het aanbod van stopondersteuning hebben deelnemers het meest gebruikgemaakt van het stopadvies en de begeleiding door de huisarts of praktijkondersteuner, nicotinepleisters, bupropion en varenicline. Respondenten met een zwaardere verslaving maakten vaker gebruik van nicotinepleisters en varenicline. De uitkomsten van deze proefimplementatie duiden erop dat het vergoeden van effectief gebleken stopondersteuning leidt tot een toename in het gebruik van deze ondersteuning. Het onderzoek toont tevens aan dat rokers met een laag welstandsniveau en zwaardere rokers ook gebruik maken van stopondersteuning als zij hiervoor niet hoeven te betalen.AbstractPrevious studies have shown that the use of tobacco dependence treatment increases success rates in quitting. The Dutch Ministry of Health, Welfare and Sports has commissioned a pilot study to assess the impact of ‘free’ tobacco dependence treatment. In this pilot study, those insured by Agis Zorgverzekeringen were offered smoking cessation treatment, without associated costs. Simultaneously, an evaluation study was performed by Regioplan Beleidsonderzoek. Participants were asked to complete a questionnaire at two points in time. In total, 2398 smokers participated in the pilot study. The following treatments were most often used by the participants: general practitioner’s advice and counselling, nicotine patches, bupropion and varenicline. Compared to smokers in the Dutch general population who make a quit attempt, significantly more participants used tobacco dependence treatment. In conclusion, the findings of this study indicate that financial interventions directed at smokers could increase the utilization of tobacco dependence treatment by smokers. Also, when no costs are charged, both smokers with a low socioeconomic status and those who are heavy smokers are willing to use smoking cessation treatment.

Mental Health and Disasters

ABSTRACT

Psychosomatics, 2009

BACKGROUND: Medically unexplained symptoms (MUS) are a common reason to seek medical care. When p... more BACKGROUND: Medically unexplained symptoms (MUS) are a common reason to seek medical care. When presented to the general practitioner (GP), more than three-quarters of symptoms such as stomach ache, headache, and pain in bones and muscles cannot be explained by a medical disorder. OBJECTIVE: The authors examined the course of MUS presented to the GP in the 1 year before the disaster and in the 4 years after a disaster in order to study the risk factors for MUS. METHOD: Data were extracted from the electronic medical records of survivors and from a questionnaire (N=1,216). RESULTS: Although the mean number of MUS was significantly increased statistically in the first 2 years post-disaster, the increase was not clinically significant. CONCLUSION: The authors identified several important risk factors, such as immigrant status and psychological problems, that are easy for GPs to recognize. Despite this, the sensitivity of the regression model was relatively low.

Psychological Medicine, 2007

BackgroundAlthough symptoms such as fatigue, headache and pain in bones and muscles are common af... more BackgroundAlthough symptoms such as fatigue, headache and pain in bones and muscles are common after disasters, risk factors for these symptoms among disaster survivors have rarely been studied. We examined predisposing, precipitating and perpetuating factors for these physical symptoms among survivors of a man-made disaster. In addition, we examined whether risk factors for physical symptoms differ between survivors and controls.MethodSurvivors completed a questionnaire 3 weeks (n=1567), 18 months and 4 years after the disaster. Symptoms and risk factors were measured using validated questionnaires. A comparison group was included at waves 2 and 3 (n=821). Random coefficient analysis (RCA) was used to study risk factors for symptoms.ResultsFemale gender [beta (β)=1.0, 95% confidence interval (CI) 0.6–1.4], immigrant status (β=1.0, 95% CI 0.6–1.4) and pre-disaster psychological problems (β=0.8, 95% CI 0.1–1.4) were predisposing factors for symptoms. Although disaster-related factors...

Epidemiology, 2003

ABSTRACT May 13-2000, a firework storage facility with 1000 tons of heavy fireworks exploded in a... more ABSTRACT May 13-2000, a firework storage facility with 1000 tons of heavy fireworks exploded in a residential area in Enschede, The Netherlands. The explosions and fire killed 22 and injured over 900 people: some 400 homes were destroyed. Two to three weeks after the explosion, a health survey was performed among victims and emergency relief workers. After 18 months, a second survey was performed. We limit this presentation to victims living in the affected area. The first health survey showed that 52% of the victims had more than 5 symptoms or health complaints, such as fatigue, pain in neck and shoulders, pain in muscles, backache and headache. We cannot exclude the possibility that these symptoms are medically explainable since they are self-reported. However in other studies, these symptoms can be explained by GPs in 7-26% of the cases based on a disease diagnosis. During the second survey we had a comparable reference group with similar demographic background variables as the victims. Seventy five percent of the victims who participated in the first survey also participated in the second survey. The response rate for the comparison group was 52%. This presentation explores the determinants of medically unexplained symptoms (MUS; >5 symptoms) among victims of the firework disaster compared to a comparison group. The prevalence of MUS in the second survey (51%) was unchanged compared with the first survey. The comparison group had a prevalence of 32%. Of the victims with MUS in the second survey, 37% also had MUS in the first survey. Victims with MUS were more likely to be women (64% versus 53% of the non-cases), have a basic education (25% versus 12%), belong to the immigrant population group (31% versus 11%). A similar pattern of determinants was observed in the comparison group. In addition, among victims disaster-related determinants were having lost a loved one (7% versus 4%), having one's home destroyed (30% versus 15%) and having experienced severe anxiety during the disaster (73% versus 55%). Prevalence of an injury from the disaster was the same in victims with and without MUS. Victims and respondents from the comparison group with MUS had both a higher prevalence of having one or more self-reported chronic conditions (71% versus 37%). In conclusion, the determinants of MUS are in part similar to those of non-victims. However, some disaster-related aspects and emotions appear to have exacerbating effects in victims.

Epidemiologic Reviews, 2005

BMC Psychiatry, 2012

Background Disaster experiences have been associated with higher prevalence rates of (mental) hea... more Background Disaster experiences have been associated with higher prevalence rates of (mental) health problems. The objective of this study was to examine the independent relation between a series of single disaster experiences versus the independent predictive value of a accumulation of disaster experiences, i.e. a sum score of experiences and symptoms of distress and post-traumatic stress disorder (PTSD). Methods Survivors of a fireworks disaster participated in a longitudinal study and completed a questionnaire three weeks (wave 1), eighteen months (wave 2) and four years post-disaster (wave 3). Ten years post-disaster (wave 4) the respondents consisted of native Dutch survivors only. Main outcome measures were general distress and symptoms of PTSD. Results Degree of disaster exposure (sum score) and some disaster-related experiences (such as house destroyed, injured, confusion) were related to distress at waves 2 and 3. This relation was mediated by distress at an earlier point i...

BMC Health Services Research, 2007

Background Most studies examining medically unexplained symptoms (MUS) have been performed in pri... more Background Most studies examining medically unexplained symptoms (MUS) have been performed in primary or secondary care and have examined symptoms for which patients sought medical attention. Disasters are often described as precipitating factors for MUS. However, health consequences of disasters are typically measured by means of questionnaires, and it is not known whether these self-reported physical symptoms are presented to the GP. It is also not known if the self-reported symptoms are related to a medical disorder or if they remain medically unexplained. In the present study, three research questions were addressed. Firstly, were self-reported symptoms among survivors presented to the GP? Secondly, were the symptoms presented to the GP associated with a high level of functional impairment and distress? Thirdly, what was the GP's clinical judgment of the presented symptoms, i.e. were the symptoms related to a medical diagnosis or could they be labeled MUS? Methods Survivors ...

Archives of Internal Medicine, 2005

Background: Traumatic events are described as precipitating factors for medically unexplained sym... more Background: Traumatic events are described as precipitating factors for medically unexplained symptoms. The aim of this study was to examine the prevalence and course of symptoms reported by disaster survivors and to assess whether the symptoms have features similar to those of medically unexplained symptoms. Methods: A 3-wave longitudinal study was performed after an explosion of a fireworks depot. As a result of the explosion, 23 people were killed, more than 900 people were injured, and about 500 homes were damaged or destroyed. Respondents completed a set of validated questionnaires measuring their health problems 3 weeks (wave 1), 18 months (wave 2), and 4 years (wave 3) after the disaster. A comparison group was included at waves 2 and 3. Results: The study population included 815 survivors who participated in the 3 waves. The mean number of symptoms was higher among survivors compared with