Pauline Hakutangwi had never heard of Maastricht, let alone Maastricht University. Born in Zimbabwe but resident in the UK since the age of 10, she nevertheless headed for the South Limburg city in 2013 to pursue her master’s in Global Health. “It turned out to be ideal. The programme has given me a solid foundation to achieve my goal: improving the health of vulnerable groups of people.”
The amount of data produced by scientists increases by one third every year, according to the European Commission. How can they find their way around this mountain of data? This is the key question intriguing the new distinguished university professor of Data Science, Michel Dumontier. The 41-year-old Canadian researcher is relocating to Maastricht from the prestigious Stanford University, where he focused on discovering new drugs and precision medicine.
Twelve November it is World Pneumonia Day. Camielle Noordam did PhD research on pneumonia in children in sub-Saharan Africa. Despite improved access to healthcare, every year millions of children die before reaching their 5th birthday. Those in sub-Saharan Africa have the highest risk of mortality. Infections form the biggest threat, and of these, pneumonia is the most prevalent. Camielle Noordam spent many years living and working in Africa. Here she discusses the obstacles to proper medical care.
If you’re accustomed to approaching your professors with awe, it comes as something of a surprise when your PhD supervisor encourages you to use his first name, puts his feet up on the table as you brainstorm study designs together, and prefers you to just drop by rather than emailing in advance. Professor Luc van Loon’s style has grown on his PhD candidate Jean Nyakayiru, but it took some getting used to. “We did have to beat out of him that formal style of address”, Van Loon laughs. Nyakayiru hopes to defend his thesis in Maastricht next year.
The ‘Maastricht Study’, launched in 2010, reveals that the number of people in the preliminary phase of diabetes is much higher than initially thought: roughly a million people in the Netherlands alone. “We’re living in a time in which we can justifiably call diabetes an epidemic”, says Professor Coen Stehouwer, the director of the unique study. The researchers suspect that, beyond lifestyle-related factors, other factors are at play here. The study will run until 2019, but the preliminary results are unequivocal: “We’re living in a time in which we can justifiably call diabetes an epidemic.”
From the very first contact, the feeling was mutual: this is the kind of person I want to work with. After a six-month internship in Professor Ron Heeren’s group at the AMOLF institute, Karolina Skraskova knew she couldn’t return to the Czech Republic, where she had originally started her PhD. When Heeren offered her a new position, she gladly accepted. In her final year the entire research group moved from Amsterdam to Maastricht, and this is where, on 3 March 2016, she defended her PhD thesis.
Pregnant women who drink alcohol, or who suffer from psychological and emotional symptoms, are more at risk for a wide range of problems. How do you support women who may not be feeling quite right, or who cannot give up alcohol for nine months? With an E-health program, according to research at Maastricht University. On Thursday, 3 March, two candidates will give back-to-back defences of their theses, both of which are on research into the use of e-health in the care of pregnant women. This is purely a coincidence, because they had never met before this interview.
Yvonne Fontein was originally a midwife and had her own practice until 2008. Today, she works as a lecturer and researcher with the Midwifery programme at Rotterdam University of Applied Sciences. Fontein is a PhD candidate within the Midwifery Science research group at Zuyd University of Applied Sciences. She examined the use of a tailor-made website with practical tips that pregnant women can use to determine whether they are feeling good psychologically and emotionally, what factors throw them off balance and how they can best manage it all (coping mechanisms). In addition, the participating midwives discussed the issue with even greater emphasis than they normally do with pregnant women. The intervention ‘WazzUp Mama’ appeared to have a significant positive effect on pregnant women: they felt better about themselves than women who received no special attention on the subject from their midwife. “One of the things that surprised me in the study, is that it is highly dependent on the affinity that a midwife has for the psychological aspects of a pregnancy, whether there’s focus on it in their practice. And that often has to do with work experience; how you see the total picture of the pregnancy and not just the medical or biological aspects.”
A glass per week
Nickie van der Wulp got into alcohol research through social psychology. Today, she is director of the Korsakov Knowledge Centre, which is committed to providing quality care to patients with Korsakoff’s syndrome. Her research was commissioned by the Dutch Institute for Alcohol Policy (STAP) to examine how you can help pregnant women who drink alcohol to stop drinking during their pregnancy. “The women who participated in the research drank on average one glass per week. There is no safe lower limit, because we don’t know what the effect is of a single sip or glass, so we’re committed to zero consumption.” The website negenmaandenniet.nl gave interactive feedback on the knowledge level of pregnant women about alcohol use during pregnancy and provided recommendations. “We saw that the group that received feedback via the website stopped drinking more often than those who received feedback from midwives and especially more often than those who received no special intervention. My theory is that pregnant women didn’t dare to be honest with the midwives. It was even difficult for midwives to discuss the topic again during the second and third measurements. Annoyed reactions like: ‘I've already said that I don’t drink anymore!’, make it difficult for them to proceed.”
The role of the partner
Both PhD candidates are very aware of the workload of midwives and the fact that their research questions came on top of an already heavy workload. Van der Wulp is still adamant: “They currently ask whether you smoke, drink alcohol or use drugs, but I think that’s too limited. You should also ask if someone drank before the pregnancy and how much. If they drank regularly, they’re more likely to drink during the pregnancy. And if the partner continues drinking and even says that it doesn’t matter if his pregnant wife drinks, the risk is also higher. I thought that was notable from my research: the role of the partner is very important.” Van der Wulp also noted that some midwives still underestimate the problem of alcohol use during pregnancy. Fontein: “And they often underestimate their own influence on pregnant women. While they’re often very willing to adapt their lifestyle if it’s in the interest of the baby.”
Every year in the Netherlands, six hundred babies are born with Foetal Alcohol Syndrome (FAS): they have distinctive facial features, are smaller, have brain damage and more. “For children with behavioural problems or ADHD, we don’t know to what extent this could be caused by alcohol. There are so many women who drink alcohol during pregnancy, which is so harmful to the development of the foetus; that was an incredible motivation for me.” Fontein: “My motivation was that a pregnancy is not all roses for everyone and I think that’s a pity, because most women don’t experience many. And I see enormous improvements that can be made in prenatal care, by better observing and listening to what the pregnant women need. With the best intentions, midwives tend to fill in the women’s experiences. But you have to be very focused on what the woman needs.” Van der Wulp: “I have a lot of respect for the profession, but the knowledge about alcohol could be much better. Especially highly educated pregnant women sometimes want to have a drink and with them in particular you have to use very good arguments to convince them that it’s harmful.”
No solid figures
The problem is, of course, that there are no rock solid figures on how much alcohol is harmful. This also applies to ‘maternal distress’ during pregnancy. What is known is that one in four or five women in the Netherlands suffer from it each year, which is approximately 35,000. Potential consequences of this are a greater fear of childbirth, postpartum depression or severe prolonged psychological complaints. The child can also suffer from it, in terms of birth weight and subsequent behavioural or developmental problems. Factors that make women the most out of balance during pregnancy, as is shown in Fontein’s research, have to do with purely the expectation of having a(nother) child. “That’s also related to the role of working mothers nowadays and everything they have on their plate. Even with a second child, it may increase the amount of stress in that area. Also if the woman had previously had psychological symptoms, there was more stress during pregnancy. One of the most important ‘coping mechanisms’ was talking about your worries or problems. And in that case more with loved ones than with the midwives. That was also then encouraged through the site.”
The site www.negenmaandenniet.nl was expanded using a ZonMW grant from a research version to a public version. “Every pregnant woman should visit the website," says Van der Wulp. The future of www.wazzupmama.nl is still being considered.
Yvonne Fontein is a lecturer and researcher with the Midwifery programme at Rotterdam University of Applied Sciences. On Thursday, 3 March at 16.00 at Maastricht University, she will defend her thesis entitled ‘Wazzup Mama! The development of an intervention to reduce preventable and maternal distress during pregnancy’.
Nickie van der Wulp is director of the Korsakov Knowledge Centre. On Thursday, 3 March at 14.00 at Maastricht University, she will defend her thesis entitled ‘Zero for nine: Reducing alcohol use during pregnancy through health counselling and Internet-based computer-tailored feedback’.
With an acute shortage of donor organs, the implementation of an active donor registration system was once again an important topic of conversation in The Hague last week. Whereas before most organs came from patients who died as a result of brain death, now they are increasingly coming from people who died following cardiac or circulatory arrest. This is known as donation after circulatory death or DCD. Transplant coordinator Tineke Wind focused her doctoral research on the critical aspects of the DCD process. One of her conclusions was that relatives of organ donors perceived end-of-life care as more positive compared to those of non-donors. Wind hopes to obtain her PhD from Maastricht University on 19 February.
The number of registered organ donors in the Netherlands has increased slightly over the past few years. People can indicate their preference for organ donation in advance or leave the decision to their loved ones. While there are currently 3.5 million registered organ donors in the Netherlands, very few cases actually lead to donation. In fact, only 265 donations were performed last year. Until the Netherlands introduces an active donor registration system (ADR) that automatically registers everyone as a donor unless they object, it is extremely important for people to make their wishes known in advance.
'It's easier for family members to make a decision about organ donation when their loved one is alive and well. Most survivors tend to turn down organ donation if they're not sure what their loved one would have wanted. That's why it's so important to explain your wishes to your family or to register as an organ donor in advance. This will help prevent your family from regretting their decision later on,' explains Tineke Wind, who speaks from experience. As part of her PhD research, she investigated how surviving relatives experience the current donation procedure. To do so, she approached 158 emergency contacts for patients who died at the intensive care unit at Maastricht UMC+. 'I wanted to know how satisfied these family members were with the care, the decision-making process, the termination of medical treatment and the end-of-life care their loved ones received. More specifically, I wanted to know whether organ donation changed the way relatives experienced the process as a whole. Interestingly, the relatives of organ donors experienced the care process in a more positive way than the relatives of non-donors. This was particularly true for the end-of-life care these patients received. Whether this is the result of better communication and the extra care and attention these surviving relatives received as part of the donation procedure remains unclear.'
Half of all organs from DCD donors
In recent years, organ transplantation has focused primarily on patients who died as a result of brain death, due to the quality and condition of the organs following this type of death. But thanks to improved medical interventions, fewer people are dying from this condition. Moreover, it's now possible to transplant multiple organs from people who died of circulatory arrest (DCD). At the moment, roughly half of all transplanted organs were obtained from DCD donors. 'The Netherlands is a real front-runner in this regard, as donation has been embedded in our legal system and our hospitals are equipped to handle organ donation. We also have an excellent national protocol governing organ and tissue donation, with guidelines that clearly describe the applicable procedures.'
In the Netherlands, the doctor who meets with the family to discuss the termination of medical care is also the one who raises the issue of organ donation. This only happens if the organs are viable and if the patient did not oppose organ transplantation in the donor register. If the family consents to the donation, the transplant coordinator becomes involved.
'We go to the hospital to assess the donor's prior medical history. We determine which organs are suitable for donation and carry out tests to assess the quality of those organs,' explains Wind. 'Of course, everything is discussed in detail with the surviving relatives. It's important to make sure the family is informed of each step in the process. For example, why we're taking blood samples or an ultrasound or a chest X-ray. We then send the electronic patient file to Eurotransplant, which is responsible for managing the donor waiting lists and determining who is eligible for the organs. The transplant is usually carried out four to six hours later in the hospital where the donor patient was admitted.'
Some donors are deemed unsuitable before or during the donation process. 'An important transplant condition is that the patient died within two hours of terminating medical treatment. If not, the organs are likely to be damaged. This process takes longer for one in five patients, which means the transplant team and the recipient's medical team leave empty-handed. Unfortunately, the exact time of death is hard to determine, which is why we start the procedure just in case,' explains Wind.
During her PhD research, Wind found that medical professionals were hoping for a national protocol to help them determine death by DCD. This protocol is on its way. 'It’s currently being developed and has nothing to do with my PhD study,' Wind says. 'I was already a member of the Health Committee, which worked on revising the legislation governing organ donation at the request of the minister. As a result, the brain death protocol was revised based on recent developments and a DCD protocol was introduced. The new act will be formally implemented before the summer.'