EMGO+ Annual Report 2012

+

EMGO in 2012 Annual Report

LIFESTYLE, OVERWEIGHT, AND DIABETES MENTAL HEALTH QUALITY OF CARE MUSCULOSKELETAL HEALTH

EMGO+ in 2012 Annual Report

Colophon & Credits

Printed matter: VUmc DPC/Huisdrukkerij Circulation: 500 Paper size: Executive (184 x 267 mm) Location & date: Amsterdam, May 2013

Design & layout: Evelien de Boer Photography: Ton Dijkstra / Martijn Schuit Images: Shutterstock.com / Wordle.net Cover images: Shutterstock.com

Contact

EMGO Institute for Health and Care Research Van der Boechorststraat 7 1081 BT Amsterdam

Phone

+31 (0)20 444 8180

Email

secretariaat.emgo@vumc.nl

Website

www.emgo.nl

CONTENTS 1.

P REFACE ...................................................................................................... 7

2.

R ESEARCH AREA .......................................................................................... 9 Lifestyle, Overweight, and Diabetes ...........................................10 Mental Health ..........................................................................11 Quality of Care ........................................................................12 Musculoskeletal Health ............................................................13

3.

O RGANIZATION .......................................................................................... 14

4.

C OMPOSITION ............................................................................................ 17

5.

R ESEARCH ENVIRONMENT AND EMBEDDING ................................................. 21

6.

Q UALITY AND SCIENTIFIC RELEVANCE ........................................................ 23 LOD — 2012 highlights and key publications .............................23 MH — 2012 highlights and key publications ...............................24 QofC — 2012 highlights and key publications ............................26 MSH — 2012 highlights and key publications .............................28 Longitudinal study: LASA ..........................................................30 Interview with a fellow: Trynke Hoekstra ....................................31

7.

E DUCATION AND T RAINING : E PID M ........................................................... 33

8.

Q UALITY CONTROL .................................................................................... 35 Science Committee ..................................................................35 Quality Committee ...................................................................36 PhD Committee........................................................................36 Methodological expertise centers ..............................................37

9.

S CIENTIFIC OUTPUT ................................................................................... 39

10.

E ARNING CAPACITY .................................................................................... 43

11.

A CADEMIC REPUTATION ............................................................................. 45

12.

S OCIETAL IMPACT ...................................................................................... 47

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1

PREFACE

In this 2012 annual report we look back on a very successful year of the EMGO Institute for Health and Care Research (EMGO +). Our scientific output has kept increasing beyond the level of the past years and the earning capacity has remained intact, despite the increased constraints on research funding in the current economic crisis.

Because our research is directly connected to societally relevant questions we are confident that sufficient funding opportunities for EMGO+ researchers will present themselves nationally and internationally, but we are equally certain that we need to actively support our researchers in reaching out for public private partnerships as viable new routes to support future science.

Governance of the institute is characterized by broad involvement of the key opinion leaders (e.g. department heads, program leaders, full professors and professors by special appointment) and we note that significant changes in the top level management of the institute has not led to any disruptions, testifying to the robustness of our ‘flat’ organization.

In this annual report we present with pride and pleasure the core information about who we are, what we do, what we strive for, and what we have accomplished. You will find the information organized in a slightly different way than before. This reflects the standardization and harmonization of the annual report cycle across all VU University/VU University Medical Center research institutes, using the Standard Evaluation Protocol 2009-2015 of the Royal Dutch Academy of Science (KNAW) as the main guideline.

We hope you will enjoy reading this report!

Yours sincerely, on behalf of the EMGO Institute for Health and Care Research,

Prof. Eco de Geus, PhD Director

Prof. Henriette van der Horst, MD, PhD Vice-director

Prof. Willem van Mechelen, MD,PhD Vice-director

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2

RESEARCH AREA

Research area The EMGO+ Institute is a transdisciplinary research institute. It brings together nearly 600 researchers from departments of three different science communities, i.e. from the VU University Medical Center, and the VU University faculties of Psychology and Education, and Earth and Life Sciences.

The EMGO+ mission is to generate, conduct and publish excellent research of international standing to improve public and occupational health, mental health care, primary care, rehabilitation and long-term care.

In the above fields, the EMGO+ institute’s objectives are to: strengthen the evidence-base for the current practice in prevention and care; engage in an evidence-chase to innovate prevention and care; develop new methodology in study design, instrumentation and analyses; and provide advanced education and training for researchers and practitioners.

Programs EMGO+ focuses on applied and strategic research involving issues that are relevant for public and occupational health, mental health, primary care, rehabilitation, and long-term care. Many studies are either executed within large population-based cohorts or in public health and extramural medical practice settings, such as general practices, nursing homes, specialized mental health care organizations, residential homes for the elderly, schools, worksites, and occupational health care settings. EMGO + studies include observational research and intervention studies and are always focused on health outcomes to enable the promotion of evidencebased medical practice. Many studies are conducted within so-called Academic Collaborative Centers, i.e. formal collaborations between EMGO + and practice settings to conduct practicebased research of strong methodological rigor.

All research projects carried out at EMGO+ mainly are embedded in four research programs, three of which link to the main burdens of disease in the Netherlands, as well as internationally: Lifestyle, Overweight and Diabetes (LOD) Mental Health (MH) Musculoskeletal Health (MSH) whereas projects in the fourth program Quality of Care (QofC) focus on how to optimize physician- patient communication and decision making, increase patient participation, and improve the safety of care in the above mentioned disease areas as well as in cancer.

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Lifestyle, Overweight, and Diabetes Mission OVERWEIGHT and DIABETES are two of the main public health problems of our society and are strongly linked to common LIFESTYLE determinants such as physical inactivity and poor dietary habits. Physical inactivity and overweight are also main factors contributing to the development of cardiovascular disease. This research program is aiming to curb the obesity and diabetes epidemics by identification of the primary lifestyle and biological determinants and by evaluation of efficient ways to improve lifestyle both as a way to prevent disease and in the context of chronic disease management.

Program directors: Prof. Giel Nijpels, MD, PhD and Prof. Marjolein Visser, PhD [photo: Ton Dijkstra]

Specific research themes Pathophysiology and epidemiology of overweight and diabetes. This theme includes experimental and epidemiological studies of the biological, genetic and behavioral determinants of overweight and diabetes and their potential interrelations.

Prevention of overweight and diabetes. Research aims to modify unhealthy lifestyles with a particular emphasis on improving dietary intake and promoting or increasing physical activity. This research is conducted in a variety of settings, including communities, schools and workplaces.

Care for patients with overweight and diabetes. This theme studies the effectiveness and efficiency of health care aimed at chronic disease management of obesity and type2 diabetes.

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Mental Health Mission Common mental disorders have a major impact on public health and are among the conditions with the world-wide highest disease burden. By conducting observational as well as intervention studies, the MENTAL HEALTH program contributes to a better evidence base for the prevention and treatment of mental disorders in order to improve general mental health.

Program directors: Prof. Brenda Penninx, PhD and Prof. Hans Koot, PhD [photo: Martijn Schuit]

Specific research themes Epidemiology of mental health. This theme includes observational research in the community setting, the general practice setting as well as the psychiatric care setting that increases our knowledge of the occurrence, the determinants and consequences of mental health disorders.

Prevention and treatment of mental disorders. This theme refers to research that contributes to evidence-based information on innovative prevention and treatment interventions to improve mental health and reduce associated disability.

Developmental perspective in mental health. Psychopathology often starts in childhood and continues into late adulthood, but some forms also show a lateonset. This theme refers to research that specifically examines developmental trajectories of psychopathology across the lifespan.

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Quality of Care Mission A long healthy life requires not only disease specific prevention and care, but also attention for more generic themes such as effective health communication, taking patient perspectives into account in prevention and care, and patient safety issues. In this program, QUALITY OF CARE, research focuses on the organization of care, for example regulations for end-of-life care; on health professionals, for example educational programs in genetics, and on individual health care consumers, for example the quality of life of chronically ill and information needed to make health decisions.

Program directors: Prof. DaniĂŤlle Timmermans, PhD and Prof.

Bregje Onwuteaka-Philipsen, PhD [photo: Martijn Schuit]

Specific research themes Health, Communication and Decision Making. Research concentrates on improving the quality of information about e.g. health risks and treatments and to improve the communication between patients and doctors in order to enable health care consumers and patients to have the role in the decision making process regarding their treatment.

Disease, Disability and Participation. Research focuses on personal factors and environmental factors that might hinder or help maintaining functional autonomy and quality of life of people with chronic illness or a disability.

Effectiveness and Safety of Care. Describing and monitoring the quality and safety of both prevention and care is the focus of this theme. Important topics are the development and subsequent testing of specific quality indicators as well as the effectiveness of interventions to improve collaboration between professionals or organization of care in order to optimize quality and safety of care.

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Musculoskeletal Health Mission To improve MUSCULOSKELETAL HEALTH and to reduce the burden of musculoskeletal disorders the MSH program seeks knowledge about the development and lifelong maintenance of a healthy musculoskeletal system and about the occurrence, prognosis, prevention and treatment of musculoskeletal disorders. The goals are to initiate, conduct and publish excellent research that contributes to evidence-based practice on musculoskeletal disorders and health in the settings of public health, occupational health, primary and secondary health care, and rehabilitation practice.

Program directors: Prof. Maurits van Tulder, PhD and Prof. Allard van der Beek, PhD [photo: Ton Dijkstra]

Specific research themes Epidemiology of musculoskeletal disorders Prevention of musculoskeletal disorders Treatment of musculoskeletal disorders

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Figure 1: Organization of the EMGO + Institute

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3

ORGANIZATION

Strategic management of the EMGO + institute lies with the Directorate consisting of the Director and two members selected from the heads of the departments participating in the EMGO + institute. Figure 1 outlines the organization of the EMGO + institute.

The Directorate answers to the Board of Deans representing the VU University Medical Center, VU University Faculty Earth and Life Sciences, and VU University Faculty Psychology and Education. Strategic advice on positioning of the institute in the national and international context is obtained from the External Advisory Board consisting of:

Prof. dr. S.E. Buitendijk

University of Leiden

Prof. dr. R. van Dyck

Prof. dr. V.W.M. van Hinsbergh

Prof. dr. J.A. Knottnerus Dr. Ir. M.N. Pieters Dr. H. Kroneman Prof. dr. K. Stronks

The Institute for Cardiovascular Research of the Vrije Universiteit of Amsterdam (ICaR-VU) Scientific Council for Governement Policy (WAR) Ministry of Health, Welfare and Sport (VWS) Department for Social Benefits (UWV) Academic Medical Center Amsterdam, University of Amsterdam

Vice Rector Magnificus Emeritus professor Psychiatry, former head of the department of Psychiatry, VU University Medical Center Director

Chair Director of the Public Health and Health Services Division Chief Medical Officer Head of the department of Social Medicine, Amsterdam Medical Center

Table 1: Advisory Board of the EMGO + institute

Day to day management of the institute is done by the Director and the Manager assisted by administrative support staff and three committees. The Science Committee discusses and approves all project proposals and consists of a mix of midcareer and senior scientists representing EMGO+ scientific and methodological expertise. The Quality Committee is chaired by the Quality officer. Their role is to introduce all EMGO + researchers to the quality guidelines laid down in the EMGO+ quality handbook (http://www.emgo.nl/kc/), to advise on policies regarding scientific quality and integrity, and to perform yearly audits of research projects. The PhD committee organizes the introductory day for PhDs, maintains a buddy system for PhDs, and reviews the PhD training- and education plans. It also produces PhD handbooks with tips and tricks, including the recently produced ‘Handboek einde promotie’.

The eight Program Directors provide the scientific leadership of the institute. Per program two directors ensure sufficient interfaculty cross-talk and scientific focus within the program. Together with the Directorate they facilitate productivity in scientific and societal output as well as in external fund raising. Broad support for scientific and strategic policy is ensured through biannual meetings with the Management Committee that consists of the heads of all participating departments (listed in table 2).

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3

ORGANIZATION

VU

FALW Health Sciences

Jaap Seidell

60

28,66

VU

FPP Biological Psychology

Dorret Boomsma

23

13,64

VU

FPP Clinical Psychology

Pim Cuijpers

50

26,61

VU

FPP Developmental Psychology

Hans Koot

22

9,63

VU

FPP Orthopedagogy

Carlo Schuengel total VU

30

11,15

185

89,69

3

1,32

VUmc

Anesthesiology

Stephan Loer

VUmc

Child & Adolescent Psychiatry

Theo Doreleijers

22

11,5

VUmc

Clinical Genetics

Hanne Meijers-Heijboer

17

9,23

VUmc

Clinical Pharmacology & Pharmacy

Noortje Sw art

2

0,5

VUmc

Epidemiology & Biostatistics

Bernard Uitdehaag

56

33,1

VUmc

General Practice & Elderly Care Medicine

HenriĂŤtte van der Horst

68

35,3

VUmc

Otolaryngology, Head & Neck Surgery

RenĂŠ Leemans

21

8,11

VUmc

Internal Medicine

Mark Kramer

6

4,05

VUmc

Medical Humanities

Guy Widdershoven

30

15,41

VUmc

Medical Psychology

Frank Snoek

VUmc

Midw ifery Science

Gea Vermeulen

VUmc

Ophthalmology

VUmc

Pediatrics

VUmc

Psychiatry

Aartjan Beekman

VUmc

Public & Occupational Health

Willem van Mechelen

VUmc

Rehabilitation Medicine

Vincent de Groot

9

3,55

10

6,02

Stevie Tan

9

4,17

Hans van Goudoever

2

1,06

47

20,42

110

48,71

16

6,79

428

209,23

total VUmc

*19 researchers are employed by tw o departments, so grand total of EMGO + researchers is 594.

Table 2: Departments participating in the EMGO + institute in 2012

The multidisciplinary nature of the EMGO+ institute is amply illustrated by the diversity of the participating departments, listed in table 2. At the VU University the largest contribution comes from the Health Sciences and Clinical Psychology departments, whereas at the VU Medical center the departments of Public and Occupational Health, General Practice & Elderly Care Medicine, Epidemiology and Biostatistics, and Psychiatry are the largest contributors in keeping with the extramural roots of the institute. However, there is also a growing contribution of the clinical departments reflecting the growing importance of clinical evaluation research and evidence-based practice in trans- and intramural research.

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4

COMPOSITION

The total count of scientific personnel in 2012 was 594 individuals amounting to 299 fte contributing to research within the EMGO + institute. The VU University Medical Center is the largest contributor with ~209 research fte, followed by Psychology and Education (~61 research fte) and Earth and Life Sciences (~29 research fte). The ratio VU / VUmc formation in fte is 30% / 70%. The break down per job category is provided in table 3. To provide a historical context, the data from previous years has been added.

Tenured staff

48,5

52,16

54,78

73,96

74,85

65,99

Non-tenured staff

54,5

58,8

94,7

101,72

99,39

101,77

PhD-students

59,5

65,2

97,29

109,35

117,28

131,17

Total research staff

162,5

176,16

246,77

285,03

291,52

298,93

Support staff

46,34

49,6

62,94

n/a

n/a

46,29

208,84

225,76

309,71

285,03

291,52

345,22

Tenured staff

12,6

14,44

13,25

16,28

15,48

16,14

Non-tenured staff

11,8

14

29,2

29,63

31,26

23,17

PhD-students

22,1

22,6

23,6

26,29

23,82

21,1

Total research staff

46,5

51,04

66,15

72,2

70,56

60,41

Tenured staff

11,9

9,93

16,31

22,66

22,6

22,52

5,8

9,2

27

28,74

19,8

33,25

Total staff

Non-tenured staff PhD-students

16,9

18,7

40,1

45,8

53,06

46,22

Total research staff

34,6

37,83

83,41

97,2

95,46

101,99

Tenured staff

14,8

14,55

14,33

19,3

22,54

16,46

Non-tenured staff

22,2

22,8

23

27,53

36,07

36,75

PhD-students

12,8

15

19,59

19,95

20,66

39,68

Total research staff

49,8

52,35

56,92

66,78

79,27

92,89

9,2

13,24

10,89

15,72

14,23

10,88

14,7

12,8

15,5

15,82

12,26

8,58

7,7

8,9

14

17,31

19,74

23,78

31,6

34,94

40,39

48,85

46,23

43,24

Tenured staff Non-tenured staff PhD-students Total research staff

Table 3 (SEP 5.4) Total research fte for the institute and per program

The EMGO+ institute showed a modest growth in personnel in 2012, but the explosive growth that started in 2007/2008 when VUmc EMGO became VUmc/VU EMGO + is gradually leveling off. There is a decline in tenured staff in favor of PhD students. The full list of 594 EMGO + researchers is provided in appendix 1.

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4

COMPOSITION

To unambiguously define EMGO+ researchers the following definitions, in accordance with the Program Committee Research (PCO) guidelines, were used throughout: An EMGO+ researcher is any tenured or untenured academic personnel that has been listed as part of EMGO+ by one of the department heads in table 2, or takes part in an EMGO+ project, where An EMGO+ project is any project that has been reviewed by the Science Committee and positively judged to fit the EMGO + research programs and to be of sufficient scientific and methodological quality.

For each EMGO researcher the department head is asked to indicate the total amount of time (in fte) that the researcher spends on EMGO+ projects; this is the basis of the research fte in table 3. We compare the indicated research time to the mean research time for the rank of the researcher (e.g. Post-doc 100%; Assistant professor, 60%; Associate professor, 40%; Full professor, 30% ) and ask the heads of department for confirmation in case of a large deviation. All PhD students have been assigned 0.75 research fte (based on full time employment).

Selection of participants The above mentioned definitions also largely determine how researchers are selected to be part of the EMGO+ institute. Selection is primarily based on the department to which the individual belongs, where the individual must also be participating in one or more projects approved by the Science Committee in the past three years. The selection of EMGO + departments is done by the Directorate in close consultation with the Management Committee. Current EMGO+ departments have been carried forward from 2011, because performance was stable (or improved). New departments can apply for EMGO + membership if the bulk of their research falls in one or more of the research themes of the four programs and if they have a good track record in publication and fund raising. A good track record is defined relative to the average EMGO+ performance, using a minimum of 75% of the average over the past two years as a guideline. Whether the research of the department fits the EMGO + themes is decided by the Directorate after seeking the advice of the program directors. Departments that do not yet qualify, can obtain an affiliate membership status for two years (after which membership is reevaluated); neither input nor output is counted for researchers in affiliated groups.

Financial input Table 4 provides an overview of the various sources of financing of research personnel in the EMGO+ institute. A total of 28% of the researchers’ salaries comes from direct University funding (‘1e lijns’). 70% comes from public funding agencies like ZonMW, NWO and the European Union or the Ministry of health and Welfare or from charitable societies and charity funds like the Dutch Heart Foundation. Currently only a very small part comes from industry funding (~2%).

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4

COMPOSITION

2007 2008 2009 2010 2011 2012

57,61 65,83 73,21 86,77 80,9 83,95

34,98 47,35 66,38 89,8 93,28 78,23

64,38 65,22 91,12 99,82 112,5 131,92

5,43 2,6 9,79 8,64 4,84 4,77

104,79 115,17 167,29 198,26 210,62 214,92

2007 2008 2009 2010 2011 2012

19,89 12,84 17,4 23,93 20,18 22,51

5,03 8,5 10,96 17,17 20,6 13,81

20,9 21,45 21,04 24,71 27,61 22,46

3,6 3,68 2,28 6,39 2,17 1,63

29,53 33,63 34,28 48,27 50,38 37,9

2007 2008 2009 2010 2011 2012

13,31 11,93 16,92 29,66 29,27 23,67

12,37 9,55 11,78 39,49 40,65 38,76

11,6 13,15 11,83 27,45 25,34 38,74

0 0 0 0,6 0,2 0,81

23,97 22,7 23,61 67,54 66,19 78,31

2007 2008 2009 2010 2011 2012

11,9 17,12 16,25 12,68 11,94 23,93

10,42 9,13 13,71 21,82 21,64 14,63

22,46 21,68 23,41 30,64 43,25 52,41

0,1 1,75 0,15 1,64 2,44 2,31

32,98 32,56 37,27 54,1 67,33 69,35

2007 2008 2009 2010 2011 2012

13,5 15,73 15,26 20,5 19,51 13,84

11,8 7,8 10,9 11,32 10,39 11,03

8,84 8,05 8,94 17,02 16,3 18,35

0 0 0,17 0,01 0,03 0,02

20,64 15,85 20,01 28,35 26,72 29,4

Table 4 (SEP 5.4): Sources of funding of the research staff for the institute and per program

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Figure 2: Some of the universities, institutes, and hospitals with which EMGO+ researchers collaborated in 2012

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5

RESEARCH ENVIRONMENT AND EMBEDDING

EMGO+ researchers have extended national and international collaborations (see some examples in figure 2), the majority of which are academic in nature and concerned joint participation in program grants (e.g. KP7 EU), multicenter trials, meta-analytic consortia, joint papers, exchange of staff and (PhD) students, European policy development, and educational modules.

69% of the 420 research collaborations are international in nature, spanning 31 different countries on all continents. Main international ties are with the USA (66 contacts), UK (53 contacts), Australia (23 contacts) and Germany (17 contacts). A word cloud of the cities to which EMGO+ is connected is shown in figure 3 The full list of recorded collaborations is provided in appendix 2.

Figure 3: International cities of the Universities, institutes, centers, and hospitals with which EMGO + researchers collaborated in 2012. Font size reflects the amount of collaborations with the same city.

There are 22 professors by special appointment active in the EMGO + institute, usually on the basis of a 0.2 fte appointment. An important function of the special professorships is to link EMGO+ to non-university based research institutes and societal stakeholders in health care research like health insurance companies and (mental) health care providers. A full list of professors by special appointment is provided in appendix 3.

On October 19, during the 132st dies natalis of the VU University, an honorary doctorate was awarded to Peter Kaptein for his exceptional contribution to fund raising in cancer research.

The honorary doctor is co-founder and ambassador of the Stichting Alpe d’HuZes, a charity fund that finances, among others, the work of EMGO + researchers who seek to improve the quality of life in cancer patients and the role of diet and physical activity in cancer prevention and revalidation.

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Figure 4: Some EMGO+ dissertations 2012

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6

QUALITY AND SCIENTIFIC RELEVANCE

Although not perfect, journal impact factors are regarded as the best benchmark to test the quality of the scientific output of the institute. With help of the VUmc METIS officer, we obtained the relative impact factors of all journals in which we publish using Thomson Reuter’s journal citation reports (JCR) table. This table assigns all journals to a number of domains and computes the relative ranking of the journal within its own domain. All EMGO + publications were then classified by the rank order of the journal as belonging to the top 10% or top 25% in their respective domain. We then counted the number of publications in top 10% and top 25% for the entire institute and each of the 4 programs. As shown in table 5, 29% of our publications are in the top 10% of their field and another 31% belongs to the top 25%.

205 (100%)

321 (100%)

228 (100%)

199 (100%)

Top 10% impact factor

64 (31%)

106 (33%)

46 (20%)

57 (29%)

Top 25% impact factor

120 (59%)

213 (66%)

120 (53%)

115 (58%)

Refereed articles

Table 5: Total number of refereed publications in 2012 and proportion in top 10% and top 25% journals in the relevant research field

Below we give a few examples of representative publications per program, as well as general scientific highlights. Taken together we conclude that our scientific output remains to be of the highest standard while maintaining a strong emphasis on applied and applicable biomedical research.

Lifestyle, Overweight and Diabetes 2012 Highlights Jaap Seidell was awarded the prestigious VU University Professorship. His main mission will be to better connect Science and Society and to develop and implement new methods to improve health on a local and regional level.

The Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project was started. LOD researchers Jolanda Maas and Mireille van Poppel are key researcher in this EUfunded project. PHENOTYPE intends to provide a better understanding of the relation between Nature and human health and wellbeing and its potential mechanisms (www.phenotype.eu or Twitter via @greenhealth4eu).

A non-laboratory based risk assessment tool for identification of people at high cardiometabolic disease risk was developed. The tool is being implemented within the Dutch NHG-guideline ‘Het Preventie Consult’ for referring the highest risk individuals to health care for further (multivariable) risk assessment.

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QUALITY AND SCIENTIFIC RELEVANCE

2012 Key publications & chapters Alssema, M., Newson, R.S., Bakker, S.J.L., Stehouwer, C.D., Heijmans, M.W., Nijpels, G., Hillege, H.L., Hofman, A., Witteman, J.C.M., Gansevoort, R.T. & Dekker, J.M. (2012). One risk assessment tool for cardiovascular disease, type 2 diabetes, and chronic kidney disease. Diabetes Care, 35(4), 741-748.

Altenburg, T.M., Hofsteenge, G.H., Weijs, P.J.M., Delemarre-van de Waal, H.A. & Chin A Paw, M.J.M. (2012). Self-reported screen time and cardiometabolic risk in obese Dutch adolescents.

PLoS ONE, 7(12).

Ruyter, J.C. de, Olthof, M.R., Seidell, J.C. & Katan, M.B. (2012). A Trial of Sugar-free or SugarSweetened Beverages and Body Weight in Children. New England Journal of Medicine, 367(15), 1397-1406 Malanda, U.L., Welschen, L.M.C., Riphagen, II, Dekker, J.M., Nijpels, G. & Bot, S.D.M. (2012). Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Systematic Reviews.

Neelemaat, F., Bosmans, J.E., Thijs, A., Seidell, J.C. & Bokhorst-de van der Schueren, M.A.E. van (2012). Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs. Clinical Nutrition, 31(2), 183-190.

Brug, J., Smit, H. & Burdorf, A. (2012). Primaire preventie. In J.P. Mackenbach & K. Stronks (Eds.), Volksgezondheid en gezondheidszorg (pp. 167-199). Reed Business: Amsterdam.

Dekker, J.M., Diamant, M. & Nijpels, G. (2012). Diagnostiek en epidemiologie van diabetes. In C.J. Tack, M. Diamant & E.J.P. De Koning (Eds.), Handboek Diabetes Mellitus (pp.

25-34). Utrecht: De Tijdstroom.

Visser, M. & Harris, T.B. (2012). Body composition and aging. In A.B. Newman & J.A. Cauley (Eds.), Epidemiology of Aging. New York: Springer-Verlag.

Number of articles in top 10% van de publications relevant to the discipline: 64.

Number of articles in top 25% van de publications relevant to the discipline: 120.

Mental Health 2012 Highlights Prof dr A. Beekman was appointed as the President of the Dutch Society of Psychiatry (NVvP).

Dr A. Huizink, embedded in the department of Developmental Psychology and dr M. Huibers, embedded in the department of Clinical Psychology, were appointed as full professors. Dr H. Riper was appointed part-time at Leuphana in Germany as professor of E-mental health.

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QUALITY AND SCIENTIFIC RELEVANCE Within EMGO+ longitudinal cohort studies (e.g. LASA and NESDA) we have confirmed evidence for an association between low vitamin D levels and an increased risk for depression. An important resulting question is whether vitamin D supplementation can prevent the onset of depression in high-risk individuals. This will be tested in the newly obtained ZonMw grant for the D-Vitaal RCT (Profs Lips 7 Penninx; Drs van Schoor, van Marwijk, Elders).

The Biological Psychology and Psychiatry departments remain heavily involved in many ongoing international genetics consortia, which examine the genetic basis of psychiatric - but also (related) somatic - traits. In 2012, this involvement resulted in 7 Nature (Genetics) papers.

2012 Key publications & chapters Balkom, A.J.L.M. van, Emmelkamp, P.M.G., Eikelenboom, M., Hoogendoorn, A.W., Smit, J.H. & Oppen, P.C. van (2012). Cognitive therapy versus fluvoxamine as a second-step treatment in obsessive-compulsive disorder nonresponsive to first-step behavior therapy. Psychotherapy and Psychosomatics, 81(6), 366-374.

Batelaan, N.M., Rhebergen, D., Graaf, R. de, Spijker, J., Beekman, A.T.F. & Penninx, B.W.J.H. (2012). Panic attacks as a dimension of psychopathology: evidence for associations with onset and course of mental disorders and level of functioning. Journal of Clinical Psychiatry, 73(9), 1195-1202.

Licht, C.M.M., Penninx, B.W.J.H. & Geus, E.J.C. de (2012). Effects of antidepressants, but not psychopathology, on cardiac sympathetic control: a longitudinal study. Neuropsychopharmacology, 37(11), 2487-2495.

Geels, L.M., Bartels, M., Beijsterveldt, C.E.M. van, Willemsen, G., Aa, N. van der, Boomsma, D.I. & Vink, J.M. (2012). Trends in adolescent alcohol use: Effects of age, sex and cohort on prevalence and heritability. Addiction, 107(3), 518-527.

Cuijpers, P., Beekman, A.T.F. & Reynolds, C.F. (2012). Preventing Depression. A Global Priority. JAMA, 2012(10), 1033-1034.

Michielsen, M., Semeijn, E., Comijs, H.C., Ven, P.M. van de, Beekman, A.T.F., Deeg, D.J.H. & Kooij, J.J.S (2012). Prevalence of attention-deficit hyperactivity disorder in older adults in The Netherlands. British Journal of Psychiatry, 201(4), 298-305.

Vlasveld, M.C., Feltz-Cornelis, C. van der, Ader, H.J., Anema, J.R., Hoedeman, R., Mechelen, W. van & Beekman, A.T.F. (2012). Collaborative care for major depressive disorder in an occupational healthcare setting. British Journal of Psychiatry, 200(6), 510-511.

Lier, P.A.C. van, Barker, E.D., Brendgen, M., Tremblay, R.E., Vitaro, F. & Boivin, M. (2012). Peer victimization, poor academic achievement, and the link between childhood Annual Report 2012 | EMGO+ | 25

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QUALITY AND SCIENTIFIC RELEVANCE externalizing and internalizing problems. Child Development, 83(5), 1775-1788.

Balkom, A.J.L.M. van & Vliet, I.M. van (2012). Angststoornissen. In L. Pepplinkhuizen, W.M.A. Verhoeven & J.M.A. Sitsen (Eds.), Het psychiatrisch formularium (pp. 33-41).

Houten: Bohn Stafleu van Loghum.

Cuijpers, P. (2012). Psychotherapie; een wetenschappelijk perspectief. Amsterdam: Uitgeverij Bert Bakker.

Gaag, M. van der, Staring, T. & Valmaggia, L. (2012). Handboek Psychose, theorie, diagnostiek en behandeling. Amsterdam: Boom.

Number of articles in top 10% of publications relevant to the discipline: 106 Number of articles in top 25% of publications relevant to the discipline: 213

Quality of Care 2012 Highlights Dr. Thomas Koelewijn (Department ENT/ Audiology) was awarded an NWO Veni career award for his research proposal ‘Do our eyes betray how attentively we listen?

Dr. Tineke Abma, professor of client participation in elderly care and of diversity, received an NWO Aspasia career award. In line with the idea behind Aspasia – stimulating the participation of talented women in academic settings - professor Abma will partly use her Aspasia grant to allow three talented female post-docs to prepare a Veni proposal, and partly in a PhD trajectory on the topic of culturally diverse teams in VUmc. The department of general practice and elderly care medicine and 6 international partners were awarded 3 million euro by the European Union FP7 programme to develop a benchmark method to compare cost effectiveness of (home)care for frail elderly within and between countries (IBenC).The departments of Clinical Genetics of VUmc and AMC were frontrunners on the road to a full alliance of AMC/VUmc in the new University Medical Center Amsterdam (UMCA). Both departments as well as the departments of Public Health and of Gynaecology and Obstetrics engaged in a study on new prenatal screening tests or non-invasive prenatal testing (NIPT) and the ESPRIT study (Ethical Social Psychological Research for Implementing Screening for fetal Trisomies).

Annual Report 2012 | EMGO+ | 26

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QUALITY AND SCIENTIFIC RELEVANCE How do health care consumers use the increasingly abundant information from health checks to make informed health decisions? To tackle this question the departments of Public and Occupational Health (EMGO+) and Language and Communication formed a public private partnership with NWO (program ‘Begrijpelijke Taal’), NIPED (NDDO Institute for Prevention and Early Diagnostics), and the social partners the Dutch Kidney Foundation, the Dutch Heart Foundation, and the Dutch Diabetes Research Foundation.

2012 Key publications & chapters Duijts, S.F.A., Beurden, M. van, Oldenburg, H.S., Hunter, M.S., Kieffer, J.M., Stuiver, M.M., Gerritsma, MA, Menke-Pluymers, M.B.E., Plaisier, P.W., Rijna, H., Cardozo, A.M.F.L., Timmers, G., Meij, S. van der, Veen, H. van der, Bijker, N., Widt-Levert, L.M. de, Geenen, M.M., Heuff, G., Dulken, E.J. van, Boven, E. & Aaronson, N.K. (2012). Efficacy of Cognitive Behavioral Therapy and Physical Exercise in Alleviating Treatment-Induced Menopausal Symptoms in Patients With Breast Cancer: Results of a Randomized, Controlled, Multicenter Trial. Journal of Clinical Oncology, 30(33), 4124-4133.

Galenkamp, H., Huisman, M., Braam, A.J. & Deeg, D.J.H. (2012). Estimates of prospective change in self-rated health in older people were biased owing to potential recalibration response shift. Journal of Clinical Epidemiology, 65(9), 978-988.

Jans, S.M.P.J., Jonge, J. de, Henneman, L., Cornel, M.C. & Lagro-Janssen, A.L. (2012). Attitudes of general practitioners and midwives towards ethnicity-based haemoglobinopathy-carrier screening. European Journal of Human Genetics, 20(11), 1112-1117.

Nachtegaal, J., Festen, J.M. & Kramer, S.E. (2012). Hearing Ability in Working Life and Its Relationship With Sick Leave and Self-Reported Work Productivity. Ear and Hearing, 33(1), 94-103.

Onwuteaka-Philipsen, B.D., BrinkmanStoppelenburg, A., Penning, C., Jong-Krul, G.J. de, Delden, J.J. van & Heide, A. van der (2012). Trends in endof-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet, 380(9845), 908-915.

Bleijenberg, G., Horst, H.E. van der, Meer, J. van der & Knoop, H. (2012). Handboek chronische vermoeidheid. Amsterdam: Tijdstroom.

Frederiks, B.J.M. (2012). Casus 20 Huisarts als mediator tussen moeder en zoon. In W. De Ruijter, A. Hendriks & M. Verkerk (Eds.), Huisarts tussen individu en familie: Morele dilemma's in de huisartsenpraktijk. Houten: Annual Report 2012 | EMGO+ | 27

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QUALITY AND SCIENTIFIC RELEVANCE Uitgeverij Van Gorcum.

Pasman, H.R.W. (2012). When Requests Do Not Result in Euthanasia or Assisted Suicide.

In S.J. Youngner & G.K. Kimsma (Eds.), Physician-Assisted death in perspective: Assessing the Dutch experience. Cambridge University Press.

Steen, J.T. van der, Helton, M.R., Sloane, P.D. & Ribbe, M.W. (2012). Palliative care in institutional long-term care settings. In J. Cohen & L. Deliens (Eds.), A Public Health Perspective on End of Life Care (pp. 122-134). Oxford university press.

Widdershoven, G.A. & Abma, T.A. (2012). Autonomy, dialogue and practical rationality.

In L. Radoilska (Ed.), Autonomy and mental disorder (pp. 217-232). Oxford: Oxford University Press.

Number of articles in top 10% van de publications relevant to the discipline: 46 Number of articles in top 25% van de publications relevant to the discipline: 120

Musculoskeletal Health 2012 Highlights Dr R. Ostelo, currently head of the EMGO+ PhD committee, was appointed professor at the VU University in the field of “Evidence-Based Physiotherapy” dr C. Maher joined EMGO+ as Visiting Scientist in Musculoskeletal Health program The American College of Sports Medicine (ACSM) awarded the International Student Award to A.C.J. Balemans. MSc at the ACSM Annual meeting in San Francisco drs J.T. Dennerlein, C. Emery, and M. Fransen were appointed as Adjunct Scientists in the EMGO+ program Musculoskeletal Health The New York Times (May 16, 2012) devoted an article to the work on colorectal cancer survivors of dr .M. Buffart working in the Alpe d’HuZes Cancer Rehabilitation Research program.

2012 Key publications Dekker, J. (2012). OSTEOARTHRITIS Promoting exercise for OA in ambivalent older adults. Nature Reviews Rheumatology, 8(8), 442-444.

Estrada, K., Styrkarsdottir, U., Evangelou, E., Hsu, Y.H., Duncan, E.L., Ntzani, E.E., Oei, L., Albagha, O.M.E., Amin, N., Kemp, J.P., Koller, D.L., Li, G., Liu, C.T., Minster, R.L., Moayyeri, A., Vandenput, L., Willner, D., Xiao, S.M., Yerges-Armstrong, L.M., Zheng, H.F., Alonso, N., Eriksson, J., Kammerer, C.M., Kaptoge, S.K., Leo, P.J., Thorleifsson, G., Wilson, S.G., Wilson, J.F., Aalto, V., Alen, M., Aragaki, A.K., Aspelund, T., Center, J.R., Dailiana, Z., Duggan, DJ, Garcia, M., Garcia-Giralt, N., Giroux, S., Hallmans, G., Hocking, L.J., Annual Report 2012 | EMGO+ | 28

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QUALITY AND SCIENTIFIC RELEVANCE Husted, L.B., Jameson, K.A., Khusainova, R., Kim, G.S., Kooperberg, C., Koromila, T., Kruk, M., Laaksonen, M., LaCroix, A.Z., Lee, S.H., Leung, P.C., Lewis, J.R., Masi, L., MencejBedrac, S., Nguyen, T.V., Nogues, X., Patel, M.S., Prezelj, J., Rose, L.M., Scollen, S., Siggeirsdottir, K., Smith, A.V., Svensson, O., Trompet, S., Trummer, O., Schoor, N.M. van, Woo, J., Zhu, K., Balcells, S., Brandi, M.L., Buckley, B.M., Cheng, S.L., Christiansen, C., Cooper, C., Dedoussis, G., Ford, I., Frost, M., Goltzman, D., Gonzalez-Macias, J., Kahonen, M., Karlsson, M., Khusnutdinova, E., Koh, J.M., Kollia, P., Langdahl, B.L., Leslie, W.D., Lips, P.T.A.M., Ljunggren, O., Lorenc, R.S., Marc, J., Mellstrom, D., Obermayer-Pietsch, B., Olmos, J.M., Pettersson-Kymmer, U., Reid, D.M., Riancho, J.A., Ridker, P.M., Rousseau, F. & Slagboom, P.E. (2012). Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture.

Nature Genetics, 44(5), 491-501.

Simon-Sanchez, J., Dopper, E.G.P., Hokke, P.E., Hukema, R.K., Nicolaou, N., Seelaar, H., Schoor, N.M. van, Deeg, D.J.H., Rozemuller, J.M., Pijnenburg, Y.A.L., Heutink, P. & Swieten, J.C. van (2012). The clinical and pathological phenotype of C9ORF72 hexanucleotide repeat expansions. Brain, 163(3), 723-735.

Rubinstein, S.M., Terwee, C.B., Assendelft, W.J.J., Boer, M.R. de & Tulder, M.W. van (2012). Spinal manipulative therapy for acute low-back pain. Cochrane Database Systematic Reviews (9).

Schoor, N.M. van, Jongh, R.T. de, Daniels, J.M.A., Heijmans, M.W., Deeg, D.J.H. & Lips, P.T.A.M. (2012). Peak expiratory flow rate shows a gender-specific association with vitamin D deficiency. Journal of Clinical Endocrinology and Metabolism, 97(6), 2164-2171.

Number of articles in top 10% van de publications relevant to the discipline: 57 Number of articles in top 25% van de publications relevant to the discipline: 115

Annual Report 2012 | EMGO+ | 29

Longitudinal study: LASA LASA (Longitudinal Aging Study Amsterdam) is an interdisciplinary, longitudinal study on predictors and consequences of changes in social, emotional, cognitive and physical functioning during aging. The LASA study is unique in the Netherlands by its broad, interdisciplinary, and long-term design. LASA uses representative samples of the Dutch population aged 55 years and older. Successive samples were drawn in 1992, 2002 and 2012, which facilitates research of successive generations elderly. In 2013, moreover, representative samples of two migrant groups, Turkish and Morroccan, will be involved in the study.

In addition to research on the key questions of LASA, changes in functioning and differences between population groups, LASA also focuses on the social and psychological consequences of specific disorders such as hearing disorders and joint disorders, and on consequences of major life events such as retirement, switching homes and widowhood on physical and mental health. Substudies elaborate on specific themes such as life and the role of religion.

Currently, 35 young researchers affiliated with LASA were promoted, and 20 PhD students are planning to. Many of the PhDs are still working in scientific research and some have become scientific and administrative leaders in their field. Six have since become professor. The main stimulus for the scientific development of young researchers consists of the constant interdisciplinary exchange of theories and methodology in the field of research on aging and the elderly. Sociologists, psychologists and gerontologists benefit from each other's insights, and from those of medical scientists, and influence each other's work. Young researchers have lots of opportunities to learn from the more experienced LASA researchers, through colloquia where scientific articles were discussed with (independent) senior researchers, and through lectures for LASA seminars.

Commissioned by the Ministry of Health, Welfare and Sport - the largest grant provider of LASA - an international advisory group consisting of scientific experts in the field of social sciences and gerontology provided an evaluation of the functioning of LASA. The advisory group wrote that LASA "[...] is a world-class study that can be proud of substantialism contributions to aging research and public policy." LASA data are frequently requested by foreign researchers to answer their research questions. There are also many collaborations with foreign researchers and institutions, bilaterally or within a European or international research.

The increasing proportion of elderly in the population is an unprecedented demographic change in our society, which has great influence on issues such as welfare, social cohesion, health care utilization and health of the elderly. Because of its board scope, LASA is fully equipped to examine this issues. Annually, LASA researchers contribute to public policies on the elderly and aging, in consultation with various departments of the Ministry of Health, Welfare and Sport, and by writing reports on current issues. LASA results are also used by government advisory bodies such as the Netherlands Institute for Social Research, the National Institute for Public Health and Environment, and the Dutch Health Council.

Annual Report 2012 | EMGO+ | 30

Interview with a fellow: Trynke Hoekstra “Within epidemiology and medical research, interest in observational, prospective cohort studies is increasing, mainly because the most important advantage is that the individual development of an outcome variable over time can be studied. This approach helps to better understand how risk factors for diseases naturally develop over time and further unravels the aetiology of diseases, which is important for early detection or prevention. Statistical techniques to analyse longitudinal data have evolved quickly, making techniques such as mixed models relatively easy to use.

However, these techniques cannot reveal subgroups of individuals with different trajectories of risk factors and consequently, potentially differential risks of disease.

Also, knowledge of distinct trajectories and their determinants/consequences can allow for the identification of high-risk individuals, who may need additional treatment or preventive measures in addition to the standard package of care or prevention.

“Although several statistical techniques are available to study distinct trajectories, latent class growth mixture models (LCGMM) are very flexible techniques available and have shown their merit in the fields of criminology in particular, where recognising heterogeneity has led to new theories of multiple pathways of criminal behaviour. In epidemiology, however, this approach is much less applied, but it is becoming clear that multiple pathways to develop chronic diseases exist as well, justifying taking into account this heterogeneity.

“In my PhD-thesis, I studied the applicability and usability of LCGMM for epidemiology in several ways. I demonstrated the value of these techniques, but some unresolved, yet crucial issues remained: i) important methodological issues and ii) widespread acknowledgement of the added value of LCGMM for public health in practice. With this fellowship I will aim to further extend my knowledge on LCGMM, strengthen the position of both EMGO+ and myself in the field and increase the use of LCGMM in epidemiology. I will do this by writing high-impact methodological papers in which recommendations will be given regarding when to use which approach in practice, by writing papers applying LCGMM as well as by designing and lecturing a course on LCGMM in the near future.”

Annual Report 2012 | EMGO+ | 31

Annual Report 2012 | EMGO+ | 32

7

EDUCATION AND TRAINING

Since 1989 the department of Epidemiology & Biostatistics organizes in co-operation with the EMGO+ institute a postgraduate epidemiology program called EpidM. The program includes a Master’s Program in Epidemiology and offers additional courses in epidemiological and advanced statistical methods.

The Master’s Program is a 2,5 years, part-time program of 60 EC. The theoretical part (27 EC) consists of six compulsory courses and three optional courses. The program also includes a scientific internship (33 EC).

The Master’s Program trains postgraduates from a range of disciplines (Medicine, Health Sciences, Biomedical Sciences, Pharmaceutical Sciences etc.). It focuses on applied research in primary care and public health. The program provides the methodological tools for evidencebased medicine and evidence-based health policy. The students taking part in the program are researchers (including PhD students) and professionals working in the health services field.

They often combine their work (including clinical work) with research activities. The research that they carry out at their place of work represents their scientific internship.

The Master’s Program has been accredited by the Accreditation Organization of The Netherlands and Flanders (NVAO). NVAO independently ensures the quality of higher education in the Netherlands and Flanders by assessing and accrediting programs and contributes to enhancing this quality. This means that upon successful completion of the program students will receive a Master of Science degree. In 2012 the Master’s Program has been visited for an external evaluation by the Dutch Epidemiological Society (Vereniging voor Epidemiologie) and they confirmed the program meets the requirements for a registration as an epidemiologist.

In 2012, 29 students enrolled in the Master’s Program. Furthermore, 410 students attended one or more courses of EpidM, resulting in a total of 690 course registrations. 31% of these students were PhD students within EMGO+, 12% were researchers of the VU University Medical Center, and the remaining 57% were researchers employed at a range of other universities (including VU University).

The epidemiology program EpidM is entirely funded from course fees and is not supported by regular government funding for higher education. PhD students of the EMGO + institute get a 25% discount on the course fees. The fact that the program attracts certainly enough students to be in a financially good shape, indicates that the program is well attended, and the course evaluations indicate that the program is well appreciated by the participating students. More information can be found on http://www.epidm.nl.

Annual Report 2012 | EMGO+ | 33

Annual Report 2012 | EMGO+ | 34

8

QUALITY CONTROL

The EMGO+ institute has a number of institute specific resources that strongly facilitate scientific integrity and scientific quality of all phases of research, including study design, data collection, data analysis and reporting. It is clearly recognized that our role is to provide an environment that encourages good conduct in research and discourages misconduct, and to provide tools that maximize high quality research. However, as the institute has no formal role in the governance of research personnel, the responsibility for actual behavior remains with the department heads.

Science Committee The Science Committee advises the Directorate on the quality and feasibility of all research proposals that have been submitted to the EMGO+ directorate for formal inclusion in one of the EMGO+ research programs. The committee also gives solicited and unsolicited advice to the directorate on all matters concerning research policy, and prioritizes awards and (travel) grant proposals funded by the Institute itself. The Science Committee is a representative reflection of midcareer and senior scientists in the Institute with at least 2 members from each of the four EMGO + research programs.

A proposal is first sent to the appropriate program directors who will evaluate the proposal on its relevance to the EMGO+ mission and its fit with the program’s scientific mission. When both conditions are fulfilled, the scientific quality of the proposal is evaluated by the Science Committee. To judge the scientific quality the committee appoints two reviewers to review the proposal: one member of the Science Committee and one senior researcher within EMGO +. Both reviewers assess the theoretical embedding, methodological quality and feasibility of the proposal. The reviewers are requested to return the proposal with their recommendation to the Science Committee within two weeks. The outcome categories are: Positive, with recommendations for improvement Negative, offering the possibility of resubmission after the recommendations have been processed Negative In case of a negative assessment by one reviewer and a positive assessment by another, the proposal will be assessed by a third reviewer (a member of the Science Committee), who’s judgment will be final. The Science Committee sends its advice to the directorate who makes a final decision regarding approval of research proposals. Only after approval of the directorate Annual Report 2012 | EMGO+ | 35

8

QUALITY CONTROL

following a positive judgment by the Science Committee, a project will be embedded within EMGO+. In addition, approval of the EMGO+ Science Committee is required before evaluation of a project by the Medical Ethical Committee of the VU University Medical Center. A full list of discussed and approved protocols in 2012 is presented in appendix 4.

Quality Committee The Quality Committee is responsible for developing, implementing and maintaining a system for quality assurance and control for the institute. The system is aimed at supporting and improving the research process. Moreover, the Quality Committee advises the directorate on quality issues. To fulfill its tasks the quality committee audits research projects, maintains and expands a web-based quality manual (http://www.emgo.nl/kc/) and provides personal introductions to all newly appointed researchers within the institute.

In 2012 the Quality Committee has audited 15 research projects.

In addition, a pilot was conducted with a web-based do-it-yourself audit, in which 30 PhD students tested their knowledge and application of the quality manual. The quality officer has given 59 personal introductions in proper scientific conduct for newly appointed investigators with a focus on privacy, medical ethical committee, experimental log books, data organization and back-up, and the guidelines in the quality manual guidelines most directly relevant to the individual researcher. A total of 8 incidents of possible violations of scientific conduct or privacy protection were reported to the Quality officer, all of which have been handled through the appropriate channels (one incident required us to inform the Scientific Integrity officer (‘Ombudsman’). In their yearly self-evaluation, the quality committee has voiced some concern that EMGO + researchers may not be prepared for the new more strict guidelines for handling privacy-sensitive data that are being promulgated by the Data Protection Authority ( ‘College Bescherming Persoonsgegevens’). Adequate instruction, support and monitoring of researcher behavior in this area will be a major action point in 2013.

PhD Committee The PhD Committee consists of four senior investigators and one PhD student. They advise the directorate on matters concerning education, supervision and assessment of PhD students. The PhD committee is responsible for reviewing the ‘education and supervision agreement’ that is designed and signed at the beginning of each PhD project. This agreement lists the auxiliary courses as defined by EMGO+ and other selected courses that the student must complete alongside the PhD research project. The overall aim of the agreement is to ensure a course program that combines a general academic education with specialized training tailored Annual Report 2012 | EMGO+ | 36

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QUALITY CONTROL

to the individual PhD student and project requirements. Beyond its review and advice functions, the committee organizes the introduction of new PhDs into the institute and its committees and expertise, offers assistance when PhD students find themselves in a dispute with their supervisors, and directs and supports a ‘PhD student buddy system’ that links each new PhD student to a more experienced student in order to provide new students a way to get quickly introduced within the institute.

Methodological expertise centers Researchers in the Institute can request support by a number of crucial steps in the research process of which we highlight three elements here, data management, clinimetrics and statistical analysis. The main tasks and responsibilities of the central data management group within EMGO+ are: Data management consultancy to researchers and providing executive data management support when necessary in the areas of standardised data collection, data processing, data-handling, data cleaning, data-documentation and data-archiving.

Support with online survey research and online patient data collection by general practitioners, therapists, or nurses participating in research projects.

Data-entry and building face to face and telephone interviews.

Dedicated support for large (longitudinal) cohort studies within EMGO +.

The mission of the knowledge center Measurement Instruments is to optimize the quality of measurement in health science and medical research by consultations, education, and research. For this purpose, the center gives advice and cooperates with researchers from different fields of health science and medical research in searching for available measurement instruments, examining the quality of the available measurement instruments, choosing the most appropriate measurement instrument for a certain purpose, and designing and performing studies on measurement properties of measurement instruments. In 2012 more than 30 researchers visited the center for advice and over 100 researchers asked advice by e-mail or telephone. Several small grants were obtained to appoint a post doc fellow and junior researcher to further strengthen the center.

EMGO+ has a long standing expertise in advanced statistical data analysis, of which the EpidM master program, accredited by the Accreditation Organization of the Netherlands and Flanders (NVAO) is a prime example (www.epidm.nl ). Apart from the standard arsenal of epidemiological techniques, EMGO+ researchers are well versed in multilevel analysis, metaanalysis, genetic association analysis and mixed methods techniques. The latter are needed when addressing research questions that require a mix of quantitative and qualitative methods. For instance, quantitative methods can give insight in the frequency of a phenomenon, while qualitative methods can shed light on the way this phenomenon is experienced and impacts the life of people who encounter this phenomenon. Especially within the research program Quality of Care there is extensive experience with mixed methods of research, and this expertise is broadly shared with fellow EMGO + researchers.

Annual Report 2012 | EMGO+ | 37

Figure 5: Wordcloud of all international refereed EMGO+ articles in 2012

Annual Report 2012 | EMGO+ | 38

9

SCIENTIFIC OUTPUT

Publications or other forms of scientific output are considered EMGO + output if and only if the institute has been mentioned in the affiliations of one (or more) of the co-authors, and the coauthor was an EMGO+ researcher in the year of publication. Table 6 lists the number of refereed papers that were published in 2012 as well as other scientific output. The number has increased by about 100 over the tally in 2011 with only a minor increase in research fte (+7).

Although the bulk of the output is in the form of papers in scientific journals EMGO + researchers also produce many book chapters and professional publications in clinical practice oriented journals. Appendix 5 provides a full list of the 2012 EMGO + publications, ordered per program and by the main categories used in table 6 (i.e. refereed, non-refereed, book chapters, professional, general public).

Refereed articles Non-refereed articles Books and book chapters PhD-theses

440

411

632

786

851

953

0

52

130

157

17

18

77

69

50

131

82

110

29

36

51

52

42

61

Professional publications

117

78

76

75

110

164

Publications aimed at the general public

n/a

46

39

4

5

18

Refereed articles

117

110

128

139

218

205

12

37

15

3

2

Non-refereed articles Books and book chapters

18

7

3

15

4

17

PhD-theses

6

7

10

3

9

10

Professional publications

8

9

10

9

5

15

Publications aimed at the general public

n/a

6

2

1

2

2

Refereed articles

98

98

245

270

288

321

Non-refereed articles

13

56

42

7

7

Books and book chapters

23

29

22

62

38

57

PhD-theses

10

10

16

29

18

30

Professional publications

23

24

31

12

44

49

Publications aimed at the general public

n/a

10

7

0

0

3

Refereed articles

128

94

115

199

210

228

14

28

76

6

8

21

21

16

47

36

32

8

9

14

10

9

16

Professional publications

64

34

33

39

51

81

Publications aimed at the general public

n/a

24

25

3

3

11

Non-refereed articles Books and book chapters PhD-theses

Annual Report 2012 | EMGO+ | 39

9

SCIENTIFIC OUTPUT

Refereed articles

97

Non-refereed articles Books and book chapters PhD-theses

109

144

178

135

199

13

9

24

1

1

15

12

9

7

4

4

5

10

11

10

6

5

Professional publications

22

11

2

15

10

19

Publications aimed at the general public

n/a

6

5

0

0

2

Table 6 (SEP 5.3): EMGO+ scientific output in 2012 for the institute and per program

Table 6 also lists the number of PhD theses completed in 2012. In 2012, 182 PhD students were working on their PhD thesis within the institute, representing 131 research fte (see table 3). A total of 61 PhD theses were produced in 2012, the titles of which give a very good overview of the EMGO+ research output (see appendix 6)

2007

162,50

29

440

0

194

2008

176,16

36

411

52

193

2009

246,77

51

632

130

165

2010

285,03

52

786

157

210

2011

291,52

42

851

17

197

2012

298,93

61

953

18

292

Table 7/Figure 6: FTE total research staff, number of dissertations, refereed articles, non -refereed articles and other publications ( 1 Other publications are: [professional publications, publications aimed at the general public, and books and book chapters)

Annual Report 2012 | EMGO+ | 40

9

SCIENTIFIC OUTPUT

CWTS crown indicator In the Netherlands the research performance of all 8 medical faculties is externally benchmarked by the Center for Science and Technology Studies (CWTS; www.cwts.nl) of the University of Leiden. This CWTS analysis has a one year lag. According to the CWTS bibliometric analysis EMGO+ researchers co-authored 849 scientific publications in ISI indexed journals in 2011.

CWTS calculates for between faculties and between institutes comparisons a so-called crown indicator for which 1 represents world average. The 2011 + CWTS bibliometric analysis of research papers in peer1997-2010 1,72 reviewed international scientific journals reports a crown 1997-2011 1,73 indicator of 1.73 for EMGO+’s research (see table 8). This + reflects that the scientific impact of EMGO ’s research is Table 8: CWTS-crown indicator (trendanalysis 1997-2010 73% above world average in the scientific fields that and 1997-2011) + EMGO contributes to. All four research programs have a crown indicator well above 1.0.

Annual Report 2012 | EMGO+ | 41

Annual Report 2012 | EMGO+ | 42

10

EARNING CAPACITY

As shown in table 10 (next page) and figure 7 (below), the earning capacity of the EMGO + institute has increased from 2011 to over 21 million € but we did not reach the 2010 peak. Taken into account the increased constraints on Science funding in the current economic crisis this is not surprising.

Current external research funding is mostly from public organizations (‘2 e en 3e geldstroom’), with the bulk of funding coming from ZonMw/NWO (44%). The European Union is a second important source of EMGO + funding with nearly 4 million € newly acquired in 2012. A recent analysis by the VUmc has identified that, amongst the VUmc departments, the EMGO + departments have the highest hit rate in European Union funding. Appendix 7 lists all grants awarded to EMGO+ researchers in 2012.

Judging from the already obtained funding in the first half of 2013, future prospects are somewhat encouraging, but the anticipated ‘gap’ in European funding preceding Horizon 2020 in combination with the reduced ZonMw/NWO funding in the Top Sector plan do give cause for concern. For this reason, the directorate is intensifying the investment in building networks that may spawn public-private partnerships.

Figure 7: Past and current acquisition of research funds for the institute

Annual Report 2012 | EMGO+ | 43

10 2007

EARNING CAPACITY € 4.134.805

€ 6.816.592

€ 378.183

€ 11.329.580

2008

€ 3.564.580

€ 8.593.411

€ 404.109

€ 12.562.100

2009

€ 10.538.287

€ 8.582.927

€ 580.960

€ 19.702.174

2010

€ 18.815.942

€ 9.713.825

€ 437.078

€ 28.966.845

2011

€ 9.891.265

€ 7.423.260

€ 190.600

€ 17.505.125

2012

€ 14.726.635

€ 6.383.789

€ 350.000

€ 21.460.424

Of w ich European grants (Of (17,8%) which European grants: €€ 3.823.929,00 3.823.929)

2007

€ 853.200

€ 2.758.700

€ 218.200

€ 3.830.100

2008

€ 587.000

€ 552.000

€ 550.000

€ 1.689.000

2009

€ 3.829.800

€ 737.800

€ 447.400

€ 5.015.000

2010

€ 3.716.977

€ 2.200.517

€ 169.953

€ 6.087.447

2011

€ 1.150.369

€ 1.541.115

€ 32.500

€ 2.723.984

2012

€ 2.277.395

€ 1.001.199

€ 1.500

€ 3.280.094

2007

€ 541.500

€ 712.200

€ 160.000

€ 1.413.700

2008

€ 539.500

€ 5.186.500

€ 330.000

€ 6.056.000

2009

€ 2.976.000

€ 2.872.900

€0

€ 5.848.900

2010

€ 7.892.491

€ 3.399.377

€1

€ 11.291.869

2011

€ 5.147.627

€ 2.060.524

€ 158.100

€ 7.366.251

2012

€ 2.994.078

€ 3.170.810

€ 125.000

€ 6.289.888

2007

€ 1.974.500

€ 1.947.800

€0

€ 3.922.300

2008

€ 43.700

€ 2.869.400

€0

€ 2.913.100

2009

€ 3.720.000

€ 3.045.000

€ 95.000

€ 6.860.000

2010

€ 4.489.200

€ 1.796.925

€ 267.121

€ 6.553.246

2011

€ 2.271.571

€ 2.765.767

€0

€ 5.037.338

2012

€ 7.806.707

€ 1.846.428

€ 220.860

€ 9.873.995

2007

€ 765.600

€ 1.397.900

€0

€ 2.163.500

2008

€ 414.400

€ 1.489.600

€0

€ 1.904.000

2009

€ 12.500

€ 1.927.200

€ 38.600

€ 1.978.300

2010

€ 2.717.274

€ 2.317.006

€3

€ 5.034.283

2011

€ 1.321.698

€ 1.055.854

€0

€ 2.377.552

2012

€ 1.648.455

€ 365.351,91

€ 2.640

€ 2.016.447

Table 10: Past and current acquisition of research funds for the institute and per program

Annual Report 2012 | EMGO+ | 44

11

ACADEMIC REPUTATION

EMGO+ was externally evaluated in 2010. The institute as well as its four research programs were rated as excellent. In its evaluation report, the committee was very positive about the Institute’s viability and future perspectives. This external evaluation covered the 2004-2009 period. As can be judged from tables 6 and 10, EMGO +’s output in terms of publications, PhD theses, and acquired research grants was relatively more increased from 2009 to 2012 than could simply be accounted for by the increase in research ftes.

The excellent reputation of EMGO+ researchers is further illustrated by the many lectures given at scientific meetings (appendix 8), the awards and honors they obtained in 2012 (appendix 9) as well as their prominence in the organization of conferences (appendix 10) and their gate keeping positions as grant reviewers, (associate) editors of international journals or executive board/committee members of academic societies (appendix 11A and appendix 11B).

Annual Report 2012 | EMGO+ | 45

Figure 8: Media attention to EMGO+ research in 2012

Annual Report 2012 | EMGO+ | 46

12

SOCIETAL IMPACT

Societal impact EMGO+ aims to produce excellent scientific research, but we really only fulfill our potential when that research benefits society at large. Striving for societal impact not only justifies our use of public funds, but also provides focus for our research projects and direction for the institute’s policy. We use the indicators proposed by the Dutch Health Council to evaluate and monitor of societal impact of our research. In 2012 EMGO + researchers contributed to 18 clinical guidelines on various topics, reflected in the form of co-authorships. These guidelines contribute to evidence based practice and thus represent an important aspect of the societal impact of our research. A detailed list of these clinical guidelines can be found in appendix 12.

In 2012, EMGO+ staff members were involved as (co)authors of 24 health policy reports on a great variety of topics. For an overview of these policy reports, please refer to appendix 13.

In addition to the clinical guidelines and health policy reports, there are articles in national professional journals, articles written for the general public and (chapters in) handbooks that we consider contributing to the societal impact of our research. These products are included in appendix 5, in particular under the headings professional and popular publications.

In 2012, the results of EMGO+ research projects attracted substantial attention from the media (see appendix 14). Members of our staff were interviewed on television more than 37 times, and 21 interviews on national public radio were broadcasted. Interviews and articles about research projects and their results were published locally or nationally in more than 135 newspapers and 66 magazines and newsletters and on at least 120 different websites on the internet. (see figure 8 and 9) The internet is arguably the most important source of health information. Therefore, websites can be highly relevant for measuring the societal impact of EMGO+’s research. EMGO+ maintains a Figure 9: EMGO+ researchers on television in 2012 number of own websites, in [photos: RTLXL, uitzendinggemist] part conveying general information, in part explaining the rationale and/or the results of our ongoing research and research collaborations. The list of our most important websites is given in appendix 15, with the websites divided into three categories: health information, research projects, and research Annual Report 2012 | EMGO+ | 47

12

SOCIETAL IMPACT

collaborations. A further indicator of societal impact is the many invitations EMGO + staff receives to deliver lectures to health care professionals, policy makers and non professionals.

Topics covered in these presentations can be gleaned from appendix 16, which provides an overview of the 2012 lectures for various non-scientific audiences.

Members of our staff are frequently involved in teaching programs based on the results of EMGO+ research projects. We have a major contribution to the regular curriculum of the bachelor and master programs of medicine (VUmc), psychology & educational science (VU FPP) and health sciences (VU- FALW) as well as to the Master of Epidemiology. We also provide a substantial contribution to the ‘life long learning’ of healthcare professionals. Examples of EMGO + involvement in this post initial education are listed in appendix 17.

In order to have a true impact on the daily practice of extramural and transmural health care EMGO+ has established over the years a number of Research & Expertise Centers and the socalled Academic Collaborative Centers (‘Academische werkplaatsen’). The Research & Expertise Centers, listed in appendix 18, cover specific topics of applied research and develop and provide expertise relevant to health care practice, whereas the Academic Collaborative Centers provide direct links with daily practice. Table 11 lists the EMGO + Academic Collaborative Centers active in 2012. In these collaborative networks, research, education, policy and practice are brought together by direct collaboration between clinician, teachers, researchers and managers.

Child and Youth Health Care

Improve knowledge transfer between health policy, research and education in child and youth health care.

Municipal Health Services of Amsterdam, Holllands Noorden and ZaanstreekWaterland, and Youth Health Care Kennemerland

Healthcare Inspection (AWP Toezicht)

Build a scientific evidence base for health care inspection activities and to provide insight in the process and effects of inspection activities on health care.

Healthcare Inspection (IGZ), IBMG, NIVEL, IQ Healthcare

Insurance Medicine

Improve the quality of work disability assessments and developing and evaluating new return-to-work strategies and tools.

National Institute for Employee Benefits (UWV), AMC, UMCG

Occupational and Environmental Health Service VUAMD

Prevention of work-related complaints and disease, and effective return-to work intervention for those off work because of sickness. Improving work conditions, lifestyle and workers health.

VU University/VU University Medical Center, Academic Medical Department (AMD)

Table 11: EMGO+ Academic Collaborative Centers

Annual Report 2012 | EMGO+ | 48

12

SOCIETAL IMPACT

Occupational and Environmental Health Service KLM

Prevention of work-related complaints and disease, and effective return-to work intervention for those off work because of sickness. Improving work conditions, lifestyle and workers health.

KLM Health Services

Occupational and Environmental Health Service Tata Steel

Prevention of work-related complaints and disease, and effective return-to work intervention for those off work because of sickness. Improving work conditions, lifestyle and workers health.

Tata Steel

Network of Academic General Practices

Integrate scientific research, medical education, vocational training and innovation in general-practice care.

1) Huisartsen cooperatie Groot Zuid; 2) Stichting Amsterdamse Gezondheidscentra (SAG); 3) HOED Leonard Springer, Haarlem

University Network of Organizations for Elderly care (UNO)

Build a bridge between research and practice in long term elderly care, especially in nursing homes.

NIVEL, Clinical Neuropsychology VU University Amsterdam, UKON- Universitair Kennisnetwerk Ouderenzorg Nijmegen

Anxiety Disorders (AWA)

Establish the biological basis of anxiety and compulsion disorders, and co morbidity with somatic disorders to develop innovative interventions for patients treated for anxiety and compulsions disorders.

Department of Psychiatry, VU Medical Center, poliklinieken Angst- en dwangstoornissen GGZ inGeest

Care for the Intellectually Disabled

Develop academic research on de- s'Heerenloo Institution velopmental pathways, personalized treatment and quality of care for people with intellectual disabilities in the Institution.

Prezens

Provide evidence-based advice and support in case of sadness, anxiety, stress and other psychological symptoms.

GGZ inGeest

Funding for the research done within the academic collaborative centers for a large part comes from the societal stakeholders (e.g. companies, services, institutions) so these activities directly qualify as valorization. Economic product-based valorization of research, for instance in public-private partnerships, has not yet been strongly developed in the EMGO +, although a few partnerships (e.g. GeriMedica, www.gerimedica.nl) have been established that can serve as models for future developments.

Annual Report 2012 | EMGO+ | 49

EMGO Institute for Health and Care Research VU University Medical Center Van der Boechorststraat 7 1081 BT Amsterdam

Phone

+31 (0)20 444 8180

Email

secretariaat.emgo@vumc.nl

Website

www.emgo.nl