At the beginning of the twenty first century obesity entered Dutch maternity care as a ‘new illness’ challenging maternity care professionals in providing optimal care for women with higher BMI’s. International research revealed that obese women had more perinatal problems than normal weight women. However, the effect of higher BMIs on perinatal outcomes had never been studied in women eligible for midwife-led primary care at the outset of their pregnancy. In the context of the Dutch maternity care system, it was not clear if obesity should be treated as a high-risk situation always requiring obstetrician-led care or as a condition that may lead to problems that could be detected in a timely manner in midwife-led care using the usual risk assessment tools. With the increased attention on obesity in maternity care there was also increased interest in GWG. Regarding GWG in the Netherlands, the effect of insufficient or excessive GWG on perinatal outcomes had never been studied and there were no validated guidelines for GWG. A midwife’s care for the individual woman in the context of the Dutch maternity care system - characterised by ‘midwife-led care if possible, obstetrician-led care if needed’ - is hampered by the lack of national multidisciplinary consensus regarding obesity and weight gain. Obesity has not yet been included in the OIL and local protocols contain varying recommendations. To enable sound clinical decisions and to offer optimal individual care for pregnant women in the Netherlands more insights in weight and weight gain in relation to perinatal outcomes are required. With this thesis the author intends to contribute to the body of knowledge on weight and weight gain to enhance optimal midwife-led primary care for the individual woman and to guide midwives’ clinical decision-making.
Objective: Product Information Leaflets (PILs) are an important source of information for patients on their medication, but may cause confusion and questions. Patients then may seek clarification, for instance from pharmacy technicians. The aim of this study was to explore which questions pharmacy technicians get about PIL-related issues, why and when, and how they handle such questions. Methods: an online survey in a panel of 785 Dutch pharmacy technicians. Key results: Net response rate was 37%. PIL-related questions frequently concerned drug actions, problems with use, side effects, intolerances and pregnancy and lactation. Patients who received generic alternatives instead of the branded product they had received previously, also came more often to pharmacy staff with PIL-related questions. The requested information could not always be found in the PIL itself, not even by the pharmacy technicians themselves. They mentioned that the PIL is not easy to read, understand or recall. Conclusions: Pharmacy staff is often approached by patients having difficulties in understanding PILs. Even pharmacy technicians find PILs difficult to read and often use other sources of information. PIL layout and contents should become more standardized and easier to read and understand.
