Evaluation of community-wide interventions: The ecologic case-referent study design

In a setting of long-standing, community-wide and generally accepted prevention activities like youth health care services in The Netherlands, evaluative research in the form of experimental studies is hardly possible. Furthermore, as most interventions will bear fruit only after several years and the effects are often described in rather vague terms, even nonexperimental study designs are fraught with possible difficulties. Although a study design using aggregate data is generally considered inferior or 'incomplete', in many cases, especially in health services research, this approach can be the only one feasible to evaluate the effectiveness of preventive programmes and interventions. In this article we present the ecologic case-referent design as a potentially expedient and valid method for estimating the ecologic effect of a population-wide intervention on the outcome rate in those populations. In this case-referent design, many variables are measured at the individual level, whereas the main exposure variable is measured at an aggregate or ecologic level. Using recently published studies as an example, the advantages and drawbacks of the design are discussed using the randomised controlled trial design as the referent study design

Adolescents' use of care for behavioral and emotional problems: Types, trends, and determinants

Objective: While adolescents use various types of care for behavioral and emotional problems, evidence on age trends and determinants per type is scarce. We aimed to assess use of care by adolescents because of behavioral and emotional problems, overall and by type, and its determinants, for ages 10-19 years. Methods: We obtained longitudinal data on 2,230 adolescents during ages 10-19 from four measurements regarding use of general care and specialized care (youth social care and mental healthcare) in the preceding 6 months, the Child Behavior Checklist (CBCL) and Youth Self-Report, and child and family characteristics. We analyzed data by multilevel logistic regression. Results: Overall rates of use increased from 20.1% at age 10/11 to 32.2% at age 19: general care was used most. At age 10/11 use was higher among boys, at age 19 among girls. Use of general care increased for both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change was associated with CBCL externalizing and internalizing problems, school problems, family socioeconomic status, and parental divorce. Preceding CBCL problems predicted more use: most for mental health care and least for general care. Moreover, general care was used more frequently by low and medium socioeconomic status families, with odds ratios (95%-confidence intervals): 1.52 (1.23;1.88) and 1.40 (1.17;1.67); youth social care in case of parental divorce, 2.07 (1.36;3.17); and of special education, 2.66 (1.78;3.95); and mental healthcare in case of special education, 2.66 (1.60;4.51). Discussion: Adolescents with behavioral and emotional problems use general care most frequently. Overall use increases with age. Determinants of use vary per type

A structured registration program can be validly used for quality assessment in general practice

ABSTRACT: BACKGROUND: Patient information, medical history, clinical outcomes and demographic information, can be registered in different ways in registration programs. For evaluation of diabetes care, data can easily be extracted from a structured registration program (SRP). The usability of data from this source depends on the agreement of this data with that of the usual data registration in the electronic medical record (EMR). Aim of the study was to determine the comparability of data from an EMR and from an SRP, to determine whether the use of SRP data for quality assessment is justified in general practice. METHODS: We obtained 196 records of diabetes mellitus patients in a sample of general practices in the Netherlands. We compared the agreement between the two programs in terms of laboratory and non-laboratory parameters. Agreement was determined by defining accordance between the programs in absent and present registrations, accordance between values of registrations, and whether the differences found in values were also a clinically relevant difference. RESULTS: No differences were found in the occurrence of registration (absent/present) in the SRP and EMR for all the laboratory parameters. Smoking behaviour, weight and eye examination were registered significantly more often in the SRP than in the EMR. In the EMR, blood pressure was registered significantly more often than in the SRP. Data registered in the EMR and in the SRP had a similar clinical meaning for all parameters (laboratory and non-laboratory). CONCLUSIONS: Laboratory parameters showed good agreement and non-laboratory acceptable agreement of the SRP with the EMR. Data from a structured registration program can be used validly for research purposes and quality assessment in general practice

Migrant children within Europe: a systematic review of children’s perspectives on their health experiences

Objectives: To review the extant literature in order to explore what is known about children’s own perspectives on the ir health experiences , focusing upon children and young people who have migrated into, and within, Europe. Study Design: A systematic review with narrative synthesis. Methods: A review of English language articles was performed in June 2016 using the following databases: Medline, CINAHL, Coc hrane and Web of Science. Included papers had to report data generated directly with children, up to 18 years of age, who had migrated across national borders into, or within, Europe during their own lifetimes. Extraction from articles was undertaken by a ll authors and quality assessment of included reviews was performed using the Mixed Methods Appraisal Tool ( MMAT ) . Results: The articles in the final dataset included research based on 4 broad areas: alcohol, smoking and substance use; diet, eating disorde rs and overweight; emotional, psychological and mental health issues and; children’s views and experiences of health and health services. The majority of studies were cross - sectional analytic or incidence or prevalence studies. Conclusion: There is a gene ral lack of clarity in the literature regarding the reporting of children’s own migration status. Children’s voices are often subsumed within those of their adult parents or carers. There is a need to promote more child - focussed research which gives voice to migrant children to better understand the complex and multidimensional factors that contribute to their (ill) health

Broken home or drug using peers: 'significant relations'?

This study reports the results of a comparative survey with representative samples of 3,386 school attending youths, most of whom were 15 years of age and residing in five European cities. We found significant but low correlations between the type of family structure (intact family, model family, dual career housefhold, single mother) and five forms of deviant behavior (tobacco smoking, cannabis use, delinquency, general drug use and a composite risk behavior scale). These correlations will be displaced by very high correlations with the level of drug using friends/peers. A number of differences were found between the youth from differeent cities in relation to these concerns. Results indicate differences among the cities in terms of the youths' relationships with drug use/deviance/risky behavior and family structure, gender role, and peer group behavior. This suggests that the cultural meanings associated with family, gender role, peer group, and risk behavior influence deviant outcomes

Structured primary care for type 2 diabetes has positive effects on clinical outcomes

Background Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved