Childhood Characteristics of Adolescent Inpatients with Early-Onset and Adolescent-Onset Disruptive Behavior

Childhood characteristics are associated with life-course-persistent antisocial behavior in epidemiological studies in general population samples. The present study examines this association in an inpatient sample. The purpose is to identify easily measurable childhood characteristics that may guide choice of treatment for adolescent psychiatric inpatients with severe disruptive behavior. Patients (N = 203) were divided into two groups with either early-onset (EO) or adolescent-onset (AO) disruptive behavior, based on ages at which professional care was used for disruptive behavior, referral to special education, and criminal offences. Both groups differed on several childhood characteristics. No gender differences in these characteristics were found. Logistic regression analysis indicated that individuals with grade retention in primary school, childhood impulsive behavior, and a history of physical abuse, had the highest probability of being member of the EO group. These characteristics are reasonably easy to identify, likely apply to other clinical samples as well, and may help clinicians to target their treatment

Comparing Pandemic to Seasonal Influenza Mortality: Moderate Impact Overall but High Mortality in Young Children

Background: We assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality. Methods and Findings: We used data on all-cause mortality (1999-2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266-958) influenza-attributed deaths; for seasonal influen

Validity and Reliability of the Strengths and Difficulties Questionnaire in 5–6 Year Olds: Differences by Gender or by Parental Education?

Introduction: The Strengths and Difficulties Questionnaire (SDQ) is a relatively short instrument developed to detect psychosocial problems in children aged 3-16 years. It addresses four dimensions: emotional problems, conduct problems, hyperactivity/inattention problems, peer problems that count up to the total difficulties score, and a fifth dimension; prosocial behaviour. The validity and reliability of the SDQ has not been fully investigated in younger age groups. Therefore, this study assesses the validity and reliability of the parent and teacher versions of the SDQ in children aged 5-6 years in the total sample, and in subgroups according to child gender and parental education level. Methods: The SDQ was administered as part of the Dutch regularly provided preventive health check for children aged 5-6 years. Parents provided information on 4750 children and teachers on 4516 children. Results: Factor analyses of the parent and teacher SDQ confirmed that the original five scales were present (parent RMSEA = 0.05; teacher RMSEA = 0.07). Interrater correlations between parents and teachers were small (ICCs of 0.21-0.44) but comparable to what is generally found for psychosocial problem assessments in children. These correlations were larger for males than for females. Cronbach's alphas for the total difficulties score were 0.77 for the parent SDQ and 0.81 for the teacher SDQ. Four of the subscales on the parent SDQ and two of the subscales on the teacher SDQ had an alpha <0.70. Alphas were generally higher for male children and for low parental education level. Discussion: The validity and reliability of the total difficulties score of the parent and teacher SDQ are satisfactory in all groups by informant, child gender, and parental education level. Our results support the use of the SDQ in younger age groups. However, some subscales are less reliable and we recommend only to use the total difficulties score for screening purposes

How important is income in explaining individuals having forgone healthcare due to cost-sharing payments?: Results from a mixed methods sequential explanatory study

BACKGROUND: Patients having forgone healthcare because of the costs involved has become more prevalent in recent years. Certain patient characteristics, such as income, are known to be associated with a stronger demand-response to cost-sharing. In this study, we first assess the relative importance of patient characteristics with regard to having forgone healthcare due to cost-sharing payments, and then employ qualitative methods in order to understand these findings better. METHODS: Survey data was collected from a Dutch panel of regular users of healthcare. Logistic regression models and dominance analyses were performed to assess the relative importance of patient characteristics, i.e., personal characteristics, health, educational level, sense of mastery and financial situation. Semi-structured interviews (n = 5) were conducted with those who had forgone healthcare. The verbatim transcribed interviews were thematically analyzed. RESULTS: Of the 7,339 respondents who completed the questionnaire, 1,048 respondents (14.3%) had forgone healthcare because of the deductible requirement. The regression model indicated that having a higher income reduced the odds of having forgone recommended healthcare due to the deductible (odds ratios of higher income categories relative to the lowest income category (reference): 0.29-0.49). However, dominance analyses revealed that financial leeway was more important than income: financial leeway contributed the most (34.8%) to the model's overall McFadden's pseudo-R2 (i.e., 0.123), followed by income (25.6%). Similar results were observed in stratified models and in population weighted models. Qualitative analyses distinguished four main themes that affected the patient's decision whether to use healthcare: financial barriers, structural barriers related to the complex design of cost-sharing programs, individual considerations of the patient, and the perceived lack of control regarding treatment choices within a given treatment trajectory. Furthermore, "having forgone healthcare" seemed to have a negative connotation. CONCLUSION: Our findings show that financial leeway is more important than income with respect to having forgone recommended healthcare due to cost-sharing payments, and that other factors such as the perceived necessity of healthcare also matter. Our findings imply that solely adapting cost-sharing programs to income levels will only get one so far. Our study underlines the need for a broader perspective in the design of cost-sharing programs

The Transmural Trauma Care Model can be implemented well but some barriers and facilitators should be considered during implementation: a mixed methods study

Questions: What is the reach, dose delivered, dose received and fidelity of the Transmural Trauma Care Model (TTCM)? What are the barriers and facilitators associated with the implementation of the TTCM? Design: Mixed-methods process evaluation with quantitative evaluation of the extent to which the TTCM was implemented as intended and qualitative evaluation of barriers and facilitators to its implementation. Participants: Focus group participants included trauma patients, trauma surgeons, hospital-based physiotherapists and primary care network physiotherapists. Outcome measures: Implementation was assessed with reach, dose delivered, dose received and fidelity. Data analysis: A framework method was used to analyse the focus groups and the ‘constellation approach’ was used to categorise barriers and facilitators into three categories: structure, culture and practice. Results: The TTCM's reach was 81%, its dose delivered was 99% and 100%, and its dose received was 95% and 96% for the multidisciplinary TTCM consultation hours at the outpatient clinic for trauma patients and the primary care network physiotherapists, respectively. Various fidelity scores ranged from 66 to 93%. Numerous barriers and facilitators associated with the implementation of the TTCM were identified and categorised. Conclusion: This process evaluation showed that the TTCM was largely implemented as intended. Furthermore, various facilitators and barriers were identified that need to be considered when implementing the TTCM more widely. Differences were found among stakeholders but they were generally of the opinion that if the barriers were overcome, the quality of care and patient satisfaction were likely to improve significantly after implementing the TTCM. Registration: NTR5474

The Transmural Trauma Care Model can be implemented well but some barriers and facilitators should be considered during implementation: a mixed methods study

Questions: What is the reach, dose delivered, dose received and fidelity of the Transmural Trauma Care Model (TTCM)? What are the barriers and facilitators associated with the implementation of the TTCM? Design: Mixed-methods process evaluation with quantitative evaluation of the extent to which the TTCM was implemented as intended and qualitative evaluation of barriers and facilitators to its implementation. Participants: Focus group participants included trauma patients, trauma surgeons, hospital-based physiotherapists and primary care network physiotherapists. Outcome measures: Implementation was assessed with reach, dose delivered, dose received and fidelity. Data analysis: A framework method was used to analyse the focus groups and the ‘constellation approach’ was used to categorise barriers and facilitators into three categories: structure, culture and practice. Results: The TTCM's reach was 81%, its dose delivered was 99% and 100%, and its dose received was 95% and 96% for the multidisciplinary TTCM consultation hours at the outpatient clinic for trauma patients and the primary care network physiotherapists, respectively. Various fidelity scores ranged from 66 to 93%. Numerous barriers and facilitators associated with the implementation of the TTCM were identified and categorised. Conclusion: This process evaluation showed that the TTCM was largely implemented as intended. Furthermore, various facilitators and barriers were identified that need to be considered when implementing the TTCM more widely. Differences were found among stakeholders but they were generally of the opinion that if the barriers were overcome, the quality of care and patient satisfaction were likely to improve significantly after implementing the TTCM. Registration: NTR5474

Urethritis bij de man in de huisartsenpraktijk. Soa's vooral op jongere leeftijd

To estimate the incidence of urethritis in men in Dutch general practice, the applied diagnostic procedures in relation to existing guidelines, and the underlying causes. Descriptive. The incidence of urethritis in the period 1998-2007 was calculated from data received from 45 GP sentinel stations. The network of participating general practices is nationally representative of age, sex and geographical distribution, and of distribution between town and countryside. From 2004 to 2007 additional questionnaires for each patient were filled in by the general practitioner, and were analysed for applied diagnostics and final diagnosis. From 1998-2003 the incidence of urethritis increased from 17 to 25 per 10,000 men and decreased to 20 per 10,000 men in 2007. The highest incidence of urethritis was found in urban areas and in the 15-34 years age group. Penile discharge was reported in 82% of the men for whom a questionnaire was filled out. In 10% of the men without discharge the first voided urine sediment was assessed for the presence of leucocytes. Diagnostic tests were generally carried out on urethral smears and sometimes on urine samples. 10.5% of the men were not tested. In 76% of men both gonorrhoea and Chlamydia were tested and found to be positive in 11% and 28% respectively. The remaining cases (62%) were defined as non-specific urethritis, in which in the majority no microbiological pathogen was identified. Urethritis was more often caused by gonorrhoea and/or Chlamydia in younger men, while it was more often diagnosed as non-specific urethritis in older men. One third of men with urethritis who underwent laboratory tests had a Chlamydia or gonorrhoea infection. In the majority of cases no pathogen was identified. Compliance with the diagnostic guidelines for urethritis may be improved by more frequent testing of first voided urine sample

Course of pandemic influenza A(H1N1) 2009 virus infection in Dutch patients.

Contains fulltext : 110734.pdf (publisher's version ) (Open Access)The clinical dynamics of influenza A(H1N1) 2009 infections in 61 laboratory-confirmed Dutch cases were examined. An episode lasted a median of 7.5 days of which 2 days included fever. Respiratory symptoms resolved slowly, while systemic symptoms peaked early in the episode and disappeared quickly. Severity of each symptom was rated highest in the first few days. Furthermore, diarrhoea was negatively associated with viral load, but not with faecal excretion of influenza virus. Cases with comorbidities appeared to have higher viral loads than the cases without, suggesting a less effective immune response. These results complement information obtained through traditional surveillance.1 mei 201