Multimorbidity and comorbidity in the Dutch population - data from general practices

<p>Abstract</p> <p>Background</p> <p>Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities.</p> <p>Methods</p> <p>We used 7 years data (2002–2008) of a large Dutch representative network of general practices (212,902 patients). Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014) logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases.</p> <p>Results</p> <p>Multimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases.</p> <p>Conclusion</p> <p>Multimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical research and healthcare policy.</p

Usefulness of primary care electronic networks to assess the incidence of chlamydia, diagnosed by general practitioners

Background: Chlamydia is the most common curable sexually transmitted infection (STI) in the Netherlands. The majority of chlamydia diagnoses are made by general practitioners (GPs). Baseline data from primary care will facilitate the future evaluation of the ongoing large population-based screening in the Netherlands. The aim of this study was to assess the usefulness of electronic medical records for monitoring the incidence of chlamydia cases diagnosed in primary care in the Netherlands. Methods. In the electronic records of two regional and two national networks, we identified chlamydia diagnoses by means of ICPC codes (International Classification of Primary Care), laboratory results in free text and the prescription of antibiotics. The year of study was 2007 for the two regional networks and one national network, for the other national network the year of study was 2005. We calculated the incidence of diagnosed chlamydia cases per sex, age group and degree of urbanization. Results: A large diversity was observed in the way chlamydia episodes were coded in the four different GP networks and how easily information concerning chlamydia diagnoses could be extracted. The overall incidence ranged from 103.2/100,000 to 590.2/100,000. Differences were partly related to differences between patient populations. Nevertheless, we observed similar trends in the incidence of chlamydia diagnoses in all networks and findings were in line with earlier reports. Conclusions: Electronic patient records, originally intended for individual patient care in general practice, can be an additional source of data for monitoring chlamydia incidence in primary care and can be of use in assessing the future impact of population-based chlamydia screening programs. To increase the usefulness of data we recommend more efforts to standardize registration by (specific) ICPC code and laboratory results across the existing GP networks

Cytoarchitectural and metabolic adaptations in muscles with mitochondrial and cytosolic creatine kinase deficiencies

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External Validation of EPICON: A Grouping System for Estimating Morbidity Rates Using Electronic Medical Records

Objective: To externally validate EPICON, a Computerized system for grouping diagnoses from EMRs in general practice into episodes of care. These episodes can be used for estimating morbidity rates. Design: Comparative observational study. Measurements: Morbidity rates from an independent dataset, based on episode-oriented EMRs, were used as the gold standard. The EMRs in this dataset contained diagnoses which were manually grouped by GPs. The authors ungrouped these diagnoses and regrouped them automatically into episodes using EPICON. The authors then used these episodes to estimate morbidity rates that were compared to the gold standard. The differences between the two sets of morbidity rates were calculated and the authors analyzed large as well as structural differences to establish possible causes. Results: In general, the morbidity rates based on EPICON deviate only slightly from the gold standard. Out of 675 diagnoses, 36 (5%) were considered to be deviating diagnoses. The deviating diagnoses showed differences for two main reasons: "differences in rules between the two methods of episode construction" and "inadequate performance of EPICON." Conclusion: The EPICON system performs well for the large majority of the morbidity rates. We can therefore conclude that EPICON is useful for grouping episodes to estimate morbidity rates using EMRs from general practices. Morbidity rates of diseases with a broad range of symptoms should, however, be interpreted cautiously

Diamonds are for ever?: the welfare effects of national champions

Philips, Akzo Nobel, ING, Shell, ASML, Heineken en Ahold - Nederland heeft flink wat kampioenen in huis, maar de Nederlandse overheid voert geen expliciet nationale kampioenenbeleid, zoals bijvoorbeeld de Duitsers en Fransen dat wel doen. Frankrijk heeft recent zelfs nieuw beleid geformuleerd onder de noemer ‘economisch patriottisme’. Het Franse argument is simpel : « Il y a un patriotisme économique parce qu'il y a une guerre économique ». Doet Nederland er economisch gezien verstandig aan om het Franse voorbeeld te volgen? SEO Economisch onderzoek onderzocht samen met PwC voor het ministerie van Economische Zaken of nationale kampioenenbeleid effectief is en zo ja, of het efficiënt is Overheden die actief kampioenenbeleid voeren, gaan ervan uit dat dit beleid goed voor de economie is. Net als met elk overheidsingrijpen ligt de bewijslast bij de overheid, die het beleid moet kunnen rechtvaardigen door het welvaartsverhogende effect ervan aan te tonen. In ons onderzoek hebben wij geen bewijs gevonden dat nationale kampioenenbeleid in het algemeen inderdaad effectief en efficiënt is. Kampioenenbeleid kan marktuitkomsten alleen dan verbeteren als het gericht is op het corrigeren van marktfalens (op bijv. de kapitaalmarkt waar te weinig geld beschikbaar is voor ‘infant industries’) of op het flexibeler maken van de arbeidsmarkt

LMM analysis results for news-related attentional measures.

<p>LMM analysis results for news-related attentional measures.</p

Predicting an accelerated lung function decline in smokers: is there a proper threshold?

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