The burden of varicella from a parent's perspective and its societal impact in The Netherlands: an Internet survey

<p>Abstract</p> <p>Background</p> <p>Varicella is a common childhood disease. Only 5% of first varicella-zoster-virus infections occur asymptomatically. Most data on the burden of varicella stem from health service databases. This study aims to provide insight in the burden of varicella from a parent's perspective including cases outside the healthcare system.</p> <p>Methods</p> <p>An internet questionnaire was developed for parents in the Netherlands to report health care resource use and productivity losses during the varicella episode in their child younger than 6 years. 11,367 invitations were sent out to members with children of an internet panel of a market research agency. 4,168 (37%) parents started the questionnaire (response rate), of which 360 (9%) stopped before completion and 1,838 (44%) were out of the target group. In total 1,970 parents completed the questionnaire. The questionnaire provided a symptom list ranging from common symptoms, such as skin vesicles, itching to fits or convulsions. A posteriori, in the analyses, the symptoms 'skin infections', 'fits/convulsions', 'unconsciousness', and 'balance and movement disorders' were labelled as complications. There was no restriction to time since the varicella episode for inclusion in the analyses.</p> <p>Results</p> <p>The 1,970 respondents had in total 2,899 children aged younger than six years, of which 2,564 (88%) children had had varicella. In 62% of the episodes the parent did not seek medical help. In 18% of all episodes symptoms labelled as complications were reported; in 11% of all episodes parents visited a medical doctor (MD) for a complication. Reporting of complications did not differ (X²; p = 0.964) between children with a recent (≤ 12 months ago) or a more distant (> 12 months) history of varicella. Prescription drugs were used in 12% of the children with varicella; OTC drugs in 72%. Parents reported work loss in 17% of the varicella-episodes (23% when MD visit; 14% when no MD-visit) for on average 14 hours, which equals to 2.5 hours of work loss for any given varicella-episode.</p> <p>Conclusions</p> <p>This study shows the full spectrum of varicella-episodes and associated healthcare use, including the large proportion of cases not seeking medical care and the societal impact associated with those cases.</p

Cause-specific mortality time series analysis: a general method to detect and correct for abrupt data production changes

<p>Abstract</p> <p>Background</p> <p>Monitoring the time course of mortality by cause is a key public health issue. However, several mortality data production changes may affect cause-specific time trends, thus altering the interpretation. This paper proposes a statistical method that detects abrupt changes ("jumps") and estimates correction factors that may be used for further analysis.</p> <p>Methods</p> <p>The method was applied to a subset of the AMIEHS (Avoidable Mortality in the European Union, toward better Indicators for the Effectiveness of Health Systems) project mortality database and considered for six European countries and 13 selected causes of deaths. For each country and cause of death, an automated jump detection method called Polydect was applied to the log mortality rate time series. The plausibility of a data production change associated with each detected jump was evaluated through literature search or feedback obtained from the national data producers.</p> <p>For each plausible jump position, the statistical significance of the between-age and between-gender jump amplitude heterogeneity was evaluated by means of a generalized additive regression model, and correction factors were deduced from the results.</p> <p>Results</p> <p>Forty-nine jumps were detected by the Polydect method from 1970 to 2005. Most of the detected jumps were found to be plausible. The age- and gender-specific amplitudes of the jumps were estimated when they were statistically heterogeneous, and they showed greater by-age heterogeneity than by-gender heterogeneity.</p> <p>Conclusion</p> <p>The method presented in this paper was successfully applied to a large set of causes of death and countries. The method appears to be an alternative to bridge coding methods when the latter are not systematically implemented because they are time- and resource-consuming.</p

Burden of acute otitis media in primary care pediatrics in Italy: A secondary data analysis from the Pedianet database

Background: The incidence of acute otitis media (AOM) vary from country to country. Geographical variations together with differences in study designs, reporting and settings play a role. We assessed the incidence of AOM in Italian children seen by primary care paediatricians (PCPs), and described the methods used to diagnose the disease.Methods: This secondary data analysis from the Pedianet database considered children aged 0 - 6 years between 01/2003 and 12/2007. The AOM episodes were identified and validated by means of patient diaries. Incidence rates/100 person-years (PY) were calculated for total AOM and for single or recurrent AOM.Results: The 92,373 children (52.1% males) were followed up for a total of 227,361 PY: 23,039 (24.9%) presented 38,241 episodes of AOM (94.6% single episodes and 5.4% recurrent episodes). The total incidence rate of AOM in the 5-year period was 16.8 episodes per 100 PY (95% CI: 16.7-16.9), including single AOM (15.9 episodes per 100 PY; 95% CI: 15.7-16.1) and recurrent AOM (0.9 episodes per 100 PY; 95% CI: 0.9-0.9). There was a slight and continuously negative trend decrease over time (annual percent change -4.6%; 95%CI: -5.3, -3.9%). The AOM incidence rate varied with age, peaking in children aged 3 to 4 years (22.2 episodes per 100 PY; 95% CI 21.8-22.7). The vast majority of the AOM episodes (36,842/38,241, 96.3%) were diagnosed using a static otoscope; a pneumatic otoscope was used in only 3.7%.Conclusions: Our data fill a gap in our knowledge of the incidence of AOM in Italy, and indicate that AOM represents a considerable burden for the Italian PCP system. Educational programmes concerning the diagnosis of AOM are needed, as are further studies to monitor the incidence in relation to the introduction of wider pneumococcal conjugate vaccines

Quality of Life in the National Public Health Compass. A disease-specific approach

De doelstelling van dit onderzoek is het beschrijven van de gezondheid-gerelateerde kwaliteit van leven bij 53 ziekten en aandoeningen ten behoeve van het Nationaal Kompas Volksgezondheid, een van de websites van de Volksgezondheid Toekomst Verkenning. Door middel van een literatuuronderzoek zijn per ziekte gegevens gezocht over kwaliteit van leven, zo mogelijk in relatie tot ziektekenmerken. De inventarisatie is beperkt tot generieke meetinstrumenten (met name de SF-36) afkomstig uit Nederlands onderzoek gepubliceerd in de periode 1990-2001. Voor 24 (45%) ziekten was het mogelijk om de kwaliteit van leven te beschrijven op basis van generieke meetinstrumenten. Voor 6 (11%) ziekten waren er alleen data beschikbaar op basis van ziektespecifieke instrumenten. Hier is volstaan met een verwijzing naar enkele kernpublicaties. Voor 23 (43%) ziekten was er geen informatie. Informatie over kwaliteit van leven van patienten kan in de toekomst verder aangevuld worden door nieuwe gegevens van omvangrijke bevolkingsstudies. Om de informatie over kwaliteit van leven beter toepasbaar te maken voor het beleid, zou meer informatie over ziektekenmerken gewenst zijn.The goal of the study was to describe the health related quality of life for 53 diseases for publication in the National Public Health Compass, one of the websites of the Public Health Status and Forecast. A literature search on the quality of life conducted for all 53 diseases was confined to generic instruments and to Dutch studies published in the period 1990-2001. The quality of life, based on generic instruments, could be described for 24 diseases (45%). In the case of 6 diseases (11%), the only avalaible information was based on disease-specific instruments. For these diseases, only a reference was made to key publications. For 23 diseases, no information was found. In the future, additional information on quality of life for many diseases will be obtainable from new longitudinal studies. As far as applications for health policy are concerned, it would seem advisable to collect more data on disease characteristics related to quality of life.VW

Quality of Life in the 'Public Health Status and Forecast': A pilot study on eight diseases

The Public Health Status and Forecast (PHSF) describes the health status of the Dutch population. Previous editions of the PHSF described diseases in terms of mortality, prevalence and incidence. This pilot-study was conducted to investigate if there is also adequate information available in The Netherlands on health-related quality of life for diseases, and if this can be compared among diseases. This pilot study made use of a literature search on eight selected diseases to find information on generic quality of life and, where available, on patient characteristics, disease characteristics and health care factors. For breast cancer, visual impairments, osteoarthritis, and traffic accidents, the information was very limited. For the remaining half of the selected diseases (anxiety disorders, stroke, COPD/astma, diabetes) it was possible to describe the quality of life. Data on patient characteristics (age, education) were also available, but information on disease characteristics (severity) and health care factors was often lacking. In conclusion, the currently available information on quality of life can be used to complete the descriptions of the diseases in the PHSF. This pilot study will be applied to other diseases, with data being published in the 'National Compass on Public Health'.De Volksgezondheid Toekomst Verkenning (VTV) beschrijft de gezondheidstoestand van de Nederlandse bevolking. In de tot nu toe verschenen VTV's zijn hiervoor per ziekte onder meer de indicatoren sterfte, prevalentie, incidentie en beloop beschreven. Dit rapport is een verslag van de haalbaarheidsstudie die is uitgevoerd om na te gaan of er in Nederland ook voldoende informatie beschikbaar is over de gezondheid-gerelateerde kwaliteit van leven per ziekte en of het mogelijk is een vergelijking tussen ziekten te maken. Voor de haalbaarheidsstudie zijn acht ziekten geselecteerd, waarvoor door middel van een literatuuronderzoek gegevens gezocht zijn over de generieke kwaliteit van leven, zo mogelijk naar pati6nt-, ziekte- en zorgkenmerken. Voor borstkanker, gezichts-stoornissen, artrose en verkeersongevallen was zeer weinig informatie beschikbaar. Voor de andere helft van de geselecteerde ziekten (angststoornissen, beroerte, COPD/astma en suikerziekte) was het redelijk goed mogelijk om de kwaliteit van leven te beschrijven. Hierbij waren gegevens over pati6ntkenmerken (leeftijd, opleiding, etc) aanwezig, maar informatie over kwaliteit van leven naar ziektekenmerken (o.a. ernst) en zorgkenmerken was beperkt. De conclusie is dat de huidig beschikbare gegevens over kwaliteit van leven gebruikt kunnen worden om de beschrijving van de ziekten in de VTV aan te vullen. De haalbaarheidsstudie zal daarom een vervolg krijgen voor de overige ziekten en de gegevens hiervan zullen opgenomen worden in het Nationaal Kompas Volksgezondheid