Estimating and comparing incidence and prevalence of chronic diseases by combining GP registry data: the role of uncertainty

Background: Estimates of disease incidence and prevalence are core indicators of public health. The manner in which these indicators stand out against each other provide guidance as to which diseases are most common and what health problems deserve priority. Our aim was to investigate how routinely collected data from different general practitioner registration networks (GPRNs) can be combined to estimate incidence and prevalence of chronic diseases and to explore the role of uncertainty when comparing diseases. Methods. Incidence and prevalence counts, specified by gender and age, of 18 chronic diseases from 5 GPRNs in the Netherlands from the year 2007 were used as input. Generalized linear mixed models were fitted with the GPRN identifier acting as random intercept, and age and gender as explanatory variables. Using predictions of the regression models we estimated the incidence and prevalence for 18 chronic diseases and calculated a stochastic ranking of diseases in terms of incidence and prevalence per 1,000. Results: Incidence was highest for coronary heart disease and prevalence was highest for diabetes if we looked at the point estimates. The between GPRN variance in general was higher for incidence than for prevalence. Since uncertainty intervals were wide for some diseases and overlapped, the ranking of diseases was subject to uncertainty. For incidence shifts in rank of up to twelve positions were observed. For prevalence, most diseases shifted maximally three or four places in rank. Conclusion: Estimates of incidence and prevalence can be obtained by combining data from GPRNs. Uncertainty in the estimates of absolute figures may lead to different rankings of diseases and, hence, should be taken into consideration when comparing disease incidences and prevalences

Fishery Discards: Factors Affecting Their Variability within a Demersal Trawl Fishery

Discards represent one of the most important issues within current commercial fishing. It occurs for a range of reasons and is influenced by an even more complex array of factors. We address this issue by examining the data collected within the Danish discard observer program and describe the factors that influence discarding within the Danish Kattegat demersal fleet over the period 1997 to 2008. Generalised additive models were used to assess how discards of the 3 main target species, Norway lobster, cod and plaice, and their subcomponents (under and over minimum landings size) are influenced by important factors and their potential relevance to management. Our results show that discards are influenced by a range of different factors that are different for each species and portion of discards. We argue that knowledge about the factors influential to discarding and their use in relation to potential mitigation measures are essential for future fisheries management strategies

Comparing Dutch Case management care models for people with dementia and their caregivers: The design of the COMPAS study

<p>Abstract</p> <p>Background</p> <p>Dementia care in the Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalised care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in the Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered.</p> <p>Design</p> <p>Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of the Netherlands with and without case management including a qualitative process evaluation. Inclusion criteria for the cohort study are: community-dwelling individuals with a dementia diagnosis who are not terminally-ill or anticipate admission to a nursing home within 6 months and with an informal caregiver who speaks fluent Dutch. Person with dementia-informal caregiver dyads are followed for two years. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Secondary outcomes include: quality of life and needs assessment in both persons with dementia and caregivers, activity of daily living, competence of care, and number of crises. Costs are measured from a societal perspective using cost diaries. Process indicators measure the quality of care from the participant’s perspective. The qualitative study uses purposive sampling methods to ensure a wide variation of respondents. Semi-structured interviews with stakeholders based on the theoretical model of adaptive implementation are planned.</p> <p>Discussion</p> <p>This study provides relevant insights into care processes, description of two case management models along with clinical and economic data from persons with dementia and caregivers to clarify important differences in two case management care models compared to usual care.</p

Thirty years of fleet dynamics modelling using discrete-choice models: what have we learned?

Anticipating fisher behaviour is necessary for successful fisheries management. Ofthe different concepts that have been developed to understand individual fisherbehaviour, random utility models (RUMs) have attracted considerable attention inthe past three decades, and more particularly so since the 2000s. This study aimedat summarizing and analysing the information gathered from RUMs used duringthe last three decades around the globe. A methodology has been developed tostandardize information across different studies and compare RUM results. Thestudies selected focused on fishing effort allocation. Six types of fisher behaviourdrivers were considered: the presence of other vessels in the same fishing area, tradition,expected revenue, species targeting, costs, and risk-taking. Analyses wereperformed using three separate linear modelling approaches to assess the extent towhich these different drivers impacted fisher behaviour in three fleet types: fleetsfishing for demersal species using active gears, fleets fishing for demersal speciesusing passive gears and fleets fishing for pelagic species. Fishers are attracted byhigher expected revenue, tradition, species targeting and presence of others, butavoid choices involving large costs. Results also suggest that fishers fishing fordemersal species using active gears are generally more influenced by past seasonal(long-term) patterns than by the most recent (short-term) information. Finally, thecomparison of expected revenue with other fisher behaviour drivers highlights thatdemersal fishing vessels are risk-averse and that tradition and species targetinginfluence fisher decisions more than expected revenue

Public health forecast for primary care in the Netherlands in 2020

This report concerns the future of primary health care in the Netherlands. With the year 2020 as time horizon, we present perspectives on demand, supply and the organization of primary care. How many caregivers will be needed, and what will the organization look like? The report offers a wealth of information about current and future primary care. Due to the many facts and figures, this report not only gives a forecast, it is also a useful reference work for everyone who is involved in primary health care. In the autumn of 2004, the Ministry of Public Health, Welfare and Sports and the parties in the field declared themselves in favor of a 'reinforcement of primary health care' as a common ambition. This study intends to provide a contribution to this goal. The report is the result of a joint project of the Netherlands Institute for Health Services Research (NIVEL) and the National Institute for Public Health and the Environment (RIVM), and it is part of the series of Public Health Status and Forecasting 2006.Dit themarapport gaat over de toekomst van de eerstelijnsgezondheidszorg in Nederland. Met het jaar 2020 als tijdshorizon worden verkenningen gepresenteerd over de zorgvraag, het zorgaanbod en de organisatie van de eerste lijn. Daarmee wordt zichtbaar welke zorgvragen in 2020 op de eerste lijn afkomen, hoeveel hulpverleners daarvoor nodig zijn en hoe de organisatie eruit kan zien. Mogelijke organisatieveranderingen worden steeds bezien vanuit de wetenschappelijke evidentie die er voor de effecten bestaat. Het rapport biedt een schat aan informatie over de huidige en toekomstige eerstelijnszorg. Door de vele feiten en cijfers is het rapport - behalve een toekomstverkenning - een nuttig naslagwerk voor allen die bij de eerstelijnszorg betrokken zijn. De veldpartijen en het Ministerie van VWS hebben zich in het najaar van 2004 uitgesproken voor 'versterking van de eerstelijnsgezondheidszorg' als een gezamenlijke ambitie. Deze studie beoogt daaraan een bijdrage te leveren. Dit rapport is het resultaat van een samenwerkingsproject van het NIVEL en het RIVM, en maakt deel uit van de reeks Volksgezondheid Toekomst Verkenningen 2006

Public health forecast for primary care in the Netherlands in 2020

Het rapport is verkrijgbaar bij Bohn, Stafleu en Van LoghumDit themarapport gaat over de toekomst van de eerstelijnsgezondheidszorg in Nederland. Met het jaar 2020 als tijdshorizon worden verkenningen gepresenteerd over de zorgvraag, het zorgaanbod en de organisatie van de eerste lijn. Daarmee wordt zichtbaar welke zorgvragen in 2020 op de eerste lijn afkomen, hoeveel hulpverleners daarvoor nodig zijn en hoe de organisatie eruit kan zien. Mogelijke organisatieveranderingen worden steeds bezien vanuit de wetenschappelijke evidentie die er voor de effecten bestaat. Het rapport biedt een schat aan informatie over de huidige en toekomstige eerstelijnszorg. Door de vele feiten en cijfers is het rapport - behalve een toekomstverkenning - een nuttig naslagwerk voor allen die bij de eerstelijnszorg betrokken zijn. De veldpartijen en het Ministerie van VWS hebben zich in het najaar van 2004 uitgesproken voor 'versterking van de eerstelijnsgezondheidszorg' als een gezamenlijke ambitie. Deze studie beoogt daaraan een bijdrage te leveren. Dit rapport is het resultaat van een samenwerkingsproject van het NIVEL en het RIVM, en maakt deel uit van de reeks Volksgezondheid Toekomst Verkenningen 2006.This report concerns the future of primary health care in the Netherlands. With the year 2020 as time horizon, we present perspectives on demand, supply and the organization of primary care. How many caregivers will be needed, and what will the organization look like? The report offers a wealth of information about current and future primary care. Due to the many facts and figures, this report not only gives a forecast, it is also a useful reference work for everyone who is involved in primary health care. In the autumn of 2004, the Ministry of Public Health, Welfare and Sports and the parties in the field declared themselves in favor of a 'reinforcement of primary health care' as a common ambition. This study intends to provide a contribution to this goal. The report is the result of a joint project of the Netherlands Institute for Health Services Research (NIVEL) and the National Institute for Public Health and the Environment (RIVM), and it is part of the series of Public Health Status and Forecasting 2006.VW

Op een lijn - Toekomstverkenning eerstelijnszorg 2020

Het rapport is verkrijgbaar bij Bohn, Stafleu en Van Loghum<br

The MSY concept in a multi-objective fisheries environment - Lessons from the North Sea

One of the most important goals in current fisheries management is to maintain or restore stocks above levels that can produce the maximum sustainable yield (MSY). However, it may not be feasible to achieve MSY simultaneously for multiple species because of trade-offs that result from interactions between species, mixed fisheries and the multiple objectives of stakeholders. The premise in this study is that MSY is a concept that needs adaptation, not wholesale replacement. The approach chosen to identify trade-offs and stakeholder preferences involved a process of consulting and discussing options with stakeholders as well as scenario modelling with bio-economic and multi-species models. It is difficult to intuitively anticipate the consequences of complex trade-offs and it is also complicated to address them from a political point of view. However, scenario modelling showed that the current approach of treating each stock separately and ignoring trade-offs may result in unacceptable ecosystem, economic or social effects in North Sea fisheries. Setting FMSY as a management target without any flexibility for compromises may lead to disappointment for some of the stakeholders. To treat FMSY no longer as a point estimate but rather as a “Pretty Good Yield” within sustainable ranges was seen as a promising way forward to avoid unacceptable outcomes when trying to fish all stocks simultaneously at FMSY. This study gives insights on how inclusive governance can help to reach consensus in difficult political processes, and how science can be used to make informed decisions inside a multi-dimensional trade-off space