On gonads and reproductive behaviour in the cichlid fish <i>Aequidens portalegrensis</i> (Hensel)

In this paper on the cichlid fish Aequidensp ortalegrensis,in formation is given on 1) the anatomy and histology of the gonads, 2) the functional anatomy of the accessory organs, 3) the occurrence of cyclical changes in the gonads, 4) the mutual behaviour of male and female under different conditions, 5) the temporal pattern of spawning, and 6) periodic changes in responsiveness of reproductive behaviour patterns to adequate external stimulation, in an attempt to contribute to a picture of the mechanism of reproduction in this species. Zie: Summar

Cost of Illness in the Netherlands: description, comparison and projection

Over the past decades health economics has emerged as a new scientific discipline. From the very beginning the field has continued to expand and take on increasing significance. An important focus is on the economic evaluation of health care facilities withln the area of Medical Technology Assessment (MTA) or Health Technology Assessment (HTA). Other topics studied by health economists regard among others the demand for care, the role of health insurance, the industrial organisation of the health care sector and the international comparison of health care systems. Cost-of-illness (COI) studies have also attracted the attention of health economists. Since the pioneering work of Dorothy Rice in the United States in the Sixties [Rice 1966], co

Why does healthcare utilisation differ between socioeconomic groups in OECD countries with universal healthcare coverage?:A protocol for a systematic review

Introduction: Even in advanced economies with universal healthcare coverage (UHC), a social gradient in healthcare utilisation has been reported. Many individual, community and healthcare system factors have been considered that may be associated with the variation in healthcare utilisation between socioeconomic groups. Nevertheless, relatively little is known about the complex interaction and relative contribution of these factors to socioeconomic differences in healthcare utilisation. In order to improve understanding of why utilisation patterns differ by socioeconomic status (SES), the proposed systematic review will explore the main mechanisms that have been examined in quantitative research. Methods and analysis: The systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and will be conducted in Embase, PubMed, Scopus, Web of Science, Econlit and PsycInfo. Articles examining factors associated with the differences in primary and specialised healthcare utilisation between socioeconomic groups in Organisation for Economic Co-operation and Development (OECD) countries with UHC will be included. Further restrictions concern specifications of outcome measures, factors of interest, study design, population, language and type of publication. Data will be numerically summarised, narratively synthesised and thematically discussed. The factors will be categorised according to existing frameworks for barriers to healthcare access

Jonge ouderen: last of lust? Kathrin Komp. The young old in Europe – Burden on or resource to the welfare state?

bespreking proefschrift Kathrin Komp. The young old in Europe – Burden on or resource to the welfare state

Gezondheidseconomie van de vergrijzing

bespreking recent onderzoek Tranzo is het wetenschappelijk centrum voor zorg en welzijn van Tilburg University. Binnen Tranzo werken mensen uit wetenschap, beleid en praktijk samen in onderzoeksprogramma’s op alle terreinen van zorg en welzijn. Rondom de door het RIVM ingestelde leerstoel ‘economische aspecten van gezondheid en zorg’ (Johan Polder) onderzoeken enkele promovendi de kosten van de gezondheidszorg vanuit het perspectief van de grote demografische en epidemiologische veranderingen die zich aan het voltrekken zijn.

Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65+

Abstract Background: Long-term care is often associated with high health care expenditures. In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. The development of risk profiles will not only be useful for projecting future demand, but also for providing clues that may prevent or delay long-term care utilization. Here, we report our identification of predictors of long-term care utilization in a cohort of hospital patients aged 65+ following their discharge from hospital discharge and who, prior to hospital admission, were living at home. Methods: The data were obtained from three national databases in the Netherlands: the national hospital discharge register, the long-term care expenses register and the population register. Multinomial logistic regression was applied to determine which variables were the best predictors of long-term care utilization. The model included demographic characteristics and several medical diagnoses. The outcome variables were discharge to home with no formal care (reference category), discharge to home with home care, admission to a nursing home and admission to a home for the elderly. Results: The study cohort consisted of 262,439 hospitalized patients. A higher age, longer stay in the hospital and absence of a spouse were found to be associated with a higher risk of all three types of long-term care. Individuals with a child had a lower risk of requiring residential care. Cerebrovascular diseases [relative risk ratio (RRR) = 11.5] were the strongest disease predictor of nursing home admission, and fractures of the ankle or lower leg (RRR = 6.1) were strong determinants of admission to a home for the elderly. Lung cancer (RRR = 4.9) was the strongest determinant of discharge to the home with home care. Conclusions: These results emphasize the impact of age, absence/presence of a spouse and disease on long-term care utilization. In an era of demographic and epidemiological changes, not only will hospital use change, but also the need for long-term care following hospital discharge. The results of this study can be used by policy-makers for planning health care utilization services and anticipating future health care needs. Background In countries all over the world, the health sector faces the challenge of an ageing population. It is expected that the prevalence of chronic diseases will rise, and thus the number of people in need of long-term care. This global development will have a significant effect on health care services in terms of capacity, planning and costs. The World Health Organization (WHO) defines long-ter

Sharp upturn of life expectancy in the Netherlands: effect of more health care for the elderly?

During the 1980s and 1990s life expectancy at birth has risen only slowly in the Netherlands. In 2002, however, the rise in life expectancy suddenly accelerated. We studied the possible causes of this remarkable development. Mortality data by age, gender and cause of death were analyzed using life table methods and age-period-cohort modeling. Trends in determinants of mortality (including health care delivery) were compared with trends in mortality. Two-thirds of the increase in life expectancy at birth since 2002 were due to declines in mortality among those aged 65 and over. Declines in mortality reflected a period rather than a cohort effect, and were seen for a wide range of causes of death. Favorable changes in mortality determinants coinciding with the acceleration of mortality decline were mainly seen within the health care system. Health care expenditure rose rapidly after 2001, and was accompanied by a sharp rise of specialist visits, drug prescriptions, hospital admissions and surgical procedures among the elderly. A decline of deaths following non-treatment decisions suggests a change towards more active treatment of elderly patients. Our findings are consistent with the idea that the sharp upturn of life expectancy in the Netherlands was at least partly due to a sharp increase in health care for the elderly, and has been facilitated by a relaxation of budgetary constraints in the health care system