Epidemiology of chronic pain in the Netherlands

Chronic pain is very common but good data are scarce about the prevalence, incidence, diagnosis, severity, treatment, utilization of health care, and the impact of chronic pain on society, health care systems and the patient. Information about the epidemiology of chronic pain can help decision and policy makers decide about health budgets and prioritization, patient segmenting and budget fencing, and therapy budgets, including behavioural therapy and drug budgets. This report aims to provide epidemiological information about chronic pain in the Netherlands using the most representative, recent, comprehensive and valid studies. Out of 16 619 retrieved titles and abstracts, we selected 155 studies from the Netherlands that were relevant to the project questions. From these, we selected at least three studies per question that provided the most recent, representative and valid data

PCSK9 inhibitors and ezetimibe with or without statin therapy for cardiovascular risk reduction: a systematic review and network meta-analysis.

OBJECTIVE To compare the impact of ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on cardiovascular outcomes in adults taking maximally tolerated statin therapy or who are statin intolerant. DESIGN Network meta-analysis. DATA SOURCES Medline, EMBASE, and Cochrane Library up to 31 December 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of ezetimibe and PCSK9 inhibitors with ≥500 patients and follow-up of ≥6 months. MAIN OUTCOME MEASURES We performed frequentist fixed-effects network meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) to assess certainty of evidence. Results included relative risks (RR) and absolute risks per 1000 patients treated for five years for non-fatal myocardial infarction (MI), non-fatal stroke, all-cause mortality, and cardiovascular mortality. We estimated absolute risk differences assuming constant RR (estimated from network meta-analysis) across different baseline therapies and cardiovascular risk thresholds; the PREDICT risk calculator estimated cardiovascular risk in primary and secondary prevention. Patients were categorised at low to very high cardiovascular risk. A guideline panel and systematic review authors established the minimal important differences (MID) of 12 per 1000 for MI and 10 per 1000 for stroke. RESULTS We identified 14 trials assessing ezetimibe and PCSK9 inhibitors among 83 660 adults using statins. Adding ezetimibe to statins reduced MI (RR 0.87 (95% confidence interval 0.80 to 0.94)) and stroke (RR 0.82 (0.71 to 0.96)) but not all-cause mortality (RR 0.99 (0.92 to 1.06)) or cardiovascular mortality (RR 0.97 (0.87 to 1.09)). Similarly, adding PCSK9 inhibitor to statins reduced MI (0.81 (0.76 to 0.87)) and stroke (0.74 (0.64 to 0.85)) but not all-cause (0.95 (0.87 to 1.03)) or cardiovascular mortality (0.95 (0.87 to 1.03)). Among adults with very high cardiovascular risk, adding PCSK9 inhibitor was likely to reduce MI (16 per 1000) and stroke (21 per 1000) (moderate to high certainty); whereas adding ezetimibe was likely to reduce stroke (14 per 1000), but the reduction of MI (11 per 1000) (moderate certainty) did not reach MID. Adding ezetimibe to PCSK9 inhibitor and statin may reduce stroke (11 per 1000), but the reduction of MI (9 per 1000) (low certainty) did not reach MID. Adding PCSK9 inhibitors to statins and ezetimibe may reduce MI (14 per 1000) and stroke (17 per 1000) (low certainty). Among adults with high cardiovascular risk, adding PCSK9 inhibitor probably reduced MI (12 per 1000) and stroke (16 per 1000) (moderate certainty); adding ezetimibe probably reduced stroke (11 per 1000), but the reduction in MI did not achieve MID (8 per 1000) (moderate certainty). Adding ezetimibe to PCSK9 inhibitor and statins did not reduce outcomes beyond MID, while adding PCSK9 inhibitor to ezetimibe and statins may reduce stroke (13 per 1000). These effects were consistent in statin-intolerant patients. Among moderate and low cardiovascular risk groups, adding PCSK9 inhibitor or ezetimibe to statins yielded little or no benefit for MI and stroke. CONCLUSIONS Ezetimibe or PCSK9 inhibitors may reduce non-fatal MI and stroke in adults at very high or high cardiovascular risk who are receiving maximally tolerated statin therapy or are statin-intolerant, but not in those with moderate and low cardiovascular risk

Can fruit and vegetable consumption oppose the negative health effects of tobacco?

Aging is associated with an increased risk of chronic diseases such as cancer and CVD. Smoking increases the risk of such diseases further. The intake of fruit and vegetables is often promoted as part of a healthy lifestyle to prevent chronic diseases. In this chapter we will discuss the health effect of smoking on cancer and CVD, describe the association between fruit and vegetable consumption and these diseases and review whether the negative health effects of smoking can be countered by fruit and vegetable consumption. Our review will focus on studies in the elderly where possible. Studies that reported on nutrients such as antioxidants were not taken into consideration.edition: 4status: publishe

ADAPTE-youth Résumé Francophone

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ADAPTE-youth Nederlandstalige samenvatting

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Evaluating the potential negative effects of school-based prevention programs aiming to reduce alcohol and drug misuse in adolescents: A systematic review of research articles prior to 2013

Issues: Reviews of alcohol and drug prevention programs commonly focus on positive effects, whilst disregarding possible iatrogenic effects. Our objective was to summarize evidence on iatrogenic effects of alcohol and drug prevention programs targeting adolescents. We systematically investigated the nature of these effects, the number of iatrogenic effects reported on, the sort of impact they have (e.g. in terms of severity) and the type of programs associated with iatrogenic effects. Approach: On January 2013, we searched the Cochrane Central Register of Controlled Trials, Medline, PsycINFO, Web of Science, Eric, Scirus and we actively searched for grey literature via Google Scholar and OpenGrey. Included were (quasi) RCTs that evaluated the effectiveness of school-based alcohol and drug prevention programs for adolescents. Ninety-three articles were eligible for inclusion and were screened for potential iatrogenic effects. Key findings: Ten articles reported on iatrogenic effects, which were predominantly found on substance use outcomes. The quality of these articles was assessed and a meta-analysis was not possible due to the heterogeneity in interventions and outcome measures. An increase in substance use was found in 5 out of 7 RCTs and in 1 quasi RCT. The magnitude of the iatrogenic effects found was not always clear due to the outcome measures used. Implications: Iatrogenic effects were assessed in a limited number of studies. In future studies on prevention programs the number, nature and impact of iatrogenic effects should standardly be assessed and reported. It allows us to detect potential problem areas in the conceptualization of prevention programs.nrpages: 33status: publishe