Old as Methuselah?:Supercentenarians, Narrative Wisdom and the Importance of History for Health

According to the Arnhemse Courant of 21 October 1828, eighteenth-century Northern Europe counted no less than 1,672 people between 100 and 185 years old. This news report defies the imagination. Who would believe that centuries ago so many people could live to such old ages? In her inaugural lecture, Rina Knoeff shows that we should take this report - and other stories about unusual diseases, miraculous cures, and remarkable scientific insights - seriously.People in the past were no fools. Historical accounts of centenarians show how knowledge and health experiences were embedded in historically grown cultural patterns in which moral views and political motivations prevailed alongside medical theories. This is no different today. Like no other, the historian can show that our ideas about health and well-being are bound in place and time. By studying historical narratives that seem strange – even unbelievable – to us now, we can recognise what is particular about our own perceptions of health. This skill, which Knoeff characterises as "narrative wisdom", is also crucial for analysing and improving public health care. In her inaugural lecture, Knoeff shows that health is not exclusively biomedical, but above all a societal issue. This also means that in public health care, we should move away from a focus on clinical perspectives, and give more space to the humanities, which are much better at explaining the cultural factors that determine our health

Automated Engineering in Levee Risk Management

Flood Defenc

Medication practice in hospitals: are nanosimilars evaluated and substituted correctly?

Introduction: This study investigates the drug selection and dispensing behaviour of hospital pharmacists of intravenous iron products including iron sucrose and iron sucrose similar, with special emphasis on substitution and interchangeability in France and Spain. Iron– carbohydrate complex drugs represent different available intravenous iron drugs and are part of the non-biological complex drug (NBCD) class, an expanding drug class with up to 30 brands available in intravenous pharmacotherapy and over 50 in clinical development. Follow-on versions of iron sucrose have appeared in some markets such as France and Spain, which were authorised by the generic approval pathway. However, differences in clinical efficacy and safety of iron sucrose similars compared with the reference originator drug Venofer have been observed, putting a question mark on their equivalence as assessed for authorisation and consequently their substitutability and interchangeability.Method: 70 French and 70 Spanish hospital pharmacists were surveyed via an online questionnaire on their formulary selection and dispensing behaviour of intravenous iron medicines.Results: There is little awareness about the characteristics of this class of drugs and the reported differences in safety and efficacy between iron sucrose and iron sucrose similars. In approximately 85% of cases the intravenous iron is chosen according to the hospital formulary. In 30% (France) and 34% (Spain) of cases an iron sucrose similar was dispensed because the formulary requires dispensing an alternative lower cost drug when available. In 26% (France) and 52% (Spain) of cases the physician is not informed on such a medication change using a similar product.Conclusions: Evaluation of NBCD similars for substitution and interchange by hospital pharmacists is rarely based on scientific and clinical criteria but rather on cost aspects only, which does not ensure safe, efficacious and cost-effective use of such drugs

Kindersterfte door ongevallen: ontwikkeling in de afgelopen 40 jaar

Van alle landen in Europa heeft Nederland het op een na laagste sterftecijfer ten gevolge van nietnatuurlijkeoorzaken, waaronder ongevallen, bij kinderen. In dit artikel beschrijven wij de ontwikkeling van de kindersterfte door ongevallen in Nederland in de periode 1969-2011 en geven we mogelijke verklaringen voor deze ontwikkeling. Daartoe zijn de gegevens geanalyseerd over de primaire doodsoorzaken, die sinds 1969 zijn opgenomen in de doodsoorzakenstatistiek van het Centraal Bureau voor de Statistiek (CBS), en beschikbaar zijn via Statline. De sterfte door ongevallen bij kinderen in de leeftijd 0-19 jaar is sinds 1969 sterk afgenomen, met name door de daling in het aantal vervoersongevallen van 20/100.000 in 1973 naar 1,9/100.000 in 2011. Diverse verkeersmaatregelen die vanaf 1973 door de overheid zijn getroffen, lijken te hebben geresulteerd in de enorme afname van het aantal ongevallen in het wegverkeer. Wat betreft de overige ongevallen is de daling van de accidentele verdrinking in de periode 1996-2011 opmerkelijk: van 0,9/100.000 in 1996 naar 0,1/100.000 in 2011. Bij deze afname spelen waarschijnlijk sociaal-culturele factoren en effectieve preventieve maatregelen een rol. Jongens blijken vaker het slachtoffer van ongevallen dan meisjes. De sterfte door ongevallen bij kinderen kan verder afnemen door bestaande preventievemaatregelen te borgen en hiervoor blijvend aandacht te vragen via de professionals in dejeugdgezondheidszorg en beleidsmakers. Verder kan systematische analyse van de aard enomstandigheden van elk sterfgeval aanwijzingen geven voor nieuwe preventiemogelijkhede