Evaluatie leeftijdgrensverlaging voor de griepprik

In 2008 is de leeftijdgrens om voor een gratis influenzavaccinatie in Nederland in aanmerking te komen, verlaagd van 65 naar 60 jaar. Deze maatregel heeft tot nu toe echter weinig effect gehad op het gedrag van de gezonde mensen die tot deze doelgroep behoren. Een duidelijke voorlichting zou het vaccinatieprogramma ten goede komen

Zorggebruik en beloning van medisch specialisten

De introductie van het nieuwe zorgstelsel in 2006 had als doel om een efficiëntere zorgverlening en betere kwaliteit van de zorg te realiseren. Regio’s vertonen tijdspersistente verschillen in het aantal behandelingen in ziekenhuizen bij eenzelfde zorgvraag tussen 2006 en 2009. Deze verschillen hangen sterk samen met het aantal artsen en de beloningsstructuur van de specialist. De prikkel tot meer behandelen speelt sterker bij vrij gevestigde specialisten dan bij specialisten in loondienst

Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum TimeCourse

Introduction: Increased cardiovascular (CV) morbidity and mortality is observed in inflammatory joint diseases (IJDs) such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, the management of CV disease in these conditions is far from being well established.Areas covered: This review summarizes the main epidemiologic, pathophysiological, and clinical risk factors of CV disease associated with IJDs. Less common aspects on early diagnosis and risk stratification of the CV disease in these conditions are also discussed. In Europe, the most commonly used risk algorithm in patients with IJDs is the modified SCORE index based on the revised recommendations proposed by the EULAR task force in 2017.Expert opinion: Early identification of IJD patients at high risk of CV disease is essential. It should include the use of complementary noninvasive imaging techniques. A multidisciplinary approach aimed to improve heart-healthy habits, including strict control of classic CV risk factors is crucial. Adequate management of the underlying IJD is also of main importance since the reduction of disease activity decreases the risk of CV events. Non-steroidal anti-inflammatory drugs may have a lesser harmful effect in IJD than in the general population, due to their anti-inflammatory effects along with other potential beneficial effects.This research was partially funded by FOREUM—Foundation for Research in Rheumatolog

Association of Variants in the SPTLC1 Gene With Juvenile Amyotrophic Lateral Sclerosis

Importance: Juvenile amyotrophic lateral sclerosis (ALS) is a rare form of ALS characterized by age of symptom onset less than 25 years and a variable presentation.Objective: To identify the genetic variants associated with juvenile ALS.Design, Setting, and Participants: In this multicenter family-based genetic study, trio whole-exome sequencing was performed to identify the disease-associated gene in a case series of unrelated patients diagnosed with juvenile ALS and severe growth retardation. The patients and their family members were enrolled at academic hospitals and a government research facility between March 1, 2016, and March 13, 2020, and were observed until October 1, 2020. Whole-exome sequencing was also performed in a series of patients with juvenile ALS. A total of 66 patients with juvenile ALS and 6258 adult patients with ALS participated in the study. Patients were selected for the study based on their diagnosis, and all eligible participants were enrolled in the study. None of the participants had a family history of neurological disorders, suggesting de novo variants as the underlying genetic mechanism.Main Outcomes and Measures: De novo variants present only in the index case and not in unaffected family members.Results: Trio whole-exome sequencing was performed in 3 patients diagnosed with juvenile ALS and their parents. An additional 63 patients with juvenile ALS and 6258 adult patients with ALS were subsequently screened for variants in the SPTLC1 gene. De novo variants in SPTLC1 (p.Ala20Ser in 2 patients and p.Ser331Tyr in 1 patient) were identified in 3 unrelated patients diagnosed with juvenile ALS and failure to thrive. A fourth variant (p.Leu39del) was identified in a patient with juvenile ALS where parental DNA was unavailable. Variants in this gene have been previously shown to be associated with autosomal-dominant hereditary sensory autonomic neuropathy, type 1A, by disrupting an essential enzyme complex in the sphingolipid synthesis pathway.Conclusions and Relevance: These data broaden the phenotype associated with SPTLC1 and suggest that patients presenting with juvenile ALS should be screened for variants in this gene.</p

Evaluating Reforms in the Netherlands' Competitive Health Insurance System

The 2006 health care reform in the Netherlands attracted widespread international interest in the impact of regulated competition on key factors such as prices, quality, and volume of care. This article reviews evidence on the performance of the health care system six years after the reform: health care costs have kept growing; quality information has become readily available; hospital efficiency has improved on an annual basis; and consumers have had greater choice. The transition to regulated competition is a gradual process. The full effects may not become evident until sometime in the future. Looking forward, monitoring the health care system is an important prerequisite to better understand the effects of regulated competition in health care