Search

Background: In prostate cancer (PCa) screening men and their physicians aim to rule out the presence of potentially life threatening PCa. To date, prostate specific antigen (PSA) testing and systematic prostate biopsy (Bx)-in case of an elevated PSA-are still the main modes of PCa detection. Often uncertainty remains when a PSA-test is < 3.0 ng/mL or a Bx shows a benign result, leading to the continuous repeating of procedures. Here we assess the potential consequences of false negatives by studying follow-up data of a purely PSA-based approach with applying sextant Bx, an approach considered to have a high risk of missing PCa diagnosis. Methods: Our study population consisted of 19,970 men from the ERSPC project section Rotterdam, initially screened in 1993-1999. We assessed clinically significant Gleason ≥3+4 PCa (csPCa) diagnosis within the 4-year screening interval and subsequent screening round 4 years later in men having a PSA < 3.0 ng/mL at initial screening (no Bx) and men with Bx (PSA > 3.0 ng/mL), but no PCa detected at that time. In addition, we addressed PCa mortality and PCa diagnosis for men with a negative PSA test and negative Bx, who were retested every 4 years covering a 15-year follow-up. Results: A total of 14,935 men had PSA < 3.0 ng/mL in the initial screening round, of whom 75 (0.5%) were diagnosed with csPCa at a subsequent screening examination and 2 ( < 0.1%) in the 4-year screening interval. For 2,260 men with a previously negative Bx at first screening, the figures were 17 (0.8%) and 2 (0.1%) respectively. Indolent PCa (Gleason ≥3+3) was diagnosed in 312 (2%) men with PSA < 3.0 ng/mL initially and 115 (5%) men with initial negative Bx. After a 15-year follow-up, 45 (0.3%) PCa deaths occurred in men with initially low PSA, and 29 men (0.2%) had metastasis. For men with negative Bx, 11 (0.5%) PCa deaths occurred and 4 (0.2%) experienced metastasis. Conclusions: The false negative rates for men with PSA < 3.0 ng/mL and negative sextant Bx are extremely low but not negligible. Proper risk stratification before deciding to biopsy is expected to hardly miss any clinical significant PCa diagnosis. This is especially relevant with the increased use of the relatively expensive multi-parametric magnetic resonance imaging (mpMRI) guided targeted Bx procedures.

The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region. A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n=3220) were recruited through organisations involved in YHC (participation: 88%). The YHC workforce is multi-disciplinary, 62% had > 10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range: 688-1007). All essential public health operations were provided. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need. The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries

There are about 1.8 million children between 10 and 18 years of age in the Netherlands in 2016. These teenagers account for approximately 10% of the total population. Teenagers are relatively healthy and do not make much use of curative care. However, they are an important group in terms of public health, because a basis for good health in later life is created in the teenage years. Good health in teenagers is also important for education, relationships and employment, and their health has an influence on the health of the next generation. Child and adolescent healthcare plays an important part in preventive care for teenagers. Better cooperation and exchange of information between paediatricians, specialists in child and adolescent healthcare and general practitioners are important in order to optimise care for teenagers.

Life expectancy in western countries has increased continuously over recent years. The issue at stake is if this rise includes healthy years. The answer depends on the health indicator used, e.g., perceived health, disability, or cognitive impairment. A study by Jagger et al. (2016) provides evidence for an increase in life expectancy without cognitive impairment and an absolute compression of cognitive impairment between 1991 and 2011. Information on life expectancy without cognitive impairment is not yet available for the Netherlands. Similar to England, Dutch trends in life expectancy in excellent or good self-perceived health and in life expectancy without severe disability are favourable, although less pronouncedly so. Dutch and English data suggest that the additional years lived by the population are at least partly spent in good health

Background: Public health workforce planning and policy development require adequate data on the public health workforce and the services provided. If existing data sources do not contain the necessary information, or apply to part of the workforce only, primary data collection is required. The aim of this study was to develop a strategy to enumerate and characterize the public health workforce and the provision of essential public health operations (EPHOs), and apply this to the environmental public health workforce in the Netherlands as an example. Methods: We specified WHO's EPHOs for environmental public health and developed an online questionnaire to assess individual involvement in these. Recruitment was a two-layered process. Through organisations with potential involvement in environmental public health, we invited environmental public health workers (n = 472) to participate in a national survey. Existing benchmark data and a group of national environmental public health experts provided opportunities for partial validity checks. Results: The questionnaire was well accepted and available benchmark data on physicians supported the results of this study regarding the medical part of the workforce. Experts on environmental public health recognized the present results on the provision of EPHOs as a reasonable reflection of the actual situation in practice. All EPHOs were provided by an experienced, highly educated and multidisciplinary workforce. 27 % of the total full-time equivalents (FTEs) was spent on EPHO 'assuring governance for health'. Only 4 % was spent on 'health protection'. The total FTEs were estimated as 0.66 /100,000 inhabitants. Conclusions: Characterisation of the public health workforce is feasible by identification of relevant organisations and individual workers on the basis of EPHOs, and obtaining information from those individuals by questionnaire. Critical factors include the operationalization of the EPHOS into the field of study, the selection and recruitment of eligible organisations and the response rate within organisations. When existing professional registries are incomplete or do not exist, this strategy may provide a start to enumerate the quantity and quality of the public health within or across countries.

Comparison of the association between socioeconomic status (SES) and psychosocial problems in preterm-born and term-born children. Cohort study (Amsterdam Born Children and their Development (ABCD) cohort). For 217 preterm-born children (mean gestation 34 weeks), Strengths and Difficulties Questionnaire (SDQ) scores were compared with 4336 term-born children at age 5-6 years. Associations between SDQ scores and SES (maternal education and perceived income adequacy) were examined with multivariate linear regression analysis. Mothers of preterm-born children often had a lower level of education. The mean SDQ total score was significantly higher for preterm-born children (6.1; SD: 4.7) than for term-born children (5.2; SD: 4.1). No significant differences were found between preterm-born and term-born children in the SDQ scores reported by teachers. For preterm-born children, 16.1% of the mothers reported psychosocial problems compared with 10.1% for term-born children. Lower maternal education and lower income adequacy were significantly related to higher SDQ scores. Differences in SDQ score between preterm-born and term-born children were most pronounced in the group with highly educated mothers (Δ0.9; 95%-CI: 0.2-1.5) and high income (Δ0.9; 95%-CI: 0.3-1.6). There was no additional effect of preterm birth on psychosocial problems in children with a low level of maternal education or inadequate income. This study corroborates earlier evidence regarding the disadvantageous effects of low SES on psychosocial development

OBJECTIVE: To assess the impact of tuberculosis (TB) and its treatment on patients' health status. METHODS: Questionnaires were administered prospectively to patients at three clinics in London at diagnosis and 2 months into therapy. We assessed generic health-related quality of life (Short Form 36 [SF-36] and EQ-5D) and psychological burden (State-Trait Anxiety Short-Form, Center for Epidemiologic Studies Depression Scale, worry items). RESULTS: Of the 61 participants (response rate 94%), 89% were non-UK born, 67% had pulmonary TB and 38% were aged 30-45 years. At diagnosis, scores for all eight SF-36 dimensions were significantly worse than UK general population norm scores. At follow-up, scores had improved significantly (P < 0.01), except for physical functioning and general health perception, but remained below the UK norm, except for vitality and mental health. Respondents' mean anxiety and depression scores were high at diagnosis (48 and 22, respectively), and anxiety scores remained high at follow-up. Worries most frequently reported concerned patients' own health (92%) and that of their family (82%). CONCLUSIONS: TB patients suffer from significantly diminished health-related quality of life at diagnosis. Although treatment significantly improved patients' health status within 2 months, scores for many domains remain below UK norm scores. This emphasises the importance of a holistic approach to care and should inform the evaluation of future interventions.

OBJECTIVE : To analyse whether specific attention is needed for the improvement of health for pregnant asylum seekers by producing an overview of obstetric outcomes, risk factors and expressed health needs of asylum seekers in the Netherlands and other Western host countries. DESIGN : Literature study. METHOD : A search was performed in Medline, Embase and PsycInfo for empirical studies about pregnancy and delivery specifically among asylum seekers in Western host countries and published since 1995. Picarta and the authors' literature collections were used to find Dutch studies. Google was used to find grey literature. RESULTS : Published empirical studies on pregnancy outcome indicators specific for asylum seekers were scarce and limited to the Netherlands. The studies found revealed an increased risk of perinatal and maternal mortality and severe maternal morbidity. These studies, however, were based on small numbers of cases. Qualitative studies revealed that pregnant asylum seekers expressed the following needs: a) information about pregnancy and about healthcare in the host country, b) healthcare professionals who pay attention to their problems and c) mothers' groups for social contacts and information exchange. CONCLUSION : Specific attention must be paid to improving the care for pregnant asylum seekers, since the limited number of studies suggest that asylum seekers are at increased risk of perinatal mortality, maternal mortality and severe maternal morbidity. More studies are needed into risk factors and quality of care for pregnant asylum seekers. The publications studied contain recommendations for an improved matching of the care with the needs expressed. The recommendations concern provision of information, cultural competencies of care providers, identification of risk factors, health networks approach, continuity of care and organising mother's groups

OBJECTIVE: Comparison of the indicators of effectiveness and efficiency of the Dutch national cervical cancerscreening programme in 2003 and 1994, the last year before implementation of important changes in the medical and organisational guidelines. DESIGN: Descriptive. METHOD: Data on all Pap smears made in 1994 and 2003 were retrieved from the Pathologic Anatomical National Automated Archive (PALGA), together with the matching cytological and histological follow-up until April 2004. In order to calculate the 5-year coverage, the number of women that had had a smear taken was placed in the numerator and divided by the number of women that had been invited for the screening programme during those 5 years. RESULTS: The 5-year coverage in the age range 30-64 years increased from 69 in 1994 to 77% in 2003. The percentage of smears resulting in a recommendation for a repeat smear decreased from 10 to 2. The percentage of timely compliance with recommendations for a repeat smear increased from 47 to 86, while that of smears with an immediate referral recommendation remained the same (about go). There was a sharp decrease in screening outside of the target-age range and screening with too short an interval. As a consequence, despite the higher coverage, the total number of smears decreased. CONCLUSION: The changes in the Dutch cervical cancerscreening programme in 1996 with regard to participation, the number of and compliance with recommendations for repeat smears, and screening activity outside of the target group were accompanied by significant improvements in agreement with the goals of the revision. The potential consequences for the effectiveness of the screening programme (reduction of cervical cancer mortality) will become apparent in the years to come

Postpartum haemorrhage is a common and potentially serious complication of delivery. In clinical obstetrics, exact measurement of blood loss is often difficult. Red blood cell (RBC) transfusion is the most important intervention to treat the complications of this sustained blood loss. Despite the introduction of various new guidelines, the triggers for transfusion still vary widely between clinicians. Therefore, a prospective randomised multicentre trial, the 'Wellbeing of obstetric patients on minimal blood transfusions' (WOMB) study, was developed. This study assesses the effect of RBC transfusion on the health-related quality of life (HRQoL) of the mother after delivery. Patients with a haemoglobin (Hb) level between 3.0 and 4.9 mmol/l and a blood loss of at least 1000 ml or a decrease of > 1.2 mmol/l in the Hb level are randomly assigned to receive RBC transfusion or not. A total of 400 patients will be included. Primary outcome is physical fatigue. The total follow-up period is 6 weeks. Currently, the study is ongoing in 10 hospitals in the Netherlands. The goal of this study is to develop a new transfusion policy based on Hb-levels as well as HRQoL criteria

BACKGROUND: The purpose of this study was to evaluate baseline health-related quality of life (HRQOL) in patients with localized prostate cancer before primary treatment (radical prostatectomy or radiotherapy). METHODS: Two hundred patients with newly diagnosed localized (screen-detected or clinically diagnosed) prostate cancer completed HRQOL questionnaires (generic and disease-specific measures). Clinical data were collected from patients' medical records in four Rotterdam hospitals. RESULTS: Screen-detected tumors were of more favorable stages and grades than clinically diagnosed ones. The diagnostic groups did not differ significantly in bowel and sexual functioning. Differences were found in urinary functioning, favoring patients with screen-detected tumors of T2-T3 stages. Patients with screen-detected T2 cancer reported better generic HRQOL (physical aspects) than the clinical group, but HRQOL of the latter group was similar to the population norm. Radiotherapy patients were significantly older and had more comorbidity than subjects referred to prostatectomy. Urinary, bowel, and sexual problems were uncommon. Older (> 65 years) radiotherapy patients appeared to be less sexually active. Radiotherapy patients also reported poorer levels of generic HRQOL. CONCLUSIONS: Screen-detected prostate cancer patients presented with more favorable cancer stage and grade. HRQOL was related to both the tumor stage and the detection method. Pre-treatment HRQOL differences between prostatectomy and radiotherapy patients were associated neither with tumor characteristics nor with the detection method. Baseline differences in HRQOL should be taken into account when evaluating post-treatment HRQOL

STUDY OBJECTIVES: To assess the change in health-related quality of life (HRQL) among Dutch lung transplant patients before and after transplantation. DESIGN: Prospective longitudinal study on HRQL among 24 Dutch lung transplant patients who participated first as transplant candidates, and later as recipients in the study. This study design provides an accurate estimate of the change in HRQL as a result of lung transplantation because there is no confounding between change due to differences in composition between groups of patients at the different points of follow-up and the true change as a result of the transplantation. Patients completed self-administered questionnaires before transplantation, and at 1, 4, 7, 13, and 19 months after transplantation. The main HRQL measures were: the Nottingham health profile (NHP), the State-trait Anxiety Inventory, the Self-rating Depression Scale-Zung, the Karnofsky Performance Index, the index of well-being, and activities of daily living (ADL). SETTING: University Hospital Groningen, the Netherlands. RESULTS: Before transplantation, patients report major restrictions on the dimensions mobility and energy of the NHP, a low level of experienced well-being, and depressive symptoms. In addition, patients experience difficulties in performing ADL and report a low ability to take care of themselves. About 4 months after transplantation, mobility, energy, sleep, ADL dependency level, and dyspnea were particularly positively affected by the lung transplantation. These improvements were maintained in the following 15 months. CONCLUSIONS: Lung transplantation contributes positively to the HRQL of surviving patients over time