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The Extramural Leiden University Medical Center Academic Network (ELAN) is a data infrastructure in the Netherlands that combines healthcare data from various sources to improve patient care and health outcomes through research collaborations. The data includes information on 2.6 million individuals residing in South Holland province since 2007, with coded clinical measurements, morbidities, medication use, and social determinants of health. The document also provides data on characteristics of different countries, including population, gender distribution, age, urbanization, disposable household income, education level, and country of origin. The ELAN database contains information from general practitioners, hospitals, mental healthcare organizations, and national and municipal sources, covering medical information, pregnancies, births, and social determinants of health. The data is pseudonymized, linked across sources, and undergoes harmonization for research projects. While there are limitations to the data, researchers can request access for approved collaborative projects. [Extracted from the article]

Introduction Helicobacter pylori (H. pylori) is causally associated with chronic gastritis, peptic ulcer and gastric cancer, with a reported prevalence of 19-35%. Due to increasing antibiotic resistance, the worldwide efficacy of H. pylori eradication treatment has decreased. Aims & Methods This study aimed to determine eradication success of H. pylori in primary care in the Netherlands, as a proxy measure for antibiotic resistance development. Real-world routine health care data from Electronic Medical Records from general practices in the region Leiden/The Hague was used. Data was provided by ELAN (Extramural LUMC Academic Network). Patients with an ICPC-code for gastric symptoms or an ATC code for acid inhibition in the period 2010-2020 were selected. Patients with H. Pylori infection were detected based on having received eradication treatment. We investigated antibiotic resistance, defined as the prescription of a second eradication treatment within 12 months. The types of antibiotics prescribed as first eradication treatment were evaluated for resistance rates. If no second treatment was prescribed within 12 months, patients were considered to have been successfully treated. Results We identified 138,455 patients with gastric symptoms or acid inhibition from 80 general practices. Mean age was 57 years (SD 18.2) of whom 43% were male. A total of 5,224 (4%) patients received a first eradication treatment and were considered H. pylori positive. The antibiotic treatment combinations amoxicillin-clarithromycin, amoxicillin-metronidazole and clarithromycin- metronidazole were used in 4,847 (93%), 154 (3%) and 111 (2%) of first eradication treatments, respectively. A second eradication treatment was prescribed within one year to 416 (8%) patients. Thereof, 380 (8%) patients received amoxicillin-clarithromycin, 16 (10%) amoxicillin-metronidazole and 11 (10%) clarithromycin-metronidazole as first eradication treatment and were considered antibiotic resistant. We saw a 0.8% increment per year of patients in need of a second eradication treatment (p=0.003, 95% CI 0.33-1.22). Conclusion Almost one-tenth of H. pylori infections in primary care are not successfully treated using a first intervention with clarithromycin and/or metronidazole and require a second eradication treatment. Our study leads to the conclusion that antibiotic resistance plays a slowly increasing role in primary care treatment of patients with H. pylori. Further targeting of the guidelines, Presenters Gertrude van den Brink, PhD, Lieke M Koggel, MD, Joris JH Hendriks, Mattijs E Numans, MD, [...]

Background and objective: Even though children with complex problems frequently need psychosocial care, two thirds does not receive treatment. Various barriers, particularly expectations of barriers, can hinder effective access of care. Our aim was to assess the practical barriers expected by parents, and the child, family and need factors associated with these expected barriers. Methods: We sent web‐based questionnaires to parents of a random sample of children known to have or be at risk of having complex problems (response = 77%). We used backward regression analyses to examine which factors were associated with expected barriers for children using psychosocial care, or no care at all. Results: Seventy‐three percent of all parents expected practical barriers. Parents of children using psychosocial care expected more barriers than when using no care at all. For children who used no care, parents of girls expected more barriers (regression coefficient 0.54; 95%—confidence interval 0.16, 0.92) as did families having less social support (−0.30; −0.50, −0.11). When children used psychosocial care, parents expected more barriers when their child was of school‐age (0.38; 0.01, 0.75), of non‐western origin (vs. native) (0.52; 0.17, 0.88), when parents were older (i.e., 36+ years) (−0.77; −1.12, −0.42), experienced more adverse life events (0.29; 0.13, 0.45) or had less social support (−0.17; −0.34, 0.00). Conclusion: Even when their child is already receiving treatment, parents continue to expect practical barriers to psychosocial care. Psychosocial care services and their gatekeepers should address these concerns. Access to psychosocial care can be improved by removing practical barriers, especially if children already receive psychosocial care, or when parents have a limited network or belong to an ethnic minority. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis and treatment of obesity in primary care may help to tackle the obesity pandemic. Nonetheless, GPs frequently fail to address obesity and demonstrate limited adherence to guidelines. Aim: To explore Dutch GPs' perspectives on addressing obesity regarding the following three target behaviours: discussing weight; diagnosing; and referring patients with obesity. Design & setting: A qualitative focus group study with Dutch GPs. Method: Six focus groups were conducted with a purposive sample of 21 GPs. Thematic analysis was performed using deductive coding, according to the Theoretical Domains Framework (TDF). Results: For discussing weight, the main barriers identified were a presented complaint unrelated to obesity (environmental context and resources), concerns about a negative response from the patient (beliefs about consequences), and worries about obesity being a sensitive subject to discuss (emotions). A long-term trustworthy relationship (social influences) facilitated discussing weight. For diagnosing patients with obesity, the main barriers were related to resources; for example, lack of (appropriate) measuring equipment and time (environmental context and resources). For referring patients with obesity, the main barriers were no referral options nearby (environmental context and resources), and doubts about the positive effects of the referral on weight change (beliefs about consequences). Conclusion: Different barriers for discussing weight, diagnosing, and referring patients with obesity were identified, underscoring the importance for tailored interventions to these specific behaviours. Improving knowledge and skills of GPs seems insufficient as this study showed that particular attention should be paid to establishing long-term relationships, addressing GPs' beliefs about consequences, and creating a supportive environment with sufficient time and resources. [ABSTRACT FROM AUTHOR]

Hematologic measures such as hematocrit and white blood cell (WBC) count are heritable and clinically relevant. We analyzed erythrocyte and WBC phenotypes in 52,531 individuals (37,775 of European ancestry, 11,589 African Americans, and 3,167 Hispanic Americans) from 16 population-based cohorts with Illumina HumanExome BeadChip genotypes. We then performed replication analyses of new discoveries in 18,018 European-American women and 5,261 Han Chinese. We identified and replicated four new erythrocyte trait-locus associations (CEP89, SHROOM3, FADS2, and APOE) and six new WBC loci for neutrophil count (S1PR4), monocyte count (BTBD8, NLRP12, and IL17RA), eosinophil count (IRF1), and total WBC count (MYB). The association of a rare missense variant in S1PR4 supports the role of sphingosine-1-phosphate signaling in leukocyte trafficking and circulating neutrophil counts. Loss-of-function experiments for S1pr4 in mouse and s1pr4 in zebrafish demonstrated phenotypes consistent with the association observed in humans and altered kinetics of neutrophil recruitment and resolution in response to tissue injury.