Dirk Ruwaard

Causes and consequences of comorbidity: a review.

A literature search was carried out to identify and summarize the existing information on causes and consequences of comorbidity of chronic somatic diseases. A selection of 82 articles met our inclusion criteria. Very little work has been done on the causes of comorbidity. On the other hand, much work has been done on consequences of comorbidity, although comorbidity is seldom the main subject of study. We found comorbidity in general to be associated with mortality, quality of life, and health care. The consequences of specific disease combinations, however, depended on many factors. We recommend more etiological studies on shared risk factors, especially for those comorbidities that occur at a higher rate than expected. New insights in this field can lead to better prevention strategies. Health care workers need to take comorbid diseases into account in monitoring and treating patients. Future studies on consequences of comorbidity should investigate specific disease combinations.

Original articleCauses and consequences of comorbidity: A review

A literature search was carried out to identify and summarize the existing information on causes and consequences of comorbidity of chronic somatic diseases. A selection of 82 articles met our inclusion criteria. Very little work has been done on the causes of comorbidity. On the other hand, much work has been done on consequences of comorbidity, although comorbidity is seldom the main subject of study. We found comorbidity in general to be associated with mortality, quality of life, and health care. The consequences of specific disease combinations, however, depended on many factors. We recommend more etiological studies on shared risk factors, especially for those comorbidities that occur at a higher rate than expected. New insights in this field can lead to better prevention strategies. Health care workers need to take comorbid diseases into account in monitoring and treating patients. Future studies on consequences of comorbidity should investigate specific disease combinations.

Factors associated with quality of life of people with dementia in long-term care facilities: A systematic review

BACKGROUNDnQuality of life has become an important outcome measure in dementia research. Currently there is no convincing evidence about which factors are associated with quality of life of people with dementia living in long-term care facilities.nnnOBJECTIVEnThis study aims to investigate which factors are associated with quality of life, including factors associated with change over time, of people with dementia living in long-term care facilities.nnnDESIGNnA systematic literature review was performed.nnnDATA SOURCESnCochrane, Pubmed, CINAHL, Web of Science, and PsycINFO were searched.nnnREVIEW METHODSnThree researchers independently assessed studies for eligibility. The inclusion criteria were: (1) the primary focus was on factors related to quality of life; (2) the study was performed in long-term care facilities; (3) the study regarded quality of life as multidimensional construct. Methodological quality of studies included in the review was assessed with a quality criteria checklist.nnnRESULTSnTen cross-sectional and three longitudinal articles were included in the review. In cross-sectional studies, depressive symptoms were negatively related to self-rated quality of life of people with dementia. The association between depressive symptoms and proxy-rated quality of life was less clear. Behavioural disturbances, especially agitation, appeared to be negatively related to proxy-rated quality of life. There appeared to be a negative relation between quality of life, activities of daily living and cognition, although this could not be confirmed in all studies. In longitudinal studies, depressive symptoms were negatively related and cognition was positively related to self-rated quality of life, whereas dependency and depressive symptoms were negatively related to proxy-rated quality of life.nnnCONCLUSIONSnThere are only few high quality studies that investigate associations of (change in) quality of life of people with dementia living in long-term care facilities. Our results suggest that depressive symptoms and agitation are related to lower quality of life. Perspective of quality of life measurement, i.e. self- or proxy rating, may influence its associations. Longitudinal studies are needed to determine which factors are related to change in quality of life over time. This information is essential for the development of interventions that aim to improve quality of life.

Prevalence of macrovascular disease amongst type 2 diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the Hoorn Screening Study

Objectives.u2002 Screening for type 2 diabetes has been recommended and targeted screening might be an efficient way to screen. The aim was to investigate whether diabetic patients identified by a targeted screening procedure differ from newly diagnosed diabetic patients in general practice with regard to the prevalence of macrovascular complications.

Is the Incidence of Diabetes Increasing in All Age-Groups in The Netherlands?: Results of the second study in the Dutch Sentinel Practice Network

OBJECTIVE To assess possible changes in the incidence of diabetes in all age-groups in The Netherlands during a 10-year period (1980–1983/1990–1992). RESEARCH DESIGN AND METHODS Since 1970, a network of sentinel stations (the Dutch Sentinel Practice Network) consisting of ∼ 1% of the Dutch population has been in operation to gain insight into the morbidity patterns of the Dutch population as recorded by general practitioners. One of the items recorded from 1990 to 1992 was the incidence of diabetes. The first study with a similar design that registered the incidence of diabetes was conducted from 1980 to 1983. RESULTS The overall incidence of diabetes increased significantly by 12.1% in the period between the two studies. This overall increase can largely be attributed to a statistically significant increase in the age-group 45–64 years (30.5%). Although not statistically significant, the 36% increase of diabetes in the age-group 0–19 years is in accordance with the increase of type I diabetes based on the first and second nationwide retrospective studies covering the total Dutch population. CONCLUSIONS There is a marked increase in the incidence of diabetes in the age-group 45–64 years. This selective increase is probably not due to a real rise caused by changes in exposure to risk factors but to an earlier recognition of symptoms and signs of diabetes followed by blood glucose measurements and/or to more intensive case finding in general practice.

Forecasting the number of diabetic patients in The Netherlands in 2005.

OBJECTIVESnThere is evidence from past decades that the number of diabetic patients has increased independently of changes in demography. A static model that takes into account only demographic changes is therefore unable to forecast the expected number of diabetic patients correctly.nnnMETHODSnWe developed a dynamic model in which actual incidence, prevalence, and life expectancy data are used and alternative assumptions about future trends in these parameters can be incorporated.nnnRESULTSnThis dynamic model forecasts higher numbers of diabetic patients than the less sophisticated static model. According to the dynamic model, a 46% increase in the number of diabetic patients in The Netherlands can be expected, from 244,000 in 1990 to 355,000 in 2005 (about 2.5% annually). The static model forecasts a 22% increase.nnnCONCLUSIONSnDiabetes mellitus will become a more serious public health problem than can be expected from demographic changes only. In planning future health care, monitoring of trends in incidence, prevalence, remission, and mortality or life expectancy is a necessary prerequisite.

Exploring the success of an integrated primary care partnership: a longitudinal study of collaboration processes

BackgroundForming partnerships is a prominent strategy used to promote integrated service delivery across health and social service systems. Evidence about the collaboration process upon which partnerships evolve has rarely been addressed in an integrated-care setting. This study explores the longitudinal relationship of the collaboration process and the influence on the final perceived success of a partnership in such a setting. The collaboration process through which partnerships evolve is based on a conceptual framework which identifies five themes: shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management.MethodsFifty-nine out of 69 partnerships from a national programme in the Netherlands participated in this survey study. At baseline, 338 steering committee members responded, and they returned 320 questionnaires at follow-up. Multiple-regression-analyses were conducted to explore the relationship between the baseline as well as the change in the collaboration process and the final success of the partnerships.ResultsMutual gains and process management were the most significant baseline predictors for the final success of the partnership. A positive change in the relationship dynamics had a significant effect on the final success of a partnership.ConclusionsInsight into the collaboration process of integrated primary care partnerships offers a potentially powerful way of predicting their success. Our findings underscore the importance of monitoring the collaboration process during the development of the partnerships in order to achieve their full collaborative advantage.

The burden of mortality of diabetes mellitus in The Netherlands

Our objective was to estimate the excess mortality and the reduction in life expectancy related to diabetes mellitus. We developed a life table to describe the Dutch population in two states, diabetic and non-diabetic, using age- and sex-specific prevalence of diabetes mellitus and risks of dying for diabetic subjects. We compared the calculated excess deaths with registered deaths. The cause-of-death registration practice underestimates diabetes-related mortality. The method used in this study, combining mortality data with data from epidemiologic studies, provides an assessment of the impact of diabetes on the Dutch population.

Determinants and protective behaviours regarding tick bites among school children in the Netherlands: a cross-sectional study

BackgroundLyme borreliosis (LB) is the most common tick-borne disease in the United States and Europe. The incidence is 13.4 per 100,000 inhabitants in the United States and more than 300 per 100,000 inhabitants in Europe. Children are at highest risk of LB. In the Netherlands in 2007, the incidence of tick bites in children between 10–14xa0years varied from 7,000 -11,000 per 100,000, depending on age. This study among Dutch school children aimed to examine the knowledge, perceived threat, and perceived importance of protective behaviour in relation to tick bites and their potential consequences.MethodsIn April 2012, the municipal health services (MHS) contacted primary schools to recruit children 9–13xa0years by telephone, e-mail, or advertisement in MHS newsletters. In total, 1,447 children from 40 schools participated in this study by completing a specifically developed and pretested compact paper questionnaire. Regression models were used to determine which covariates (e.g. forest cover, previous education, knowledge) are associated with our response variables.Results70% (nu2009=u20091,015) of the children answered at least six out of seven knowledge questions correctly. The vast majority (93%; nu2009=u20091345) regarded body checks as very or somewhat important, 18% (nu2009=u2009260) was routinely checked by their parents. More frequent body checks were associated with good knowledge about ticks and tick-borne diseases and knowing persons who got ill after tick bite. Children in areas with a higher forest cover were more likely to be checked frequently.ConclusionsMost children have a good knowledge of ticks and the potential consequences of tick bites. Knowing persons who personally got ill after tick-bite is associated with a good knowledge score and leads to higher susceptibility and better appreciation of the need for body checks. Perceived severity is associated with a good knowledge score and with knowing persons who got ill after tick-bite. Is seems to be useful to additionally address children in health education regarding ticks and tick-borne diseases. The relationship between health education programs for children (and their parents) about ticks and their possible consequences and prevention of these deserves further study.

The relation between mood, activity, and interaction in long-term dementia care

ABSTRACT Objective: The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities. Method: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool. Results: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response. Conclusion: Fulfilling PwDs need for occupation and social interaction is consistent with a person-centred dementia care focus and should have priority in dementia care.