Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Background Adolescents frequently have behavioural and emotional problems, that limit their daily... more Background Adolescents frequently have behavioural and emotional problems, that limit their daily functioning. A minority of them receives care. Evidence on determinants and types of care used, including the role of specialized vs. general care is lacking. Objective: To assess the use of various types of care by adolescents because of behavioural and emotional problems, the determinants of this use, and to what extent these determinants explain trends in use by age, for ages 10-19 years. Design/Methods We obtained longitudinal data on 2,230 adolescents during ages 10-19 years in four measurement waves. Data concerned use of various types of care (general including paediatric care, and specialized car i.e. youth social care, and youth mental healthcare) in the preceding 6 months, behavioural and emotional problems (CBCL), and child and family characteristics. We used multilevel logistic regression to analyse the effects of determinants on use per type of care. Results At all ages, use of general care was higher than of specialized care. Overall rates of use increased from 20.1% at age 10/11 to 32.2%. at 19. At age 10/11 use was higher among boys than among girls, but towards age 19, it more than doubled among girls while being rather stable among boys. Use of general care increased among both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change could partially be accounted for by a few factors, being CBCL externalizing and internalizing problems, school problems, family socioeconomic status (SES) and parental divorce. Moreover, use of general care was more likely among low and medium SES families (odds ratios, OR:
The objective of the study was to examine the effect of screening programmes for adolescent idiop... more The objective of the study was to examine the effect of screening programmes for adolescent idiopathic scoliosis on population rates for adolescent idiopathic scoliosis surgery. A case-control study with data from The National Hospital Discharge Register, youth health care (YHC) departments in The Netherlands and a relevant census was used. The cases were 182 subjects aged 12-19 years, admitted to hospital in The Netherlands for surgical treatment of adolescent idiopathic scoliosis between 1990 and 1993. The total population of 12 or 13 year olds in the consecutive years of 1987-1992 in the regions of the participating YHC departments served as controls. Of the 182 patients that had surgery for adolescent idiopathic scoliosis in The Netherlands in the years 1990-1993,37.9% had at one time had a screening for spinal deformities at the age of 12 or 13 years as compared to 37.9% of the control subjects. The odds ratio for cases that had surgery was 1.00 (95% confidence interval: 0.74-1.35). This study does not support the view that screening for adolescent idiopathic scoliosis reduces the population rates for scoliosis surgery. As the primary aim of screening for adolescent idiopathic scoliosis is to prevent surgical intervention, this practice should be reconsidered.
To present recent changes and ideas in social security policy in Norway with respect to sickness ... more To present recent changes and ideas in social security policy in Norway with respect to sickness absence and disability pensions. Present situation To receive benefits, individuals with disease or injury must see a physician within 4 days, to have the existence of a disease causing work incapacity certified. Thereby disease is pivotal. A new agreement between the government, and the associations of employers and employees suggests a stronger focus on function rather than disease. Both the employee and the treating physician will be requested to supply information on the individual's functioning. The employer is requested to supply information on work demands. In the Norwegian social insurance system, more emphasis is now placed on claimants' active participation in the rehabilitation process. Recently an expert conference was held to give impetus to development of functional assessment. It was strongly suggested to base the work on scientific evidence, and within the conceptual framework of the new classification on functioning from WHO-ICF. Several research institutions will be engaged in future work to develop and suggest new functional measurements. Two Norwegian assessment instruments were presented at the conference. One was designed as a method to start a dialogue between employer and employee, and has been successfully tested locally. The other is a standardized ICF-based instrument for self-assessed function that can be used in consultations with physicians and within the National Insurance Scheme. The latter instrument has been piloted among sick-listed persons, and was valid, reliable and useful in many cases for the caseworkers. Conclusion A unique model to counteract high sickness absence and disability pension rates is being tried in Norway. For its success, the model depends on a new conceptual consensus on what should be acceptable reasons for sickness absence.
Background: Although a great deal of evidence is available on the patterns and determinants of un... more Background: Although a great deal of evidence is available on the patterns and determinants of unmet health care needs among adolescents with mental health problems, little is known about the factors that influence the need for care. The aim of this study is to assess the occurrence of need for care for mental problems in adolescents and the determinants of this need. Methods: Data were obtained from three assessment waves of TRAILS (TRacking Adolescents' Individual Lives Survey) (N = 1406). Need for care was assessed at age 16/17 (parent report). Determinants concerned previous health care utilization, emotional and behavioral problems (child behavior checklist and youth self-report) and child and family characteristics. Results: Of the 1406 parents, 409 parents (29%) reported that their child needed help for mental problems. Of these adolescents, only 29% received specialized mental health treatment. The determinants of need for mental health care at age 16/17 were family break-up and parental internalizing problems (age 10/11), parent-reported internalizing and externalizing (age 10/11 and 13/14) and receiving specialized help (age 13/14). Conclusion: A substantial proportion of all adolescents need care for their mental problems, according to their parent. There is also a large group of adolescents with mental health problems according to their parents, but for whom no parental reported need for care is expressed. The findings stress the importance of early interventions focusing on raising parental and child awareness of mental health problems.
The objective of this study was to examine the effect of freely accessible consultation hours in ... more The objective of this study was to examine the effect of freely accessible consultation hours in secondary schools by youth health care departments, on population rates for suicide and parasuicide. To this end, an ecologic case-referent study design was used, with data from the Netherlands Bureau of Statistics, the National Hospital Discharge Register, the High-School Students Study, the youth health care departments in the Netherlands and relevant census. Cases were 137 suicide victims aged 15 ± 19 y and 182 12 ± 18 y old subjects admitted to hospital because of parasuicide and additionally coded as having had surgery as a consequence of the attempted suicide or having a pertinent psychiatric disorder. The relevant census in the regions of the participating youth health care departments served as referents. The High-School Students Study included 4997 students aged 12 ± 18 y of which 303 reported having attempted suicide at least once. In the ecologic case-referent studies the adjusted Odds Ratio for completed suicide in regions with open consultation hours was 0.98 (95% CI 0.69 ± 1.38) and the weighted Odds Ratio for parasuicide was 1.30 (95% CI 0.97 ± 1.75). Analysis of the data of the High-School Students Study resulted in an Odds Ratio of 0.96 (95% CI 0.72 ± 1.26). The overall homogeneous Odds Ratio for (para)suicide in regions with open consultation hours for all three studies was 1.00 (95% CI 0.97 ± 1.04); the heterogeneous Odds Ratio was 1.08 (95% CI 0.95 ± 1.09). This study does not support the hypothesis that regions, where youth health care departments have instituted freely accessible consultation hours in secondary schools, show lower rates of suicide or parasuicide compared to regions where no consultation hours were implemented.
Στόχοι: ο στόχος αυτής της μελέτης ήταν αφενός να διερευνήσει τη δομή της οικογένειας και να υπολ... more Στόχοι: ο στόχος αυτής της μελέτης ήταν αφενός να διερευνήσει τη δομή της οικογένειας και να υπολογίσει τη λειτουργικότητά της αναφορικά με τη χρήση ουσιών από τους εφήβους και αφετέρου να αποδείξει εάν αυτές οι σχέσεις διέφεραν ανάλογα με το φύλο ή ανάλογα με την πόλη απ’ όπου κατάγεται το δείγμα. Σχεδιασμός, χώρος, συμμετέχοντες: η μελέτη αυτή πραγματοποίησε επισκόπηση αντιπροσωπευτικού δείγματος μαθητών ηλικίας 14–15 ετών από πέντε ευρωπαϊκές πόλεις: Νιούκασλ στον Tyne, Δουβλίνο, Ρώμη, Βρέμη και Groningen. Τα στοιχεία συγκεντρώθηκαν από 3.984 συμμετέχοντες αναφορικά με τη χρήση ουσιών που έκαναν, τη διαβίωση και με τους δυο βιολογικούς γονείς, την εκμυστήρευση σε γονείς και παππούδες και την επίβλεψη καθώς και άλλες μεταβλητές που αφορούσαν στην παραβατικότητα, την κοινωνική τάξη και τη διαθεσιμότητα των ουσιών. Αποτελέσματα: η διαβίωση και με τους δύο βιολογικούς γονείς σχετιζόταν με χαμηλά επίπεδα χρήσης ουσιών στις τέσσερις πόλεις, αλλά όχι στο Δουβλίνο, ίσως εξαιτίας της μεγάλης διαθεσιμότητας από ομότιμους που υπάρχει σε αυτή την πόλη. Δεν σχετιζόταν με χαμηλά επίπεδα τακτικής πόσης. Η εκμυστήρευση στη μητέρα είχε εμφανή επιρροή σε όλες τις πόλεις και γενικότερα αναφορικά με τη χρήση ουσιών. Όταν, παρόλα αυτά, προστίθετο μια μεταβλητή παραβατικότητας στις λογαριθμικές παλινδρομήσεις, η σημασία της σε σχέση με την πολυτοξικομανία χανόταν. Η επίβλεψη ήταν αρκετά σημαντικότερος παράγοντας για τους άντρες από ό,τι για τις γυναίκες. Συμπέρασμα: η διαβίωση και με τους δύο γονείς είναι ένα λιγότερο σημαντικό εμπόδιο για τη χρήση ουσιών από ό,τι οι ποιοτικές πλευρές της οικογενειακής ζωής, και ιδιαίτερα η προσκόλληση με τη μητέρα. Το τελευταίο αποτελεί σημαντική αναστολή για τη χρήση ουσιών ανεξάρτητα από τις τοπικές ιδιαιτερότητες διαθεσιμότητας των ουσιών, η οποία αποδυναμώνεται μόνο με την ύπαρξη γενικότερων προβληματικών συμπεριφορών. Ίσως λόγω της μεγαλύτερης τάσης των ανδρών να εκτίθενται σε επικίνδυνες συμπεριφορές ή να παραβιάζουν κανόνες, η επίβλεψη δείχνει να είναι σημαντικότερη για τη χρήση ουσιών από άντρες από ό,τι για γυναίκες. Αυτά τα ευρήματα υπογραμμίζουν το ρόλο όλης της οικογένειας, και ιδιαίτερα της μητέρας, στη ρύθμιση συμπεριφορών χρήσης από τους νέους ανθρώπους.
Journal of Evaluation in Clinical Practice, Jul 8, 2010
Background Patients with type 2 diabetes have an increased risk of developing microvascular and m... more Background Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved. Objective The aim of the study was to evaluate the effects of structured diabetes care on clinical outcomes of patients with type 2 diabetes in primary care. Methods We performed a quasi-experimental study on the effects of structured care consisting of organizational and educational components (n = 581) compared with careas-usual (n = 152). We assessed clinical outcomes of HbA1c, blood pressure, cholesterol, creatinine and body mass index, at baseline and after 1 year. The long-term effects in the structured care group were determined after another 2 years. Results Structured care led to improvement in HbA1c and long-term improvements in blood pressure and cholesterol compared with care-as-usual. After 1 year, the percentage of patients who did not deteriorate was higher in the structured care group, again for HbA1c, diastolic blood pressure, low-density lipoprotein cholesterol and body mass index. Conclusions Structured diabetes care consisting of multiple components has a positive effect on clinical outcomes compared with care-as-usual. Our findings support its further implementation in order to reduce complications in type 2 diabetes patients.
Journal of Nervous and Mental Disease, Feb 1, 2011
Children of asylum seekers are at risk for psychosocial problems because of their flight history ... more Children of asylum seekers are at risk for psychosocial problems because of their flight history and exceptional living circumstances. This study aims to assess the association of sociodemographic factors and asylum procedural factors with psychosocial problems of asylum seekers' children, and differences herein by informant (parents, teachers, and children). To this end, we obtained data on psychosocial problems among a random sample of 267 children aged 4 to 16, living in Dutch asylum seekers' centers, using the multi-informant Strength and Difficulties Questionnaire. The results show that the prevalence rate of psychosocial problems among asylum seekers' children was high. The occurrence was not associated with asylum-procedural variables but only with child-contextual factors such as mental health of the mother and leaving behind a parent in the country of origin. The associations varied in strength by informant. Therefore, preventive and supportive measures to improve psychosocial health of young asylum-seekers should concentrate on these contextual issues.
Abstract: The effect on health of urbanisation is two-edged. On the one hand, there are the benef... more Abstract: The effect on health of urbanisation is two-edged. On the one hand, there are the benefits of ready access to healthcare, sanitation, and secure nutrition, whilst on the other there are the evils of overcrowding, pollution, social deprivation, crime, and stress-related ...
Background In this study the effect is assessed of (repeated) well-care visits and freely accessi... more Background In this study the effect is assessed of (repeated) well-care visits and freely accessible consultation hours at secondary schools on the prevalence of adolescent healthcompromising behaviour and later obesity.
G Damiani*, R Galasso, L Sommella, L Pinnarelli, SC Colosimo, R Almiento, L Sicuro, W Ricciardi D... more G Damiani*, R Galasso, L Sommella, L Pinnarelli, SC Colosimo, R Almiento, L Sicuro, W Ricciardi Department of Public Health-Universita Cattolica S.Cuore-Rome, Italy Referral Oncological Center of Basilicata Rionero in Vulture (PZ), Italy ‘San Filippo Neri’ Hospital Trust-Rome, Italy *Contact details: gdamiani@rm.unicatt.it Background Reducing undesirable practice variations in care has long been promoted for its potential to improve the quality of health care. Besides, Computerized Clinical Decision Support Systems, designed to help physicians in clinical decision making and based on patient-specific recommendations, are widely spreading. Due to these two issues, computerized guideline (CG) implementation strategies have been considered as useful means of improving health outcomes, optimizing resource utilization and patient care quality. This study carried out a systematic review of scientific articles to evaluate the effectiveness of CG on clinicians’ behaviour, patients and organization outcomes. Methods Our literature search was carried out through electronic databases, using keywords, hand searching and analysis of further references from the bibliographic citations for each article meeting selected criteria. Analytical and experimental studies published in five languages, in adult population without time restriction. All studies were scored for methodological quality (MQ) on a previously validated scale. Proportions of studies reporting an improvement on physician, patient, and organization outcomes and their 95% confidence intervals (CI) were calculated. A logistic regression model, adjusted for study MQ, was used to investigate association between the outcomes of interest and study-specific covariates (i.e. degree of automation, user training, type of electronic suggestion). Results Out of 3672 articles found according to chosen keywords, 39 matched our criteria. Thirty were set in the USA, 6 in Europe, 2 in Asia and 1 in Australia. CG improved physician performance in 23 (67%), 95% CI 1⁄4 51.9–83.4, of the 34 studies assessing this outcome. Out of 17 articles assessing patient and organization outcomes 8 trials (47%), 95% CI 1⁄4 23.3–70.8, reported improvements for both issues. Studied covariates showed no association with outcomes. Conclusions Our initial results suggest that CG improve physician performance. The effects on patient and organization outcomes remain understudied and, when studied, inconsistent, so that further researches are needed.
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Background Adolescents frequently have behavioural and emotional problems, that limit their daily... more Background Adolescents frequently have behavioural and emotional problems, that limit their daily functioning. A minority of them receives care. Evidence on determinants and types of care used, including the role of specialized vs. general care is lacking. Objective: To assess the use of various types of care by adolescents because of behavioural and emotional problems, the determinants of this use, and to what extent these determinants explain trends in use by age, for ages 10-19 years. Design/Methods We obtained longitudinal data on 2,230 adolescents during ages 10-19 years in four measurement waves. Data concerned use of various types of care (general including paediatric care, and specialized car i.e. youth social care, and youth mental healthcare) in the preceding 6 months, behavioural and emotional problems (CBCL), and child and family characteristics. We used multilevel logistic regression to analyse the effects of determinants on use per type of care. Results At all ages, use of general care was higher than of specialized care. Overall rates of use increased from 20.1% at age 10/11 to 32.2%. at 19. At age 10/11 use was higher among boys than among girls, but towards age 19, it more than doubled among girls while being rather stable among boys. Use of general care increased among both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change could partially be accounted for by a few factors, being CBCL externalizing and internalizing problems, school problems, family socioeconomic status (SES) and parental divorce. Moreover, use of general care was more likely among low and medium SES families (odds ratios, OR:
The objective of the study was to examine the effect of screening programmes for adolescent idiop... more The objective of the study was to examine the effect of screening programmes for adolescent idiopathic scoliosis on population rates for adolescent idiopathic scoliosis surgery. A case-control study with data from The National Hospital Discharge Register, youth health care (YHC) departments in The Netherlands and a relevant census was used. The cases were 182 subjects aged 12-19 years, admitted to hospital in The Netherlands for surgical treatment of adolescent idiopathic scoliosis between 1990 and 1993. The total population of 12 or 13 year olds in the consecutive years of 1987-1992 in the regions of the participating YHC departments served as controls. Of the 182 patients that had surgery for adolescent idiopathic scoliosis in The Netherlands in the years 1990-1993,37.9% had at one time had a screening for spinal deformities at the age of 12 or 13 years as compared to 37.9% of the control subjects. The odds ratio for cases that had surgery was 1.00 (95% confidence interval: 0.74-1.35). This study does not support the view that screening for adolescent idiopathic scoliosis reduces the population rates for scoliosis surgery. As the primary aim of screening for adolescent idiopathic scoliosis is to prevent surgical intervention, this practice should be reconsidered.
To present recent changes and ideas in social security policy in Norway with respect to sickness ... more To present recent changes and ideas in social security policy in Norway with respect to sickness absence and disability pensions. Present situation To receive benefits, individuals with disease or injury must see a physician within 4 days, to have the existence of a disease causing work incapacity certified. Thereby disease is pivotal. A new agreement between the government, and the associations of employers and employees suggests a stronger focus on function rather than disease. Both the employee and the treating physician will be requested to supply information on the individual's functioning. The employer is requested to supply information on work demands. In the Norwegian social insurance system, more emphasis is now placed on claimants' active participation in the rehabilitation process. Recently an expert conference was held to give impetus to development of functional assessment. It was strongly suggested to base the work on scientific evidence, and within the conceptual framework of the new classification on functioning from WHO-ICF. Several research institutions will be engaged in future work to develop and suggest new functional measurements. Two Norwegian assessment instruments were presented at the conference. One was designed as a method to start a dialogue between employer and employee, and has been successfully tested locally. The other is a standardized ICF-based instrument for self-assessed function that can be used in consultations with physicians and within the National Insurance Scheme. The latter instrument has been piloted among sick-listed persons, and was valid, reliable and useful in many cases for the caseworkers. Conclusion A unique model to counteract high sickness absence and disability pension rates is being tried in Norway. For its success, the model depends on a new conceptual consensus on what should be acceptable reasons for sickness absence.
Background: Although a great deal of evidence is available on the patterns and determinants of un... more Background: Although a great deal of evidence is available on the patterns and determinants of unmet health care needs among adolescents with mental health problems, little is known about the factors that influence the need for care. The aim of this study is to assess the occurrence of need for care for mental problems in adolescents and the determinants of this need. Methods: Data were obtained from three assessment waves of TRAILS (TRacking Adolescents' Individual Lives Survey) (N = 1406). Need for care was assessed at age 16/17 (parent report). Determinants concerned previous health care utilization, emotional and behavioral problems (child behavior checklist and youth self-report) and child and family characteristics. Results: Of the 1406 parents, 409 parents (29%) reported that their child needed help for mental problems. Of these adolescents, only 29% received specialized mental health treatment. The determinants of need for mental health care at age 16/17 were family break-up and parental internalizing problems (age 10/11), parent-reported internalizing and externalizing (age 10/11 and 13/14) and receiving specialized help (age 13/14). Conclusion: A substantial proportion of all adolescents need care for their mental problems, according to their parent. There is also a large group of adolescents with mental health problems according to their parents, but for whom no parental reported need for care is expressed. The findings stress the importance of early interventions focusing on raising parental and child awareness of mental health problems.
The objective of this study was to examine the effect of freely accessible consultation hours in ... more The objective of this study was to examine the effect of freely accessible consultation hours in secondary schools by youth health care departments, on population rates for suicide and parasuicide. To this end, an ecologic case-referent study design was used, with data from the Netherlands Bureau of Statistics, the National Hospital Discharge Register, the High-School Students Study, the youth health care departments in the Netherlands and relevant census. Cases were 137 suicide victims aged 15 ± 19 y and 182 12 ± 18 y old subjects admitted to hospital because of parasuicide and additionally coded as having had surgery as a consequence of the attempted suicide or having a pertinent psychiatric disorder. The relevant census in the regions of the participating youth health care departments served as referents. The High-School Students Study included 4997 students aged 12 ± 18 y of which 303 reported having attempted suicide at least once. In the ecologic case-referent studies the adjusted Odds Ratio for completed suicide in regions with open consultation hours was 0.98 (95% CI 0.69 ± 1.38) and the weighted Odds Ratio for parasuicide was 1.30 (95% CI 0.97 ± 1.75). Analysis of the data of the High-School Students Study resulted in an Odds Ratio of 0.96 (95% CI 0.72 ± 1.26). The overall homogeneous Odds Ratio for (para)suicide in regions with open consultation hours for all three studies was 1.00 (95% CI 0.97 ± 1.04); the heterogeneous Odds Ratio was 1.08 (95% CI 0.95 ± 1.09). This study does not support the hypothesis that regions, where youth health care departments have instituted freely accessible consultation hours in secondary schools, show lower rates of suicide or parasuicide compared to regions where no consultation hours were implemented.
Στόχοι: ο στόχος αυτής της μελέτης ήταν αφενός να διερευνήσει τη δομή της οικογένειας και να υπολ... more Στόχοι: ο στόχος αυτής της μελέτης ήταν αφενός να διερευνήσει τη δομή της οικογένειας και να υπολογίσει τη λειτουργικότητά της αναφορικά με τη χρήση ουσιών από τους εφήβους και αφετέρου να αποδείξει εάν αυτές οι σχέσεις διέφεραν ανάλογα με το φύλο ή ανάλογα με την πόλη απ’ όπου κατάγεται το δείγμα. Σχεδιασμός, χώρος, συμμετέχοντες: η μελέτη αυτή πραγματοποίησε επισκόπηση αντιπροσωπευτικού δείγματος μαθητών ηλικίας 14–15 ετών από πέντε ευρωπαϊκές πόλεις: Νιούκασλ στον Tyne, Δουβλίνο, Ρώμη, Βρέμη και Groningen. Τα στοιχεία συγκεντρώθηκαν από 3.984 συμμετέχοντες αναφορικά με τη χρήση ουσιών που έκαναν, τη διαβίωση και με τους δυο βιολογικούς γονείς, την εκμυστήρευση σε γονείς και παππούδες και την επίβλεψη καθώς και άλλες μεταβλητές που αφορούσαν στην παραβατικότητα, την κοινωνική τάξη και τη διαθεσιμότητα των ουσιών. Αποτελέσματα: η διαβίωση και με τους δύο βιολογικούς γονείς σχετιζόταν με χαμηλά επίπεδα χρήσης ουσιών στις τέσσερις πόλεις, αλλά όχι στο Δουβλίνο, ίσως εξαιτίας της μεγάλης διαθεσιμότητας από ομότιμους που υπάρχει σε αυτή την πόλη. Δεν σχετιζόταν με χαμηλά επίπεδα τακτικής πόσης. Η εκμυστήρευση στη μητέρα είχε εμφανή επιρροή σε όλες τις πόλεις και γενικότερα αναφορικά με τη χρήση ουσιών. Όταν, παρόλα αυτά, προστίθετο μια μεταβλητή παραβατικότητας στις λογαριθμικές παλινδρομήσεις, η σημασία της σε σχέση με την πολυτοξικομανία χανόταν. Η επίβλεψη ήταν αρκετά σημαντικότερος παράγοντας για τους άντρες από ό,τι για τις γυναίκες. Συμπέρασμα: η διαβίωση και με τους δύο γονείς είναι ένα λιγότερο σημαντικό εμπόδιο για τη χρήση ουσιών από ό,τι οι ποιοτικές πλευρές της οικογενειακής ζωής, και ιδιαίτερα η προσκόλληση με τη μητέρα. Το τελευταίο αποτελεί σημαντική αναστολή για τη χρήση ουσιών ανεξάρτητα από τις τοπικές ιδιαιτερότητες διαθεσιμότητας των ουσιών, η οποία αποδυναμώνεται μόνο με την ύπαρξη γενικότερων προβληματικών συμπεριφορών. Ίσως λόγω της μεγαλύτερης τάσης των ανδρών να εκτίθενται σε επικίνδυνες συμπεριφορές ή να παραβιάζουν κανόνες, η επίβλεψη δείχνει να είναι σημαντικότερη για τη χρήση ουσιών από άντρες από ό,τι για γυναίκες. Αυτά τα ευρήματα υπογραμμίζουν το ρόλο όλης της οικογένειας, και ιδιαίτερα της μητέρας, στη ρύθμιση συμπεριφορών χρήσης από τους νέους ανθρώπους.
Journal of Evaluation in Clinical Practice, Jul 8, 2010
Background Patients with type 2 diabetes have an increased risk of developing microvascular and m... more Background Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved. Objective The aim of the study was to evaluate the effects of structured diabetes care on clinical outcomes of patients with type 2 diabetes in primary care. Methods We performed a quasi-experimental study on the effects of structured care consisting of organizational and educational components (n = 581) compared with careas-usual (n = 152). We assessed clinical outcomes of HbA1c, blood pressure, cholesterol, creatinine and body mass index, at baseline and after 1 year. The long-term effects in the structured care group were determined after another 2 years. Results Structured care led to improvement in HbA1c and long-term improvements in blood pressure and cholesterol compared with care-as-usual. After 1 year, the percentage of patients who did not deteriorate was higher in the structured care group, again for HbA1c, diastolic blood pressure, low-density lipoprotein cholesterol and body mass index. Conclusions Structured diabetes care consisting of multiple components has a positive effect on clinical outcomes compared with care-as-usual. Our findings support its further implementation in order to reduce complications in type 2 diabetes patients.
Journal of Nervous and Mental Disease, Feb 1, 2011
Children of asylum seekers are at risk for psychosocial problems because of their flight history ... more Children of asylum seekers are at risk for psychosocial problems because of their flight history and exceptional living circumstances. This study aims to assess the association of sociodemographic factors and asylum procedural factors with psychosocial problems of asylum seekers' children, and differences herein by informant (parents, teachers, and children). To this end, we obtained data on psychosocial problems among a random sample of 267 children aged 4 to 16, living in Dutch asylum seekers' centers, using the multi-informant Strength and Difficulties Questionnaire. The results show that the prevalence rate of psychosocial problems among asylum seekers' children was high. The occurrence was not associated with asylum-procedural variables but only with child-contextual factors such as mental health of the mother and leaving behind a parent in the country of origin. The associations varied in strength by informant. Therefore, preventive and supportive measures to improve psychosocial health of young asylum-seekers should concentrate on these contextual issues.
Abstract: The effect on health of urbanisation is two-edged. On the one hand, there are the benef... more Abstract: The effect on health of urbanisation is two-edged. On the one hand, there are the benefits of ready access to healthcare, sanitation, and secure nutrition, whilst on the other there are the evils of overcrowding, pollution, social deprivation, crime, and stress-related ...
Background In this study the effect is assessed of (repeated) well-care visits and freely accessi... more Background In this study the effect is assessed of (repeated) well-care visits and freely accessible consultation hours at secondary schools on the prevalence of adolescent healthcompromising behaviour and later obesity.
G Damiani*, R Galasso, L Sommella, L Pinnarelli, SC Colosimo, R Almiento, L Sicuro, W Ricciardi D... more G Damiani*, R Galasso, L Sommella, L Pinnarelli, SC Colosimo, R Almiento, L Sicuro, W Ricciardi Department of Public Health-Universita Cattolica S.Cuore-Rome, Italy Referral Oncological Center of Basilicata Rionero in Vulture (PZ), Italy ‘San Filippo Neri’ Hospital Trust-Rome, Italy *Contact details: gdamiani@rm.unicatt.it Background Reducing undesirable practice variations in care has long been promoted for its potential to improve the quality of health care. Besides, Computerized Clinical Decision Support Systems, designed to help physicians in clinical decision making and based on patient-specific recommendations, are widely spreading. Due to these two issues, computerized guideline (CG) implementation strategies have been considered as useful means of improving health outcomes, optimizing resource utilization and patient care quality. This study carried out a systematic review of scientific articles to evaluate the effectiveness of CG on clinicians’ behaviour, patients and organization outcomes. Methods Our literature search was carried out through electronic databases, using keywords, hand searching and analysis of further references from the bibliographic citations for each article meeting selected criteria. Analytical and experimental studies published in five languages, in adult population without time restriction. All studies were scored for methodological quality (MQ) on a previously validated scale. Proportions of studies reporting an improvement on physician, patient, and organization outcomes and their 95% confidence intervals (CI) were calculated. A logistic regression model, adjusted for study MQ, was used to investigate association between the outcomes of interest and study-specific covariates (i.e. degree of automation, user training, type of electronic suggestion). Results Out of 3672 articles found according to chosen keywords, 39 matched our criteria. Thirty were set in the USA, 6 in Europe, 2 in Asia and 1 in Australia. CG improved physician performance in 23 (67%), 95% CI 1⁄4 51.9–83.4, of the 34 studies assessing this outcome. Out of 17 articles assessing patient and organization outcomes 8 trials (47%), 95% CI 1⁄4 23.3–70.8, reported improvements for both issues. Studied covariates showed no association with outcomes. Conclusions Our initial results suggest that CG improve physician performance. The effects on patient and organization outcomes remain understudied and, when studied, inconsistent, so that further researches are needed.
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Papers by Auke Wiegersma