J Broer - Academia.edu (original) (raw)
Papers by J Broer
Schizophrenia Research, 2004
Nederlands Tijdschrift voor Geneeskunde, 2008
Objective. To determine the effectiveness of the obligatory notification of pertussis in the Neth... more Objective. To determine the effectiveness of the obligatory notification of pertussis in the Netherlands and the measures based on this notification in the prevention of infection in unvaccinated or insufficiently vaccinated children. Design. Descriptive, retrospective. Method. The period between the firstday of the illness and the date of notification was calculated for all 9310 cases of pertussis that were notified in the Netherlands in 2004. A period of 21 days is the maximum during which appropriate measures can be taken in the family of the index patient to protect unprotected siblings at risk from infection. For the province of Groningen (n = 411 notified cases), it was also determined whether there were actually children that were not or insufficiently vaccinated in the immediate environment and whether preventive measures were necessary. Results. In the Netherlands in 2004, 890 (10.7%) of all notified pertussis cases were notified within a three-week period after the first d...
Tijdschrift voor psychiatrie, 2020
BACKGROUND Compulsory treatment in mental health care has continuously increased for years. Regis... more BACKGROUND Compulsory treatment in mental health care has continuously increased for years. Registration of court ordered compulsory psychiatric care is based upon counts of legal authorisations. These counts do not refer to number of individual persons involved. AIM: To report the number age-specific prevalence of coercion in psychiatric care, number of persons involved, age distribution and regional differences. METHOD: Analysis of the number of requests for compulsory care and population size according to the age groups for the years 2013-2017. We used direct age standardisation at the level of jurisdiction regions. RESULTS: The annual number of unique persons for whom compulsory care was requested was 28% less than the number of requested court orders. The annual increase in compulsory care was 3%. Per specific treatment order the increase during 2013-2017 was 12% for emergency compulsory admissions, 8% for hospital admissions, 10% for extended hospital admissions and 43% for co...
European journal of public health, Jun 1, 2018
Psychosocial problems negatively affect school performance, social skills and mental development.... more Psychosocial problems negatively affect school performance, social skills and mental development. In recent years, researchers have investigated the relationship between physical activity and psychological health. With this large school-based study, we examined whether physically inactive adolescents and slightly active adolescents experience more psychosocial problems compared with active adolescents. This study is based on the Dutch National Youth Health Monitor. This monitor uses a, school-based, cross-sectional questionnaire conducted among 96 617 adolescents in 2015. To examine the association between physical exercise and psychosocial problems, multi-level linear regression was carried out. The weighted average Strengths and Difficulties Questionnaire score of active adolescents was lower than that of inactive adolescents. Adolescents who are inactive had 12% (β = 1.12; 95% CI: 1.10-1.14; P <0 .001) more psychosocial problems compared with active adolescents. Further, inact...
The American Journal of Clinical Nutrition, 2002
Background: The effect of long-term increased intakes of ␣-linolenic acid (ALA; 18:3nϪ3) on cardi... more Background: The effect of long-term increased intakes of ␣-linolenic acid (ALA; 18:3nϪ3) on cardiovascular risk factors is unknown. Objectives: Our objectives were to assess the effect of increased ALA intakes on cardiovascular risk factors and the estimated risk of ischemic heart disease (IHD) at 2 y and the effect of nutritional education on dietary habits. Design: Subjects with multiple cardiovascular risk factors (124 men and 158 women) were randomly assigned in a double-blind fashion to consume a margarine rich in either ALA [46% linoleic acid (LA; 18:2nϪ6) and 15% ALA; n = 114] or LA (58% LA and 0.3% ALA; n = 168). An intervention group (n = 110; 50% ALA) obtained group nutritional education, and a control group (n = 172; 34% ALA) received a posted leaflet containing the standard Dutch dietary guidelines. Results: Average ALA intakes were 6.3 and 1.0 g/d in the ALA and LA groups, respectively. After 2 y, the ALA group had a higher ratio of total to HDL cholesterol (+0.34; 95% CI: 0.12, 0.56), lower HDL cholesterol (Ϫ0.05 mmol/L; Ϫ0.10, 0), higher serum triacylglycerol (+0.24 mmol/L; 0.02, 0.46), and lower plasma fibrinogen (Ϫ0.18 g/L; Ϫ0.31, Ϫ0.04; after 1 y) than did the LA group (adjusted for baseline values, sex, and lipid-lowering drugs). No significant difference existed in 10-y estimated IHD risk. After 2 y, the intervention group had lower saturated fat intakes and higher fish intakes than did the control group. Conclusions: Increased ALA intakes decrease the estimated IHD risk to an extent similar to that found with increased LA intakes. Group nutritional education can effectively increase fish intake.
OBJECTIVE: To describe pre-hospital delay times in patients with acute myocardial infarction (AMI... more OBJECTIVE: To describe pre-hospital delay times in patients with acute myocardial infarction (AMI) in two regions in the Netherlands: Groningen (a region with high mortality for coronary heart disease (CHD)) and Rotterdam (a region with low CHD mortality). DESIGN: Descriptive. METHOD: The pre-hospital treatment delay of AMI patients in Rotterdam in 1990-1991 versus 1993-1995 was compared and also compared between Groningen en Rotterdam (1993-1995). In each region 3 hospitals participated (1 academic, 2 regional). The data were collected with a structured interview within 7 days after onset of symptoms in hospitalized AMI patients (n = 924) or by interviewing relatives of deceased patients (n = 40). The median patient, general practitioner (GP) and ambulance delays were calculated. RESULTS: Total median pre-hospital delay was 2.5 hours (5-95-percentile: 50 min-36 hours). Median patient delay time was shorter in Groningen than in Rotterdam (respectively 30 and 45 min) and the same applied to doctor delay times (respectively 38 and 72 min). In Rotterdam doctor delay time decreased by 23 min between 1990-1991 and 1993-1995. Median ambulance delay was 30 min in Rotterdam and 35 min in Groningen. Total pre-hospital delay times of self referred patients were 32-78 min shorter than those of patients who consulted a GP before admission. CONCLUSION: Reduction of pre-hospital delay in Rotterdam between 1990-1991 and 1993-1995 was due to faster decision time by the GP. The short pre-hospital treatment delay in Groningen in hospitalized patients suggests that relatively more AMI patients die outside hospital which may contribute to the high CHD mortality in this region.
Tijdschrift voor psychiatrie, 2015
Since the introduction of the new Dutch law on compulsory mental health care, the Bopz, there has... more Since the introduction of the new Dutch law on compulsory mental health care, the Bopz, there has been a marked increase in the number of compulsory admissions in mental health care in the Netherlands. When the new law underwent its third evaluation in 2002, it was decided that the law no longer reflected current views on the admission policy in mental health care. The draft on a new law on compulsory admissions to mental health care has already been published. One of the goals of the new law is to reduce the number of compulsory hospital admissions and to ensure that patients with mental health problems receive compulsory community care and outpatient care.<br/> To describe and analyse the use of compulsory admissions and community treatment orders (CTOs), and to make recommendations.<br/> We analyse the number of CTOs and court-ordered admissions in the Netherlands between 2003 and 2013 on the basis of figures supplied by the Council for the Judiciary.<br/> In th...
The International journal of risk & safety in medicine, 2001
To gain insight into the psychosocial consequences of a screening programme on the progression of... more To gain insight into the psychosocial consequences of a screening programme on the progression of heart, vascular and kidney damage. Over 85,000 people aged 28-75 were invited to participate in a screening for albuminuria. Nearly half of them sent in their morning urine of which almost 10,000 had a (slightly) elevated urinary albumin level. This latter group was invited to participate in a follow-up screening (24-hour urine samples, blood pressure, glucose, cholesterol) together with ±3,000 randomly selected subjects with a normal urinary albumin concentration. A questionnaire on the psychosocial consequences of the screening was sent to 335 participants of the screening programme each of whom had received their (positive or negative) screening results two weeks previously. The response rate was 75%. A minority of the respondents, diagnosed for risk factors, expressed some concern. No influence on the well-being of this group of participants could be established. Almost one third of...
![Research paper thumbnail of [Reduction in the consumption of benzodiazepines due to a letter to chronic users from their own general practitioner]](https://attachments.academia-assets.com/113495348/thumbnails/1.jpg)
](Nederlands tijdschrift voor geneeskunde, Jan 12, 2005
To investigate the effectiveness of a minimal intervention in reducing the volume of prescription... more To investigate the effectiveness of a minimal intervention in reducing the volume of prescription of benzodiazepines at the regional level. Prospective. Patients on compulsory health insurance who had received 180 or more daily doses of benzodiazepines in the course of one year received a letter from their general practitioner (GP) with information about the risks of chronic use, the advice to reduce or stop use, and an invitation to make an appointment to discuss the problem. This intervention took place in 19 GP practices in East Groningen. A reminder was sent six months later to the patients who had not responded in 9 randomly selected GP-practices. Thirty-seven practices in East Groningen and 91 practices in Northwest Groningen served as controls. Outcome measures were: (a) the percentage of patients who stopped, and (b) the change in average benzodiazepine consumption. During the period 6-12 months after the first letter in the intervention group (n = 1343), 11.3% of the patien...
Nederlands tijdschrift voor geneeskunde, 2003
Description of causes of death among asylum seekers in the Netherlands compared to the Dutch stan... more Description of causes of death among asylum seekers in the Netherlands compared to the Dutch standard population and identification of preventive measures to avoid preventable death. An analysis of the causes of death of asylum seekers accommodated in housing facilities of the Central Organ Asylum seekers (COA) for the period 1998-1999 was performed. The primary cause of death was attributed using the International Classification of Diseases (ICD-10) and grouped according to the most important causes of death list issued by Statistics Netherlands. After stratification for gender and age standardised mortality ratios (SMR) were computed. In 82% of the observed deaths amongst asylum seekers a description of the cause and circumstances of death could be obtained. During the 2-year study period 156 asylum seekers died (of which 49 due to an unnatural cause of death and 15 due to infectious diseases). Fourteen stillbirths were registered in an index population of 37,688 in 1998 and 54,11...
Nederlands tijdschrift voor geneeskunde, Jan 8, 2000
To describe pre-hospital delay times in patients with acute myocardial infarction (AMI) in two re... more To describe pre-hospital delay times in patients with acute myocardial infarction (AMI) in two regions in the Netherlands: Groningen (a region with high mortality for coronary heart disease (CHD)) and Rotterdam (a region with low CHD mortality). Descriptive. The pre-hospital treatment delay of AMI patients in Rotterdam in 1990-1991 versus 1993-1995 was compared and also compared between Groningen en Rotterdam (1993-1995). In each region 3 hospitals participated (1 academic, 2 regional). The data were collected with a structured interview within 7 days after onset of symptoms in hospitalized AMI patients (n = 924) or by interviewing relatives of deceased patients (n = 40). The median patient, general practitioner (GP) and ambulance delays were calculated. Total median pre-hospital delay was 2.5 hours (5-95-percentile: 50 min-36 hours). Median patient delay time was shorter in Groningen than in Rotterdam (respectively 30 and 45 min) and the same applied to doctor delay times (respecti...
Nederlands tijdschrift voor geneeskunde, Jan 23, 1998
To find out to what extent the recommendations from the standard 'Influenza and influenza vac... more To find out to what extent the recommendations from the standard 'Influenza and influenza vaccination' of the Dutch association of general practitioners (NHG) were implemented by the GPs in the period 1993-1996. Descriptive questionnaire study. Municipal Health Services Groningen, the Netherlands. All GPs active in the province of Groningen were sent a questionnaire in the period 1993-1996. Practical support of GPs in organizing influenza vaccination was offered as a part of the project 'Preventie: maatwerk' (Prevention made to measure). Automated selection of risk patients showed a distinct increase over the years. This increase was greatest in 1996, especially in rural practices. Inviting by personal letter, as recommended in the NHG standard increased to 48% in 1996. Not all GPs organized special vaccination office hours. An increasing number offered vaccination at other times as well. In urban municipalities, vaccine was available in the practice less often. Half...
Medicine and law, 1995
The primary responsibility of (local) governments is to enable people to make healthy choices in ... more The primary responsibility of (local) governments is to enable people to make healthy choices in order to promote public health. Social circumstances are important determinants of choices that people make. Social risk factors for problematic use of drugs should be reduced to a minimum. Health education goals need to be matched to the different developmental stages of drug use behaviours of subgroups in the population. Employment perspectives for school leavers form an essential ingredient of policies which aim to reduce the demand for 'hard' drugs in order to divert (young) people from drug careers. Primary preventive strategies form the backbone of public policies focused on reduction of demand for hard drugs. Primary preventive strategies are population based and implemented by the public and private sector. Secondary preventive strategies are focused on specific high-risk groups and aim to prevent the development of drug dependence and/or to reduce harm for drug users. Te...
Tijdschrift voor gezondheidswetenschappen, 2011
Sexually Transmitted Infections, 2005
The order of the authors of the paper by Götz et al on page 24 of the February 2005 issue (HM Göt... more The order of the authors of the paper by Götz et al on page 24 of the February 2005 issue (HM Götz et al. A prediction rule for selective screening of Chlamydia trachomatis infection. Sex Transm Infect 2005;81:24-30) were wrong. The order should have been as follows:
Vaccine, 2009
Since 2008, (pre)pandemic vaccines against H5N1 influenza have been available and pandemic vaccin... more Since 2008, (pre)pandemic vaccines against H5N1 influenza have been available and pandemic vaccines against new influenza H1N1 are currently produced. In The Netherlands, the vaccination call for seasonal influenza among the recommended groups approximates 70%. These statistics raise the question if adults in Western societies are willing to get a (pre)pandemic influenza vaccination, for example, against avian H5N1 or swine-like H1N1 virus. A questionnaire was performed to determine the predictors of a negative intention to be immunized against pandemic influenza among adults. Demographical, behavioural and organisational determinants were studied. Thirty-four and five percent of the respondents were negatively intended to get a pandemic influenza vaccination in a pre-pandemic or pandemic phase, respectively. On the basis of six behavioural determinants negative intention to get a pandemic influenza vaccination can be predicted correctly in almost 80% of the target group. These determinants should be targeted in pandemic preparedness plans.
Sexually Transmitted Infections, 2005
Objectives: Chlamydia trachomatis (Chlamydia) is the most prevalent sexually transmitted bacteria... more Objectives: Chlamydia trachomatis (Chlamydia) is the most prevalent sexually transmitted bacterial infection and can cause considerable reproductive morbidity in women. Chlamydia screening programmes have been considered but policy recommendations are hampered by the lack of population based data. This paper describes the prevalence of Chlamydia in 15-29 year old women and men in rural and urban areas, as determined through systematic population based screening organised by the Municipal Public Health Services (MHS), and discusses the implications of this screening strategy for routine implementation. Methods: Stratified national probability survey according to ''area address density'' (AAD). 21 000 randomly selected women and men in four regions, aged 15-29 years received a home sampling kit. Urine samples were returned by mail and tested by polymerase chain reaction (PCR). Treatment was via the general practitioner, STI clinic, or MHS clinic. Results: 41% (8383) responded by sending in urine and questionnaire. 11% (2227) returned a refusal card. Non-responders included both higher and lower risk categories. Chlamydia prevalence was significantly lower in rural areas (0.6%, 95% CI 0.1 to 1.1) compared with very highly urbanised areas (3.2%, 95% CI 2.4 to 4.0). Overall prevalence was 2.0% (95% CI 1.7 to 2.3): 2.5% (95% CI 2.0 to 3.0%) in women and 1.5% (95% CI 1.1 to 1.8) in men. Of all cases 91% were treated. Infection was associated with degree of urbanisation, ethnicity, number of sex partners, and symptoms. Conclusion: This large, population based study found very low prevalence in rural populations, suggesting that nationwide systematic screening is not indicated in the Netherlands and that targeted approaches are a better option. Further analysis of risk profiles will contribute to determine how selective screening can be done.
Sexually Transmitted Diseases, 2005
Objective: The objective of this study was to study the acceptability and consequences of home-ba... more Objective: The objective of this study was to study the acceptability and consequences of home-based chlamydia (CT) screening by Municipal Health Services (MHS) among 15-to 29-year-old participants. Study: This study consisted of a cross-section of 156 CT-positives and 600 random sampled CT-negatives after receiving the result of their CT test. Results: Thirty-eight percent of the men and 59% of the women responded. The screening method was well-accepted. Seventy percent (52) of the CT-positives were surprised about their result. Infected women more often than men reported a feeling of being dirty and of anxiety about infertility. Curiosity for the CT result was decisive for participation in 68% and perception of personal risk was poor. The willingness to be tested regularly was determined by present chlamydial infection, young age, multiple lifetime partners, short relationship, and earlier test for chlamydia. Conclusions: Chlamydia screening organised by MHS is acceptable for future screening. Participants with an elevated risk are interested in screening as long as test kits are easily available. Counseling with focus on effects of CT, especially on women, is essential. Alternative approaches are needed to motivate men and non-Dutch highrisk groups.
Schizophrenia Research, 2004
Nederlands Tijdschrift voor Geneeskunde, 2008
Objective. To determine the effectiveness of the obligatory notification of pertussis in the Neth... more Objective. To determine the effectiveness of the obligatory notification of pertussis in the Netherlands and the measures based on this notification in the prevention of infection in unvaccinated or insufficiently vaccinated children. Design. Descriptive, retrospective. Method. The period between the firstday of the illness and the date of notification was calculated for all 9310 cases of pertussis that were notified in the Netherlands in 2004. A period of 21 days is the maximum during which appropriate measures can be taken in the family of the index patient to protect unprotected siblings at risk from infection. For the province of Groningen (n = 411 notified cases), it was also determined whether there were actually children that were not or insufficiently vaccinated in the immediate environment and whether preventive measures were necessary. Results. In the Netherlands in 2004, 890 (10.7%) of all notified pertussis cases were notified within a three-week period after the first d...
Tijdschrift voor psychiatrie, 2020
BACKGROUND Compulsory treatment in mental health care has continuously increased for years. Regis... more BACKGROUND Compulsory treatment in mental health care has continuously increased for years. Registration of court ordered compulsory psychiatric care is based upon counts of legal authorisations. These counts do not refer to number of individual persons involved. AIM: To report the number age-specific prevalence of coercion in psychiatric care, number of persons involved, age distribution and regional differences. METHOD: Analysis of the number of requests for compulsory care and population size according to the age groups for the years 2013-2017. We used direct age standardisation at the level of jurisdiction regions. RESULTS: The annual number of unique persons for whom compulsory care was requested was 28% less than the number of requested court orders. The annual increase in compulsory care was 3%. Per specific treatment order the increase during 2013-2017 was 12% for emergency compulsory admissions, 8% for hospital admissions, 10% for extended hospital admissions and 43% for co...
European journal of public health, Jun 1, 2018
Psychosocial problems negatively affect school performance, social skills and mental development.... more Psychosocial problems negatively affect school performance, social skills and mental development. In recent years, researchers have investigated the relationship between physical activity and psychological health. With this large school-based study, we examined whether physically inactive adolescents and slightly active adolescents experience more psychosocial problems compared with active adolescents. This study is based on the Dutch National Youth Health Monitor. This monitor uses a, school-based, cross-sectional questionnaire conducted among 96 617 adolescents in 2015. To examine the association between physical exercise and psychosocial problems, multi-level linear regression was carried out. The weighted average Strengths and Difficulties Questionnaire score of active adolescents was lower than that of inactive adolescents. Adolescents who are inactive had 12% (β = 1.12; 95% CI: 1.10-1.14; P <0 .001) more psychosocial problems compared with active adolescents. Further, inact...
The American Journal of Clinical Nutrition, 2002
Background: The effect of long-term increased intakes of ␣-linolenic acid (ALA; 18:3nϪ3) on cardi... more Background: The effect of long-term increased intakes of ␣-linolenic acid (ALA; 18:3nϪ3) on cardiovascular risk factors is unknown. Objectives: Our objectives were to assess the effect of increased ALA intakes on cardiovascular risk factors and the estimated risk of ischemic heart disease (IHD) at 2 y and the effect of nutritional education on dietary habits. Design: Subjects with multiple cardiovascular risk factors (124 men and 158 women) were randomly assigned in a double-blind fashion to consume a margarine rich in either ALA [46% linoleic acid (LA; 18:2nϪ6) and 15% ALA; n = 114] or LA (58% LA and 0.3% ALA; n = 168). An intervention group (n = 110; 50% ALA) obtained group nutritional education, and a control group (n = 172; 34% ALA) received a posted leaflet containing the standard Dutch dietary guidelines. Results: Average ALA intakes were 6.3 and 1.0 g/d in the ALA and LA groups, respectively. After 2 y, the ALA group had a higher ratio of total to HDL cholesterol (+0.34; 95% CI: 0.12, 0.56), lower HDL cholesterol (Ϫ0.05 mmol/L; Ϫ0.10, 0), higher serum triacylglycerol (+0.24 mmol/L; 0.02, 0.46), and lower plasma fibrinogen (Ϫ0.18 g/L; Ϫ0.31, Ϫ0.04; after 1 y) than did the LA group (adjusted for baseline values, sex, and lipid-lowering drugs). No significant difference existed in 10-y estimated IHD risk. After 2 y, the intervention group had lower saturated fat intakes and higher fish intakes than did the control group. Conclusions: Increased ALA intakes decrease the estimated IHD risk to an extent similar to that found with increased LA intakes. Group nutritional education can effectively increase fish intake.
OBJECTIVE: To describe pre-hospital delay times in patients with acute myocardial infarction (AMI... more OBJECTIVE: To describe pre-hospital delay times in patients with acute myocardial infarction (AMI) in two regions in the Netherlands: Groningen (a region with high mortality for coronary heart disease (CHD)) and Rotterdam (a region with low CHD mortality). DESIGN: Descriptive. METHOD: The pre-hospital treatment delay of AMI patients in Rotterdam in 1990-1991 versus 1993-1995 was compared and also compared between Groningen en Rotterdam (1993-1995). In each region 3 hospitals participated (1 academic, 2 regional). The data were collected with a structured interview within 7 days after onset of symptoms in hospitalized AMI patients (n = 924) or by interviewing relatives of deceased patients (n = 40). The median patient, general practitioner (GP) and ambulance delays were calculated. RESULTS: Total median pre-hospital delay was 2.5 hours (5-95-percentile: 50 min-36 hours). Median patient delay time was shorter in Groningen than in Rotterdam (respectively 30 and 45 min) and the same applied to doctor delay times (respectively 38 and 72 min). In Rotterdam doctor delay time decreased by 23 min between 1990-1991 and 1993-1995. Median ambulance delay was 30 min in Rotterdam and 35 min in Groningen. Total pre-hospital delay times of self referred patients were 32-78 min shorter than those of patients who consulted a GP before admission. CONCLUSION: Reduction of pre-hospital delay in Rotterdam between 1990-1991 and 1993-1995 was due to faster decision time by the GP. The short pre-hospital treatment delay in Groningen in hospitalized patients suggests that relatively more AMI patients die outside hospital which may contribute to the high CHD mortality in this region.
Tijdschrift voor psychiatrie, 2015
Since the introduction of the new Dutch law on compulsory mental health care, the Bopz, there has... more Since the introduction of the new Dutch law on compulsory mental health care, the Bopz, there has been a marked increase in the number of compulsory admissions in mental health care in the Netherlands. When the new law underwent its third evaluation in 2002, it was decided that the law no longer reflected current views on the admission policy in mental health care. The draft on a new law on compulsory admissions to mental health care has already been published. One of the goals of the new law is to reduce the number of compulsory hospital admissions and to ensure that patients with mental health problems receive compulsory community care and outpatient care.<br/> To describe and analyse the use of compulsory admissions and community treatment orders (CTOs), and to make recommendations.<br/> We analyse the number of CTOs and court-ordered admissions in the Netherlands between 2003 and 2013 on the basis of figures supplied by the Council for the Judiciary.<br/> In th...
The International journal of risk & safety in medicine, 2001
To gain insight into the psychosocial consequences of a screening programme on the progression of... more To gain insight into the psychosocial consequences of a screening programme on the progression of heart, vascular and kidney damage. Over 85,000 people aged 28-75 were invited to participate in a screening for albuminuria. Nearly half of them sent in their morning urine of which almost 10,000 had a (slightly) elevated urinary albumin level. This latter group was invited to participate in a follow-up screening (24-hour urine samples, blood pressure, glucose, cholesterol) together with ±3,000 randomly selected subjects with a normal urinary albumin concentration. A questionnaire on the psychosocial consequences of the screening was sent to 335 participants of the screening programme each of whom had received their (positive or negative) screening results two weeks previously. The response rate was 75%. A minority of the respondents, diagnosed for risk factors, expressed some concern. No influence on the well-being of this group of participants could be established. Almost one third of...
Nederlands tijdschrift voor geneeskunde, Jan 12, 2005
To investigate the effectiveness of a minimal intervention in reducing the volume of prescription... more To investigate the effectiveness of a minimal intervention in reducing the volume of prescription of benzodiazepines at the regional level. Prospective. Patients on compulsory health insurance who had received 180 or more daily doses of benzodiazepines in the course of one year received a letter from their general practitioner (GP) with information about the risks of chronic use, the advice to reduce or stop use, and an invitation to make an appointment to discuss the problem. This intervention took place in 19 GP practices in East Groningen. A reminder was sent six months later to the patients who had not responded in 9 randomly selected GP-practices. Thirty-seven practices in East Groningen and 91 practices in Northwest Groningen served as controls. Outcome measures were: (a) the percentage of patients who stopped, and (b) the change in average benzodiazepine consumption. During the period 6-12 months after the first letter in the intervention group (n = 1343), 11.3% of the patien...
Nederlands tijdschrift voor geneeskunde, 2003
Description of causes of death among asylum seekers in the Netherlands compared to the Dutch stan... more Description of causes of death among asylum seekers in the Netherlands compared to the Dutch standard population and identification of preventive measures to avoid preventable death. An analysis of the causes of death of asylum seekers accommodated in housing facilities of the Central Organ Asylum seekers (COA) for the period 1998-1999 was performed. The primary cause of death was attributed using the International Classification of Diseases (ICD-10) and grouped according to the most important causes of death list issued by Statistics Netherlands. After stratification for gender and age standardised mortality ratios (SMR) were computed. In 82% of the observed deaths amongst asylum seekers a description of the cause and circumstances of death could be obtained. During the 2-year study period 156 asylum seekers died (of which 49 due to an unnatural cause of death and 15 due to infectious diseases). Fourteen stillbirths were registered in an index population of 37,688 in 1998 and 54,11...
Nederlands tijdschrift voor geneeskunde, Jan 8, 2000
To describe pre-hospital delay times in patients with acute myocardial infarction (AMI) in two re... more To describe pre-hospital delay times in patients with acute myocardial infarction (AMI) in two regions in the Netherlands: Groningen (a region with high mortality for coronary heart disease (CHD)) and Rotterdam (a region with low CHD mortality). Descriptive. The pre-hospital treatment delay of AMI patients in Rotterdam in 1990-1991 versus 1993-1995 was compared and also compared between Groningen en Rotterdam (1993-1995). In each region 3 hospitals participated (1 academic, 2 regional). The data were collected with a structured interview within 7 days after onset of symptoms in hospitalized AMI patients (n = 924) or by interviewing relatives of deceased patients (n = 40). The median patient, general practitioner (GP) and ambulance delays were calculated. Total median pre-hospital delay was 2.5 hours (5-95-percentile: 50 min-36 hours). Median patient delay time was shorter in Groningen than in Rotterdam (respectively 30 and 45 min) and the same applied to doctor delay times (respecti...
Nederlands tijdschrift voor geneeskunde, Jan 23, 1998
To find out to what extent the recommendations from the standard 'Influenza and influenza vac... more To find out to what extent the recommendations from the standard 'Influenza and influenza vaccination' of the Dutch association of general practitioners (NHG) were implemented by the GPs in the period 1993-1996. Descriptive questionnaire study. Municipal Health Services Groningen, the Netherlands. All GPs active in the province of Groningen were sent a questionnaire in the period 1993-1996. Practical support of GPs in organizing influenza vaccination was offered as a part of the project 'Preventie: maatwerk' (Prevention made to measure). Automated selection of risk patients showed a distinct increase over the years. This increase was greatest in 1996, especially in rural practices. Inviting by personal letter, as recommended in the NHG standard increased to 48% in 1996. Not all GPs organized special vaccination office hours. An increasing number offered vaccination at other times as well. In urban municipalities, vaccine was available in the practice less often. Half...
Medicine and law, 1995
The primary responsibility of (local) governments is to enable people to make healthy choices in ... more The primary responsibility of (local) governments is to enable people to make healthy choices in order to promote public health. Social circumstances are important determinants of choices that people make. Social risk factors for problematic use of drugs should be reduced to a minimum. Health education goals need to be matched to the different developmental stages of drug use behaviours of subgroups in the population. Employment perspectives for school leavers form an essential ingredient of policies which aim to reduce the demand for 'hard' drugs in order to divert (young) people from drug careers. Primary preventive strategies form the backbone of public policies focused on reduction of demand for hard drugs. Primary preventive strategies are population based and implemented by the public and private sector. Secondary preventive strategies are focused on specific high-risk groups and aim to prevent the development of drug dependence and/or to reduce harm for drug users. Te...
Tijdschrift voor gezondheidswetenschappen, 2011
Sexually Transmitted Infections, 2005
The order of the authors of the paper by Götz et al on page 24 of the February 2005 issue (HM Göt... more The order of the authors of the paper by Götz et al on page 24 of the February 2005 issue (HM Götz et al. A prediction rule for selective screening of Chlamydia trachomatis infection. Sex Transm Infect 2005;81:24-30) were wrong. The order should have been as follows:
Vaccine, 2009
Since 2008, (pre)pandemic vaccines against H5N1 influenza have been available and pandemic vaccin... more Since 2008, (pre)pandemic vaccines against H5N1 influenza have been available and pandemic vaccines against new influenza H1N1 are currently produced. In The Netherlands, the vaccination call for seasonal influenza among the recommended groups approximates 70%. These statistics raise the question if adults in Western societies are willing to get a (pre)pandemic influenza vaccination, for example, against avian H5N1 or swine-like H1N1 virus. A questionnaire was performed to determine the predictors of a negative intention to be immunized against pandemic influenza among adults. Demographical, behavioural and organisational determinants were studied. Thirty-four and five percent of the respondents were negatively intended to get a pandemic influenza vaccination in a pre-pandemic or pandemic phase, respectively. On the basis of six behavioural determinants negative intention to get a pandemic influenza vaccination can be predicted correctly in almost 80% of the target group. These determinants should be targeted in pandemic preparedness plans.
Sexually Transmitted Infections, 2005
Objectives: Chlamydia trachomatis (Chlamydia) is the most prevalent sexually transmitted bacteria... more Objectives: Chlamydia trachomatis (Chlamydia) is the most prevalent sexually transmitted bacterial infection and can cause considerable reproductive morbidity in women. Chlamydia screening programmes have been considered but policy recommendations are hampered by the lack of population based data. This paper describes the prevalence of Chlamydia in 15-29 year old women and men in rural and urban areas, as determined through systematic population based screening organised by the Municipal Public Health Services (MHS), and discusses the implications of this screening strategy for routine implementation. Methods: Stratified national probability survey according to ''area address density'' (AAD). 21 000 randomly selected women and men in four regions, aged 15-29 years received a home sampling kit. Urine samples were returned by mail and tested by polymerase chain reaction (PCR). Treatment was via the general practitioner, STI clinic, or MHS clinic. Results: 41% (8383) responded by sending in urine and questionnaire. 11% (2227) returned a refusal card. Non-responders included both higher and lower risk categories. Chlamydia prevalence was significantly lower in rural areas (0.6%, 95% CI 0.1 to 1.1) compared with very highly urbanised areas (3.2%, 95% CI 2.4 to 4.0). Overall prevalence was 2.0% (95% CI 1.7 to 2.3): 2.5% (95% CI 2.0 to 3.0%) in women and 1.5% (95% CI 1.1 to 1.8) in men. Of all cases 91% were treated. Infection was associated with degree of urbanisation, ethnicity, number of sex partners, and symptoms. Conclusion: This large, population based study found very low prevalence in rural populations, suggesting that nationwide systematic screening is not indicated in the Netherlands and that targeted approaches are a better option. Further analysis of risk profiles will contribute to determine how selective screening can be done.
Sexually Transmitted Diseases, 2005
Objective: The objective of this study was to study the acceptability and consequences of home-ba... more Objective: The objective of this study was to study the acceptability and consequences of home-based chlamydia (CT) screening by Municipal Health Services (MHS) among 15-to 29-year-old participants. Study: This study consisted of a cross-section of 156 CT-positives and 600 random sampled CT-negatives after receiving the result of their CT test. Results: Thirty-eight percent of the men and 59% of the women responded. The screening method was well-accepted. Seventy percent (52) of the CT-positives were surprised about their result. Infected women more often than men reported a feeling of being dirty and of anxiety about infertility. Curiosity for the CT result was decisive for participation in 68% and perception of personal risk was poor. The willingness to be tested regularly was determined by present chlamydial infection, young age, multiple lifetime partners, short relationship, and earlier test for chlamydia. Conclusions: Chlamydia screening organised by MHS is acceptable for future screening. Participants with an elevated risk are interested in screening as long as test kits are easily available. Counseling with focus on effects of CT, especially on women, is essential. Alternative approaches are needed to motivate men and non-Dutch highrisk groups.