Calcium intake and 28-year cardiovascular and coronary heart disease mortality in Dutch civil servants.

Data obtained from a general health examination in 1953-1954 of 2605 middle-aged Dutch civil servants were analysed to investigate the relation between dietary calcium and cardiovascular (CVD) and coronary heart disease (CHD) mortality. Calcium intake was assessed at baseline by a 1-week food frequency recall. Multivariate adjusted odds ratios (OR) were calculated using the highest quintile of calcium intake as the reference. No statistically significant associations were observed for low calcium intake in 15 and 28 years of follow-up in both men and women. For men, multivariate adjusted OR for the lowest quintile of calcium intake were 1.3 (95% confidence interval (CI): 0.8-1.9) and 0.9 (95% CI: 0.6-1.6) for 28-year CVD and CHD mortality, respectively. For women, corresponding OR were 1.1 (95% CI: 0.6-2.0) and 1.1 (95% CI: 0.5-2.5). Although an inverse association between calcium intake and CVD and CHD mortality, possibly mediated by blood pressure, might be hypothesized, no clear association was observed. Because dietary patterns in the 1950s were quite stable, and major calcium sources were addressed, misclassification of calcium intake may not be fully responsible for this finding.

Quality of care: a comparison of preferences between medical specialists and patients with chronic diseases.

UNLABELLED: In this study, we have looked for differences between medical specialists and patients with chronic diseases (COPD, rheumatoid arthritis and diabetes mellitus) in preferences of aspects of care in relation to the quality of care. Firstly, to enumerate relevant aspects for chronic diseases, open interviews and a concept mapping were conducted among patients with chronic disease, and medical specialists treating them. Here, the respondents have been asked to evaluate statements in relation to the quality of care. Secondly, a final questionnaire, including statements of nine relevant aspects of care, was presented to patients and medical specialists. The response rate among patients was 96% (N = 260) and among medical specialists 67% (N = 340). Both study populations ranked 'effectiveness of care' the highest. However, the difference in opinion between the two populations was significant, mainly due to the patient's giving a higher ranking to 'continuity of care' and a lower ranking to 'efficiency'. Significant differences were also found between the three patient groups on the aspects 'knowledge' and 'waiting time for treatment'. Patients with rheumatoid arthritis ranked 'knowledge' higher and 'waiting time for treatment' lower than did the other two patient groups. A lower level of education, having state-regulated health insurance and being older were associated with a higher preference for 'continuity'. Between the three groups of the medical specialists, no significant differences were found regarding to the profession, age, and sex. IN CONCLUSION: the patients and medical specialists researched did not show wide differences of opinion on preferences of care in relation to quality. The only exception to this concerned 'continuity of care' which was ranked higher by patients.

Quality and cost of healthcare: a cross-national comparison of American and Dutch attitudes.

OBJECTIVE: To compare attitudes of consumers in America and Holland toward the quality and cost of healthcare. STUDY DESIGN: Data were derived from one American (n = 466) and two Dutch (n = 260, n = 1629) surveys. PATIENTS AND METHODS: Questionnaires were completed by respondents. Pairwise comparisons requiring respondents to compare statements with one another were used to assess preferences for quality of care. Respondents were asked to "indicate the extent to which each of the factors listed plays a role in placing demands on the American (Dutch) healthcare system." Factors included the public's tendency to consume, high technology, defensive medicine, decrease in informal care, increase in standard diagnostic procedures, and medicalization. RESULTS: Americans reported comparatively greater concern with empathy, whereas the Dutch were more interested in the continuity of care. Effectiveness, knowledge, information, and patient-physician relationships were ranked higher in both nations than waiting time, autonomy, and efficiency. Respondents in both countries attributed the increase in healthcare cost primarily to the high cost of technology. Compared with their Dutch peers, Americans were less likely to attribute increases in the cost of healthcare to the public tendency to consume and to the decrease in informal care and were more likely to implicate defensive medicine and an increase in diagnostic procedures. CONCLUSIONS: As both nations experience pressures to reduce costs while maintaining and augmenting the quality of healthcare, planners and government officials should tailor their approaches to each nation's problems within the context of their public perspectives. Replication of such studies should help assess the impact of changing societal values on healthcare delivery.

Need for consensus development in prehospital emergency medicine: effect of an expert panel approach.

The objective of this study was to look at the need for consensus development in prehospital emergency medicine, and to determine the effect of an expert panel approach. The study took place in Euregio Scheldemond, comprising Sealand Flanders, The Netherlands, and Belgian Flanders, Belgium. Firstly, seven experts rated in organized mailings 153 (random selection out of 505) existing cases of acute or critically ill patients, situated in Dutch Sealand-Flanders. Experts were asked to decide whether assistance from neighbouring Belgian Flanders, consisting of a trauma team with or without the use of a highly equipped ambulance/helicopter, was needed or not in Dutch Sealand-Flanders, at: (1) the site of the incident, and (2) for transport to the hospital. They also had to decide on: (3) the required type of destination hospital (Belgian centre/university, versus Dutch regional). In a subsequent meeting using a modified nominal group technique 23 'worst' cases from the postal rounds with the lowest agreement were discussed and re-rated. We present a framework for the consensus measurement and development procedures. Agreement among experts was poor with multiple rater (Fleiss) kappa values for all 153 postal cases for the first, second and third decisions of 0.32, 0.08 and 0.45, respectively. After group discussions of the 23 'worst' postal cases, kappa values increased significantly and substantially; for the first, second and third decisions from 0.08 to 0.51, from -0.08 to 0.39 and from 0.16 to 0.62, respectively (all p < 0.001). Agreement increased significantly for medical cases, but not for trauma cases. It is concluded that consensus development for prehospital emergency medicine is needed. An expert panel approach seems fruitful in achieving more agreement, which forms a basis for guideline or protocol development.

Differences in preferences between diabetic patients and diabetologists regarding quality of care: a matter of continuity and efficiency of care?

Diabetologists and diabetic patients were asked about their preferences for aspects of care which are considered of importance in relation to the quality of care. A questionnaire was constructed using the method of pairwise comparison in which respondents constantly had to chose between the statements in order to get a priority list. Adults with diabetes mellitus (Types 1 and 2) attending outpatient departments were asked to fill in the questionnaire. A response rate of 97% was recorded (n = 94). Diabetologists received a postal questionnaire and the response rate was 65% (n = 126). There was a reasonable agreement between both populations and 'effectiveness of care' was ranked the highest. However, the patients gave a significant higher ranking to 'continuity of care' and a lower ranking to 'efficiency'. Neither the age and sex of the patients nor the duration of the disease had any influence on their opinions. Patients who were treated with oral medication ranked 'information' higher than patients using insulin, but the difference was not significant. A lower level of education and having public-health insurance were associated with a higher preference for 'continuity'. No differences were found regarding age and sex within the diabetologist population.