Relative risk of irritable bowel syndrome following acute gastroenteritis and associated risk factors.

SUMMARY: A prospective cohort study using electronic medical records was undertaken to estimate the relative risk (RR) of irritable bowel syndrome (IBS) following acute gastroenteritis (GE) in primary-care patients in The Netherlands and explore risk factors. Patients aged 18-70 years who consulted for GE symptoms from 1998 to 2009, met inclusion/exclusion criteria and had at least 1 year of follow-up data were included. Patients with non-GE consultations, matched by age, gender, consulting practice and time of visit, served as the reference group. At 1 year, 1·2% of GE patients (N = 2428) had been diagnosed with IBS compared to 0·3% of the reference group (N = 2354). GE patients had increased risk of IBS [RR 4·85, 95% confidence interval (CI) 2·02-11·63]. For GE patients, concomitant cramps and history of psycho-social consultations were significantly associated with increased risk. GE patients had increased risk of IBS up to 5 years post-exposure (RR 5·40, 95% CI 2·60-11·24), suggesting there may be other contributing factors.

Risk of psychiatric treatment for mood disorders and psychotic disorders among migrants and Dutch nationals in Utrecht, The Netherlands.

PURPOSE: While there are consistent reports of a high psychosis rate among certain groups of migrants in Europe, there is little information on their risk for mood disorders. The aim of this study was to investigate the risk of receiving psychiatric treatment for mood disorders or psychotic disorders, comparing migrants and Dutch nationals in an ethnically mixed catchment area. A second aim was to calculate the 1-year prevalence rates of psychotic disorders in first-generation migrants. METHOD: A psychiatric registry provided information on treatments at all in- and outpatient facilities. Statistics Netherlands provided annual population figures. RESULTS: The risk of receiving treatment for unipolar depressive disorder was increased for the Turkish-Dutch (first and second generation combined; age- and sex-adjusted relative risk 4.9; 95% CI: 4.4-5.5), Moroccan-Dutch (RR = 3.6; 3.3-4.0) and Surinamese-Dutch (RR=1.8; 1.5-2.2). The risk of being treated for bipolar disorder was not significantly increased for any group, except for the Turkish-Dutch of the second generation. The risk of treatment for non-affective psychotic disorder was very high for the Turkish-Dutch, Moroccan-Dutch and Surinamese-Dutch of the second generation. There was a large difference in the relative risk of this disorder between the Turkish-Dutch of the first (RR = 1.3; 1.0-1.8) and the second generation (RR = 8.7; 5.5-13.9). The 1-year prevalence rates of treated psychotic disorders were highest for Surinamese-Dutch (2.1%) and Moroccan-Dutch males (1.2%) of the first generation. Migrants from western-European countries were not at increased risk for any of these disorders. CONCLUSIONS: The stressful position of non-Western migrants in Dutch society has negative consequences on their mental health.

[Regional differences in the care and treatment of compulsory admissions in the Netherlands]. / Regionale verschillen in nazorg bij inbewaringstelling.

BACKGROUND: In the Netherlands compulsory admissions are on the increase. However, there are regional differences even when demographic factors are taken into account. AIM: To find out whether there are regional differences in the type and duration of care given to detainees. METHOD: On the basis of case-register data for Groningen, South Limburg, Utrecht and Rotterdam, we monitored the psychiatric history and aftercare that followed emergency compulsory admissions and we analysed the differences between patient groups ('old acquaintances', 'newcomers' and 'passers-by'). RESULTS: Almost 60% of patients were well known to the mental health care service and had previously received psychiatric care. 85% of the patients were still receiving care three months after admission. Even when patient and admission characteristics were taken into account, there were still regional variations in the type and length of mental health care episodes before and after compulsory admission. CONCLUSION: The continuity of health care for emergency admissions in the context of the Dutch Mental Health Act varies from region to region. It remains to be seen whether the situation will change when the new Mental Health Act comes into force.

Low treatment adherence with antipsychotics is associated with relapse in psychotic disorders within six months after discharge.

OBJECTIVE: The aim of this study was to assess the association between treatment adherence with antipsychotics and schizophrenia relapse on a continuous scale. METHOD: A cohort study with a total of 477 patients with schizophrenia who were recently discharged from an inpatient clinic was performed. RESULTS: In the 160 people who relapsed within the six months after discharge the average medication possession ratio was 0.50. This was 0.59 in the 317 persons who were not readmitted. The resulting hazard ratio for the medication possession ratio on relapse risk was 0.60 (95% confidence interval: 0.42-0.88). CONCLUSION: The found hazard ratio indicates that the risk of relapse is substantially decreased when a patient is properly adherent to the antipsychotic therapy that was prescribed at the inpatient clinic.

Intervention with educational outreach at large scale to reduce antibiotics for respiratory tract infections: a controlled before and after study.

BACKGROUND: A multiple intervention targeted to reduce antibiotic prescribing with an educational outreach programme had proven to be effective in a randomized controlled trial in 12 peer review groups, demonstrating 12% less prescriptions for respiratory tract infections. OBJECTIVE: To assess the effectiveness of a multiple intervention in primary care at a large scale. METHODS: A controlled before and after study in 2006 and 2007 was designed. Participants were from general practices within a geographically defined area in the middle region of The Netherlands. Participants were GPs in 141 practices in 25 peer review groups. A control group of GP practices from the same region, matched for type of practice and mean volume of antibiotic prescribing. The multiple intervention consisted of the following elements: (i) group education meeting and communication training; (ii) monitoring and feedback on prescribing behaviour; (iii) group education for GPs and pharmacists assistants and (iv) patient education material. The main outcome measures are as follows: (i) number of antibiotic prescriptions per 1000 patients per GP and (ii) number of second-choice antibiotics, obtained from claims data from the regional health insurance company. The associations between predictors and outcome measurements were assessed by means of a multiple regression analyses. RESULTS: At baseline, the number of antibiotic prescriptions per 1000 patients was slightly higher in the intervention group than in the control group (184 versus 176). In 2007, the number of prescriptions had increased to 232 and 227, respectively, and not differed between intervention and control group. CONCLUSIONS: The implementation of an already proven effective multiple intervention strategy at a larger scale showed no reduction of antibiotic prescription rates. The failure might be attributed to a less tight monitoring of intervention and audit. Inserting practical tools in the intervention might be more successful and should be studied.

[Health care usage by Moroccans and Turks compared to the indigenous Dutch population: no higher consumption of health care and lower medication costs]. / Zorggebruik door Marokkanen en Turken vergeleken met autochtone Nederlanders: geen hogere zorgconsumptie en lagere geneesmiddelkosten.

OBJECTIVE: Examination of whether health care consumption of Moroccan or Turkish insured under the Dutch national health system varies from that of the indigenous Dutch population. DESIGN: Retrospective, transverse. METHOD: Research was performed on the database of an insurance company concerning medication, referrals to a specialist, admissions to the hospital and use of physiotherapy. Data of 22,603 Moroccan and 15,190 Turkish persons from the records for 1999 were compared with a random sample of 17,976 other persons in the database and differences were tested after correction for differences in age and sex. RESULTS: Foreigners received 50% less physiotherapy, while hospital admissions did not differ from the control group. The number of referrals to a specialist and the number of prescriptions for Moroccans appeared to be higher, but the number of consumers appeared to be equal to the control group. Turks on the contrary showed an equal number of referrals, but fewer prescriptions. The differences concerned mostly long-term physiotherapy and also referrals to specialists in internal medicine and gynaecology. Differences in prescriptions were found for certain medication groups. Costs for medication for foreigners were lower per insured person. CONCLUSION: Foreigners did not have a higher consumption of health services than indigenous persons, whilst medication costs were lower.