[Regional differences in compulsory treatment in mental health care in the Netherlands during 2013-2017]. / Gedwongen opnames en ambulante dwang in de ggz: onderzoek naar regionale verschillen tussen arrondissementen, leeftijdsgroepen en unieke personen, 2013-2017.

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 community treatment order.
CONCLUSION: The number of persons for whom compulsory mental care is requested increased on average by 3% each year. Greatest increase was observed for age groups 25-44 years and 80 years and older. After age-standardisation substantial differences remain between jurisdiction regions.

Association between physical exercise and psychosocial problems in 96 617 Dutch adolescents in secondary education: a cross-sectional study.

Background: 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. Methods: 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. Results: The weighted average Strengths and Difficulties Questionnaire score of active adolescents was lower than that of inactive adolescents. Adolescents who are inactive had 12% (ß = 1.12; 95% CI: 1.10-1.14; P <0 .001) more psychosocial problems compared with active adolescents. Further, inactive adolescents had a higher score on the subscales emotional problems (ß = 1.19; 95% CI: 1.17-1.22; P < 0.001) and problems with peers (ß = 1.16; 95% CI: 1.14-1.19; P < 0.001). There was no statistical significant difference in total score of the Strengths and Difficulties Questionnaire between active and slightly active adolescents. Conclusion: Physically active adolescents have fewer psychosocial problems compared with physically inactive adolescents. Not only is this association significant, but there is an indication that it is also of clinical relevance.

[The number of compulsory admissions continues to rise: implications for the new Dutch law on obligatory mental health care]. / Stijgende trend in dwangtoepassing onder de Wet Bopz zet door; implicaties voor de nieuwe Wet verplichte geestelijke gezondheidszorg.

BACKGROUND: 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. AIM: To describe and analyse the use of compulsory admissions and community treatment orders (CTOs), and to make recommendations. METHOD: 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. RESULTS: In the period 2003-2013 the number of compulsory emergency admissions increased from 43 to 47 per 100,000 inhabitants. During the same period the number of court-ordered admissions rose from 44 per 100,000 inhabitants in 2003 to 89 per 100,000 in 2013. (These figures include CTOs.) We were unable to perform more detailed studies because of the lack of records giving, for instance, the characteristics of patients who have undergone compulsory admission. CONCLUSION: Emergency compulsory admissions, CTOs and court-ordered admissions to mental health care continued to rise in the period 2003-2013. There is an urgent need for more detailed registration of the type an duration of compulsory admissions to psychiatric care and for more research into the type of treatment that can prevent the use of coercion to mental health care.

Molecular radiotherapy: the NUKFIT software for calculating the time-integrated activity coefficient.

PURPOSE: Calculation of the time-integrated activity coefficient (residence time) is a crucial step in dosimetry for molecular radiotherapy. However, available software is deficient in that it is either not tailored for the use in molecular radiotherapy and/or does not include all required estimation methods. The aim of this work was therefore the development and programming of an algorithm which allows for an objective and reproducible determination of the time-integrated activity coefficient and its standard error. METHODS: The algorithm includes the selection of a set of fitting functions from predefined sums of exponentials and the choice of an error model for the used data. To estimate the values of the adjustable parameters an objective function, depending on the data, the parameters of the error model, the fitting function and (if required and available) Bayesian information, is minimized. To increase reproducibility and user-friendliness the starting values are automatically determined using a combination of curve stripping and random search. Visual inspection, the coefficient of determination, the standard error of the fitted parameters, and the correlation matrix are provided to evaluate the quality of the fit. The functions which are most supported by the data are determined using the corrected Akaike information criterion. The time-integrated activity coefficient is estimated by analytically integrating the fitted functions. Its standard error is determined assuming Gaussian error propagation. The software was implemented using MATLAB. RESULTS: To validate the proper implementation of the objective function and the fit functions, the results of NUKFIT and SAAM numerical, a commercially available software tool, were compared. The automatic search for starting values was successfully tested for reproducibility. The quality criteria applied in conjunction with the Akaike information criterion allowed the selection of suitable functions. Function fit parameters and their standard error estimated by using SAAM numerical and NUKFIT showed differences of <1%. The differences for the time-integrated activity coefficients were also <1% (standard error between 0.4% and 3%). In general, the application of the software is user-friendly and the results are mathematically correct and reproducible. An application of NUKFIT is presented for three different clinical examples. CONCLUSIONS: The software tool with its underlying methodology can be employed to objectively and reproducibly estimate the time integrated activity coefficient and its standard error for most time activity data in molecular radiotherapy.

Which factors are important in adults' uptake of a (pre)pandemic influenza vaccine?

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.

Changing patterns in emergency involuntary admissions in the Netherlands in the period 2000-2004.

BACKGROUND: In England, rates of involuntary admissions increased in subgroups of patients. It is unknown whether this is true in other European countries. AIMS: To establish whether the increase in emergency commitments was uniform across subgroups of patients and dangerousness criteria used to justify commitment in The Netherlands. METHOD: National data on all commitments in the period 2000-2004. RESULTS: Commitments increased from 40.2 to 46.5 (16%) per 100,000 inhabitants. Controlling for population changes in age and sex, relatively large increases were found in patients over 50 years (25-40% increase), in patients with dementia (59%), 'other organic mental disorders' (40%) and substance abuse (36%). 'Arousing aggression', increased most strongly as a dangerousness criterion for commitment (30%). CONCLUSION: Changing patterns of commitments in The Netherlands and England might indicate a wider European shift in diagnoses and reasons for admission of committed patients.

[The obligatory notification of pertussis is not effective for the protection of unvaccinated children]. / Meldingsplicht voor kinkhoest niet effectief om ongevaccineerde kinderen te beschermen.

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 first day 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 day of illness. In Groningen, this number was 30 (9.1%) and in none of these cases was there an insufficiently vaccinated child in the family. CONCLUSION: In an endemic situation with severe under-reporting, the obligatory notification of pertussis is not effective to prevent infection of insufficiently vaccinated children. Alternative vaccination strategies directed at the prevention of the spread of pertussis among insufficiently vaccinated children would probably be more effective and merit further investigation.

Prevalence of urogenital Chlamydia trachomatis infections in the Netherlands suggests selective screening approaches. Results from the PILOT CT Population Study.

Chlamydia trachomatis screening is being considered in the Netherlands, but policy recommendations are hampered by the lack of population-based data. We studied the prevalence of chlamydia infection in 15-29-year-old women and men in a national representative sample of 21,000 inhabitants of rural and urban areas in the Netherlands. Of this sample, 41% responded by sending in urine and an answered questionnaire, while 11% returned a refusal card. The overall prevalence of chlamydia infection was 2.0% (CI: 1.7-2.3); 2.5% (CI: 2.0-3.0) in women and 1.5% (1.1-1.8) in men. Chlamydia prevalence was significantly greater in very highly urbanized areas (3.2%, CI: 2.4-4.0) compared to rural areas (0.6%, CI: 0.1-1.1). In very highly urbanized areas the greatest prevalence was found among 15-19-year-old women (4.3%) and among 25-29-year-old men (4.2%). A risk profile could be determined and a prediction rule was developed. These data suggest that nationwide systematic screening is not indicated in the Netherlands and that targeted approaches are a better option. Roll-out of selective screening is recommended.

[Accelerated increase in the number of involuntary admissions following the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ)]. / Versnelde stijging van het aantal inbewaringstellingen na de invoering van de Wet Bijzondere Opnemingen in Psychiatrische Ziekenhuizen (BOPZ).

OBJECTIVE: To determine whether the observed accelerated increase in the number of involuntary admissions in The Netherlands coincides with the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ) in 1994. DESIGN: Retrospective. METHOD: The extent to which the number of involuntary admissions changed after implementation of the BOPZ was examined by means of Poisson regression on the basis of national data from the Patient Registration of Intramural Mental Healthcare for the period 1979-1995 and data from the Healthcare Inspectorate for the period 1992-2004. For this purpose, the curve prior to implementation of the BOPZ was compared with that following its implementation. RESULTS: The number of involuntary admissions of psychiatric patients had more than doubled in 25 years, from 3101 in 1979 to 7450 in 2004. The increase in annual numbers accelerated significantly after implementation of the BOPZ in 1994. CONCLUSION: There was an accelerated increase in the number of involuntary admissions after the implementation of the BOPZ. Other possible contributing factors include an increased number of admissions, shorter hospital stays, and changes in social concepts.

Acceptability and consequences of screening for chlamydia trachomatis by home-based urine testing.

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 high-risk groups.

[Reduction in the consumption of benzodiazepines due to a letter to chronic users from their own general practitioner]. / Vermindering van gebruik van benzodiazepinen door een brief van de eigen huisarts aan chronische gebruikers.

OBJECTIVE: To investigate the effectiveness of a minimal intervention in reducing the volume of prescription of benzodiazepines at the regional level. DESIGN: Prospective. METHOD: 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. RESULTS: During the period 6-12 months after the first letter in the intervention group (n = 1343), 11.3% of the patients (95% CI: 9.6-13.1) received no prescription whatsoever for benzodiazepines compared to 5.4% (4.6-6.3) and 4.9% (4.2-5.5) in East Groningen (n = 2932) and in Northwest Groningen (n = 4562), respectively. The average decrease in prescription volume was 13% (-9.9 to -15.1) in the intervention group compared to 3% (-0.1 to -4.1) and 3% (-1.5 to -4) in the control groups. The reminder sent half a year later had no additional effect. CONCLUSION: The informative letter from the GP to chronic users of benzodiazepines with the advice to stop or reduce this use was effective.

Prevalence of urogenital Chlamydia trachomatis increases significantly with level of urbanisation and suggests targeted screening approaches: results from the first national population based study in the Netherlands.

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.

A prediction rule for selective screening of Chlamydia trachomatis infection.

BACKGROUND: Screening for Chlamydia trachomatis infections is aimed at the reduction of these infections and subsequent complications. Selective screening may increase the cost effectiveness of a screening programme. Few population based systematic screening programmes have been carried out and attempts to validate selective screening criteria have shown poor performance. This study describes the development of a prediction rule for estimating the risk of chlamydial infection as a basis for selective screening. METHODS: A population based chlamydia screening study was performed in the Netherlands by inviting 21,000 15-29 year old women and men in urban and rural areas for home based urine testing. Multivariable logistic regression was used to identify risk factors for chlamydial infection among 6303 sexually active participants, and the discriminative ability was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with bootstrap resampling techniques. RESULTS: The prevalence of C trachomatis (CT) infection was 2.6% (95% CI 2.2 to 3.2) in women and 2.0% (95% CI 1.4 to 2.7) in men. Chlamydial infection was associated with high level of urbanisation, young age, Surinam/Antillian ethnicity, low/intermediate education, multiple lifetime partners, a new contact in the previous two months, no condom use at last sexual contact, and complaints of (post)coital bleeding in women and frequent urination in men. A prediction model with these risk factors showed adequate discriminative ability at internal validation (AUC 0.78). CONCLUSION: The prediction rule has the potential to guide individuals in their choice of participation when offered chlamydia screening and is a promising tool for selective CT screening at population level.

Increased alpha-linolenic acid intake lowers C-reactive protein, but has no effect on markers of atherosclerosis.

OBJECTIVE: To investigate the effects of increased alpha-linolenic acid (ALA)-intake on intima-media thickness (IMT), oxidized low-density lipoprotein (LDL) antibodies, soluble intercellular adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), and interleukins 6 and 10. DESIGN: Randomized double-blind placebo-controlled trial. SUBJECTS: Moderately hypercholesterolaemic men and women (55 +/- 10 y) with two other cardiovascular risk factors (n = 103). INTERVENTION: Participants were assigned to a margarine enriched with ALA (fatty acid composition 46% LA, 15% ALA) or linoleic acid (LA) (58% LA, 0.3% ALA) for 2 y. RESULTS: Dietary ALA intake was 2.3 en% among ALA users, and 0.4 en% among LA users. The 2-y progression rate of the mean carotid IMT (ALA and LA: +0.05 mm) and femoral IMT (ALA:+0.05 mm; LA:+0.04 mm) was similar, when adjusted for confounding variables. After 1 and 2 y, ALA users had a lower CRP level than LA users (net differences -0.53 and -0.56 mg/l, respectively, P < 0.05). No significant effects were observed in oxidized LDL antibodies, and levels of sICAM-1, interleukins 6 and 10. CONCLUSIONS: A six-fold increased ALA intake lowers CRP, when compared to a control diet high in LA. The present study found no effects on markers for atherosclerosis. SPONSORSHIP: The Dutch 'Praeventiefonds'.

[High mortality due to infectious diseases and unnatural causes of death among asylum seekers in the Netherlands, 1998-1999]. / Hoge sterfte door infectieziekten en niet-natuurlijke doodsoorzaak onder asielzoekers in 1998-1999.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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 54,110 in 1999. The crude mortality rate was 1.95 per 1000 for male asylum seekers and 1.25 per 1000 for female asylum seekers. Compared to the Dutch standard population, the SMR was 1.23 (95%-CI: 1.01-1.42) for male asylum seekers and 0.85 (0.59-1.11) for female asylum seekers. The elevated mortality in male asylum seekers was due to the high mortality for infectious diseases with an SMR of 4.1 (1.3-6.9) and unnatural death with an SMR of 2.5 (1.7-3.2). More specifically, drowning had an SMR of 11.1 (2.3-20.7), murder and manslaughter 7.3 (2.5-12.0) and suicide 2.8 (1.5-4.1). AIDS accounted for half of the mortality due to infectious diseases. CONCLUSION: In 1998-1999, drowning, murder, manslaughter and suicide contributed significantly to an elevated mortality rate amongst male asylum seekers in the Netherlands. Some of these unnatural deaths could be avoided by implementing preventive measures.

Psychosocial consequences of screening for albuminuria and certain other risk factors.

OBJECTIVE: To gain insight into the psychosocial consequences of a screening programme on the progression of heart, vascular and kidney damage. DESIGN: 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. RESULTS: 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 the respondents claimed to follow a healthier lifestyle as a result of the screening. There are, however, also indications for a certain 'certificate of health effect': about half of the smokers and the physically inactive considered that the favourable screening results legitimated their unhealthy lifestyle. An unfavourable screening result led to additional medical consumption in almost half of the respondents. The respondents appreciated the screening and especially the less educated had a very positive attitude towards early diagnosis in general. CONCLUSIONS: Those screened positive showed no diminished well-being; their health behaviour improved because of the screening and their medical consumption increased. Many of those screened negative considered the test result a reason to continue their unhealthy lifestyle.

Impact of Mediterranean diet education versus posted leaflet on dietary habits and serum cholesterol in a high risk population for cardiovascular disease.

OBJECTIVE: To investigate the impact of intensive group education on the Mediterranean diet on dietary intake and serum total cholesterol after 16 and 52 weeks, compared to a posted leaflet with the Dutch nutritional guidelines, in the context of primary prevention of cardiovascular disease (CVD). DESIGN: Controlled comparison study of an intervention group given intensive group education about the Mediterranean diet and a control group of hypercholesterolaemic persons given usual care by general practitioners (GPs). SETTING: A socioeconomically deprived area in the Netherlands with an elevated coronary heart disease (CHD) mortality ratio. SUBJECTS: Two hundred and sixty-six hypercholesterolaemic persons with at least two other CVD risk factors. RESULTS: After 52 weeks, the intervention group decreased total and saturated fat intake more than the control group (net differences were 1.8 en% (95%CI 0.2-3.4) and 1.1 en% (95%CI 0. 4-1.9), respectively). According to the Mediterranean diet guidelines the intake of fish, fruit, poultry and bread increased in the intervention group, more than in the control group. Within the intervention group, intake of fish (+100%), poultry (+28%) and bread (+6%) was significantly increased after 1 year (P < 0.05). The intensive programme on dietary education did not significantly lower serum cholesterol level more (-3%) than the posted leaflet (-2%) (net difference 0.06 mmol l-1, 95%CI -0.10 to 0.22). Initially, the body mass index (BMI) decreased more in the intervention group, but after 1 year the intervention and control group gained weight equally (+1%). CONCLUSIONS: Despite beneficial changes in dietary habits in the intervention group compared with the control group, after 1 year BMI increased and total fat and saturated fat intake were still too high.