[The health of children in the Netherlands: relatively healthy, but lifestyle raises some concerns]. / De gezondheid van de Nederlandse jeugd: relatief gezond, maar leefstijl vraagt aandacht.

Dutch young people are generally healthy, and more than 80% of them feel healthy and happy. This percentage is high compared with other European countries. Infant mortality rates are low, and the prevalence of most health problems among children is less than 10%. However, children from risk groups more often engage in unhealthy behaviours or have psychosocial problems. Adolescents smoke and drink less than they did 10 years ago, but extreme alcohol use has increased. The number of overweight children has stabilised in the past few years, but remains at a high level. These trends are expected to follow the same line in the future. Attention to the increasing use of social media is important, and the increasing number of high-risk children will also require attention. Due to these changes, along with policy changes in the provision of healthcare services for young people, intensive communication and cooperation between general practitioners, healthcare physicians, and care workers responsible for young people is increasingly important.

Worksite mental health interventions: a systematic review of economic evaluations.

OBJECTIVE: To give an overview of the evidence on the cost-effectiveness (CE) and financial return of worksite mental health interventions. METHODS: A systematic search was conducted in relevant databases. Included economic evaluations were classified into two groups based on type of intervention: (1) aimed at prevention or treatment of mental health problems among workers or (2) aimed at return to work (RTW) for workers sick-listed from mental health problems. The quality of the included economic evaluations was assessed using the Consensus Health Economic Criteria list (CHEC-list). RESULTS: Ten economic evaluations were included in this systematic review. All four economic evaluations on the prevention or treatment of mental health problems found a positive cost-benefit ratio, although three of these studies had low to moderate methodological quality. In five out of six economic evaluation studies on RTW interventions, no favourable CE or cost-benefit balance was found. One study of moderate methodological quality reported on a positive CE balance. CONCLUSIONS: Due to a limited number of economic evaluations on worksite mental health interventions of which a majority was lacking methodological quality or lacking evidence, only a tentative conclusion can be drawn from the results of this systematic review. Worksite interventions to prevent or treat mental health problems might be cost-effective, while those RTW interventions that included a full economic evaluation aimed at depressed employees do not seem to be cost-beneficial. More high-quality economic evaluation studies of effective worksite mental health interventions are needed to get more insight into the economic impact of worksite mental health interventions.

[Cost-effectiveness: euros per QALY is not enough]. / Kosteneffectiviteit: euro's per QALY is niet genoeg.

The number of economic evaluations being published in scientific literature each year is increasing exponentially. Cost-effectiveness seems to be playing an increasing role in decisions about reimbursement or the implementation of curative or preventive interventions. A cost-effectiveness ratio represents the fraction between the costs and effects that are associated with an intervention. What costs are included in the numerator of the fraction? What assumptions on effectiveness and reach are made to express the denominator? Various examples have shown that small differences in assumptions can have significant consequences for the cost-effectiveness ratio. This holds true for presumptions on the long-term effects of an intervention as well as the willingness to participate in an intervention. Such assumptions and choices can sometimes highly determine the outcome of a cost-effectiveness analysis. For this reason, caution in interpreting results of cost-effectiveness analyses is warranted.

The polypill in the primary prevention of cardiovascular disease: cost-effectiveness in the Dutch population.

Objectives The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease. Design A health economic modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. Interventions Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the Systematic Coronary Risk Evaluation function of alternatively 5%, 7.5% or 10%. Different versions of the polypill were considered, depending on composition: (1) the Indian polycap, with three different types of blood pressure-lowering drugs, a statin and aspirin; (2) as (1) but without aspirin and (3) as (2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated. Primary outcome measures Cases of acute myocardial infarction or stroke prevented, quality-adjusted life years (QALYs) gained and the costs per QALY gained. All interventions were compared with usual care. Results All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7900 and 12 300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as the threshold, this pill would prevent approximately 3.5% of all cardiovascular events. Conclusions Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose.

The scope of costs in alcohol studies: Cost-of-illness studies differ from economic evaluations.

BACKGROUND: Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse. METHOD: To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies. RESULTS: The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%. CONCLUSIONS: The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.

Age-related differences in muscular capacity among workers.

PURPOSE: To quantify the age-related changes in muscular capacity in a working population, and to investigate whether these changes are dependent on sports participation. METHODS: Data were used from the longitudinal study on musculoskeletal disorders, absenteeism, stress and health (n = 1,800). At baseline, isokinetic lifting strength and static muscle endurance were assessed, and endurance measurements were repeated after 3 years of follow-up. Sports participation was assessed using a questionnaire. RESULTS: Cross-sectionally, static endurance of the neck/shoulder muscles was highest among older workers, but decreased longitudinally among all age groups. Younger workers who participated in sports 3 h per week or more had the best performance, but older workers who participated between 0 and 3 h per week had better performance than those who participated in sports more frequently. CONCLUSIONS: There were age-related differences on muscular capacity. Younger workers who participated in sports frequently had the best muscular capacity. For aging workers, moderate sports participation seems to be effective in keeping them suitable for the relatively growing work demands.

The effect of a resistance-training program on muscle strength, physical workload, muscle fatigue and musculoskeletal discomfort: an experiment.

The aim of the study was to investigate the effectiveness of a resistance-training program on muscle strength of the back and neck/shoulder muscles, relative physical workload, muscle fatigue and musculoskeletal discomfort during a simulated assembly and lifting task. Twenty-two workers were randomized over an 8-week resistance-training group, and a control group. Isokinetic muscle strength was assessed using the Cybex dynamometer, muscle fatigue was measured using EMG, and perceived discomfort was measured using a 10-point scale. At the follow-up, we found no effect of the resistance-training program on isokinetic muscle strength of the back and shoulder muscles. Furthermore, we did not find any effect on EMG data, nor on musculoskeletal discomfort during the simulated work tasks. However, trained workers performed the lifting tasks for a longer time before reporting considerable discomfort than those in the control group.

Does musculoskeletal discomfort at work predict future musculoskeletal pain?

The objective of this prospective cohort study was to evaluate if peak or cumulative musculoskeletal discomfort may predict future low-back, neck or shoulder pain among symptom-free workers. At baseline, discomfort per body region was rated on a 10-point scale six times during a working day. Questionnaires on pain were sent out three times during follow-up. Peak discomfort was defined as a discomfort level of 2 at least once during a day; cumulative discomfort was defined as the sum of discomfort during the day. Reference workers reported a rating of zero at each measurement. Peak discomfort was a predictor of low-back pain (relative risk (RR) 1.79), neck pain (RR 2.56), right or left shoulder pain (RR 1.91 and 1.90). Cumulative discomfort predicted neck pain (RR 2.35), right or left shoulder pain (RR 2.45 and 1.64). These results suggest that both peak and cumulative discomfort could predict future musculoskeletal pain.

A systematic review of the relation between physical capacity and future low back and neck/shoulder pain.

The results of longitudinal studies reporting on the relation between physical capacity and the risk of musculoskeletal disorders have never been reviewed in a systematic way. The objective of the present systematic review is to investigate if there is evidence that low muscle strength, low muscle endurance, or reduced spinal mobility are predictors of future low back or neck/shoulder pain. Abstracts found by electronic databases were checked on several inclusion criteria. Two reviewers separately evaluated the quality of the studies. Based on the quality and the consistency of the results of the included studies, three levels of evidence were constructed. The results of 26 prospective cohort studies were summarized, of which 24 reported on the longitudinal relationship between physical capacity measures and the risk of low back pain and only three studies reported on the longitudinal relationship between physical capacity measures and the risk of neck/shoulder pain. We found strong evidence that there is no relationship between trunk muscle endurance and the risk of low back pain. Furthermore, due to inconsistent results in multiple studies, we found inconclusive evidence for a relationship between trunk muscle strength, or mobility of the lumbar spine and the risk of low back pain. Finally, due to a limited number of studies, we found inconclusive evidence for a relationship between physical capacity measures and the risk of neck/shoulder pain. Due to heterogeneity, the results of this systematic review have to be interpreted with caution.

Is an imbalance between physical capacity and exposure to work-related physical factors associated with low-back, neck or shoulder pain?

OBJECTIVES: This study investigates whether an imbalance between physical capacity and exposure to work-related physical factors is associated with low-back, neck, or shoulder pain. METHODS: Data of the longitudinal study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), with a follow-up of 3 years (N=1789), were used. At baseline, physical capacity (isokinetic lifting strength, static muscle endurance, and mobility of the spine) and exposure to work-related physical factors were assessed. During the follow-up, low-back, neck, and shoulder pain were self-reported annually. "Imbalance" was defined as lower than median capacity combined with higher than median exposure, "high balance" was high capacity and high exposure, and "low balance" was low capacity and low exposure. RESULTS: For both the low-back and neck, imbalance between static endurance and working with flexed postures was a risk factor for pain [relative risk (RR) 1.35, 95% confidence interval (95% CI) 1.08-1.68, and RR 1.36, 95% CI 0.96-1.91, respectively]. Low balance was also associated with low-back pain (RR 1.29, 95% CI 1.04-1.68). Furthermore, low balance between isokinetic lifting strength and lifting exposure was a risk factor for low-back and neck pain [RR between 1.22 (95% CI 0.99-1.49) and 1.35 (95% CI 1.03-1.79)]. No associations were found with shoulder pain. CONCLUSIONS: Some relationship between low-back and neck pain and combined measures of physical capacity with exposure to work-related physical factors seems to exist, but an imbalance between physical capacity and exposure was not found to yield higher risks than high balance or low balance.

Cost-effectiveness of face-to-face smoking cessation interventions: a dynamic modeling study.

OBJECTIVES: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs per quitter, costs per life-year gained, and costs per quality-adjusted life-year (QALY) gained. METHODS: Scenarios on increased implementation of smoking cessation interventions were compared with current practice in The Netherlands. One of the five interventions was implemented for a period of 1, 10, or 75 years reaching 25% of the smokers each year. A dynamic population model, the RIVM chronic disease model, was used to project future gains in life-years and QALYs, and savings of health-care costs from a decrease in the incidence of 11 smoking-related diseases over a time horizon of 75 years. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size, and discount rates. RESULTS: Compared with current practice, minimal GP counseling was a dominant intervention, generating both gains in life-years and QALYs and savings that were higher than intervention costs. For the other interventions, incremental costs per QALY gained ranged from about 1100 per thousand for telephone counseling to 4900 per thousand for intensive counseling with nicotine patches or gum for implementation periods of 75 years. CONCLUSIONS: All five smoking cessation interventions were cost-effective compared with current practice, and minimal GP counseling was even cost-saving.