Publications (108) View all
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Article: Reply letter to: Do breast cancer survivors visit their General Practitioner for psychological problems? - Reply to Heins et al.: For which health problems do cancer survivors visit their General Practitioner?
European journal of cancer (Oxford, England: 1990) 03/2013; · 4.12 Impact Factor -
Article: Prevalence and resistance of commensal Staphylococcus aureus, including meticillin-resistant S aureus, in nine European countries: a cross-sectional study.
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ABSTRACT: BACKGROUND: Information about the prevalence of Staphylococcus aureus resistance to antimicrobial drugs has mainly been obtained from invasive strains, although the commensal microbiota is thought to be an important reservoir of resistance. We aimed to compare the prevalence of nasal S aureus carriage and antibiotic resistance, including meticillin-resistant S aureus (MRSA), in healthy patients across nine European countries. METHODS: In this cross-sectional study, nasal swabs were obtained from 32 206 patients recruited by family doctors participating in existing nationwide family doctor networks in Austria, Belgium, Croatia, France, Hungary, Spain, Sweden, the Netherlands, and the UK. Eligible patients were aged 4 years or older (≥18 years in the UK) and presented with a non-infectious disorder. Swabs were sent to national microbiological laboratories for identification and isolation of S aureus. Antibiotic resistance testing was done at one central microbiological laboratory. We established the genotypic structure of the isolated MRSA strains with the spa typing method. FINDINGS: S aureus was isolated from 6956 (21·6%) of 32 206 patients swabbed. The adjusted S aureus prevalence for patients older than 18 years ranged from 12·1% (Hungary) to 29·4% (Sweden). Except for penicillin, the highest recorded resistance rate was to azithromycin (from 1·6% in Sweden to 16·9% in France). In total, 91 MRSA strains were isolated, and the highest MRSA prevalence was reported in Belgium (2·1%). 53 different spa types were detected-the most prevalent were t002 (n=9) and t008 (n=8). INTERPRETATION: The prevalence of S aureus nasal carriage differed across the nine European countries assessed, even after correction for age, sex, and family doctor. Generally, the prevalence of resistance, including that of MRSA, was low. The MRSA strains recorded showed genotypic heterogeneity, both within and between countries. FUNDING: European Commission, 7th Framework Programme(grant agreement 223083).The Lancet Infectious Diseases 03/2013; · 17.39 Impact Factor -
Article: Type II diabetes patients in primary care: profiles of healthcare utilization obtained from observational data.
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ABSTRACT: BACKGROUND: The high burden of diabetes for healthcare costs and their impact on quality of life and management of the disease have triggered the design and introduction of disease management programmes (DMPs) in many countries. The extent to which diabetes patients vary with regard to their healthcare utilisation and costs is largely unknown and could impact on the design of DMPs. The objectives of this study are to develop profiles based on both the diabetes-related healthcare utilisation and total healthcare utilisation in primary care, to investigate which patient and disease characteristics determine 'membership' of each profile, and to investigate the association between these profiles. METHODS: Data were used from electronic medical records of 6721 known type II diabetes patients listed in 48 Dutch general practices. Latent Class Analyses were conducted to identify profiles of healthcare and regression analyses were used to analyse the characteristics of the profiles. RESULTS: For both diabetes-related healthcare utilisation and total healthcare utilisation three profiles could be distinguished: for the diabetes-related healthcare utilisation these were characterised as ' high utilisation and frequent home visits' (n=393), 'low utilisation, GP only' (n=3231) and ' high utilisation, GP and nurse' (n=3097). Profiles differed with respect to the patients' age and type of medication; the oldest patients using insulin were dominant in the 'high utilisation, GP and nurse' profile. High total healthcare utilisation was not associated with high diabetes-related healthcare utilisation. CONCLUSIONS: Healthcare utilisation of diabetes patients is heterogeneous. This challenges the development of distinguishable DMPs.BMC Health Services Research 01/2013; 13(1):7. · 1.66 Impact Factor -
Dataset: nivel bmc 2010
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Article: Functional prognosis of dizziness in older adults in primary care: a prospective cohort study.
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ABSTRACT: To investigate the 6-month functional prognosis of dizziness in older adults in primary care, to identify important predictors of dizziness-related impairment, and to construct a score to assist risk prediction. Prospective cohort study with 6-month follow-up. Twenty-four primary care practices in the Netherlands. Four hundred seventeen older adults (mean age 78.5, range 65-95, 74% female) presenting consecutively to primary care with dizziness. Tests, including history and physical and additional examination, previously selected by an international expert panel and based on an earlier systematic review, were performed. The main outcome measure was 6-month dizziness-related impairment score measured using the Dizziness Handicap Inventory. Follow-up was complete for 92% of participants. Although 61% of participants experienced less impairment at 6 months, 130 participants (34%) showed persistent dizziness-related impairment. Factors most predictive of dizziness-related impairment at 6 months were onset of dizziness at least 6 months before inclusion, standing still as a dizziness-provoking circumstance, trouble with walking or (almost) falling (associated symptom), polypharmacy, absence of diabetes mellitus, presence of anxiety or depressive disorder, and impaired functional mobility. A score was constructed using these predictors to estimate the functional prognosis of dizziness at 6 months. A score based on the presence of easily obtainable clinical information facilitates identification of older adults in primary care with poor functional prognosis of their dizziness without exactly knowing the cause(s) of their dizziness. Clinical management might be most effective by treating factors that can be influenced, such as polypharmacy, anxiety and depression, and functional mobility.Journal of the American Geriatrics Society 12/2012; 60(12):2263-9. · 3.74 Impact Factor
