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H P van de Water

Publications and source records attributed to H P van de Water.

At least 19 recordsLinked to original sources
PubMed1997

Health expectancy calculations: a novel approach to studying population health in Bulgaria.

The measurement of life expectancy in terms of either good or poor health is a novel approach to studying the health of the population in Bulgaria. The pilot study reported here-carried out among people aged > or = 60 years in a middle-sized Bulgarian town-was designed to obtain information on the years of functional restrictions expected among the elderly. In accordance with the answers to a series of questions (recommended by WHO), subjects were categorized as disabled, handicapped, or having different states of perceived health. The indicators "disability-free life expectancy", "handicap-free life expectancy" and "healthy life expectancy" (based on self-perceived health) were calculated according to Sullivan's method. The results show, for example, that 8.0 of the 16.0 years that men aged 60 years may expect to live, on average, will be free of disability. For men aged 80 years the figures are 1.3 of 5.5 years. For women at 60 years and 80 years the results are 7.3 and 0.5 disability-free years of 19.2 and 7.3 expected life years, respectively. Similar results were found for handicap-free life expectancies and healthy life expectancies. At all ages, the proportion of life in a condition free of disability, free of handicap, or in perceived good health is substantially lower for women than for men. Women may expect to live longer, but a greater proportion of their life will be spent in poor health. The approach presented here for measuring the health status of the elderly may be helpful as an aid to planning medical and social care and for the development of public health policies.

Aged↗
PubMed1996

Policy relevance of the health expectancy indicator; an inventory in European Union countries.

Due to epidemiological transitions in population health both an increase in life expectancy and in chronic morbidity and disability have been observed in many countries. Consequently the tension between 'living longer' on the one hand and the 'quality of life' on the other have become a central health policy problem. The introduction of the indicator 'health expectancy' (HE), a measurement that combines mortality data with morbidity and disability data, was a logical reaction to these changes and to the growing need of a present-day yardstick to estimate this problem. The HE indicator is still under development, a process being furthered by the international network of researchers, REVES. A European project, called Euro-REVES, aims to promote and harmonize future HE calculations in Europe. To begin this project and to gain more insight into the indicator's policy relevance, an inventory has been carried out among policy makers, National Statistical Institutes and researchers in countries of the European Union (EU). This paper presents the results of the inventory, attempts to place these within a provisional classification system of HE types, and discusses the consequences of the findings for further conceptual harmonization and development of the indicator. Already 11 of the 15 ER member states have HE results available. The actual use of such results for policy making is increasing. Notwithstanding a great diversity in sources and questions used for the calculations, there seems to be enough simularity to give the harmonization effort a good perspective.

Chronic Disease↗
PubMed1996

Occupational handicap-free life expectancy in Bulgaria 1976-1992 based on the data of the medical expert commissions.

This article presents health expectancy calculations from Bulgaria for 1976-1992. The calculations are based on mortality statistics and data from a national information system from the Expert Medical Commissions on Working Capacity about loss of working capacity. Following internationally accepted terminology, the most appropriate term for the health expectancies presented here is "occupational handicap-free life expectancy' (OHFLE). Life expectancies were calculated as partial life expectancies from ages 16 to 59. Health expectancy calculations followed Sullivan's cross-sectional method with age and sex specific prevalence data on occupational handicap. Around 1985 a three- to four-fold increase in these prevalences occurred. The distribution of occupational handicaps over sexes, age groups and severity levels, however, remained fairly constant. The results show a decrease both in partial life expectancy within the age range 16-59 and in OHFLE at the age of 16 for men. For women a more or less stable partial life expectancy and a decrease in OHFLE at the age of 16 was found around 1985. The introduction of more incentives for people who successfully registered probably caused the decrease around 1985. Major social changes may have acted as confounding factors for the fluctuations after 1985. On the other hand the findings may reflect real changes in population health due to an increasing incidence in some major disease categories. The nation-wide system for assessment and registration of health related working incapacity has proved a useful source for an attempt to calculate OHFLE. Given uncertainties about the population health underlying these changes in OHFLE, however, it is recommended that health interview and health examination surveys should be considered as alternative routes for achieving a more comprehensive picture of population health in Bulgaria.

Adolescent↗
PubMed1995

ICIDH in the calculation of health expectancy.

In this paper the use of the ICIDH in the field of calculating health expectancies is examined. The health indicator 'health expectancy' is an adaptation of the indicator 'life expectancy'; health expectancies reflect the expected number of years lived in good health in a population. To date, health expectancies have been calculated for many countries. However, many different concepts of health have been used. The theoretical framework of the ICIDH has been proposed to harmonize the calculations of health expectancy. In this paper we explore this idea. To examine the possibility to use the ICIDH framework, we calculated health expectancies for The Netherlands, trying to follow the ICIDH. Subsequently, we reviewed the health expectancies calculated for other countries, and tried to fit those into the ICIDH framework. Much of the work done could be fitted into this framework. An important exception, however, are those health expectancies that try to capture a concept of health that is more compassing than impairments, disabilities and handicaps. Although it is possible to classify different health expectancies according to the ICIDH, this does not make health expectancies within a certain class comparable. Both the calculations carried out for The Netherlands, and the comparison of instruments used internationally, show that the instruments used to measure, for example, disabilities, yield results which are not comparable. Continuing efforts to standardize measurement instruments are needed.

Activities of Daily Living↗
PubMed1992

Is the worst of the epidemic over? Back calculation of HIV seroprevalence in The Netherlands.

This article calculates back the HIV seroprevalence in the Netherlands from AIDS cases notified 1982-1990 and rates of progression from HIV to AIDS adopted from American studies. It discusses a number of problems, such as changing AIDS definitions and the possible impact of AZT treatment. We estimate that the Netherlands had approximately 6762 HIV seropositives by the end of 1988, which is considerably lower than earlier expectations. When a hypothetical decrease of 10% in the manifestation of AIDS cases due to AZT treatment was incorporated, the estimate for the end of 1988 becomes 7549. After deduction of the AIDS patients who had died by the beginning of 1989 from this estimate, the HIV seroprevalence by the end of 1988 is approximately 7000. The distribution of seroincidence over time suggests that the HIV epidemic in our country has passed its summit and that the HIV incidence is falling quickly. The question arises as to how far this fortunate development may be considered a success of the Dutch AIDS policy, a policy characterised by more openness than in many other countries. The material studied here, however, allows no definite answer to this intriguing question.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Setting priorities in prevention.

In the last few years prevention has again become the focus of attention because of various international developments such as the WHO strategy for Health for All by the year 2000. When resources are scarce, it is all the more important to set priorities. This applies to prevention as well as to curative care. In this paper, we describe a method for comparing prevention programmes with one another, using efficiency as the final parameter. To determine efficiency it is necessary to collect facts about a number of aspects of the health problems to be prevented: size of the health problem, degree of preventability, monetary and other costs involved and the probability that the prevention programme will cause changes in the overall pattern of morbidity and/or mortality. These aspects are discussed and some examples given.

Cost-Benefit Analysis↗
PubMed1991

[Sexually transmissible disorders in allochtonous population groups; a pilot study].

In the registration of sexually transmitted diseases (STD) carried out by the nursing staff in the STD clinics the share of the immigrant populations of Turkish, Moroccan, Surinam and Antilles origin was investigated for the period 1986-89. In the total population of STD patients the immigrants appear to be overrepresented. Their share has increased from one-eight to one-fifth of the total number of STD cases. The STD rates (number of cases per 1000) for the Turkish and Moroccan populations are high, even after adjusting for population size and age. High STD rates are most apparent among males, especially among Turkish males. In comparison with the Dutch population more gonorrhoea is found among immigrants, in particular penicillinase producing Neisseria gonorrhoeae (PPNG). Turkish males (and prostitutes) contributed much to this relatively high prevalence. Further research is to be initiated in order to obtain better insight into the occurrence of STD among immigrant populations in The Netherlands, especially in connection with a potentially increased risk of infection with Human Immunodeficiency Virus (HIV).

Emigration and Immigration↗
PubMed1991

Results of two methods to determine health expectancy in The Netherlands in 1981-1985.

Health expectancy is a measure providing summarizing information on mortality on one hand and morbidity and/or disability on the other hand. In this article health expectancy is determined with two approaches: method 1 leads to life expectancy free of disability at birth and at other ages; method 2 leads to life expectancy in good health. Results of the various calculations show that according to method 1 life expectancy free of disability at birth for men in the Netherlands was 58.8 years and for women 57.3 years (based on data from the period 1981-1985). Results of method 2 are different from method 1; life expectancy in good health for men was 58.9 years and for women 60.7 years. Results of both methods are compared with studies which have been carried out in other countries. The comparison shows that method 1 leads to results which deviate from the other studies while results of method 2 are to a large extent similar to the other studies. Reasons are given which explain why the results of method 1 deviate from the other studies. In spite of the fact that the two methods lead to different outcomes, the conclusion is drawn that the difference in health expectancy between men and women is much smaller than the difference in total life expectancy between men and women. The difference in total life expectancy by sex in the period 1981-1985 was 6.7 years.

Adolescent↗
PubMed1990

[Estimate of the number of HIV-seropositive persons in The Netherlands; implications for the evolution of the AIDS epidemic].

In this article we estimate the total number of HIV seropositives in the Netherlands with an extended version of the Fast Back Calculation model. As a result we found between 5500 and 6500 seropositives for the end of 1987. This is considerably lower than earlier expectations. The distribution of incidence over time suggests that the HIV epidemic has passed its summit. We argue that the total number of HIV infected persons halfway 1990 lies somewhere between 7500 and 9000. With the estimated number of HIV seropositives we also predict minimum values for the AIDS incidence in future years. We expect the number of new AIDS cases to increase to over 600 per year in the mid-nineties. We briefly discuss the consequences of our findings for AIDS control. We underline the desirability of a policy directed at risk groups and apart from continuing existing preventive measures aimed at these groups we advocate paying more attention to i.v. drug users, visitors of STD clinics and travellers to and applicants for political asylum from endemic areas.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Declining gonorrhoea rates in The Netherlands, 1976-88: consequences for the AIDS epidemic.

The national notification gonorrhoea data are analysed over the period 1976-88 in conjunction with detailed data from the two STD clinics in Amsterdam in order to get an insight into the underlying reasons for the downward trend of gonorrhoea in The Netherlands. Possible effects of variations in reporting bias, seasonality, resistance against antibiotics, and sexual behaviour on gonorrhoea rates are considered. In 1981 the incidence of gonorrhoea started to decrease, thus preceding the onset of the AIDS epidemic in The Netherlands. Since 1983 the decline in gonorrhoea further accelerated and has been most apparent among homo- and bisexual men, presumably as a result of behavioural changes because of AIDS. There is less evidence for massive (AIDS related) behavioural changes among heterosexuals. The increasing percentage of gonorrhoea patients with recurrent episodes of STDs in Amsterdam may suggest that highly sexually active individuals continue to put themselves at risk of STDs and persist in acquiring and transmitting gonorrhoea.

Acquired Immunodeficiency Syndrome↗