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Biomedical subjects

L J Gunning-Schepers

Publications and source records attributed to L J Gunning-Schepers.

At least 37 records · Page 2Linked to original sources
PubMed1998

['Public health status and perspectives' 1997. V. Effects of prevention].

For the 'Public health status and forecasts' 1997 attention has been given to the health benefit that could still be achieved by primary and secondary prevention. For selected examples of five types of methods of prevention (health education, vaccination, legislation and regulation, pharmaceutical prophylaxis and screening) the efficacy (the health benefit which can be achieved under optimal circumstances) is compared with the effectiveness (the health benefit achieved in practice). The potential health benefit through interventions aimed at (life-style related) determinants is considerable. It is advised to work towards a programmatic prevention strategy giving attention to ascertaining the correct target group and the most suitable intervention strategy, to regular evaluation of the effectiveness, to implementing an intersectoral approach and to clearly establishing the responsibilities at both the central and the local level.

Forecasting↗
PubMed1998

Socioeconomic differentials in mortality among men within Great Britain: time trends and contributory causes.

STUDY OBJECTIVE: To assess the size of mortality differentials in men by social class in Scotland as compared with England and Wales, and to analyse the time trends in these differentials. SUBJECTS: Men from England and Wales and Scotland around each census from 1951 to 1981. METHODS: Poisson regression analysis was used to calculate relative indices of inequality for disease specific and all cause mortality as a measure of mortality differentials between social classes. This measure is not dependent on the size of the social class groups, so it can be used to compare the magnitude of differentials over time periods during which the relative sizes of social class groups change. MAIN RESULTS: While overall death rates were higher in Scotland than in England and Wales around the 1951, 1961, and 1971 censuses the relative indices of inequality indicated smaller mortality differences between social classes in Scotland. Inequality, as indexed by the relative index of inequality, increased over time in both Scotland and England and Wales, but to a greater degree in Scotland, resulting in greater social class mortality differentials for Scotland in 1981 (the relative index of inequality increased from 1.40 to 2.43 for England and Wales, and from 1.22 to 2.57 for Scotland between 1951 and 1981). This greater increase in the magnitude of inequalities in all cause mortality in Scotland seemed to result from increasing social class differentials in cardiovascular disease, accidents and external causes, and "all other causes of death". Examining the trends in overall death rates, it seems that the greater increase in social class differences in Scotland occurred because of the greater decrease in death rates among the privileged social groups, in combination with a smaller decrease (or a greater increase) in the death rates in the lower social class groups. CONCLUSIONS: This study has shown that trends in mortality and in inequalities in mortality differ within Great Britain. Although death rates were higher in Scotland than in England and Wales, smaller mortality differentials by social class were found in Scotland over the period 1951 to 1971. By 1981, however, social class mortality differentials were greater in Scotland than in England and Wales. The greater increase in the social class differentials over time in Scotland, may have contributed to the worsening overall mortality profile in Scotland as compared with England and Wales that occurred between 1971 and 1981.

Adolescent↗
PubMed1998

Variation between studies in reported relative risks associated with hypertension: time trends and other explanatory variables.

OBJECTIVES: This study examined the variation in reported relative risks of coronary heart disease and stroke associated with hypertension and determined reasons for the interstudy variation. METHODS: Studies published since 1970 were examined that reported the absolute number of events and person-years for men by age and hypertensive status. The data were pooled in Poisson regression models with the coronary heart disease or stroke rate as the dependent variable. Independent variables were hypertensive status, age at entry, age of study, duration of follow-up, diastolic blood pressure cut-off point, and interactions of all these variables with hypertensive status. RESULTS: The reported relative risks associated with hypertension ranged from 1.45 to 2.77 for coronary heart disease and from 1.86 to 5.78 for stroke. Smaller relative risks were found in more recent studies, in studies with long follow-up, and in studies using a lower cut-off point to define hypertension. CONCLUSIONS: Part of the interstudy variation in relative risks associated with hypertension can be attributed to differences in duration of follow-up, blood pressure cutoff point, and time at which blood pressure was measured, suggesting declining relative risks over time.

Adult↗
PubMed1998

[Waiting lists for psychogeriatric nursing home admissions: insight into the problematic waiting times].

In this article the waiting list for psychogeriatric nursing home care has been described for a large town in the Randstad (Netherlands). A literature study on psychogeriatric waiting lists was conducted; in a qualitative research project the procedure for admission on the waiting list was studied; and in a files study the characteristics of patients on the waiting lists, the waiting times and factors influencing waiting time have been studied. During the research period (1991) 111 patients were admitted to a waiting list, including 8 patients for whom admission was considered to be very urgent. These highly urgent patients were all mildly demented and had a mean waiting time of nine days. Almost half of the patients who were considered 'normally urgent' were moderately demented. The normally urgent patients had a mean waiting time of fourteen weeks. Hospitalized patients waiting for admission to a nursing home, had a lower waiting time than patients with the same urgency who were waiting at home. In comparison to the norms (8 weeks), the mean waiting time was unacceptably long.

Aged↗
PubMed1997

Who should decide? Qualitative analysis of panel data from public, patients, healthcare professionals, and insurers on priorities in health care.

OBJECTIVE: To explore the arguments underlying the choices of patients, the public, general practitioners, specialists, and health insurers regarding priorities in health care. DESIGN: A qualitative analysis of data gathered in a series of panels. Members were asked to economise on the publicly funded healthcare budget, exemplified by 10 services. RESULTS: From a medical point of view, both panels of healthcare professionals thought most services were necessary. The general practitioners tried to achieve the budget cuts by limiting access to services to those most in need of them or those who cannot afford to pay for them. The specialists emphasised the possibilities of reducing costs by increasing the efficiency within services and preventing inappropriate utilisation. The patients mainly economised by limiting universal access to preventive and acute services. The "public" panels excluded services that are relatively inexpensive for individual patients. Moreover, they emphasised the individual's own responsibility for health behaviour and the costs of health care, resulting in the choice for copayments. The health insurers emphasised the importance of including services that relate to a risk only, as well as feasibility aspects. CONCLUSIONS: There were substantial differences in the way the different groups approached the issue of what should be included in the basic package. Healthcare professionals seem to be most aware of the importance of maintaining equal access for everyone in need of health care.

Attitude of Health Personnel↗
PubMed1997

[Intra- and extramural workshop for care, teaching, and research].

Medical care and its development, education, training and research are closely linked in academic medical centres. Traditionally, hospital-based disciplines can make use of the university hospital as a 'workshop' for the combination of these activities. In the Netherlands, however, there is no structurally financed workshop for the non-hospital based medical disciplines, such as family medicine, public health medicine, and nursing home medicine. In the Academic Medical Centre, University of Amsterdam, an integrated hospital and primary health care oriented academic workshop is being developed, for all medical disciplines, including social medicine (e.g. preventive care) and general practice.

Academic Medical Centers↗
PubMed1997

Modelling the effects of increased physical activity on coronary heart disease in England and Wales.

OBJECTIVE: To investigate the use of computer models as tools for policy makers in evaluating physical activity interventions aimed at reducing deaths from coronary heart disease (CHD). DESIGN: The cell-based computer model Prevent, adapted to simulate risk factor interventions for an English and Welsh population, was used to simulate the effect of two strategies for increasing physical activity levels in respect of CHD mortality over 25 years. The first strategy involved a 25% increase in the proportion of 15-64 year olds who were moderately active, while the second strategy involved a similar increase in the proportion who were vigorously active. The effects of focusing on narrower age ranges and on people at different initial activity levels were also explored. MAIN RESULTS: The simulations showed a small reduction in the CHD death rates--less than 0.15% and 0.06% for men and women respectively. The strategies would postpone up to 12,100 deaths over 25 years, comparable to the effect of a 2% reduction in smoking prevalence. The strategies seemed as if they would be more effective if they concentrated on men rather than women, on those over 45 years of age as opposed to all or younger age groups, and on the least active members of the population rather than those already taking some exercise. CONCLUSION: The use of computer modelling for stimulating physical activity strategies has shown that concentrating these interventions on older sedentary men will produce the greatest health gain, but efforts to encourage smoking cessation may be more effective in terms of years of life saved.

Adolescent↗
PubMed1997

How should interventions to reduce inequalities in health be evaluated?

OBJECTIVE: The effectiveness of interventions which have been proposed or are currently in progress to reduce socioeconomic inequalities in health is largely unknown. This paper aims to develop guidelines for evaluating these interventions. APPROACH: Starting from a set of general guidelines which was recently proposed by a group of experts reporting to the national Programme Committee on Socioeconomic Inequalities in Health in The Netherlands, an analysis was made of the appropriateness of different study designs which could be used to assess the effectiveness of interventions to reduce inequalities in health. RESULTS: A "full" study design requires the measurement, in one or more experimental populations and one or more control populations, of changes over time in the magnitude of socioeconomic inequalities in health. This will usually imply a community intervention trial. Five alternative study designs are distinguished which require less complex measurements but also require more assumptions to be made. Several examples are given. CONCLUSIONS: Building up a systematic knowledge base on the effectiveness of interventions to reduce socioeconomic inequalities in health will be a major enterprise. Elements of a strategy to increase learning speed are discussed. Although the guidelines and design recommendations developed in this paper apply to the evaluation of specific interventions where rigorous evaluation methods can often be used, they may also be useful for the interpretation of the results of less rigorous evaluation studies, for example of broader policies to reduce socioeconomic inequalities in health.

Evaluation Studies as Topic↗
PubMed1997

[Unhealthy differences. Part I. Socioeconomic deprivation and health].

Socioeconomic deprivation often concurs with deprivation in health. In this paper, the available evidence on socioeconomic health differences in The Netherlands is summarized. Furthermore explanations for the existence of these differences are given. Socioeconomic deprivation often leads to a worse health, but the reverse can also occur sometimes. Policies on the causes of these health differences usually concern fields like income distribution and employment. Health care can offer a compensation for the adverse health effects of socioeconomic deprivation.

Child↗
PubMed1996

[Variation in reporting of available places in the neonatal intensive care units and consequences for efficiency, fairness and quality of care].

OBJECTIVE: To determine whether the national information system on available beds in neonatal intensive care units (NICUs) leads to fair distribution and good efficiency and quality of care. SETTING: Two out of the ten NICUs in the Netherlands. DESIGN: Descriptive. METHODS: Data were gathered through observations and 18 interviews with among others neonatologists, gynaecologists and paediatricians. Another 19 doctors were interviewed by phone after a patient they had referred was refused. Interviews were analysed by means of Kwalitan, a computer programme for analysis of qualitative research. RESULTS: When a patient could not be admitted in his own region, the information system was often used to find out which NICUs had a bed available. Sometimes a NICU was called that, according to the information system, did not have a place available. Reasons were: the information was not up to date and not all available beds were reported. This last reason had to do with the wish to keep a bed free for patients from the NICU's own region. Because most doctors were aware of this, they sometimes negotiated about beds, which was time-consuming. CONCLUSION: The information system was used often, but was working below optimal level, resulting in diminished efficiency. This was primarily caused by the priority given to patients of the own region, which had to do with quality of care considerations. The existing variation in use of the priority policy deserves attention from the viewpoint of procedural justice.

Bed Occupancy↗
PubMed1996

The use of the waiting list in a fair selection of patients for nursing home care.

When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was studied. Qualitative research took place in two regions in the Netherlands, where scarcity exists in nursing home care. Selection meetings were attended and 39 health care workers were interviewed. Not only did waiting list criteria like urgency and chronology determine the final selection decision, but also efficiency and quality of care considerations (patients' preferences for particular nursing homes and nursing homes' considerations of matching the unit and work load). These considerations, their relative importance, and the resulting need for enforcement of the decision-making procedures, should be part of the discussion of patient selection. This acknowledges the complexity of the selection of patients.

Health Care Rationing↗
PubMed1995

Variation in reported prevalences of hypertension in The Netherlands: the impact of methodological variables.

STUDY OBJECTIVE: To estimate the prevalence of hypertension in The Netherlands and to quantify the influence of methodological variables on the reported prevalences. DESIGN: A pooled analysis was performed based on reported age specific prevalences of hypertension. A logistic model was used to estimate the probability of hypertension. MAIN RESULTS: The age standardised prevalence of hypertension varies more than fivefold between studies carried out in The Netherlands. The probability of having hypertension was lower if blood pressure was measured at more than one point in time (Odds ratio 0.44 (OR) (95% confidence interval (95% CI) 0.38, 0.51) for men and 0.47 (0.41, 0.54) for women, and if the study was carried out more recently (OR 0.92 (0.91, 0.93) per year). The probability was higher if the study was carried out in a general practice (OR 1.14 (1.03, 1.27) for men and 1.52 (1.36, 1.69) for women). The inclusion of treated people as hypertensive yields contradictory results for men and women. CONCLUSIONS: The strong variation in prevalence is explained by methodology and by a period effect indicating a decrease of the prevalence of hypertension over time. Whether this decrease is true or caused by confounding due to unknown or unreported methodological variation over time is unknown. For future studies, a standardised method could reduce the influence of methodological variables and thereby the variation in reported prevalences.

Adult↗
PubMed1994

Reported prevalences of former smokers in survey data: the importance of differential mortality and misclassification.

The purpose of this study was to determine whether the reported increase in the percentage of never smokers in the group of men born between 1924 and 1938, as observed in survey data in the Netherlands, can be attributed to differential mortality or to misclassification. In a spreadsheet program, the mortality experiences of the men born in 1924 and 1938 were simulated with the use of lifetable techniques. Due to differential mortality, the percentage of true never smokers would be expected to increase from 9% to 9.3% for men born in 1938 and from 9% to 10.3% for men born in 1924. In the survey, the percentage of people who reported that they had never smoked increased from 9% to 36% for the men born between 1924 and 1938. Differential mortality can only explain a very small part of the reported increase in the percentage of "never" smokers. Misclassification of former smokers as never smokers is the most likely cause for the reported increase. This is reason for concern, because even a small percentage of misclassified former smokers may bias the estimated relative risk of mortality associated with current smoking to a considerable extent. Because former smoking status cannot be measured correctly, the percentage of former smokers may be calculated by modeling the percentage of ever smokers.

Adolescent↗