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Background: Disability Adjusted Life Years (DALYs) quantify the loss of healthy years of life due to dying prematurely and due to living with diseases and injuries. Current methods of attributing DALYs to underlying risk factors fall short on two main points. First, risk factor attribution methods often unjustly apply incidence-based population attributable fractions (PAFs) to prevalence-based data. Second, it mixes two conceptually distinct approaches targeting different goals, namely an attribution method aiming to attribute uniquely to a single cause, and an elimination method aiming to describe a counterfactual situation without exposure. In this paper we describe dynamic modeling as an alternative, completely counterfactual approach and compare this to the approach used in the Global Burden of Disease 2010 study (GBD2010).Methods: Using data on smoking in the Netherlands in 2011, we demonstrate how an alternative method of risk factor attribution using a pure counterfactual approach results in different estimates for DALYs. This alternative method is carried out using the dynamic multistate disease table model DYNAMO-HIA. We investigate the differences between our alternative method and the method used by the GBD2010 by doing additional analyses using data from a synthetic population in steady state.Results: We observed important differences between the outcomes of the two methods: in an artificial situation where dynamics play a limited role, DALYs are a third lower as compared to those calculated with the GBD2010 method (398,000 versus 607,000 DALYs). The most important factor is newly occurring morbidity in life years gained that is ignored in the GBD2010 approach. Age-dependent relative risks and exposures lead to additional differences between methods as they distort the results of prevalence-based DALY calculations, but the direction and magnitude of the distortions depend on the particular situation.Conclusions: We argue that the GBD2010 approach is a hybrid of an attributional and counterfactual approach, making the end result hard to understand, while dynamic modelling uses a purely counterfactual approach and thus yields better interpretable results. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) is an important cause of hospital admission and death, but the extent of the problem of CAP at the primary healthcare level is largely unknown. Aims: To investigate the contribution of general practitioners (GPs) to the management of patients with CAP in the Netherlands. Methods: The study population consisted of all people enlisted in a GP network. We obtained information on CAP episodes from GP electronic records (using ICPC code R81) during the years 2002-2009. CAP registrations were also obtained from national hospital discharge data (ICD-9 codes) and cause of death statistics (ICD-10 codes). The three registration systems were linked at the individual level. We used descriptive analyses to estimate the annual number of CAP episodes (i.e. defined as a CAP diagnosis within 30 days). Results: From 2002 to 2009 the mean annual size of the study population was 395,039. For this population, 3,700 (0.9%) CAP episodes per year were registered in at least one of the registration systems, 2,933 (79%) of which were in the GP system only. Recovery within 30 days occurred on average in 95% (2,791/2,933) of the CAP episodes annually registered by a GP, while 2.3% (67/2,933) of patients with a GP-registered CAP episode were admitted to hospital within 30 days and 1% (26/2,933) had a fatal outcome within 30 days. Conclusions: The vast majority of CAP episodes registered in the Netherlands are managed successfully at the GP level without hospitalisation. [ABSTRACT FROM AUTHOR]

Following an increase in detection of enterovirus 68 (EV68) in community surveillance of respiratory infections in The Netherlands in 2010, epidemiological and virological analyses were performed to investigate the possible public health impact of EV68 infections. We retrospectively tested specimens collected from acute respiratory infections surveillance and through three children cohort studies conducted in The Netherlands from 1994 through 2010. A total of 71 of 13,310 (0.5%) specimens were positive for EV68, of which 67 (94%) were from symptomatic persons. Twenty-four (34%) of the EV68 positive specimens were collected during 2010. EV68-positive patients with respiratory symptoms showed significantly more dyspnea, cough and bronchitis than EV68-negative patients with respiratory symptoms. Phylogenetic analysis showed an increased VP1 gene diversity in 2010, suggesting that the increased number of EV68 detections in 2010 reflects a real epidemic. Clinical laboratories should consider enterovirus diagnostics in the differential diagnosis of patients presenting with respiratory symptoms., (Copyright © 2011 Elsevier Inc. All rights reserved.)