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Background: Acute gastroenteritis is a highly contagious disease demanding effective public health and clinical care systems for prevention and early intervention to avoid outbreaks and symptom deterioration. The Netherlands and Australia are both top-performing, high-income countries where general practitioners (GPs) act as healthcare gatekeepers. However, there is a lower annual incidence and per-case costs for childhood gastroenteritis in Australia. Understanding the systems and policies in different countries can lead to improvements in processes and care. Therefore, we aimed to compare public health systems and clinical care for children with acute gastroenteritis in both countries. Methods: A cross-country expert study was conducted for the Netherlands and Australia. Using the Health System Performance Assessment framework and discussions within the research group, two questionnaires (public health and clinical care) were developed. Questionnaires were delivered to local experts in the Netherlands and the state of Victoria, Australia. Data synthesis employed a narrative approach with constant comparison. Results: In Australia, rotavirus vaccination is implemented in a national program with immunisation requirements and legislation for prevention, which is not the case in the Netherlands. Access to care differs, as Dutch children must visit their regular GP before the hospital, while in Australia, children have multiple options and can go directly to hospital. Funding varies, with the Netherlands providing fully funded healthcare for children, whilst in Australia it depends on which GP (co-payment required or not) and hospital (public or private) they visit. Additionally, the guideline-recommended dosage of the antiemetic ondansetron is lower in the Netherlands. Conclusions: Healthcare approaches for managing childhood gastroenteritis differ between the Netherlands and Australia. The lower annual incidence and per-case costs for childhood gastroenteritis in Australia cannot solely be explained by the differences in healthcare system functions. Nevertheless, Australia's robust public health system, characterized by legislation for vaccinations and quarantine, and the Netherland's well-established clinical care system, featuring fully funded continuity of care and lower ondansetron dosages, offer opportunities for enhancing healthcare in both countries. [ABSTRACT FROM AUTHOR]

Background: Pregnant women visit complementary/alternative health care practitioners in addition to regular maternal health care practitioners. A wide variation has been reported with regard to rates and determinants of use of complementary/alternative medicine (CAM), which may be due to heterogeneous populations. The aim of this study was to examine the prevalence and determinants of use of CAM practitioners by a homogeneous population of low-risk pregnant women in the Netherlands. Methods: Data from the population-based DELIVER study was used, concerning 1500 clients from twenty midwifery practices across the Netherlands in 2009 and 2010. CAM use was measured based on patient reports. Potential determinants were derived from Andersen's behavioural model of health care utilization. Results: The prevalence of CAM practitioner use by low-risk pregnant women was 9.4 %. Women were more likely to use CAM if they had supplementary health care insurance (OR 3.11; CI 1.41-6.85), rated their health as 'bad/fair' (OR 2.63; CI 1.65-4.21), reported a chronic illness or handicap (OR 1.93; CI 1.14-3.27), smoked during pregnancy (OR 1.88; CI 1.06-3.33), or used alcohol during pregnancy (OR 2.30; CI 1.46-3.63). Conclusions: CAM is relatively frequently used by low-risk pregnant women. Determinants revealed in this study diverge from other studies using heterogeneous populations. Maternal health care practitioners must be aware of CAM use by low-risk pregnant women and incorporate this knowledge into daily practice by actively discussing this subject with pregnant women. [ABSTRACT FROM AUTHOR]

Background: Multisystemic Therapy (MST) is an intensive, short, family- and community-based treatment for serious antisocial behaviour and delinquency in youth. It is an emerging intervention for serious juvenile delinquents. However, conclusive evidence on the balance between costs and effects is limited and in fact non-existent for the Netherlands. The aim of this protocol is to describe the design of a study to evaluate the cost-effectiveness of MST as compared to Care-As-Usual (CAU). Methods: The cost-effectiveness of MST will be assessed through a Randomised Controlled Trial. Primary outcomes aggressive and delinquent behaviour will be assessed with the parent-reported CBCL and adolescent-reported YSR. Health care utilisation, production loss, and quality of life are recorded using the self-report 'Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness' (TiC-P), and with the MOS Short-Form General Health Survey (SF-20) and EuroQol -5D (EQ-5D), respectively. The study aims to enrol 100 clients in both conditions (MST and CAU). Data will be obtained before treatment (T1), immediately after treatment (T2; 5 months after T1) and at follow up (T3; 6 months after the end of the treatment) from a variety of sources, i.e. clients, parents/primary carers, professionals and police records. Discussion: Studying the cost-effectiveness of this treatment for youth antisocial behaviour is important in order to provide information to policy makers on whether the provision of this intervention represents good value for money. Introducing a cost-effective evidence based programme may result in valuable health gains for moderate costs. [ABSTRACT FROM AUTHOR]

Background: Midwives and obstetricians are the key providers of care during pregnancy and postpartum. Information about the consultations with a general practitioner (GP) during this period is generally lacking. The aim of this study is to compare consultation rates, diagnoses and GP management of pregnant women with those of non-pregnant women. Methods: Data were retrieved from the Netherlands Information Network of General Practice (LINH), a nationally representative register. This register holds longitudinal data on consultations, prescriptions and the referrals of all patients listed at 84 practices in the Netherlands in 2007-2009, including 15,123 pregnant women and 102,564 non-pregnant women in the same age-range (15 to 45 years). We compared consultation rates (including all contacts with the practice), diagnoses (ICPC-1 coded), medication prescriptions (coded according to the Anatomical Therapeutic Chemical classification system), and rate and type of referrals from the start of the pregnancy until six weeks postpartum (336 days). Results: Pregnant women contacted their GP on average 3.6 times, compared to 2.2 times for non-pregnant women. The most frequently recorded diagnoses for pregnant women were 'pregnancy' and 'cystitis/urinary infection', and 'cystitis/urinary infection' and 'general disease not otherwise specified' for non-pregnant women. The mean number of prescribed medications was lower in pregnant women (2.1 against 4.4). For pregnant women, the most frequent referral indication concerned obstetric care, for non-pregnant women this concerned physiotherapy. Conclusions: GP consultation rates in pregnancy and postpartum shows that GPs are important providers of care for pregnant women. Therefore, the involvement of GPs in collaborative care during pregnancy and postpartum should be reinforced [ABSTRACT FROM AUTHOR]

The article discusses a study regarding review of chronic health condition for children with intellectual disorder. Relevant studies were identified including children with intellectual disability who are epileptic, has a cerebral palsy, and autistic disorder. The number of the studies reported with chronic health conditions that were included are limited but there are concrete evidences of the prevalence on chronic health conditions on children with intellectual disorder.

Background: Data regarding the impact of early risk factors on later involvement in bullying are scarce. We investigated the impact of preschool behaviors, family characteristics (socio-economic status, family breakup) and parental mental health on bullying and victimization at age 11 (T1) and age 13.5 (T2). Methods: longitudinal data from a subsample of the TRacking Adolescents' Individual Lives Survey (TRAILS) (T1: N = 982; T2: N = 977). TRAILS is a prospective study of adolescent mental health in a mixed urban and rural region of the Netherlands. At T1 parents reported on family characteristics, parental mental health and retrospectively on children's preschool behavior at age 4-5. Schoolmates reported involvement of adolescents in bullying or victimization at T1 and T2. Results: Children with preschool anxiety were less likely to be bully/victim at T1. Children with preschool aggressiveness were more likely to be bully (T1), bully/victim (T1 and T2) and victim (T2) and children with good preschool motor functioning were more likely to be bully (T1) and less likely to be victim (T1 and T2). Children from low socioeconomic status families were more likely be to be bully, victim, or bully/victim and less likely to be uninvolved both at T1 and T2. Finally, children from intact two parent families were more likely to be uninvolved at T2. Conclusion: Preschool behavioral, emotional and motor problems, socioeconomic status, and family breakup are related to involvement in bullying at a later age. Prevention of bullying and its consequences can be enhanced by focusing on risk groups in early life. [ABSTRACT FROM AUTHOR]

The article outlines the role of the Health System Performance Assessment Framework for Universal Health Coverage in improving public health systems. It discusses potential challenges of applying the framework to public health systems that include difficulty in differentiating public health from primary care and absence of measures to mitigate climate change. Results of a study presented considered the governance, resource generation, financing and service delivery of the public health system.

Socioeconomic differences in health risk behaviours during pregnancy may be influenced by social relations. In this study, we aimed to investigate if social need fulfillment moderates the association between socioeconomic status (SES) and health risk behaviours (smoking and/or alcohol consumption) during pregnancy. We used baseline data from the Lifelines Cohort Study merged with data from the Lifelines Reproductive Origin of Adult Health and Disease (ROAHD) cohort. Education level was used to determine SES, categorized into low, middle, and high, with middle SES as the reference category. Social need fulfillment was taken as indicator for social relations and was measured with the validated Social Production Function Instrument for the Level of Well-being scale. The dependent variable was smoking and/or alcohol consumption during pregnancy. Univariable and multivariable logistic regression analysis was conducted to assess the association of SES and social need fulfillment with health risk behaviours and to test for effect modification. We included 1107 pregnant women. The results showed that women with a high SES had statistically significantly lower odds of health risk behaviours during pregnancy. The interaction effect between SES and social need fulfillment on health risk behaviours was not statistically significant, indicating that no moderation effect is present. The results indicate that social need fulfillment does not modify the effect of SES on health risk behaviours during pregnancy. However, in literature, social relations are identified as an important influence on health risk behaviours. More research is needed to identify which measure of social relations is the most relevant regarding the association with health risk behaviours., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)

Introduction: People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations., Method: This study used data (N = 9803) from a Dutch nationally representative registry of people with low-risk pregnancies receiving primary midwife-led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations., Results: Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 -2.59), preterm birth (OR, 1.27; 95% CI, 1.02-1.58), small for gestational age (OR, 1.19; 95% CI, 1.00-1.41), and induction of labor (OR, 1.14; 95% CI, 1.01-1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71-0.97). The timing of prenatal care initiation did not mediate any of these associations., Discussion: Our findings suggest that people in primary midwifery-led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities., (© 2024 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Introduction: During pregnancy and childbirth, health issues can arise that can negatively influence women's postpartum health. Although it is imperative to identify these health problems in order to tailor care to women's needs, they often remain unrecognized. A comprehensive overview of postpartum health problems does not exist in the current literature. This systematic review aimed to explore the health problems experienced by women residing in high-income countries during the first year postpartum., Methods: Scientific databases were searched for articles on health problems experienced by women during the first year postpartum, published between January 2000 and 2 July 2021. Studies investigating the experiences of healthy women from the age of 18 years, residing in high-income countries, who gave birth to a healthy neonate, were included. Identified health issues were divided into five categories and presented in an overview., Results: A total of 25 articles were eligible for inclusion. In all, 83 health problems were identified and divided into five different categories (physical health problems, mental health problems, social health problems, problems related to feeding the infant, and other challenges). Common health issues postpartum were exhaustion, urinary incontinence, painful breasts, depressive symptoms, problems related to sexuality and sleep, lack of social support, and problems with breastfeeding., Conclusions: This systematic review contributes to a wider understanding of postpartum health problems and can be used to adapt healthcare to women's needs. It distinguishes itself from previous studies by the wide variety of identified health problems and its specific focus on women's experiences in the postpartum period., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2023 Gmeling Meyling M. M. et al.)

Background: This study aims to address the lack of information about the long-term wellbeing of (former) teenage mothers in the Netherlands. It provides data which policymakers can use to ensure that support programmesmeet the needs of teenage mothers., Methods: Women who had given birth before the age of twenty were recruited online by Fiom, expertise centre on unintended pregnancy (December 2018-February 2019; N = 248). Survey data were obtained to assess how they perceived their wellbeing, employment, education, housing, and social support. Respondents were divided into three groups: 0-3 years after teenage childbearing (short term), 4-12 years (medium term), >12 years (long term). Results were analysed using univariate and bivariate descriptions in SPSS., Results: Almost 80% of respondents reported that they were doing well and were satisfied with their lives, 63% had a job, and 17% were students. Short-term mothers worked fewer hours per week, received more benefits, and were less satisfied with their living conditions compared to medium- and long-term mothers. 36% Of the respondents smoked cigarettes. Most support was given by family (83%), mainly by female relatives. About 24% received formal support from social workers or institutions., Conclusions: Respondents, on average, reported they were doing well and were satisfied with their lives, in both the short and long term. These results suggest that as the years pass, teenage mothers overcome difficulties. Regarding income and housing, however, short-term mothers were in a less favourable position. Tailored interventions are recommended to address smoking among (former) teenage mothers.

Several effective interventions have been developed for families with multiple problems (FMP), but knowledge is lacking as to which specific practice and program elements of these interventions deliver positive outcomes. The aim of this study is to assess the degree to which practice and program elements (contents of and structure in which care is provided) contribute to the effectiveness of interventions for FMP in general and for subgroups with child and/or parental psychiatric problems, intellectual disabilities, or substance use. We performed a quasi-experimental study on the effectiveness of practice and program elements provided in attested FMP interventions. Using self-report questionnaires, we measured primary (child's internalizing and externalizing problems) and secondary (parental stress and social contacts) outcomes at the beginning, end, and three months thereafter. By means of Latent Profile Analysis, we identified groups of families receiving similar combinations of practice elements ("profiles"), and we calculated propensity scores. Next, we assessed how practice element profiles and program elements affected improvement in outcomes, and whether these effects were moderated by subgroup characteristics. We found three practice element profiles (explorative/supportive, action-oriented, and their combination), which were equally effective. Regarding program elements, effects were enhanced by more frequent telephone contact between visits and more frequent intervision. Effectiveness of practice and program elements varied for specific FMP subgroups. Variations in the content of care for FMP do not affect its effectiveness, but variations in the structure of the care do. This finding can help to further improve effective interventions., (© 2021 The Authors. Family Process published by Wiley Periodicals LLC on behalf of Family Process Institute.)

Background: Care for children and adolescents with psychosocial problems is aimed at reducing problems. There may be a relationship between the intensity and duration of care provision and improvement of these outcomes, but evidence on this issue is lacking. We therefore examined the association between care trajectories based on duration and intensity of care for children, and the reduction in psychosocial problems after 3 years., Methods: We obtained a cohort of all children entering psychosocial care in one region (n = 1,378), the TAKECARE cohort, and followed it for 3 years, with five assessment rounds. Retention in the final round was 85.8%. Psychosocial problems were measured using the parent report of the Total Difficulty Score of the Strength and Difficulties Questionnaire (SDQ-TDS). We constructed trajectories for intensity of care using growth mixture modelling and assessed the association between duration and intensity of care trajectories and SDQ-TDS after 3 years., Results: After 3 months 60.6% of children and adolescents were receiving care, after 1 year 38.7% were receiving care and after 3 years 26.0%. Regarding intensity of care, three trajectories were found: one with minimal intensity during all 3 years, a second with initially medium intensity and strong reduction within 1 year, and a third with high intensity and a reduction after 1 year. Although the psychosocial problems of children and adolescents were reduced during the 3-year period, the rate of decline was relatively less marked for children and adolescents with longer care trajectories., Conclusion: Overall, children and adolescents with psychosocial problems who received care had improved outcomes at follow-up. However, increased provision of care does not automatically lead to reduction of problems, and although overall psychosocial problems are reduced, a substantial subgroup has longer lasting problems., (© 2019 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Background: To assess the cost-effectiveness of new treatments in Germany, the efficiency frontier (EF) method has been developed. We compared the cost-effectiveness analysis using international standards and the German methodology, using the heart failure drug sacubitril/valsartan as an example., Methods: A previously developed Markov model was adapted to include 4 treatment options: no treatment, enalapril, candesartan, and sacubitril/valsartan. The internationally used incremental cost-effectiveness ratio (ICER) was calculated, as well as cost-effectiveness acceptability curves. Additionally, EFs, net monetary benefits (NMBs), and price-acceptability curves were created according to German guidelines. All analyses were performed from the perspective of the German Statutory Health Insurance., Results: The base-case ICER for sacubitril/valsartan compared to enalapril is €19  300/quality-adjusted life-year. On the cost-effectiveness acceptability curve, sacubitril/valsartan is most likely to be cost-effective, out of all included comparators, from a hypothetical willingness-to-pay threshold of €18 250/quality-adjusted life-year onward. No EF could be constructed for the base case. Taking the uncertainty of the input parameters into account for the probabilistic sensitivity analysis, a NMB of around -€14 000 was calculated, depending on the outcome considered, with the NMB being zero at a daily price for sacubitril/valsartan ranging from €1.52 to €1.67., Conclusion: We calculated an ICER for Germany, comparable to previously published cost-effectiveness analyses for Europe, which widely concluded sacubitril/valsartan to be cost-effective. Using the German EF approach, a considerable discount needs to be applied before sacubitril/valsartan can be considered cost-effective., (Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Objective: Midwifery students have the challenge to learn to be autonomous and capable midwives to ensure a safe and emotionally satisfying experience for mothers (to be) and their babies. They have to develop and acquire knowledge and skills for practice, and they have to adopt and internalize the values and norms of the midwifery profession in order to socialize as a midwife.In this study we explored conceptualisations of 'good midwives' among nearly graduated final year midwifery students as a result of their professional socialization process., Design: A cross-sectional study consisting of an one open-ended question was undertaken. Data was analyzed qualitatively, inductively and deductively by using Halldorsdottir's theory of the primacy of a good midwife., Setting: One of three midwifery academies in the Netherlands in July 2016 were included., Participants: All midwifery students (N=67) in their final year were included., Findings: Student midwives gave broad interpretations of the features of a good midwife. Three themes - next to the themes already conceptualised by Halldorsdottir - were revealed and mentioned by nearly graduated Dutch midwifery students. They added that a good midwife has to have specific personal characteristics, organizational competences, and has to promote physiological reproductive processes in midwifery care., Key Conclusions: Students' views are broad and deep, reflecting the values they take with them to real midwifery practice. The results of this study can serve as an indicator of the level of professional socialization into the midwifery profession and highlight areas in which changes and improvements to the educational program can be made., (Copyright © 2017 Elsevier Ltd. All rights reserved.)