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This study aims to estimate the incidence and costs of osteoporosis-related fractures in The Netherlands in 2010 and project them to 2030. The incidence and costs of five different types of fractures (spine, hip, upper extremity, lower extremity, wrist/distal forearm, other) were derived from claims data of all Dutch healthcare insurers. Given that fracture-codes in claims data do not indicate whether fractures are related to osteoporosis, we used a large dataset with DXA measurements to attribute fractures to osteoporosis. Future projections used four scenarios: (1) demographic, (2) demographic + annual trend in incidence rates, (3) demographic + annual trend in incidenc

This study aims to estimate the incidence and costs of osteoporosis-related fractures in The Netherlands in 2010 and project them to 2030. The incidence and costs of five different types of fractures (spine, hip, upper extremity, lower extremity, wrist/distal forearm, other) were derived from claims data of all Dutch healthcare insurers. Given that fracture-codes in claims data do not indicate whether fractures are related to osteoporosis, we used a large dataset with DXA measurements to attribute fractures to osteoporosis. Future projections used four scenarios: (1) demographic, (2) demographic ? annual trend in incidence rates, (3) demographic ? annual trend in incidence rates ? annual trend in costs, and (4) treatment. Of all registered fractures, 32 % was attributed to osteoporosis (36 % in women and 21 % in men). Over time (2010–2030) the increase in incidence of osteoporosis-related fractures was estimated to be 40 % (scenario 1); for the hip 60–79 % (scenario 1–2). In 2010, approximately €200 million was spent on treatment of osteoporosis-related fractures, most on fractures of the hip followed by wrist/distal forearm. In both men and women, the excess costs due to osteoporosis-related fractures were highest for hip fractures (€11,000–€13,000 per person), followed by spine fractures (€6000–€7000).The costs for osteoporosisrelated fractures were projected to increase with 50 % from 2010 to 2030 (scenario 1); for the hip 60–148 % (scenario 1–3). Pharmacotherapeutic prevention can lead to costsavings of €377 million in 2030 (scenario 1 and 4 combined). The projected increase in incidence and costs of osteoporosis-related fractures calls for a wider use of prevention and treatment.

__Abstract__ Door de dubbele vergrijzing en noodzaak van kostenbesparing in de zorg wordt steeds meer een appèl gedaan op ondersteuning van ouderen door informele netwerken. Vrijwel alle ouderen willen zo lang mogelijk zelfstandig blijven leven in hun eigen buurt. Een sterk ondersteunend netwerk is een belangrijke voorwaarde om dat doel te bereiken. In Rotterdam is sinds mei 2011 het project ‘Even Buurten’ actief waarin professionals uit zorg en welzijn via een integrale wijkaanpak proberen de sociale netwerken rondom thuiswonende ouderen te versterken. Dit met als doel om (vroeg)signalering mogelijk te maken en concrete hulp en ondersteuning te bieden aan kwetsbare ouderen. Uitgangspunt hierbij is de wens van de oudere zelf, wat hij of zij zelf nog kan doen, zonodig met ondersteuning uit het informele netwerk en –pas als dat niet voldoende blijkt te zijn– professionele ondersteuning. Onderzoekers van de Erasmus Universiteit Rotterdam (EUR), instituut Beleid en Management Gezondheidszorg (iBMG) evalueren het Even Buurten project onder leiding van Professor Anna Nieboer. Doel van deze rapportage over de tussentijdse bevindingen van de evaluatie is i) inzicht geven in de relaties tussen kenmerken van ouderen zoals, geslacht, opleidingsniveau, etnische achtergrond, kwetsbaarheid en welzijn en buurtkenmerken zoals sociale cohesie, veiligheid en kwaliteit van de buurt, ii) de behoeften van (kwetsbare) ouderen beschrijven als het gaat om hun fysieke en sociale omgeving, iii) inventariseren in hoeverre een integrale wijkaanpak als Even Buurten bijdraagt aan de kwaliteit van leven van kwetsbare ouderen, iv) nagaan wat de kosten en baten zijn van de inzet van spillen in de buurt, v) beschrijven wat de ervaringen van de spillen zijn in het Even Buurten project en vi) rapporteren welke barrières er zijn bij deze wijkgerichte aanpak.

__Abstract__ Doel van de evaluatiestudie van Zichtbare Schakels Rotterdam was om i) inzicht te krijgen in de kosten en baten van de inzet van Zichtbare Schakels voor cliënten, ii) na te gaan in hoeverre cliënten, Zichtbare Schakels en andere professionals tevreden zijn over de zorg en ondersteuning door de Zichtbare Schakel, en iii) beschrijven in hoeverre de samenwerking met de Zichtbare Schakels volgens andere professionals bijdraagt aan de zorgverlening. Interessante bevinding uit de kosteneffectiviteit analyses is dat er een verschuiving in kosten lijkt plaats te vinden tussen de 3 en

__Abstract__ Background: Unemployed persons have a poorer health compared with employed persons and unemployment may cause ill health. The aim of this study was to investigate the effect of re-employment on quality of life and health among unemployed persons on social benefits. Methods. A prospective study with 18 months follow-up was conducted among unemployed persons (n=4,308) in the Netherlands, receiving either unemployment benefits or social security benefits. Quality of life, self-rated health, and employment status were measured at baseline and every 6 months of follow up with questionnaires. Generalized estimating equations (GEE) modeling was performed to study the influence of re-employment on change in self-rated health and quality of life over time. Results: In the study population 29% had a less than good quality of life and 17% had a poor self-rated health. Persons who started with paid employment during the follow-up period were more likely to improve towards a good quality of life (OR 1.76) and a good self-rated health (OR 2.88) compared with those persons who remained unemployed. Up to 6 months after re-employment, every month with paid employment, the likelihood of a good quality of life increased (OR 1.12). Conclusions: Starting with paid employment improves quality of life and self-rated health. This suggests that labour force participation should be considered as an important measure to improve health of unemployed persons. Improving possibilities for unemployed persons to find paid employment will reduce socioeconomic inequalities in health.

__Abstract__ Osteoporosis has become a major health concern, carrying a substantial burden in terms of health outcomes and costs. We constructed a model to quantify the potential effect of an additional intake of calcium from dairy foods on the risk of osteoporotic fracture, taking a health economics perspective. Introduction: This study seeks, first, to estimate the impact of an increased dairy consumption on reducing the burden of osteoporosis in terms of health outcomes and costs, and, second, to contribute to a generic methodology for assessing the health-economic outcomes of food products. Methods: We constructed a model that generated the number of hip fractures that potentially can be prevented with dairy foods intakes, and then calculated costs avoided, considering the healthcare costs of hip fractures and the costs of additional dairy foods, as well as the number of disability-adjusted life years (DALYs) lost due to hip fractures associated with low nutritional calcium intake. Separate analyses were done for The Netherlands, France, and Sweden, three countries with different levels of dairy products consumption. Results: The number of hip fractures that may potentially be prevented each year with additional dairy products was highest in France (2,023), followed by Sweden (455) and The Netherlands (132). The yearly number of DALYs lost was 6,263 for France, 1,246 for Sweden, and 374 for The Netherlands. The corresponding total costs that might potentially be avoided are about 129 million, 34 million, and 6 million Euros, in these countries, respectively. Conclusions: This study quantified the potential nutrition economic impact of increased dairy consumption on osteoporotic fractures, building connections between the fields of nutrition and health economics. Future research should further collect longitudinal population data for documenting the net benefits of increasing dairy consumption on bone health and on the related utilization of healthcare resources.

Background: An important condition for independent living is having a well-functioning social network to provide support. An Integrated Neighbourhood Approach (INA) creates a supportive environment for the frail elderly, offering them tailored care in their local context that allows them to improve self-management abilities and well-being. The purpose of our research is to investigate how an INA can contribute to outcomes of frail elderly and the cost-effectiveness of such a program. The first central study question is: To what extent does INA contribute to (a) continuous, demand-driven, coordinated care and support for the independently- living frail elderly; (b) improvement of their well-being and self-management abilities; and (c) reinforcement of their neighbourhood networks. The second central research question is: is the INA a cost-effective method to support the frail, independently- living elderly?. Methods. We investigate a Dutch INA. This transition experiment aims to facilitate the independently-living frail elderly (70+) to live the life they wish to live and improve their well-being. The study population consists of independently-living frail elderly persons in Rotterdam. The transition experiment starts in two Rotterdam districts and is later extended to two other districts. We propose a concurrent mixed methods design, that is, a combination of qualitative and quantitative research methods to evaluate processes, effects and costs of INA. Such a design will provide insight into an on-going INA and demonstrate which of its elements are potentially (cost)-effective for the frail elderly. Discussion. We embrace a wide range of scientific methodologies to evaluate the INA project and obtain information on mechanisms and contexts that will be valuable for decision making on local and national levels. The study will lead to a better understanding of how to provide support via social networks for the frail elderly and add to the knowledge on the feasibility a

Introduction Most workers with musculoskeletal disorders on sick leave often consult with regular health care before entering a specific work rehabilitation program. However, it remains unclear to what extent regular healthcare contributes to the timely return to work (RTW). Moreover, several studies have indicated that it might postpone RTW. There is a need to establish the influence of regular healthcare on RTW as outcome; "Does visiting a regular healthcare provider influence the duration of sickness absence and recurrent sick leave due to musculoskeletal disorders?". Methods A cohort of workers on sick leave for 2-6 weeks due to a-specific musculoskeletal disorders was followed for 12 months. The main outcomes for the present analysis were: duration of sickness absence till 100% return to work and recurrent sick leave after initial RTW. Cox regression analyses were conducted with visiting a general health practitioner, physical therapist, or medical specialist during the sick leave period as independent variables. Each regression model was adjusted for variables known to influence health care utilization like age, sex, diagnostic group, pain intensity, functional disability, general health perception, severity of complaints, job control, and physical load at work. Results Patients visiting a medical specialist reported higher pain intensity and more functional limitations and also had a worse h

In dit proefschrift wordt het probleem van klachten van het houdings- en bewegingsapparaat (HBA) in de arbeidssituatie benaderd middels een model dat het arbeidsongeschiktheidsproces beschrijft binnen de socio-demografische en socio-politieke context. Gegeven de complexiteit van het model, zal de scoop van dit proefschrift worden beperkt tot demografische, gezondheidsgerelateerde en werkgerelateerde factoren die het ziekteverzuim proces beïnvloeden. Deze factoren zijn gebruikt om informatie te verkrijgen over de specifieke rol van werkgerelateerde factoren en individuele karakteristieken in het ontstaan van HBA klachten (in het bijzonder lage rugklachten), duur van ziekteverzuim, herstel en werkhervatting., In this thesis the problem of musculoskeletal disorders (MSD) within the work situation is addressed using a model describing the work disability process within its sociodemographic and socio-political context. Due to the complexity of this model, the scope of this thesis was restricted to demographic, health-related and work-related factors that influence the work disability process. These factors were used to gain more information on the specific role of work-related risk factors and individual characteristics in the onset of MSD (in particular low back pai

Objective: To determine which individual and work-related factors are associated with performing modified work and to evaluate the influence of modified work on the duration of sick leave and health-related outcomes among employees with musculoskeletal complaints. Study design: A prospective study with 12 months follow-up. Methods: In this prospective study a total of 164 employees on sick leave for 2-6 weeks due to musculoskeletal complaints completed 2 questionnaires. At baseline we gathered information about individual characteristics, physical and psychosocial workload, and disease specific and general health. The follow-up questionnaire, sent to respondents who returned to their original job on full duty, collected information about having performed modified work, and disease-specific and general health. Results: Employees were less likely to perform modified work when their regular work was characterized by frequent lifting and their relationship with colleagues was less than good. Employees were more likely to return to modified work when they had a better mental health, had prolonged periods of standing in their regular job and had less skill discretion. Duration of sick leave was influenced by chronicity of complaints and disability, but not by modified work. Conclusion: Modified work, as the only advice given by a occupational health physician, did not influence the total duration of sick leav

The purpose of this meta-analysis is to review studies investigating the efficacy of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) patients and to find out whether patient characteristics influence the efficacy of IMT. A systematic literature search was performed using the Medline and Embase databases. On the basis of a methodological framework, a critical review was performed and summary effect-sizes were calculated by applying fixed and random effects models. Both IMT alone and IMT as adjunct to general exercise reconditioning significantly increased inspiratory muscle strength and endurance. A significant effect was found for dyspnoea at rest and during exercise. Improved functional exercise capacity tended to be an additional effect of IMT alone and as an adjunct to general exercise reconditioning, but this trend did not reach statistical significance. No significant correlations were found for training effects with patient characteristics. However, subgroup analysis in IMT plus exercise training revealed that patients with inspiratory muscle weakness improved significantly more compared to patients without inspiratory muscle weakness. From this review it is concluded that inspiratory muscle training is an important addition to a pulmonary rehabilitation programme directed at chronic obstructive pulmonary disease patients with inspiratory muscle weakness. The effect on exercise performance is still to be determined.