[The care standard 'Depressive disorders']. / De zorgstandaard Depressieve stoornissen.

BACKGROUND: The care standard 'Depressive disorders' describes the complete patient journey for patients with depressive symptoms and disorders from the age of 8 years onwards.
AIM: To describe the most important recommendations in this care standard.
METHOD: The care standard is an adaptation of the existing guidelines for depression, supplemented with practical knowledge from professionals and patients' values and preferences.
RESULTS: Core elements in the care for depression are an appropriate use of care and a focus on relapse prevention. A combination of psychotherapy and medication is indicated for persistent depression and more sessions of psychotherapy might be required. There is some evidence for the use of repetitive transcranial magnetic stimulation in treatment-resistant depression.
CONCLUSION: The care standard is an important instrument to improve the quality of care for depression at both the organisational and the regional level.

Otitis media with effusion and habitual mouth breathing in Dutch preschool children.

Habitual mouth breathing (HMB) is defined as the habit of in- and exhaling (part of) the air through the mouth, when an individual is at rest and the nose is sufficiently free. It is postulated that HMB is a risk factor for otitis media with effusion (OME) in preschool children. The results are presented of a prospective cohort study on 253 3-year-old children, free from OME, with a follow-up period of 3 months, to determine the role of HMB in the etiology of OME. The risk ratio for OME of habitual mouth breathers, compared to nose breathers, was found to be 2.4 (95% confidence interval (C.I.): 0.99-5.70). Moreover, there is a clear and significant linear trend in the proportion of OME in 3 breathing categories: nose breathing, intermediate and mouth breathing. This relation remains after correction for confounding. It is concluded that HMB is a risk factor for OME. It is estimated that about 20% of the incidence of OME is caused by HMB. The high incidence of OME means that HMB carries a great deal of impact. Suggestions are made for the prevention and treatment of HMB.

Screening for breast cancer in Nijmegen. Report of 6 screening rounds, 1975-1986.

A population-based screening programme for breast cancer was initiated in Nijmegen in 1975 with mammography as the only screening procedure. Up to January 1987, 6 screening rounds were carried out with a 2-year screening interval. Rates of attendance, referral, biopsy and detection were calculated and numbers of interval cancers are presented in order to give a clear view of what repeated screening can accomplish in a population. At the first screening round the attendance rate was 87% for women under age 50 and 83% for women aged 50-64. For women aged 65 or over the initial attendance rate was 40%. Rates of attendance declined in subsequent years. Detection rates were highest for elderly women at their first examination: 9.5 per 1,000 screened women. Corresponding rates were 5.6 and 2.3 per 1,000 for women aged 50-64 and below 50 respectively. The positive predictive value for referral was, on average, 20% for women under age 50 and 50% for elderly women, although a sharp increase was seen in the last 2 screening examinations for all age-groups. Predictive values for biopsy were higher: 30% on average for women aged under 50 and 60%-70% for elderly women, again with a sharp increase in the last 2 screening rounds. Interval cancer rates, calculated as the number of cancers occurring within 2 years among negatively screened women at risk, showed no particular trend and varied between 0.9-1.3 per 1,000 woman-years after each screening round. Compared to screen-detected cancers, interval cancers occurred more frequently in younger women. In women under age 50, the ratio between screen-detected and interval cancer was about 1:1, while it was about 2:1 for elderly women.