Domestic-setting corpses, an urban problem?

This study describes the domestic-setting corpses that remain unnoticed for two weeks or more. It compares the occurrence of this phenomenon in the city of Amsterdam with the surrounding municipalities of Amsterdam (SMA). Data of 437 cases were extracted from the forensic medical register of Amsterdam. Data of size and household situation of the population were extracted from Statistics Netherlands. A 3.7 (95%CI 2.8-4.9) times higher incidence rate, was observed in the city of Amsterdam (n = 379; 5.3/100,000 personyears) compared to the SMA (n = 58; 1.4/100,000 personyears). All but three cases lived alone. After limiting both cases and reference data to single households, the crude rate ratio was 2.1 (95%CI 1.6-2.7). Further adjustment for age and gender resulted in a Standardized Mortality Ratio of 0.36 (95%CI 0.28-0.47). This means the occurrence of domestic-setting corpses (14 + days) among people living alone is 2.7 times higher in the city of Amsterdam (95%CI 2.1-3.5). We conclude domestic-setting corpses are more likely to occur in an urban environment. This is partly explained by the higher proportion of single households in the city compared to the more rural areas. However, differences in social cohesion and architecture between urban and rural areas are expected to be important too.

The impact of extended closing times of alcohol outlets on alcohol-related injuries in the nightlife areas of Amsterdam: a controlled before-and-after evaluation.

BACKGROUND AND AIMS: The municipality of Amsterdam implemented a new alcohol policy allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. We investigated how levels and trends of alcohol-related injuries changed after implementation of this alcohol policy, by comparing areas with extended closing times to those without. DESIGN: A controlled before-and-after evaluation to compare changes in alcohol-related injuries between intervention and control areas. SETTING: Central district of Amsterdam, The Netherlands. PARTICIPANTS: Alcohol-related ambulance attendances for control and intervention areas between 1 April 2006 and 1 April 2009 (respectively, n = 544 and n = 499) and between 1 April 2009 and 1 April 2011 (respectively, n = 357 and n = 480). MEASUREMENTS: Alcohol-related injuries were defined as ambulance attendances for people who suffered from direct or indirect consequences of alcohol consumption. Injuries were counted per month in two intervention and three control nightlife areas. We used Poisson regression to assess changes in injuries. FINDINGS: After 1 April 2009, intervention areas showed a larger change in the level of alcohol-related injuries than control areas [incidence rate ratio 1.34, 95% confidence interval (CI) = 1.12, 1.61], but trends remained stable in all areas. This increase was only statistically significant for the following subgroups: 2.00-5.59 a.m., weekend days, men, individuals aged 25-34 years, and people transported to a hospital. However, the increase did not differ between subgroups with statistical significance. CONCLUSIONS: A 1-hour extension of alcohol outlet closing times in some of Amsterdam's nightlife areas was associated with 34% more alcohol-related injuries.

The use of the Dutch Self-Sufficiency Matrix (SSM-D) to inform allocation decisions to public mental health care for homeless people.

The current study set out to develop a decision support tool based on the Self-Sufficiency Matrix (Dutch version; SSM-D) for the clinical decision to allocate homeless people to the public mental health care system at the central access point of public mental health care in Amsterdam, The Netherlands. Logistic regression and receiver operating characteristic-curve analyses were used to model professional decisions and establish four decision categories based on SSM-D scores from half of the research population (Total n = 612). The model and decision categories were found to be accurate and reliable in predicting professional decisions in the second half of the population. Results indicate that the decision support tool based on the SSM-D is useful and feasible. The method to develop the SSM-D as a decision support tool could be applied to decision-making processes in other systems and services where the SSM-D has been implemented, to further increase the utility of the instrument.

Composing a core set of performance indicators for public mental health care: a modified Delphi procedure.

Public mental health care (PMHC) systems are responsible for the wellbeing of vulnerable groups that cope with complex psychosocial problems. This article describes the development of a set of performance indicators that are feasible, meaningful, and useful to assess the quality of the PMHC system in Amsterdam, the Netherlands. Performance indicators were selected from an international inventory and presented to stakeholders of the PMHC system in a modified Delphi procedure. Characteristics of indicators were judged individually, before consensus on a core set was reached during a plenary discussion. Involving stakeholders at early stages of development increases support for quality assessment.

Prevalence and medical risks of body packing in the Amsterdam area.

AIM: Body packing is a way to deliver packets of drugs across international borders by ingestion. The aim of the study was to provide an estimate of the medical risks of body packing, describe predictors for hospital referral in detained body packers and provide an estimate for the prevalence of body packing in the Amsterdam area. METHODS: From May 2007 to December 2008, we studied medical records of body packers immediately detained after arrival at Amsterdam Schiphol airport, hospital records of both detained body packers and self-referrers at two emergency departments of hospitals in Amsterdam and records kept by forensic physicians in charge of post-mortem examinations of all unnatural deaths in the area (years 2005-2009). RESULTS: In airport detainees, the hospital referral rate was 4.2% (30 out of 707 detained body packers), the surgery rate was 1.3%. Significant predictors of hospital referral were delayed production of drug packets after arrest, cigarette smoking and country of departure. The surgery rate in self-referrers was comparable to the rate observed in those referred from the detention centre to hospital (30% vs. 31%). In addition, from 2005 to 2009, 20 proven cases of lethal body packing were identified. Based on our data, it is estimated that minimally 38% of all incoming body packers were missed by airport controls. CONCLUSION: The risk for lethal complications due to body packing is low on a population basis and comparable to other studies. This also applies for the hospital referral and surgery rates found in this study. Cigarette smoking has not yet been described in the literature as a potential predictor for hospital referral in detained body packers and therefore deserves attention in future research. A substantial fraction of body packers manages to remain undiscovered.

Health care seeking among detained undocumented migrants: a cross-sectional study.

BACKGROUND: As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care. METHODS: This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records. RESULTS: Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands. CONCLUSION: The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants.

Fatality of suicide attempts in Amsterdam 1996-2005.

BACKGROUND: According to recent figures, Amsterdam is the municipality with the highest absolute number of suicides and the second highest suicide rate in the Netherlands. AIMS: The aim of the study was to identify time trends and demographic differences in the occurrence of nonfatal suicide attempts versus suicides. METHODS: We used registrations of forensic physicians and ambulance services of the Municipal Health Service of Amsterdam to study 1,004 suicides and 6,166 nonfatal attempts occurring in Amsterdam over the period 1996-2005. RESULTS: The number of nonfatal attempts declined from 1996 to 2005, but the number of completed suicides remained relatively stable. Although case fatality was strongly associated with method used, we also found higher case fatalities for men and older people independent of method. CONCLUSIONS: The case fatality results suggest differences in motive among different demographic groups: possibly the wish to die is stronger among men and elderly. This finding had implications for the success to be expected from different preventive measures.

Transitions in drug use in a new generation of problem drug users in Amsterdam: a 6-year follow-up study.

AIMS: This study describes the transitions in drug use in Amsterdam among young drug users (YDUs) who are inhaling or injecting cocaine or using illicitly obtained opiates. METHODS: From 2000 until 2003, 187 YDUs (< or = 30 years) were recruited of whom 126 were followed into 2007. RESULTS: During the 6 months prior to inclusion, 95% used cocaine, 60% used illicit opiates, and 9% injected more than once a week. During follow-up, the incidence of new-onset heroin use was 4.8/100 person-years. The incidence of injecting was much lower for never-injectors (2.1/100 person-years) than for ever-injectors who relapsed (13.2/100 person-years). Transition to abstinence or nonfrequent drug use is common (23/100 person-years), mostly followed by a relapse (73/100 person-years). Polydrug users were less likely to discontinue their frequent drug use than monodrug users. CONCLUSIONS: Treatment services should target the crack cocaine users to prevent further marginalization and, during abstinence, to prevent relapse. Although the prevalence and incidence of injecting are relatively low, it is still an option for opiate users, especially those with a history of injecting.

Decline in HIV incidence and injecting, but not in sexual risk behaviour, seen in drug users in Amsterdam: a 19-year prospective cohort study.

OBJECTIVE: To study temporal changes in HIV incidence, HIV transmission routes, and both injecting and sexual risk behaviour in the open Amsterdam Cohort Study (ACS) among drug users. Initiated in 1985, the ACS enables us to study changes in trends since HAART became widespread in 1996. METHODS: Person-time techniques were used to study the trend in HIV incidence among HIV-negative drug users. HIV transmission routes were determined using detailed standardised questionnaires. Trends in injecting and sexual risk behaviours were evaluated with a logistic regression model adjusted for correlations between visits of the same individual. RESULTS: The 1315 HIV-negative individuals, of whom 93 seroconverted for HIV, yielded 6970 HIV-negative person-years of follow-up. The HIV incidence was seven per 100 person-years in 1986 and varied between 0 and 0.5 per 100 person-years after 1999. The odds ratio was 15.6 (95% confidence interval, 2.6-94.6) for HIV transmission through unprotected heterosexual contact versus injecting after 1996 compared with the period before. Reports of both injecting and borrowing needles significantly declined over the period 1985-2004. Reports of sexual risk behaviour and sexually transmitted infections at follow-up visits decreased before 1996, but not after 1996. CONCLUSION: The HIV incidence among drug users in the ACS has declined since 1985. Accompanied by a reduction in injecting drug use and needle sharing, this decline occurred despite continued sexual risk behaviour. At present, new HIV seroconversions are related mainly to unprotected heterosexual contacts. Therefore, HIV prevention programmes for drug users should pay specific attention to the importance of safe sex practices.

An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam.

AIMS: It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment. DESIGN: A dynamic cohort of 5200 Amsterdam methadone clients was observed during treatment and (a maximum of 1 year) after treatment. FINDINGS: Between 1986 and 1998, 29,729 person-years (py) and 68 overdose deaths were recorded, leading to an overdose mortality rate of 2.3/1000 py (2.2 during and 2.4 after treatment). A modest increase was observed during the first 2 weeks after (re)entering treatment; 6.0/1000 py (rate ratio: 2.9; 95% confidence interval 1.4; 5.8). Directly after leaving treatment no increase was observed. CONCLUSIONS: Inhaling heroin, common among Amsterdam heroin users, is thought to account for low OD mortality rates both during and after treatment. Accumulation of methadone, inadequate assessment of tolerance of known clients re-entering treatment and concurrent periods of stress or extreme heroin use when entering treatment are mentioned as possible explanations of the increased risk within the first 2 weeks. An Australian study reported a much higher increase. The modest increase in Amsterdam is explained by low background risk of overdose mortality, low starting dosage and the low threshold to treatment.