E-health and health care behaviour of parents of young children: a qualitative study.

OBJECTIVE: Internet plays a huge role in providing information about health care problems. However, it is unknown how parents use and perceive the internet as a source of information and how this influences health care utilisation when it comes to common complaints in infants. The objective was to evaluate the perception parents have on the role of internet in providing health care information on common symptoms in infants and its effects on health care utilisation. DESIGN: A qualitative design was chosen. SETTING AND SUBJECTS: Parents were recruited from a population-based birth-cohort and selected purposefully. MAIN OUTCOME MEASURES: Semi-structured interviews were used to receive information of parents' ideas. Thematic coding and constant comparison were used for interview transcript analysis. RESULTS: Ten parents were interviewed. Parents felt anxious and responsible when their child displayed common symptoms, and appeared to be in need of information. They tried to obtain information from relatives, but more so from the internet, because of its accessibility. Nevertheless, information found on the internet had several limitations, evoked new doubts and insecurity and although parents compared information from multiple sources, only the physician was able to take away the insecurity. The internet did not interfere in the decision to consult the physician. CONCLUSIONS: Parents need information about their children's symptoms and the internet is a major resource. However, only physicians could take away their symptom-related doubts and insecurities and internet information did not play a role in parental decision making. Information gathered online may complement the information from physicians, rather than replace it. Key points Internet plays an increasing role in providing health care information but it is unknown how this influences health care utilisation. Our study suggests that: Parents need information about their children's symptoms and the internet is a major resource. However, only physicians could take away their symptom-related doubts and insecurities. Internet information did not play a role in parental decision making.

The Association between eHealth Capabilities and the Quality and Safety of Health Care in the Netherlands: Comparison of HIMSS Analytics EMRAM data with Elsevier's 'The Best Hospitals' data.

OBJECTIVE: To test the hypothesis that advanced electronic medical record (EMR) capabilities are associated with better quality and safety of hospital care. METHODS AND FINDINGS: We used data from the HIMSS Analytics EMR Adoption Model (EMRAM(SM)) to measure the adoption and use of information technology in Dutch hospitals. To measure the quality and safety of healthcare in Dutch Hospitals we used select data from the publicly available basic set and the safety set of the Health Care Inspectorate (IGZ) and the Dutch Health Care Transparency Program 'Zichtbare Zorg' (ZIZO) program. The quality and safety measures selected reflect the measures used to score Dutch hospitals as presented in Elsevier's annual 'The Best Hospitals' publication. The scores of this publication are based upon 542 of the 1516 available indicators from this basic set and safety set. Almost all indicators from the hospital-wide indicator sets are included in the selection, as are a large portion of indicators for acute care delivered by all hospitals. Of the 84 non-academic hospitals in the Netherlands, 67 (80 %) were included in this study. RESULTS: There is no statistically significant association found between a hospital's EMRAM score and their overall quality/safety performance in the Elsevier hospital scoring model. CONCLUSION: There is no evidence found to support the research hypothesis at this point in time. This outcome maybe the result of a multiplicity of factors to include the (limited) use of the methodologies used in this study, the fact that no fully digitalized hospital (EMRAM stage 7) is yet present in the NL, and/or the organizational competency of the NL hospitals in fully leveraging the EMR to facilitate patient care. Further research is needed to explore these findings.

Temporomandibular joint involvement in Juvenile Idiopathic Arthritis: reliability and validity of a screening protocol for the rheumatologist.

BACKGROUND: In Juvenile Idiopathic Arthritis (JIA) the temporomandibular joint (TMJ) can be involved leading to pain, dysfunction and growth disturbances of the mandible and associated structures. There may be value to a three minute screening protocol allowing the rheumatologist to detect TMJ involvement systematically. Reliability and validity of the TMJ protocol for detecting TMJ co-morbidity were determined in 74 consecutive JIA patients. METHODS: The assessments of the rheumatologist and of a reference examiner (RE) were compared and validity of the TMJ protocol was established using the disease activity (JADAS-27) as an external reference. RESULTS: The internal consistency of the protocol was 0.73 (Cronbach's alpha). The inter-examiner agreement between the rheumatologist and the RE varied between 0.25 and 0.87 (Cohen's Kappa). Sensitivity and specificity, with the JADAS "3.8" indicating minimal disease activity, were 0.57 and 0.77 respectively. The area under the curve (AUC) was 0.70. A cut-off value of two positive items was found to be an optimal threshold to select the patients with likely TMJ involvement. CONCLUSIONS: The use of the protocol is feasible in everyday clinical practice. Reliability and validity aspects were satisfactory. The screening protocol for TMJ involvement provides the rheumatologist with systematic and focused TMJ information which relates to the JIA disease activity (JADAS-27).

How spouses evaluate Nursing Home Placement of their demented partner: a study about the end of perseverance time.

AIM: This study was about the final decision by spouses to have their demented partner placed in a nursing home. The central question was whether the admission took place in the right time in their point of view. METHOD: Fourteen partners of persons with dementia evaluated the nursing home placement. They were interviewed at home using a semi-structured questionnaire. Grounded theory was used to explore the process of decision-making. In addition to the interviews, quantitative data were used from a 2-year follow-up study. RESULTS: Results underline that the placement decision had to be made in phases over time. The first decision is about placement of the relative on a waiting list, and the second decision is about the actual placement in a nursing home once a place becomes available. This second and final decision often had to be taken under time pressure to avoid a place in the nursing home being left empty. If they had been given more time and space to reconsider their admission decision, most partners said they could have had continued providing homecare longer. During the investigation, the following classification in timeliness of the admission emerged: Placement was at the right time, too early, too late or out of control. CONCLUSION: Spouses indicated they could have kept on giving care for a longer period of time if they had been given more time and space to make their final decision about the admission of their partner. It may be helpful for informal and formal carers to focus on perseverance time in considering placement or prolonged support at home. Placement at an appropriate time may lead to a higher degree of well-being of informal carers before and especially after the admission.

The perseverance time of informal carers of dementia patients: validation of a new measure to initiate transition of care at home to nursing home care.

BACKGROUND: Health care systems aim to involve as much informal care as possible and dementia patients prefer to stay home as long as they can. In this context, perseverance time (Pt)-the period that the informal carer indicates to be able to maintain current care if the situation remains stable-is an important concept. OBJECTIVE: The aim of this study was to introduce the concept Pt and validate it in a sample of informal carers of dementia patients living at home. METHODS: Data were collected from 223 informal carers of dementia patients. Convergent validity was assessed by looking at associations of Pt with validated instruments for measuring subjective burden (CSI, CarerQol-7D, and SRB) and happiness (CarerQol-VAS). Content validity was evaluated by performing multivariate correlations between Pt and characteristics of dementia patients, informal carers, and care situations. The Medical Ethics Committee of Utrecht MC advised positively about the study protocol. RESULTS: Correlation coefficients between Pt and the measures of burden CSI, SRB, and CarerQol-VAS were -0.46, -0.63, and 0.23 (p < 0.01), respectively. Health of dementia patient, informal carer living apart from the patient, and male gender of caregiver were positively associated with Pt; need for supervision, intensity of informal care provision, and reductions in working hours and hobbies in order to be able to provide care were negatively associated. CONCLUSIONS: Pt is helpful in monitoring need for support and planning the transition of care from home to nursing home. This study provides a first indication of its validity, but replication is necessary.

Results of a multibehavioral health-promoting school pilot intervention in a Dutch secondary school.

PURPOSE: Recent studies increasingly show adolescent health-related behaviors to be interrelated, interacting synergistically and sharing several common determinants. Therefore, research increasingly focuses on studying interventions that target a range of health behaviors simultaneously. This report describes the results of a pilot study of a secondary school-based, health-promoting intervention that simultaneously targets a range of adolescent health behaviors via a whole-school approach. METHODS: We collected self-reported behavioral data via an annual online questionnaire to 336 students. We collected data before the intervention implementation and after the intervention's first completed, 3-year curriculum cycle on the fourth-grade students (15- to 16-year-olds). We analyzed differences between pre- and postintervention groups. RESULTS: Significant behavioral changes were reported for extreme alcohol use, smoking, sedentary time, and bullying behaviors. Certain behaviors were significantly different only in girls: namely, weekly alcohol use, ever having used cannabis, compulsive Internet or computer use score, compulsive gaming score, and recent bully victimization. Differences in several sedentary time behaviors (television watching and Internet or computer use) were significant only in boys. No changes were reported regarding body mass index; physical activity; or the time spent on, or the compulsiveness of, video game playing. In addition, the postintervention group showed significantly fewer psychosocial problems. CONCLUSIONS: The intervention successfully changed student health behaviors on many accounts. It remains largely unclear as to what causes the different effects for boys and girls. Further studies regarding multiple health behavior targeting interventions for adolescents are required.

Opinions of patients with type 2 diabetes about responsibility, setting targets and willingness to take medication. A cross-sectional survey.

OBJECTIVE: To assess opinions and their determinants of patients with type 2 diabetes about responsibility for managing their diabetes, setting treatment targets and willingness taking medication. METHODS: Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. OUTCOMES: opinions about responsibility, targets and medication. Multinomial logistic regression analysis. RESULTS: Data of 994 consecutive persons were analysed (mean age 65 years; 54% males). Of these 62% agreed to take responsibility for their diabetes. In the opinion of 89% the setting of targets should be by or in cooperation with their physician or nurse and 40% were willing to take tablets until all targets were attained. Patients who perceived dysfunction by barriers to activity did not agree to take responsibility (OR 3.68; 1.65-8.19). Patients with complications preferred to set targets in cooperation with their physician or nurse (OR 1.98; 1.03-3.80). Males were more willing to take tablets until all targets were attained (OR 1.62; 1.17-2.25). CONCLUSION: Not all patients want to take responsibility for their diabetes or taking all necessary tablets, especially those with barriers to activity or complications. PRACTICE IMPLICATIONS: Doctors and nurses should ask for patients' opinions about responsibility and treatment goals before starting education.

Integrating care for people with depression: developments in the Netherlands.

INTRODUCTION: In this article we describe the history and present state of integrated care for people with depression in the Netherlands. The central question is: what are the developments in integrated care for people with depression in the Netherlands? METHODS: WE DESCRIBE THESE DEVELOPMENTS FROM THE ROLE OF AN OBSERVER, AND MAKE USE OF SEVERAL SOURCES: important Dutch policy documents and research documents, our own national survey carried out in 2007, a number of reports and project descriptions and searches in PubMed and Google. Also key people were contacted to supply additional information. RESULTS: In the Netherlands two separate phases can be distinguished within integrated care for people with depression. From the beginning of the 1990s, specialized secondary Mental Health Care (MHC) began to develop care programmes, including programmes for people with depression. The implementation of these care programmes has taken years. Mass usage of care programmes only went ahead once the large-scale mergers between ambulatory and clinical MHC organizations around 2000 had taken effect. An analysis of these programmes shows, that they did not lead to integration with primary care. This changed in the second phase from around 2000. Then attention was directed more towards strengthening the GP within the treatment of depression, collaboration between primary and specialized care and the development of collective integrated care packages. DISCUSSION: We relate these developments to projects in other countries and discuss the scientific basis by using evidence of international literature reviews and metastudies. Some general recommendations are given about functional costing, the physical presence of MHC specialists in the primary care sector and the use of a common national standard for both primary care and specialized MHC.

The effect of age on survival and quality of life in elderly head and neck cancer patients: a long-term prospective study.

Little is known about long-term treatment outcome of elderly head and neck cancer patients and their quality of life (QOL). One hundred and eighteen older (>or=70 years) and 148 younger (45-60 years) patients with head and neck cancer were followed up for 3-6 years. In the long-term follow-up 33 younger and 24 older patients completed the EORTC QLQ-C30 and H&N35 and a questionnaire about depression. The survival rate after 3-6 years for younger patients was 36%, as compared to 31% in the older patient group. Higher tumour stages, more co-morbidity and non-standard treatment showed to be independent prognostic factors for mortality. No independent prognostic value of age could be found. The global QOL score remains roughly comparable. Even up to 6 years after treatment, we found no significant differences in survival or overall QOL between older and younger head and neck cancer patients.

Role of alcohol and smoking in diagnostic delay of head and neck cancer patients.

CONCLUSIONS: This study shows that heavy drinking is a risk factor for prolonged delay in presenting with head and neck cancer and for presenting with a large tumour in the head and neck region. Excessive smoking is only a risk factor for being diagnosed with a large tumour, although there is a weak association between smoking and prolonged diagnostic delay. OBJECTIVE: It is reasonable to assume that prolonged delay in presenting with head and neck cancer is associated with an advanced stage of cancer at diagnosis. In this study we analysed the effects of drinking and smoking habits on diagnostic delay and the T stage of the tumour at diagnosis. MATERIAL AND METHODS: A total of 427 patients with newly diagnosed head and neck carcinomas were eligible for this study. Of these, 306 (72%) actually participated: 134 (77%) with an oral tumour; 117 (69%) with a larynx tumour; and 55 (65%) with a pharynx tumour. Diagnostic delay was defined as a period of >30 days between the appearance of the first tumour-related symptoms and the first visit to a physician. T3 4 tumours were defined as advanced tumours. Drinking behaviour was classified into three types: light (0 2 drinks/day); moderate (3 4 drinks/day); and heavy ( >4 drinks/day). Smoking habits were classified into 4 types: never; stopped; light (0 20 cigarettes/day); and heavy (>20 cigarettes/day). RESULTS: Logistic regression showed that there were significantly more heavy than light drinkers [p = 0.04; odds ratio (OR) 1.8; 95% CI 1.0-3.1] in the delay group than in the non-delay group. Light smokers showed a tendency towards prolonged delay (p = 0.06; OR 2.2; 95% CI 1.0-5.0). Both heavy drinking (p = 0.01; OR 2.0; 95% CI 1.2-3.6) and heavy smoking (p = 0.03; OR 3.1; 95% CI 1.1-8.4) were risk factors for a patient to be diagnosed with a large tumour.

Patient and tumour factors associated with advanced carcinomas of the head and neck.

This study identifies patient and tumour related factors associated with advanced carcinoma of the head and neck. Special attention was paid to the role of patient and professional diagnostic delays. Three-hundred and six patients newly diagnosed with carcinoma of the pharynx, larynx and oral cavity were included in the study. Logistic regression analyses were used to identify the risk factors for presenting with an advanced tumour. Multivariate analysis found that having a pharyngeal carcinoma (OR 22.68; p = .000), an oral carcinoma (OR 6.51; p = .000), or a supraglottic carcinoma (OR 8.12; p = .000), patient delay > 3 months (OR 3.47; p = .001) and having a doctors' contact for another reason than the head and neck symptom (OR 0.20; p = .022) were predictive of presenting with an advanced tumour. These results suggest that beyond tumour-related factors, the patients' care seeking behaviour contributes to an increased risk of being diagnosed with an advanced tumour of the head and neck.

Elderly patients with head and neck cancer: the influence of comorbidity on choice of therapy, complication rate, and survival.

PURPOSE OF REVIEW: Comorbidity may be an important reason for head and neck surgeons to treat elderly patients less intensively. This article provides an overview of the influence of age and comorbidity on choice of therapy, postoperative complications, and survival. RECENT FINDINGS: Several retrospective studies show that elderly patients can undergo surgery if they do not have severe comorbid disorders. Severe comorbidity influences the rate of postoperative complications, and the higher complication rate in older patients reported in some studies is probably due to a higher level of comorbidity. Comorbidity also affects the survival of cancer patients, but several studies have failed to detect a relation between age and survival after correction for comorbidity. Thus, although severe comorbidity may influence the choice of treatment, patient age as such should not be a reason to exclude patients from intensive therapy. SUMMARY: If severe comorbidity is not present, elderly patients should receive standard treatment for head and neck cancer. Treatment choice should be based on medical findings and patient preference, not on chronologic age.

Quality of life in elderly patients with head and neck cancer one year after diagnosis.

BACKGROUND: Little is known about quality of life (QOL) in elderly patients. METHODS: Seventy-eight older (> or =70 years) and 105 younger patients (45-60 years) with carcinoma of the oral cavity, pharynx (stage > or =II), or larynx (stage > or =III) completed the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and EORTC Head and Neck Cancer Quality of Life Questionnaire before treatment. Fifty-one older and 70 younger patients completed all follow-up questionnaires at 3, 6, and 12 months. RESULTS: Before and after treatment, the physical functioning of the older patients was worse than that of younger patients. This difference remained relatively constant during follow-up and is probably related to normal aging. At baseline and 3 months, no other differences were found between both groups. At 6 months, younger patients reported more pain, but at 12 months no relevant differences were found. CONCLUSIONS: Treatment did not affect QOL differently in older and younger patients. Therefore, standard treatment should always be considered, irrespective of the patient's age.

Elderly patients with head and neck cancer: physical, social and psychological aspects after 1 year.

OBJECTIVE: Elderly patients with head and neck cancer often receive non-standard treatment for reasons other than comorbidity. In this prospective study we investigated how elderly patients fare 1 year after treatment in comparison with their younger counterparts. MATERIAL AND METHODS: Seventy patients aged 45-60 years and 51 patients aged > or = 70 years with cancer of the oral cavity, pharynx (stage II-IV) or larynx (stage III-IV) participated in the study before treatment and 1 year later. Each patient was interviewed and given a questionnaire concerning physical functioning, social contacts, depressive symptoms, satisfaction with treatment and future expectations. RESULTS: At 12 months, patients in both age groups reported significantly more depressive symptoms and less social support than before treatment, and their Karnofsky Performance Score was lower. However, there were no differences between elderly and younger patients. Approximately 90% of those in both age groups said that they would choose the same treatment again, and there was no age difference regarding the impact of treatment or expectations for the future. CONCLUSION: This study shows that the impact of treatment on quality of life did not differ between elderly and younger patients with head and neck cancer. Therefore, standard treatment should be considered in elderly patients if no severe contraindications exist.