Zoekresultaten

Somatic health care utilization by patients treated for substance use disorders

From Narcis.nl :" Patients with substance use disorder (SUD) are frequently suffering from co-occurring somatic disorders, increasing the risk of mortality. Somatic health care utilization (sHCU) often remains unknown to the physician during SUD treatment. This paper analyses sHCU and associated costs among patients in SUD treatment compared to matched, non-substance dependent controls. METHODS: Health care utilization data on 4972 SUD patients were matched to 19,846 controls by gender, birth year and ethnic origin. Subcategories of patients were formed based on SUD and on co-morbid psychiatric disorder. Data on sHCU during the year prior to the last treatment contact (the 'index date') for both patients and their matched controls were extracted from a health insurance database. RESULTS: Patients had a higher sHCU (with increased associated costs) than controls, especially when alcohol dependence was involved. In particular, sHCU for cardiovascular, respiratory, infectious diseases, injuries and accidents was increased among patients. However, the use of preventive medication, such as lipid-lowering drugs, is lower among SUD patients. Co-morbidity of psychiatric disorders led to further increase of sHCU, whereas patients with comorbid non-affective psychotic disorder (NAPD) showed lower sHCU and costs. CONCLUSION: Patients with SUD overall have a high sHCU, associated with high costs. There are indications that SUD patients have less access to preventive medication. Patients with comorbid NAPD are at risk of possible underutilization of somatic health care. Furthermore, we conclude that these larger administrative databases allow for comparisons between various diagnostic categories."

RAAK MKB project "De infiltrerende stad

Storm water flooding Amsterdam, from a quick Scan analyses to an action plan

Dealing with the issue of urban storm water flooding is becoming increasingly urgent. In the Netherlands there are no clear guidelines on the level of acceptance of urban flooding. Based on an accurate DEM, a detailed quick scan tool has been used to assess an extreme storm event in Amsterdam. The resulting flood maps for the whole of the city show where flooding is likely to occur after 60 or 100 mm of rain in one hour, as well as which buildings are at risk.Based on the results from this mapping study, Amsterdam decided to start a program to make the city rainproof (Amsterdam Rainproof). Part of the program was the validation of the model based on field research. An example of this is the use of data from the extreme storm event that occurred in Amsterdam on 28 july2014. In this paper several pilots from Amsterdam will address the relevance and effectiveness of the quick scan tool.

From Pilot Projects to Transformative Infrastructures, Exploring Market Receptivity for Permeable Pavement in The Netherlands

Climate change and changing land use challenge the livability and flood safety of Dutch cities. One option cities have to become more climate-proof is to increase infiltration of stormwater into soil through permeable pavement and thus reduce discharge of stormwater into sewer systems. To analyze the market receptivity for permeable pavements in the Netherlands, this article focuses on the perception of end-users towards key transition factors in the infrastructure transformation processes. Market receptivity was studied on two levels: (1) on the system level, by analyzing 20 key factors in the Dutch urban water sector that enable wider application of permeable pavements; and (2) on the technology level, by analyzing 12 key factors that explain why decision makers select permeable pavements or not. Results show that trust between cooperating partners was perceived as the system level key factor that needs to be improved most to facilitate the wider uptake of permeable pavements. Additionally, the association of end-users with permeable pavement, particularly their willingness to apply these technologies and their understanding of what kinds of benefits these technologies could bring, was regarded the most important receptivity attribute. On the technology level, the reliability of permeable pavement was regarded as the most important end-user consideration for selecting this technology.

Youth in transition: Study protocol of a prospective cohort study into the long-term course of addiction, mental health problems and social functioning in youth entering addiction treatment

BackgroundSubstance use disorders (SUDs) are prevalent in the general population, tend to follow a chronic course, are associated with many individual and social problems, and often have their onset in adolescence. However, the knowledge base from prospective population surveys and treatment-outcome studies on the course of SUD in adolescents is limited at best. The present study aims to fill this gap and focuses on a subgroup that is particularly at risk for chronicity: adolescents in addiction treatment. We will investigate the rate of persistent SUD and its predictors longitudinally from adolescence to young adulthood among youth with DSM-5 SUD from the start of their addiction treatment to 2 and 4 years following treatment-entry. In addition to SUD, we will investigate the course of comorbid mental disorders, social functioning, and quality of life and their association with SUD over time.Methods/designIn a naturalistic, multi-center prospective cohort design, we will include youths (n = 420), who consecutively enter addiction treatment at ten participating organizations in the Netherlands. Inclusion is prestratified by treatment organization, to ensure a nationally representative sample. Eligible youths are 16 to 22 years old and seek help for a primary DSM-5 cannabis, alcohol, cocaine or amphetamine use disorder. Assessments focus on lifetime and current substance use and SUD, non-SUD mental disorders, family history, life events, social functioning, treatment history, quality of life, chronic stress indicators (hair cortisol) and neuropsychological tests (computerized executive function tasks) and are conducted at baseline, end of treatment, and 2 and 4 years post-baseline. Baseline data and treatment data (type, intensity, duration) will be used to predict outcome – persistence of or desistance from SUD.DiscussionThere are remarkably few prospective studies worldwide that investigated the course of SUD in adolescents in addiction treatment for longer than 1 year. We are confident that the Youth in Transition study will further our understanding of determinants and consequences of persistent SUD among high-risk adolescents during the critical transition from adolescence to young adulthood.Trial registrationThe Netherlands National Trial Register Trial NL7928. Date of registration January 17, 2019.