To study late-life depression and its unfavourable course and co morbidities in The Netherlands. We designed the Netherlands Study of Depression in Older Persons (NESDO), a multi-site naturalistic ...prospective cohort study which makes it possible to examine the determinants, the course and the consequences of depressive disorders in older persons over a period of six years, and to compare these with those of depression earlier in adulthood. From 2007 until 2010, the NESDO consortium has recruited 510 depressed and non depressed older persons (greater than or equal to 60 years) at 5 locations throughout the Netherlands. Depressed persons were recruited from both mental health care institutes and general practices in order to include persons with late-life depression in various developmental and severity stages. Non-depressed persons were recruited from general practices. The baseline assessment included written questionnaires, interviews, a medical examination, cognitive tests and collection of blood and saliva samples. Information was gathered about mental health outcomes and demographic, psychosocial, biological, cognitive and genetic determinants. The baseline NESDO sample consists of 378 depressed (according to DSM-IV criteria) and 132 non-depressed persons aged 60 through 93 years. 95% had a major depression and 26.5% had dysthymia. Mean age of onset of the depressive disorder was around 49 year. For 33.1% of the depressed persons it was their first episode. 41.0% of the depressed persons had a co morbid anxiety disorder. Follow up assessments are currently going on with 6 monthly written questionnaires and face-to-face interviews after 2 and 6 years. The NESDO sample offers the opportunity to study the neurobiological, psychosocial and physical determinants of depression and its long-term course in older persons. Since largely similar measures were used as in the Netherlands Study of Depression and Anxiety (NESDA; age range 18-65 years), data can be pooled thus creating a large longitudinal database of clinically depressed persons with adequate power and a large set of neurobiological, psychosocial and physical variables from both younger and older depressed persons.
Background Self-rated general health has been associated with worse outcome after a myocardial infarction (MI). Previously, however, concurrent depression or anxiety were not taken into account. ...Objective To evaluate the impact of physical health-complaints post-MI on cardiac prognosis adjusting for cardiac disease severity, depression and anxiety. Methods The somatic subscale of the Health Complaints Scale (HCS) was administered to 424 MI-patients at 3 and 12 months post-MI. Types and trajectories of health-complaints were identified with latent-transition-analysis (LTA). The prognostic impact of HCS-sum-score at 3 months, and of types and trajectories of health-complaints on combined endpoints (new cardiac events and mortality) was evaluated with Cox-regression. Adjustments were made for age, sex, education-level, living alone, history of MI, left ventricular ejection fraction, depressive symptoms and generalized anxiety disorder. Results 189 (44.9%) MI-patients had a cardiac event or died during a mean follow-up of 5.7 (3.1) years. In the fully adjusted model HCS-sum-score predicted outcome (HR=1.02 95%CI: 1.00-1.05). LTA distinguished 5 groups at 3 and 12 months characterized by 1) no/minimal complaints, 2) cardiac complaints, 3) lack of energy, 4) sleep-problems, and 5) mixed health-complaints, resulting in 25 transition-classes. Patients with cardiac and energy complaints at 3 months (HRcardiac =1.55 1.15-2.10; HRenergy =1.351.00-1.81)) and those with new or persistent cardiac, energy and mixed complaints over time had a worse prognosis (HRcardiac =1.55 1.11- 2.16, HRmixed =1.71 1.19- 2.47, HRenergy =1.51 1.09-2.08). Conclusions Physical health-complaints are predictors of cardiac outcome independent from cardiac disease, depression and anxiety. Type and trajectories of health-complaints may have additional prognostic significance.
Although a clear definition of pseudologia fantastica cannot be found in the literature, there is consensus that this condition differs quantitatively and qualitatively from 'normal lying'. We ...discuss recognition of pseudologia fantastica based on 2 patients who presented with suicidal ideations at the casualty department following a traumatic event. Early recognition is important in order to break the pattern of lying, to restrict the use of medical resources and, finally, to act in accordance with the general principle of 'primum-non-nocere'. Although a psychiatric diagnostic workup might be worthwhile, it remains difficult to engage these patients for psychiatric treatment.
Abstract Background Clinical outcomes of esophageal and gastric cancer surgery are used for internal and external benchmarking in clinical auditing. For true hospital comparisons, proper case-mix ...adjustment is required. This study aimed to develop distinct models that allow for case-mix adjusted quality assessment of esophageal and gastric cancer surgery separately and assessed the impact on between-hospital comparisons. Methods This study included all patients undergoing esophagogastric cancer surgery in the Netherlands between 2017-2022 registered in the Dutch Upper Gastrointestinal Cancer Audit. We developed distinct case-mix adjustment models for ten quality indicators (QIs) using backward selection. Model performance of each individual model was evaluated with area-under-the-receiving-operator-curve (AUC) statistics, representing the impact of case-mix on the QI scores. The impact on between-hospital comparisons was quantified using unadjusted and adjusted O/E ratios. Results A total of 4,354 esophageal cancer and 2,109 gastric cancer patients were included. The most frequently selected case-mix variables in the models for all QIs for esophageal cancer surgery were ASA-score, salvage surgery, peripheral vascular disease/aortic aneurysm, chronic lung disease, and tumor histology, whereas for gastric cancer these were age, preoperative weight loss, tumor location, and clinical M stage. The case-mix adjustment models for esophageal and gastric cancer surgery showed low to moderate performance, with internally validated AUCs of 0.58-0.73 and 0.58-0.74, respectively. Case-mix adjustment had low impact on between-hospital comparisons. For both types of cancer, case-mix adjustment had most pronounced impact on between-hospital comparisons for QIs 30-day/in-hospital mortality and failure-to-rescue. Conclusion This study showed that correct quality assessment requires different case-mix models per quality indicator for clinical outcomes of esophageal and gastric cancer surgery. The case-mix models had low to moderate performance scores, suggesting that case-mix has limited impact in between-hospital comparisons of oesopagogastric cancer surgery.
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