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[Unexplained behaviour and death: analysis of individuals reported to public mental health care]. [无法解释的行为与死亡：对向公共精神保健机构报告的个人的分析]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-08-13
Ellen Tromp, Emma R Douma, Ilona Steenkamer, Ronald B J Smit, Jaap van der Laan, Job Zwaal
{"title":"[Unexplained behaviour and death: analysis of individuals reported to public mental health care].","authors":"Ellen Tromp, Emma R Douma, Ilona Steenkamer, Ronald B J Smit, Jaap van der Laan, Job Zwaal","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To gain insight into the nature of Public Mental Health Care (OGGZ) problems and identify opportunities for timely detection and referral to appropriate care.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Method: </strong>OGGZ reports and forensic post-mortem examinations of residents from seventeen municipalities in the Utrecht region (2018-2024) were included. Descriptive analyses were conducted on all OGGZ reports and on a subgroup of individuals with both an OGGZ report and a registered forensic post-mortem examination.</p><p><strong>Results: </strong>At the time of reporting, 73% of individuals were already known to one or more healthcare services, and 33% had repeated reports. Psychiatric problems were the most frequently reported issue (70%). Among 7,172 unique individuals with an OGGZ report, 155 subsequently underwent a forensic post-mortem examination. Within this subgroup, 70% died within one year of their last report, predominantly from non-natural causes.</p><p><strong>Conclusion: </strong>Early identification, interdisciplinary collaboration, and accessible care are essential to reach individuals who avoid regular healthcare services.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Does tobacco control reach people with a migrant background?] [烟草控制是否涉及移民背景的人群？]］
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-08-13
Siebe N Tjebbes, Lejla Nikočević, Esther A Croes
{"title":"[Does tobacco control reach people with a migrant background?]","authors":"Siebe N Tjebbes, Lejla Nikočević, Esther A Croes","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Smoking remains the leading preventable cause of illness and death worldwide. The Dutch Government aims to reduce tobacco use to 5% of adults in 2040. Over 25% of the Dutch population has a migrant background. The prevalence of smoking is higher in certain migrant populations and cessation rates are lower than among native Dutch people. Social determinants, like culture, lifestyle and health skills together with limited knowledge of the healthcare system and distrust of healthcare institutions make that tobacco control measures do not reach them sufficiently, putting the 5% target at risk. In this article, we conclude that only by combining universal policies with culturally sensitive interventions, neighbourhood-focused cooperation, and coordinated efforts by healthcare providers, local authorities, employers, and social organisations these inequalities can be reduced.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[A girl with a unilateral rash]. [患单侧皮疹的女孩]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-08-12
Bart W B Sweers, Else N Kop
{"title":"[A girl with a unilateral rash].","authors":"Bart W B Sweers, Else N Kop","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 5-year-old girl developed a unilateral exanthem after an upper respiratory infection. Clinical features were consistent with asymmetric periflexural exanthem of childhood (APEC), a rare, self-limiting dermatosis. Diagnosis is clinical, without further diagnostic investigations. Increased clinical awareness is essential, as the condition is often misdiagnosed.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Ulcer cruris].
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-08-11
Miesje M Nijs, Alexis Oele, Felicia van den Burg-Groeneveld, Marie Josee E van Tongerlo-van Rijn, Catherine van Montfrans
{"title":"[Ulcer cruris].","authors":"Miesje M Nijs, Alexis Oele, Felicia van den Burg-Groeneveld, Marie Josee E van Tongerlo-van Rijn, Catherine van Montfrans","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An ulcer cruris is a leg wound that can have various causes, with venous ulcers from chronic venous insufficiency being most common. First-line treatment includes ambulatory compression therapy and wound care. Compression reduces the underlying cause, increased venous pressure. Patient education about the pathogenesis, treatment, and prognosis is important. Factors that delay healing include, among others, hypergranulation, edema, contact allergy, comorbidity, and pain. Monitoring progress is essential to ensure timely referral when healing stagnates. A dermatologist or vascular surgeon can provide outpatient treatment in cases of insufficient superficial venous system, which potentially can lead to faster healing and reducing recurrence.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Elbow fractures in children; how do we minimize the risk of missing a fracture?] 儿童肘部骨折；我们如何将遗漏骨折的风险降到最低？］
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-08-10
Tim F F Saris, Michel P J van den Bekerom, Christiaan J A van Bergen, Denise Eygendaal, Melinda Witbreuk
{"title":"[Elbow fractures in children; how do we minimize the risk of missing a fracture?]","authors":"Tim F F Saris, Michel P J van den Bekerom, Christiaan J A van Bergen, Denise Eygendaal, Melinda Witbreuk","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Elbow fractures in children represent a frequent but diagnostically challenging presentation in both primary and secondary care. Due to multiple ossification centers and often subtle clinical signs, these injuries are at risk of being overlooked. Missed fractures may result in malunion, growth disturbances, chronic pain, or long-term functional impairment. This review highlights three commonly underdiagnosed fracture types: medial epicondyle fractures, lateral condyle fractures, and supracondylar humeral fractures. Using illustrative case material, we discuss key aspects of clinical evaluation, pitfalls in radiographic interpretation, and the importance of systematic assessment of neurovascular status. In cases of persisting pain with initially normal radiographs, additional imaging such as oblique X-rays, ultrasound, or CT should be considered. Structured follow-up and timely referral to pediatricorthopedic expertise are essential to prevent complications. With a pragmatic, knowledge-based approach, clinicians can significantly reduce the risk of missed diagnoses and optimize functional outcomes for pediatric patients.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Ureaplasma infections in the immunocompromised patient]. 免疫功能低下患者的脲原体感染。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-08-04
Martine G Caris, O W Bredewold, Jogchum J Beltman, Mark G J de Boer, Pui Ki Chung, Anna H E Roukens
{"title":"[Ureaplasma infections in the immunocompromised patient].","authors":"Martine G Caris, O W Bredewold, Jogchum J Beltman, Mark G J de Boer, Pui Ki Chung, Anna H E Roukens","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of immunomodulatory medications is expanding across all fields of medicine. The selective immune deficiencies that arise with their use generate an increased incidence of infections caused by previously lesser-known or generally harmless micro-organisms. Physicians will therefore increasingly encounter patients presenting with unusual infections or their unusual manifestations. Here we present three patients who were treated with various forms of B-cell depleting medication for three very different conditions (granulomatosis with polyangiitis, multiple sclerosis, and tuberous sclerosis complex in their unborn child). In all three cases there was a significant doctor's delay - the diagnosis of a Ureaplasma infection was only made once this was specifically considered, as PCR testing had to be employed. Through this case series we demonstrate that in culture-negative infections in patients receiving therapy that affects the humoral immune response, Ureaplasma infection should be considered and specific diagnostic testing should be used.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Elderly patients with chronic limb-threatening ischemia: conservative treatment is appropriate care within an evolving healthcare landscape]. 老年慢性肢体缺血患者：在不断发展的医疗保健环境中，保守治疗是适当的护理。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-08-03
Bob T A Schultze, B J M Nardo van der Meer, Lijckle van der Laan
{"title":"[Elderly patients with chronic limb-threatening ischemia: conservative treatment is appropriate care within an evolving healthcare landscape].","authors":"Bob T A Schultze, B J M Nardo van der Meer, Lijckle van der Laan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Revascularization remains the cornerstone of treatment for CLTI. Conservative treatment represents an underexposed yet potentially appropriate alternative for selected elderly and frail patients. This population is characterized by high mortality rates, substantial perioperative risks, prolonged hospital stays, increased healthcare costs, and deterioration in functional status and quality of life following invasive interventions. Conservative treatment - including wound care, pain management, and when necessary, minor amputations - may offer an alternative for frail, elderly patients with CLTI. Emerging evidence suggests that, for selected patients, conservative treatment can result in acceptable wound healing rates and survival comparable to invasive strategies, without an increase in major amputation rates. Within the context of appropriate and value-based care, conservative treatment may better balance functional outcomes, healthcare utilization and patient preferences. Future research on prediction models to guide patient selection, cost-effectiveness analyses, and qualitative studies exploring patient-reported outcomes and experiences, should support evidence-based implementation of conservative treatment.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Pregnancy and thirst, a remarkable duo]. [怀孕和口渴，一个了不起的组合]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-07-30
Lianne Beunk, Marieke de Vries, H C van Vugt, Jacoline W Brinkman, Mariska C Vlot
{"title":"[Pregnancy and thirst, a remarkable duo].","authors":"Lianne Beunk, Marieke de Vries, H C van Vugt, Jacoline W Brinkman, Mariska C Vlot","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Establishing a differential diagnosis for polyuria and polydipsia during pregnancy can be challenging. We describe a pregnant woman with severe polyuria (urine output 9L/24h) and polydipsia without pre-existing symptoms. Gestational diabetes and electrolyte disturbances were excluded; HbA1c and daily glucose profiles were normal. Due to pregnancy, no water deprivation or arginine stimulation test was performed. Copeptin, a surrogate marker for AVP/ADH, was <2 pmol/L (reference: 0-9 pmol/L), ruling out AVP resistance. Because of disabling symptoms, a trial of oral desmopressin was initiated during admission, leading to complete normalization of diuresis without thirst. Weight, diuresis, plasma/urine sodium, and osmolality were closely monitored. After delivery of a healthy son, desmopressin was discontinued and symptoms resolved spontaneously, with copeptin remaining normal. These findings ruled out primary polydipsia. Conclusion: this was a case of pregnancy-induced AVP deficiency due to elevated placental vasopressinase activity, a rare condition (2-4 per 100,000 pregnancies).</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Looking back on the COVID-19 pandemic: what explains the excess mortality due to COVID-19 in The Netherlands?] [回顾COVID-19大流行：如何解释荷兰COVID-19造成的高死亡率？]］
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-07-30
Johan P Mackenbach
{"title":"[Looking back on the COVID-19 pandemic: what explains the excess mortality due to COVID-19 in The Netherlands?]","authors":"Johan P Mackenbach","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether previously identified deficiencies in government policy could have contributed to the high number of deaths from COVID-19 in the Netherlands.</p><p><strong>Design: </strong>Secondary analysis of data from 28 European countries extracted from harmonized international databases.</p><p><strong>Method: </strong>Correlation and regression analysis of the relationship between contact-limiting measures and vaccination campaigns on the one hand and excess mortality due to COVID-19 on the other hand.</p><p><strong>Results: </strong>There were three periods of sharply increased mortality in Europe. In the first and third periods, mortality in the Netherlands was relatively high, but not in the second period. The higher mortality in the first period was related to the fact that the epidemic had already spread widely before strict contact-restriction measures were implemented. In the third period, the higher mortality was related to the slow start of the booster campaign.</p><p><strong>Conclusion: </strong>The relatively high mortality in the Netherlands during the COVID-19 pandemic might have been partly avoidable.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148830641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[White discolouration of the fingers in a young man]. [年轻人手指变白]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-07-29
Jeroen Kruidenier, R B M van Tongeren
{"title":"[White discolouration of the fingers in a young man].","authors":"Jeroen Kruidenier, R B M van Tongeren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 26-year-old, healthy man develops complaints of his right hand, consisting of pain, paresthesia and a white discolouration. Accessory cervical ribs were detected and the patient was referred to a specialised centre for thoracic outlet syndrome, where he was successfully treated.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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