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Neighbourhood characteristics may influence the risk of psychosis, independently of their individual-level equivalents. To examine these issues in a multi-level model of schizophrenia incidence. Cases of schizophrenia, incident between 1986 and 1997, were identified from the Maastricht Mental Health Case Register. A multi-level analysis was conducted to examine the independent effects of individual-level and neighbourhood-level variables in 35 neighbourhoods. Independent of individual-level single and divorced marital status, an effect of the proportion of single persons and proportion of divorced persons in a neighbourhood was apparent (per 1% increase respectively: RR = 1.02; 95% CI 1.00-1.03; and RR = 1.12, 95% CI 1.04-1.21). Single marital status interacted with the neighbourhood proportion of single persons, the effect being stronger in neighbourhoods with fewer single-person households. The neighbourhood environment modifies the individual risk for schizophrenia. Premorbid vulnerability resulting in single marital status may be more likely to progress to overt disease in an environment with a higher perceived level of social isolation.

Background Effectiveness of services for patients diagnosed with severe mental illness (SMI) may improve when treatment plans are needs based. A regional Cumulative Needs for Care Monitor (CNCM) introduced diagnostic and evaluative tools, allowing clinicians to explicitly assess patients' needs and negotiate treatment with the patient. We hypothesized that this would change care consumption patterns. Methods Psychiatric Case Registers (PCR) register all in-patient and out-patient care in the region. We matched patients in the South-Limburg PCR, where CNCM was in place, with patients from the PCR in the North of the Netherlands (NN), where no CNCM was available. Matching was accomplished using propensity scoring including, amongst others, total care consumption and out-patient care consumption. Date of the CNCM assessment was copied to the matched controls as a hypothetical index date had the CNCM been in place in NN. The difference in care consumption after and before this date (after minus before) was analysed. Results Compared with the control region, out-patient care consumption in the CNCM region was significantly higher after the CNCM index date regardless of treatment status at baseline (new, new episode, persistent), whereas a decrease in in-patient care consumption could not be shown. Conclusions Monitoring patients may result in different patterns of care by flexibly adjusting level of out-patient care in response to early signs of clinical deterioration.

Although psychiatric comorbidity is relevant for a number of diseases, it is often ignored in technology assessment. This study examines the service use rate in mental healthcare facilities and related costs for stroke patients discharged from the University Hospital Maastricht between 1987 and 1995. Through anonymous record linkage, the medical registration of the hospital and the registration of the Maastricht Mental Health Care Register were linked. Linkage succeeded for 16% of the 2,020 stroke patients, indicating that these patients used mental health services during a 10-year period around the stroke (+/- 5 years). Of the users' group, 88% had a mental healthcare contact following stroke. Regression analysis shows that age, length of hospital stay, and mental healthcare contact before stroke are associated with mental healthcare use after stroke. It is remarkable in that there is already an increase in the consumption of mental health care in the prodromal phase just before the stroke occurred. When comparing costs before and after stroke, the outpatient costs increased on average by [symbol: see text] 42.64, semi-institutionalized costs increased on average by [symbol: see text] 208.10, and intramural costs by [symbol: see text] 1,189.21. The total increase in costs is [symbol: see text] 1,439.95. For all mental healthcare facilities, the increase in costs is significant. No study so far has revealed the total costs of mental healthcare facilities following stroke. Extrapolating these costs to the Netherlands illustrates that stroke patients have a high psychiatric comorbidity, inducing about 1.3% of total mental healthcare costs.

Previously, many patients with severe mental illness had difficulties to engage with fragmented mental health services, thus not receiving care. In a Dutch city, Assertive Community Treatment (ACT) was introduced to cater specifically for this group of patients. In a pre–post comparison, changes in mental health care consumption were examined. All mental health care contacts, ACT and non-ACT, of patients in the newly started ACT-teams were extracted from the regional Psychiatric Case Register. Analyses of mental health care usage were performed comparing the period before ACT introduction with the period thereafter. After the introduction of ACT, mental health care use increased in this group of patients, although not all patients remained under the care of ACT teams. ACT may succeed in delivering more mental health care to patients with severe mental illness and treatment needs who previously had difficulties engaging with fragmented mental health care services.

Introduction Patients diagnosed with severe mental illness (SMI) have a complex combination of psychiatric, somatic and social needs for care, requiring an integrated, multidisciplinary health care approach. The present paper describes the methods of the cumulative needs for care monitor (CNCM), a monitoring system in operation in a geographically defined area. Methods The CNCM provides information on need for care, functioning and other outcomes in SMI patients in the area. This information can be used not only to plan treatment at the individual level, but also to conduct health services research at the group level.

To study, in a geographically defined area, associations between the neighbourhood social environment and individual socioeconomic status on the one hand, and treated incidence of schizophrenia and level of subsequent service use on the other. A combined data set of (i) patients with a case register diagnosis of schizophrenia and (ii) population controls was subjected to multilevel analyses, including neighbourhood exposures (neighbourhood socioeconomic disadvantage and social capital) and individual level confounders. Separate analyses were conducted for inpatient and outpatient psychiatric service consumption as indexed by the case register. Neighbourhood socioeconomic disadvantage and neighbourhood social capital did not impact on the treated incidence of schizophrenia, but quantity of inpatient service consumption was higher in neighbourhoods with higher level of social control (i.e. where it is more likely that neighbours intervene in neighbourhood-threatening situations). In addition, most indicators of lower individual socioeconomic status were associated with higher treated incidence, while treated incidence was lower when individual educational status was low. Residents of high social control neighbourhoods may seek greater levels of resolution of psychiatric disorder in patient-residents, and by consequence may induce greater levels of inpatient service consumption in patients diagnosed with schizophrenia. Individual-level indicators of social disadvantage are associated with higher risk of treated psychotic disorder, with the exception of lower educational status, which may confer a lower probability of treatment given the presence of psychotic disorder.

Stroke is associated with psychiatric morbidity but little is known about mental health care use in stroke patients. A probability record linkage study was conducted linking stroke cases admitted to a teaching hospital serving a catchment area between 1987 and 1995 with records from a psychiatric case register covering the same area. Stroke patients had a more than twofold increased risk of contact with mental health care than individuals in the general population (yearly prevalences of respectively 88 and 39 per 1000; risk ratio 2.24; 95 % CI 2.04-2.45). One-third of all stroke admissions had had mental health care before and more than half had had mental health care after the stroke. In the year of admission for stroke, the probability of receiving mental health care was highest, while in the more remote years the risk was lower. Stroke is associated with an increased probability of contact with mental health services. The pattern of mental health care of a stroke patient is different from that of other mental health patients: more episodic and concentrated around the time of admission for stroke.

Objectives: Although psychiatric comorbidity is relevant for a number of diseases, it is often ignored in technology assessment. This study examines the service use rate in mental healthcare facilities and related costs for stroke patients discharged from the University Hospital Maastricht between 1987 and 1995. Methods: Through anonymous record linkage, the medical registration of the hospital and the registration of the Maastricht Mental Health Case Register were linked. Results: Linkage succeeded for 16% of the 2,020 stroke patients, indicating that these patients used mental health services during a 10-year period around the stroke (±5 years). Of the users' group, 88% had a mental healthcare contact following stroke. Regression analysis shows that age, length of hospital stay, and mental healthcare contact before stroke are associated with mental healthcare use after stroke. It is remarkable in that there is already an increase in the consumption of mental health care in the prodromal phase just before the stroke occurred. When comparing costs before and after stroke, the outpatient costs increased on average by \\epsfbox{cj108-4-euro.eps}42.64, semi-institutionalized costs increased on average by \\epsfbox{cj108-4-euro.eps}208.10, and intramural costs by \\epsfbox{cj108-4-euro.eps}1,189.21. The total increase in costs is \\epsfbox{cj108-4-euro.eps}1,439.95. For all mental healthcare facilities, the increase in costs is significant. Conclusions: No study so far has revealed the total costs of mental healthcare facilities following stroke. Extrapolating these costs to the Netherlands illustrates that stroke patients have a high psychiatric comorbidity, inducing about 1.3% of total mental healthcare costs.

The recently developed histological scoring system for non-alcoholic fatty liver disease (NAFLD) by the NASH Clinical Research Network (NASH-CRN) has been widely used in clinical settings, but is increasingly employed in preclinical research as well. However, it has not been systematically analyzed whether the human scoring system can directly be converted to preclinical rodent models. To analyze this, we systematically compared human NAFLD liver pathology, using human liver biopsies, with liver pathology of several NAFLD mouse models. Based upon the features pertaining to mouse NAFLD, we aimed at establishing a modified generic scoring system that is applicable to broad spectrum of rodent models. The histopathology of NAFLD was analyzed in several different mouse models of NAFLD to define generic criteria for histological assessment (preclinical scoring system). For validation of this scoring system, 36 slides of mouse livers, covering the whole spectrum of NAFLD, were blindly analyzed by ten observers. Additionally, the livers were blindly scored by one observer during two separate assessments longer than 3 months apart. The criteria macrovesicular steatosis, microvesicular steatosis, hepatocellular hypertrophy, inflammation and fibrosis were generally applicable to rodent NAFLD. The inter-observer reproducibility (evaluated using the Intraclass Correlation Coefficient) between the ten observers was high for the analysis of macrovesicular steatosis and microvesicular steatosis (ICC = 0.784 and 0.776, all p<0.001, respectively) and moderate for the analysis of hypertrophy and inflammation (ICC = 0.685 and 0.650, all p<0.001, respectively). The intra-observer reproducibility between the different observations of one observer was high for the analysis of macrovesicular steatosis, microvesicular steatosis and hypertrophy (ICC = 0.871, 0.871 and 0.896, all p<0.001, respectively) and very high for the analysis of inflammation (ICC = 0.931, p<0.001). We established a simple NAFLD scoring system with high reproducibility that is applicable for different rodent models and for all stages of NAFLD etiology.