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PubMedDate not supplied

MRI of the abdomen and pelvis: an update in The Netherlands.

MRI with its excellent contrast resolution and direct multiplanar imaging has become a valuable medical tool in diagnostic imaging. Due to physiological motion artifacts, the role of MRI in the abdomen is still under discussion. The use of ultrafast sequences and the development of oral contrast agents, however, offers new promises for abdominal MRI. In the area of the retroperitoneum and pelvis, MRI produces excellent images as motion-artifacts are absent. Up to the end of 1989 clinical MRI in The Netherlands was performed in only four University hospitals; nevertheless these centers proved able to compete with international standards. The rapidly increasing number of MR units that recently became available in The Netherlands could result in a surpassing of CT in many pelvic and abdominal pathological conditions.

Abdomen↗
PubMed1995

Vascular radiology in The Netherlands in 1992: a quantitative approach.

A survey was held into methods and extent of vascular radiology in the Netherlands. For the year 1992, quantitative data on the number of patients, vascular radiological examinations and characteristics of angiography facilities were obtained from more than 80% of the Dutch hospitals with angiography rooms (120). The following estimates have been inferred: approximately 50,600 patients were referred for non-cardiac vascular radiology, including 32,100 patients for intra-arterial arteriography, 8900 for intravenous DSA arteriography, 4600 for phlebography and 5000 for interventional radiology. On average about two vascular examinations were carried out per patient referred for arteriography. In interventional radiology, the number of patients and the number of examinations are quite similar. The total number of angiography rooms in the Netherlands was 136. The average age of angiography X-ray systems was 7.1 years, of imaging equipment 5.7 years. In 56% of the hospitals, the X-ray tube was normally applied in the undercouch position, in 40% in overcouch position and in 4% there was no preferred position. An additional survey of occupational exposure conditions in angiography rooms (19 hospitals) showed that, in most hospitals, protective lead aprons of 0.5 mm Pb-equivalent were in use. Thyroid collars were used rather infrequently.

Angiography↗
PubMedDate not supplied

The role of anesthesiology in the health care system of The Netherlands.

With the initiation of regular anesthesia services in the Netherlands in 1947, anesthesiology has grown to a large and influential profession, including intensive care, resuscitation, pain therapy, and emergency medical care. Pre- and postgraduate training programs are formalized and compete with some of the best in the world. After a long struggle, anesthesiology's social and legal status now compares with all other medical sciences. Anesthesia is restricted to medical specialists, but with the permanent support of fully trained and qualified nurses. Anesthesia in the Netherlands is a "two person" job.

Anesthesia↗
PubMed1992

Trends in mortality from malignant cutaneous melanoma in The Netherlands, 1950-1988.

This paper presents an analysis of trends in mortality from malignant melanoma of the skin in The Netherlands, 1950-1988. Statistical analyses show that time period effects are needed to describe the mortality trends in The Netherlands. Because this contrasts with reports from other countries, in which the trends were ascribed to a cohort effect only, log-linear models including the three factors age, time period and birth cohort, were fitted to the data. To be able to separate time period effects from birth cohort effects we assumed a mathematical function for the mortality rates in relation to age. The results obtained in this way indicate that time period effects increased up to 1970. An increase of birth cohort effects is seen for cohorts born between 1900 and 1955. For cohorts born after 1955 the mortality from melanoma seems to decrease. The most plausible explanation for the time period effect probably is improvement in death certification.

Adolescent↗
PubMed1995

Striking changes in smoking behaviour and lung cancer incidence by histological type in south-east Netherlands, 1960-1991.

Changes in lung cancer incidence in south-east Netherlands between 1960 and 1991 were analysed, using data from the Eindhoven Cancer Registry, and related to previous changes in smoking habits. Male lung cancer incidence rates increased markedly from birth cohorts 1890-1899 to 1910-1919, followed by a decline. The peak incidences for both squamous cell carcinoma and small cell carcinoma were reached in 1978, while for adenocarcinoma it was 1985. A rising trend in female lung cancer incidence up to 1988 was found for each successive birth cohort and for every histological type. These changes in lung cancer incidence rates are most likely related to the pattern of past smoking habits: the percentage of male adult smokers in the southern part of the Netherlands decreased from 95% in 1960 to 40% in 1981 and the percentage of female adult smokers increased from 27% in 1960 to 40% in 1967, slightly decreasing only after 1979. In view of the trends in smoking behaviour, the incidence rates for male lung cancer will decline further, whereas female lung cancer incidence may decrease after the year 2000.

Adult↗
PubMed1994

Bladder cancer incidence and survival in the south-eastern part of The Netherlands, 1975-1989.

Trends in cancer occurrence and survival may reflect changing risks and prognosis, respectively, but may also be caused by changes in detection, classification and registration. Changed classification of low-stage papillary carcinomas may have a material effect on observed trends in the occurrence of bladder cancer. We studied the effect of the implementation of the WHO grading system and the third edition of the TNM staging system on bladder cancer incidence in the south-eastern part of the Netherlands. Data on superficial and invasive bladder cancer incidence between 1975 and 1989 were derived from the population-based Eindhoven cancer registry. Data on survival of patients with stages I-IV bladder cancer were derived from the municipal population registers. Age-adjusted bladder cancer incidence per 100,000 person-years rose from 25.9 to 40.7 in males and from 3.1 to 8.5 in females. This increasing trend was caused almost entirely by non-invasive pTa papillary carcinoma. A considerable shift was observed towards lower disease stages, which was less evident within the group of invasive tumours. The relative 5-year survival of patients with stages I-IV invasive bladder cancer was 59% in 1975-1977 and 70% in 1984-1986. After stratification by stage, however, no striking improvement was observed in the prognosis. We conclude that the increasing trend of bladder cancer occurrence in the Netherlands since 1975 has largely been caused by changed classification systems and reporting procedures for pTa tumours (formerly classified as papillomas).

Female↗
PubMed1995

Socioeconomic status and breast cancer survival in the southeastern Netherlands, 1980-1989.

Socioeconomic differences in breast cancer survival in the southeastern Netherlands between 1980 and 1989 were studied (n = 3928), as was the impact of prognostic factors (stage at diagnosis, morphology, and treatment) on such differences. An area-based measure of socioeconomic status (SES) in five groups, based on the postcode of residence at the time of diagnosis, was used. In univariate analyses the relative survival rate was used to correct for causes of death other than breast cancer. The measure of outcome in multivariate analyses was the hazard ratio. The results of both univariate and multivariate analyses suggested a small survival advantage for the higher SES groups. In a model with follow-up period, SES and age, the hazard ratios with 95% confidence intervals (CI) for SES groups from high to low were: 1.00, 1.06 (0.84-1.33), 1.04 (0.86-1.26), 1.15 (0.96-1.38), 1.18 (0.99-1.42). After a correction for stage at diagnosis, differences in survival were reduced substantially. Morphology and treatment were not important explanatory factors of the SES survival association. We conclude that small socioeconomic differences in breast cancer survival exist in The Netherlands and that stage at diagnosis is the most important determinant of such differences.

Adult↗
PubMed1996

Small influence of parental educational level on the survival of children with leukaemia in The Netherlands between 1973 and 1979.

We studied the effect of parental educational level (PEL), an indicator of socio-economic status (SES), on survival of children with acute lymphoblastic (ALL) and non-lymphoblastic leukaemia (ANLL). All children with ALL and ANLL diagnosed in The Netherlands in the period 1973-1979, registered by the Dutch Childhood Leukaemia Study Group and followed until 1991 were included. Bone marrow and blood smears had been uniformly classified in a central laboratory; cases with acute lymphoblastic leukaemia (ALL) were subdivided into standard risk (SR) and high risk (HR). PEL, assessed as a risk indicator in a separately conducted population-based case-control study of the same children (response rate: 88%), was divided into low, when neither of the parents had more than elementary school or lower vocational education, and high when either had more. Children with SR ALL of high PEL parents had a slightly higher 10-year survival rate than of low PEL parents (58% versus 54%, P = 0.25), whereas survival for the latter increased more (P = 0.06) from a lower level in the period 1973-1975. However, children of low PEL parents with HR ALL and ANLL had a higher 10-year survival rate compared with children of high PEL parents (P = 0.10 and 0.22, respectively). Children without information on PEL, non-responders, migrants and with missing values exhibited slightly worse survival rates. The influence of PEL on survival of acute leukaemia in children in The Netherlands during 1973-1979 appeared small or even equivocal. Small differences in SES and optimal geographic and financial access to care, delivered through national treatment protocols, may be responsible for these results.

Adolescent↗
PubMed1993

The HIV epidemic and its effect on the tuberculosis situation in The Netherlands.

To determine the influence of the HIV (human immunodeficiency virus) epidemic on the tuberculosis situation in the Netherlands, we made a retrospective analysis of all reported tuberculosis cases from 1984 through 1990. We studied the course of the tuberculosis incidence in the Netherlands among the group at highest risk for HIV infection (Dutch males, 25-49 years of age, in Amsterdam). This was compared with the course among same-age Dutch males in areas with lower risk for HIV infection and among other-age Dutch males in Amsterdam. The tuberculosis incidence among Dutch males aged 25-49 years in Amsterdam increased from 16.1 in 1984 to 34.7 per 100,000 in 1990 (chi 2 for trend, P < 0.01). The incidences among Dutch males in other places of residence in this age group and among other-age Dutch males in Amsterdam remained stable or decreased during the same period. As this increase could not be ascribed to tuberculosis among other risk groups, it appears to be related to the HIV epidemic among male homosexuals. Our results indicate that, even in a country where the prevalence of tuberculous infection is low, an increase of tuberculosis among certain subgroups can be observed as the result of the HIV epidemic.

AIDS-Related Opportunistic Infections↗
PubMed2005

Optimal working zone division for safe track maintenance in The Netherlands.

After a sequence of serious accidents, the safety of rail track workers became an urgent and political problem in The Netherlands. It turned out that the rail track workers had one of the most dangerous jobs. The board of the Dutch Railways decided that the Dutch railway infrastructure had to be divided into so-called working zones. Moreover, to carry out maintenance activities, that particular working zone of the railway system had to be taken out of service. An essential problem was how to divide the Dutch railway infrastructure into working zones such that all parties involved are satisfied. Since many parties with conflicting interests were involved, this problem was extremely difficult. In this paper we show the division rules we developed, and which had been implemented in The Netherlands.

Accidents, Occupational↗
PubMed2005

Preventive drug use in patients with a history of nonfatal myocardial infarction during 12-year follow-up in The Netherlands: a retrospective analysis.

BACKGROUND: Myocardial infarction (MI) is a common cause of death in developed countries. Long-term preventive pharmacotherapy has been shown to decrease mortality and morbidity after MI. Based on a literature search, studies of these therapies to date have estimated the use of monotherapy, whereas many patients are prescribed combination therapy. Thus, assessment of long-term combination drug use after MI is timely. OBJECTIVE: The aim of this study was to assess the use of oral antithrombotics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, hydroxymethyl-glutaryl coenzyme A reductase inhibitors ("statins"), and their combinations after MI at discharge and during 12-year follow-up. METHODS: This community-based, retrospective data analysis was conducted at Utrecht University, Utrecht, The Netherlands. Data from patients aged > or =18 years at hospital admission who experienced nonfatal acute MI between 1991 and 2000 and had a duration of follow-up > or =30 days were included in the analysis. Data were retrieved from the Pharmo Record Linkage System database, which links pharmacies' dispensation records to hospitals' discharge records on an individual patient level, allowing the investigator to observe individual patients' medication use over time. Primary outcome measures were the use of preventive medicines (oral antithrombotics, beta-blockers, ACE inhibitors, and statins) at discharge, overall use, and persistence during 12-year follow-up. RESULTS: Of 330,000 patients in the database, 4007 were included in the analysis (2828 men, 1179 women; mean [SD] age, 63.5 [12.5] years). Use at discharge and overall use of oral antithrombotics and statins increased significantly between 1991 and 2000, whereas use of beta-blockers and ACE inhibitors increased mainly in patients discharged in the latter years of the follow-up period. Therapy with any combination of drugs increased strikingly from 1991 to 2000, from 47% to 90%. At 1 year after discharge, 32% of patients had discontinued their first-prescribed combination treatments. At 5 years after discharge, this rate increased to 57%, suggesting a low rate of persistence CONCLUSIONS: Based on the results of this retrospective data analysis, the use of MI-preventive drug treatment at and after discharge increased significantly in this population in The Netherlands during the 1990s. Combination therapy increased strikingly. However, persistence with combination therapy was low.

Adrenergic beta-Antagonists↗
PubMed2005

Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000.

This study presents an overview of Dutch studies on prevalence of alcohol use and adds findings from our own study on prevalence of drinking among adolescents and young adults aged 12-30 years in the Netherlands. Data were collected as part of a longitudinal study by the Netherlands Twin Register in 1993 (n=3885), 1995 (n=4814), 1997 (n=3772) and 2000 (n=4090). Measures included lifetime alcohol use, frequency of drinking, quantity of drinking, lifetime drunkenness, frequency of drunkenness and problem drinking. The main findings are: (a) alcohol use increased with age until the age of 25, after which it decreased; (b) males exceeded females on all aspects of alcohol use, with exception of the youngest age group and lifetime alcohol use; (c) time trends indicated an increase in frequency and quantity of drinking among 12-15-year-old adolescents during the 1990s; and moreover, (d) 21-25-year-old females drank more frequently, consumed more drinks a week, had more experience with lifetime drunkenness and were drunk more often in 2000 than in 1993. Among 21-25-year-old males, an increase of drunkenness and problem drinking was displayed during the 1990s.

Adolescent↗
PubMed2004

Hepatocellular carcinoma in the Netherlands incidence, treatment and survival patterns.

To examine recent trends of hepatocellular carcinoma (HCC) in an unselected patient population in the Western world, cancer registration data of HCC in the Netherlands were analysed. Trends in incidence, mortality, treatment and survival, according to gender, age, stage of disease and period of diagnosis were studied. Age-standardised incidence of HCC in the Netherlands did not rise from 1989 to 2000. In men older than 75 years, there was a significant increase. Mortality due to primary liver cancer increased from 1989 to 2000. There was no change in the treatment pattern (1989-1998), whereas 73% of patients with HCC received no cancer-related therapy during this period of analysis. Twelve percent of the patients underwent either a partial liver resection or orthotopic liver transplantation. This low percentage suggests that patients with HCC must be analysed and discussed in specialised centres to minimise the number of patients not receiving possible curative therapy.

Adult↗
PubMed2006

Translation and validation of the SF-36 Health Survey for use among Turkish and Moroccan ethnic minority cancer patients in The Netherlands.

In this study, the SF-36 Health Survey was translated into two oral Moroccan languages and the existing Turkish version was culturally adapted for use in The Netherlands, and was tested among 79 Moroccan and 90 Turkish cancer patients. There were normal levels of missing item responses but a higher administration time. With minor exceptions, the scale structure of the SF-36 was confirmed and the reliability of the scales met the 0.70 criterion for group comparisons. The questionnaire distinguished clearly between subgroups formed on the basis of performance status and was responsive to change in performance status over time. Some evidence of differential item function (DIF) was found in both ethnic groups. These results support the use of the SF-36 among Turkish and Moroccan cancer patients in The Netherlands. Additional studies are needed to confirm the psychometrics of the questionnaire when used among these ethnic minority groups in other Western European countries.

Adult↗
PubMed2005

Management of heart failure in The Netherlands.

In The Netherlands, the incidence and prevalence of heart failure are rising as is the case in most other European countries. Overall, there are 200,000 patients with heart failure in The Netherlands and around 25,000 hospitalisations annually with a discharge diagnosis of heart failure. Most of these patients are managed in primary care, often together with a cardiologist. There is an active guideline program in different professional organisations (e.g. general practitioners, cardiologists) and in 2002 a collaborative multidisciplinary guideline for management of chronic heart failure was developed. However, there is clearly room for improvement in the adherence to these guidelines both with regard to the diagnosis and the treatment of HF patients. For example, ACE-I and beta-blockers are still under-prescribed. In particular, the more severely ill patients seem to be under treated. At present, general practitioners and cardiologists differ in their views on heart failure, resulting in differences in diagnosis and management. In addition to the multidisciplinary guidelines, several other initiatives have been developed to improve outcomes in these patients, such as rapid access clinics and outpatient heart failure clinics.

Adrenergic beta-Antagonists↗
PubMed2004

Caesarean section on request: a survey in The Netherlands.

OBJECTIVE: To determine the opinion of Dutch gynaecologists and registrars on caesarean section (CS) on request. STUDY DESIGN: Anonymous postal survey. METHODS: A structured survey was send to all 900 gynaecologists and registrars in The Netherlands. They were asked to what extent they were willing to accept a request for an elective caesarean section, without evident medical reason. The survey contained eight simulated cases in which the reason for this request differed (obstetrical history and course of the present pregnancy). In two cases, there was no medical indication at all to perform a caesarean section; and in a third case caesarean section was due to excessive maternal weight relatively contraindicated. RESULTS: The response rate was 65%. Willingness to perform an elective caesarean section ranged from 17 to 81% between the cases. Main reasons to perform a caesarean section were: (a). autonomy; (b). an unfavourable course of delivery in the absence of motivation for a natural childbirth; (c). litigation. The main reasons to refuse a request for a caesarean section were: (a). higher maternal morbidity and mortality; (b). no indication for caesarean section. A logistic regression analysis on personal characteristics showed that an experienced doctor is more willing to perform an elective caesarean section then a consultant or registrar with limited experience. The sex of the doctor was of no influence and the same held for the University at which they had been trained. Furthermore, it seems that doctors are more willing to accept the request if it is based upon unfounded, but understandable fear. CONCLUSION: In The Netherlands, a woman can always find a gynaecologist willing to perform a caesarean section for non medical reasons. This willingness increases with the age of the doctor. There is a need for guidelines when handling these cases.

Adult↗
PubMed2006

Incidence of parvovirus B19 infection among an unselected population of pregnant women in the Netherlands: A prospective study.

OBJECTIVE: To evaluate seroprevalence of anti-parvovirus B19 IgG immunoglobulins and the rate of seroconversion in seronegative pregnant women. DESIGN: Prospective assessment of anti-parvovirus B19 IgG immunoglobulins in an unselected population of pregnant women booked for antenatal care from 1998 to 2000. SETTING: Maternity departments of an academic hospital and four affiliated teaching hospitals in the Netherlands. SUBJECTS: Two thousand five hundred and sixty seven pregnant women. MAIN OUTCOME MEASURES: Seroprevalence of anti-parvovirus B19 IgG immunoglobulin in the first trimester of pregnancy and subsequent seroconversion in those women who were tested negative for parvovirus B19 antibodies in the first trimester of pregnancy. RESULTS: The estimated seroprevalence of anti-parvovirus B19 IgG immunoglobulins among the study population is 70% (95% CI: 68-71) in the first trimester of pregnancy. Seven hundred and seventy nine women tested negative for parvovirus B19 antibodies in the first trimester of pregnancy. Paired testing in these women confirmed 18 seroconversions. Based on these findings the estimated incidence of maternal parvovirus B19 infection in this population among seronegative Dutch women is 2.4% (95% CI: 1.4-3.7). CONCLUSION: Maternal infection with parvovirus B19 is relatively common. However, it is argued that in the Netherlands routine assessment of parvovirus antibodies in pregnant women is not warranted as there is a low risk of adverse fetal outcome and measures to prevent the parvovirus B19 infection and its consequences are very limited.

Adolescent↗
PubMed2006

Operative laparoscopy in The Netherlands: Diffusion and acceptance.

OBJECTIVE: To evaluate and update the current status of the implementation of operative laparoscopy in gynaecology in The Netherlands by assessing diffusion and acceptance of each specific procedure per hospital. STUDY DESIGN: In 2003 a questionnaire was sent to all hospitals (n = 102), which addressed the total number and type of laparoscopic procedures performed in 2002 stratified by level of difficulty (level 1: diagnostic laparoscopy, sterilization, tubal patency tests; level 2: adhesiolysis, ectopic pregnancy (EP), laparoscopic treatment of endometriosis, cystectomy, oophorectomy, LAVH, tubal surgery for infertility; level 3: myomectomy, total laparoscopic hysterectomy (TLH) and sacropexy). Data were compared to previously published data of 1994. RESULTS: Response rate was 79% (81/102). Diffusion and acceptance of level 2 procedures increased significantly, except endometriosis and tubal surgery for infertility. Diffusion of LAVH was only 58%. Four percent of hysterectomies were LAVH. TLH and sacropexy were not performed. The diffusion of myomectomy increased significantly (p = 0.01), whereas its acceptance remained low. CONCLUSIONS: Although the diffusion of operative procedures has increased over the last decade, acceptance is still limited, especially for laparoscopic hysterectomy. The implementation of operative gynaecological laparoscopy in The Netherlands seems to develop at a slow pace.

Diffusion of Innovation↗