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PubMed2003

Frontotemporal dementia in The Netherlands: patient characteristics and prevalence estimates from a population-based study.

Since 1994, a population-based study of frontotemporal dementia (FTD) in The Netherlands has aimed to ascertain all patients with FTD, and first prevalence estimates based on 74 patients were reported in 1998. Here, we present new prevalence estimates after expansion of our FTD population to 245 patients, with emphasis on the prevalence in the province Zuid-Holland where the main study centre is located. All neurologists and physicians in nursing homes received a yearly postal enquiry about suspected FTD cases. FTD was diagnosed in 245 patients according to the Lund-Manchester criteria, supported by neuroimaging and neuropsychology. tau mutation analysis was performed in a subgroup of 154 patients (63%), and 40 out of 98 patients (41%) who died during follow-up were autopsied during the course of the study. The prevalence of FTD in the province Zuid-Holland was 3.6 per 100,000 at age 50-59 years, 9.4 per 100,000 at age 60-69 years and 3.8 per 100,000 at age 70-79 years. The median age at onset of the 245 patients (51% female) was 58.0 years (range 33-80 years). Dementia in one or more first-degree family members was found in 43% of patients and mutation analysis of the tau gene showed mutations in 34 patients (19 P301L, five L315R, four G272V, four R406W, one Delta K280 and one S320F), all with a positive family history for dementia (14% of the total population, 32% of patients with a positive family history). Pathological findings in the 40 autopsied patients consisted of dementia lacking distinctive histology in 22%, FTD with ubiquitin-positive inclusions in 33%, Pick's disease in 15% and tauopathy in the remaining 30% of patients, with tau mutations identified in more than half of the latter patients. We conclude that the prevalence of FTD in The Netherlands is higher than previously reported, confirming that FTD is more common than was previously thought. The finding of tau mutations in 32% of patients with a positive family history for dementia justifies mutation screening in FTD patients with a positive family history, while tau mutations in non-familiar cases are rare.

Adult↗

PubMed1996

A prospective cohort study on the relationship between onion and leek consumption, garlic supplement use and the risk of colorectal carcinoma in The Netherlands.

The association between onion and leek consumption, garlic supplement use and colon and rectum carcinoma among men and women was evaluated in the Netherlands Cohort Study, a large-scale prospective cohort study on diet and cancer. Onions, leeks, and garlic belong to the Allium genus and contain large amounts of potentially chemopreventive compounds. The Netherlands Cohort Study was started in 1986 among 120 852 men and women, aged 55-69 years. Dietary intake was measured with a 150-item food frequency questionnaire. After 3.3 years of follow-up, 150 and 143 incident male and female cases of colon carcinoma, and 93 and 57 cases of rectum carcinoma, respectively, with complete dietary data were available for analysis. Dietary data were available for 1525 men and 1598 women of a randomly selected subcohort, that was followed up to estimate person-time in the entire cohort. In men, the adjusted rate ratios (RRs) in multivariable analysis for colon and rectum carcinoma in the highest compared to the lowest onion consumption categories were 0.87 (95% confidence interval [CI] = 0.48-1.65), and 0.66 (95% CI = 0.28-1.52), respectively. The RRs for proximal colon carcinoma were lower than for distal colon carcinoma. Leek consumption was not associated with colon and rectum carcinoma incidence in men. None of the RRs were significantly different from unity and no trends in the RRs were detected. A lower risk was found for rectum carcinoma in women consuming less than 0.25 onions per day (RR=0.36, 95% CI = 0.13-0.99), but the trend in the RRs was not statistically significant (P = 0.25). All other RRs for colon and rectum carcinoma associated with onion consumption were slightly higher than one. Leek consumption was not associated with colon and rectum carcinoma incidence. The use of garlic supplements was not associated with colon and rectum carcinoma in men and women combined. This study does not support an inverse association between the consumption of onions and leeks, or the use of garlic supplements and the incidence of male and female colon and rectum carcinoma.

Age Distribution↗

PubMedDate not supplied

Surveillance and control of poliomyelitis in The Netherlands.

Inactivated poliovirus vaccine was introduced to the national immunization program in The Netherlands in 1957. A compliance rate of approximately 95% has existed since 1967. Only one of the 148 reported cases of paralytic poliomyelitis (from 1966 to 1982) occurred in an individual who had been vaccinated against poliomyelitis. Apart from sporadic imported cases, local outbreaks as well as an epidemic in 1978 were observed among certain susceptible Protestant populations. These unvaccinated groups, whose members--scattered as they are among the Dutch population--form a closed community, have to be considered at high-risk as long as importation of wild poliovirus strains occurs regularly. Endemic persistence of wild poliovirus in The Netherlands has, however, virtually disappeared. Potent inactivated poliovirus vaccine appears to be highly immunogenic and confers protection of long duration.

Adolescent↗

PubMed2001

GP income in relation to workload in deprived urban areas in The Netherlands. Before and after the 1996 pay review.

BACKGROUND: General practitioner workload is higher in deprived urban areas and for the elderly. This led to the introduction of additional GP payments regarding these patients, in the UK and in the Netherlands. This study examines whether this has resulted in more equal payment for work done in the Netherlands. METHODS: GP workload and income have been assessed on the basis of a survey among 1154 GPs (response: 62%). RESULTS: Suggest that total GP income is still lower in deprived areas, but per hour and per patient contact the additional payments gave equity. CONCLUSION: It is thus concluded that Dutch deprivation payments effectively compensate GPs in deprived areas for their higher workload.

Health Services Research↗

PubMed2005

Infant mortality, ethnicity, and genetically determined disorders in The Netherlands.

BACKGROUND: Infant mortality of ethnic minorities in The Netherlands (10% of the population) is twice as high as in the indigenous Dutch population. Causes of death are different for the diverse migrant groups. METHODS: Hospital records of nearly 600 infants who died in the four major cities between 1995 and 1998 were analysed according to the cause of death, ethnicity, and possible heredity. RESULTS: There was a four to five times higher proportion of hereditary causes of death in the Moroccan and Turkish population, compared with the Surinamese/Antillians and indigenous Dutch. CONCLUSIONS: This might be explained by a high inbreeding coefficient as three-quarters of the marriage partners are recruited from the home villages and between a quarter and a third of these marriages are between first cousins. Health promotion activities in The Netherlands have not been successful so far. Preconception genetic counselling might help in reducing these differences.

Cause of Death↗

PubMed2006

Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in The Netherlands.

BACKGROUND: Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by refugees and asylum seekers and to identify determinants for this utilisation. METHODS: A population-based study was conducted in The Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran, and Somalia. A total of 178 refugees and 232 asylum seekers, living in 3 municipalities and 14 reception centres, participated. RESULTS: This study showed that there are no differences between refugees and asylum seekers in the self-reported use of health care services. Respondents from Somalia reported less contacts with a general practitioner, less use of mental health services, and less medication use than respondents from Afghanistan and Iran. Both female gender and older age were related to more contacts with a general practitioner and a medical specialist, and with higher medication use. Poor general health was related to more contacts with a medical specialist and mental health services, and with higher medication use. CONCLUSION: Asylum seekers and refugees seem to have equal access to the Dutch health care system in general. However, there are differences in the self-reported use of health care services by the different ethnic groups.

Adolescent↗

PubMed2006

The effect of age at immigration and generational status of the mother on infant mortality in ethnic minority populations in The Netherlands.

BACKGROUND: Migrant populations consist of migrants with differences in generational status and length of residence. Several studies suggest that health outcomes differ by generational status and duration of residence. We examined the association of generational status and age at immigration of the mother with infant mortality in migrant populations in The Netherlands. METHODS: Data from Statistics Netherlands were obtained from 1995 through 2000 for infants of mothers with Dutch, Turkish and Surinamese ethnicity. Mothers were categorized by generational status (Dutch-born and foreign-born) and by age at immigration (0-16 and >16 years). The associations of generational status and age at immigration of the mother with total and cause-specific infant mortality were examined. RESULTS: The infant mortality rate in Turkish mothers rose with lower age at immigration (from 5.5 to 6.4 per 1000) and was highest for Dutch-born Turkish mothers (6.8 per 1000). Infant death from perinatal and congenital causes increased with lower age at immigration and was highest in the Dutch-born Turkish women. In contrast, in Surinamese mothers infant mortality declined with lower age at immigration (from 8.0 to 6.3 per 1000) and was lowest for Dutch-born Surinamese mothers (5.5 per 1000). Generational status and lower age at immigration of Surinamese women were associated with declining mortality of congenital causes. CONCLUSIONS: Total and cause-specific infant mortality seem to differ according to generational status and age at immigration of the mother. The direction of these trends however differs between ethnic populations. This may be related to acculturation and selective migration.

Acculturation↗

PubMed1990

Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and The Netherlands.

The attitudes of general practitioners in Belgium, Britain and the Netherlands have been sought to determine if they are patient-centred or disease-centred (that is, doctor-centred). The results indicated that many of the doctors held disease-centred attitudes, which in previous studies in the Netherlands and Belgium had correlated with increased prescribing of symptomatic medication, shorter consultation time, inadequate patient records and poorer standards of care within the consultation. Doctors in Belgium had the highest level of disease-centred attitudes, Dutch doctors the lowest. Possible explanations for these differences include differences in the doctor-patient relationship that exist between these countries. Although the results must be interpreted with some care, they should form a basis for discussions about doctor-patient relations and medical education in each country.

Attitude of Health Personnel↗

PubMed2006

Patient satisfaction with large-scale out-of-hours primary health care in The Netherlands: development of a postal questionnaire.

BACKGROUND: Since the turn of the millennium, out-of-hours primary health care in The Netherlands has faced a substantial change from small locum groups towards large GP cooperatives. Improving the quality of care requires evaluation of patient satisfaction. OBJECTIVE: To develop a reliable postal questionnaire for wide-scale use by patients contacting their out-of-hours GP cooperative and to present the results of a national survey. METHODS: Literature review and interviews with both patients and health carers were carried out to identify issues of potential relevance, followed by two postal pilot studies and additional interviews to remove or rephrase items. Finally, postal questionnaires were sent to 14,400 people who contacted one of 24 GP cooperatives in The Netherlands. RESULTS: Overall response was 52.2% for all types of contact. Three scales were identified prior to the field phase and confirmed by principal components analysis: telephone nurse, doctor and organization. Reliability was high, with Cronbach's alphas and intraclass correlation coefficients exceeding 0.70 for all scales. Only items in the organization scale showed clear differences among the participating cooperatives. Respondents receiving telephone advice showed lower levels of satisfaction than respondents with other types of contact (P < 0.001); centre consultation scored lower than home visit (P < 0.030 or less for all differences). CONCLUSION: A reliable measure of patient satisfaction has been developed that can also be used for the comparison of GP cooperatives on an organizational level. Overall satisfaction was high, showing highest levels for home visit and lowest levels for telephone advice.

Adolescent↗

PubMed1997

Rectangularization of the survival curve in The Netherlands: an analysis of underlying causes of death.

This study analyzed the contribution of selected causes of death to rectangularization of the survival curve of Dutch men and women above age 60 in the 1980s, and determined why rectangularization took place in the 1980s but not in the 1970s. The contribution of causes of death was determined by means of a decomposition analysis, using mortality data by underlying cause of death, sex, and age from Statistics Netherlands. Our results show that mortality reductions from ischemic heart disease, cerebrovascular diseases, and lung cancer (men only) and mortality increases from chronic obstructive pulmonary diseases (men only) and mental disorders (women) contributed to rectangularization in the 1980s. Comparison with the 1970s, in addition, demonstrated that in particular changes in mortality at advanced ages (i.e., smaller mortality reductions and mortality increases) were responsible for the reversal from a decreasingly rectangular shape of the survival curve in the 1970s curve to rectangularization in the 1980s. The combination of increased survival to advanced ages and reduced survival at advanced ages explains why rectangularization of the survival curve took place recently in The Netherlands.

Aged↗

PubMed2003

Stagnation in mortality decline among elders in the Netherlands.

PURPOSE: This study assesses whether the stagnation of old-age (80+) mortality decline observed in The Netherlands in the 1980s continued in the 1990s and determines which factors contributed to this stagnation. Emphasis is on the role of smoking. DESIGN AND METHODS: Poisson regression analysis with linear splines was applied to total and cause-specific mortality data by age, year of death (1950-1999), and sex. An age-period-cohort analysis was carried out to determine whether the trends followed period or cohort patterns. ICD revisions were bridged by use of a concordance table. RESULTS: A sudden reversal in old-age mortality decline occurred around 1980, leading to a stagnation of the decline and even increases in mortality thereafter. Smoking-related cancers, chronic obstructive pulmonary disease, and diseases specifically related to old age contributed to this stagnation. Trends in smoking-related cancers and chronic obstructive pulmonary disease showed a cohort pattern--especially for men. When these smoking-related diseases were excluded, the trends in old-age mortality in The Netherlands showed an increasing stagnation for both sexes. IMPLICATIONS: Smoking behavior can only partly explain the stagnation of mortality. Other factors such as increased frailty and changes in medical and social services for elderly people probably played a more decisive role in the recent stagnation.

Age Distribution↗

PubMed1988

Secular trends of infectious disease mortality in The Netherlands, 1911-1978: quantitative estimates of changes coinciding with the introduction of antibiotics.

Secular trends of mortality from 21 infectious diseases in the Netherlands were studied by inspection of age/sex-standardized mortality curves and by log-linear regression analysis. An attempt was made to obtain quantitative estimates for changes coinciding with the introduction of antibiotics. Two possible types of effect were considered: a sharp reduction of mortality at the moment of the introduction of antibiotics, and a longer lasting (acceleration of) mortality decline after the introduction. Changes resembling the first type of effect were possibly present for many infectious diseases, but were difficult to measure exactly, due to late effects on mortality of World War II. Changes resembling the second type of effect were present in 16 infectious diseases and were sometimes quite large. For example, estimated differences in per cent per annum mortality change were 10% or larger for puerperal fever, scarlet fever, rheumatic fever, erysipelas, otitis media, tuberculosis, and bacillary dysentery. No acceleration of mortality decline after the introduction of antibiotics was present in mortality from 'all other diseases'. Although the exact contribution of antibiotics to the observed changes cannot be inferred from this time trend analysis, the quantitative estimates of the changes show that even a partial contribution would represent a substantial effect of antibiotics on mortality from infectious diseases in the Netherlands.

Adolescent↗

PubMed1988

Regional differences in decline of mortality from selected conditions: The Netherlands, 1969-1984.

In The Netherlands, as in many other industrialized countries, recent mortality developments have been characterized by rapid declines for a number of important causes of death. The results of an analysis of regional variation in mortality decline within The Netherlands are reported, covering the period 1969-1984. The causes of death included in this analysis are Perinatal mortality, Cerebrovascular disease, a more global 'Amenable' selection (formed by aggregating a number of causes of death considered to be amenable to medical intervention), Cancer of the stomach, Ischaemic heart disease and Traffic accidents. For Perinatal mortality, Cerebrovascular disease, the 'Amenable' selection, and Ischaemic heart disease, as well as for Total mortality, declines have not been geographically homogeneous. Perinatal mortality had a tendency to decline faster in regions where starting levels were higher, suggesting a certain convergence. For Cerebrovascular disease and the 'Amenable' selection, but especially for Ischaemic heart disease, the reverse was true. A simple correlation analysis shows that for Perinatal mortality, as well as for the 'Amenable' selection, mortality declined faster in less urbanized, more peripherally located, lower income areas. There is no association with the presence of a university hospital. This pattern suggests that faster mortality decline for these conditions is due to factors other than faster diffusion of new medical technologies. For Ischaemic heart disease, mortality declined faster in more urbanized, more centrally located, higher income areas. Although this pattern is what one would expect as a result of regional differences in the diffusion of new medical technologies, it may also be due to differences in the diffusion of new lifestyles.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗

PubMed1991

Determinants of traffic accident mortality in The Netherlands: a geographical analysis.

In the Netherlands, a country with one of the lowest levels of traffic accident mortality in the world, large regional mortality differences can be observed. An analysis was performed of the contribution of regional differences in traffic mobility (kilometers travelled/person-years), injury rate (injured people/kilometre travelled) and case fatality (traffic deaths/injured people). Subsequently, possible determinants of regional differences in traffic accident mortality and its constituent parts were investigated. Both the influence of sociodemographic factors and of factors probably more directly related to traffic deaths (road infrastructure, medical care) was studied. Regional differences in traffic accident mortality in the Netherlands can only to a very limited extent be explained by regional differences in traffic mobility. Regional differences in case fatality seem to make the most important contribution. Of the sociodemographic factors that were used in the analysis, per capita income appears to be the strongest predictor of regional mortality differences. A higher income level is associated with lower mortality levels. Of the factors more directly related to traffic deaths, traffic density and the availability of advanced trauma care (neurosurgery and computerized tomography (CT-Scan)) in the region are the most important predictors of regional mortality differences. Both variables show an inverse relationship with case fatality. Probably a higher traffic density leads to a shift towards less severe injuries. The availability of advanced trauma care could be important in early diagnosis and treatment of head injuries. The results of this study, based on existing data sources, must be interpreted with care. Some potential sources of bias (omitted variables, regional differences in accident reporting) are discussed.

Accidents, Traffic↗

PubMed1991

The decline in winter excess mortality in The Netherlands.

In most countries, numbers of deaths rise considerably during the winter season. This winter excess in mortality has, however, been declining during recent decades. The causes of this decline are hardly known. This paper attempts to derive a number of hypotheses on the basis of a detailed description of trends in winter excess mortality in the Netherlands. Numbers of death by age, cause of death, and month of death for the period 1953-1988 were analysed by log-linear regression. There was a 50% reduction in winter excess mortality between the 1950s and 1970 followed by a much smaller reduction in later years. The decline in winter excess for total mortality can largely be attributed to parallel declines for a number of cardiovascular and respiratory diseases. Excess mortality decreased for winter months without influenza epidemics as well as for those with epidemics. The results suggest that the decline in winter excess mortality in the Netherlands can only partly be explained by decreases in influenza-associated mortality. It is argued that the role of the introduction of central heating is minimal and that a fundamental role is played by factors closely related to socioeconomic progress.

Adolescent↗

PubMed1992

Subacute sclerosing panencephalitis in The Netherlands--1976-1990.

Since 1976, when general immunization against measles was introduced in the Netherlands, all new cases of subacute sclerosing panencephalitis (SSPE) were registered and detailed data about immunization, epidemiology and disease progression were collected on them. Up to 1991, 99 new patients have been registered of which 81 were born in this country and 18 elsewhere. From 1981 onwards, the incidence of SSPE among those born in the Netherlands decreased gradually from 13 cases per year to one case per year. This decrease is attributed to the large scale of immunization against measles. Three SSPE patients had been immunized against measles, all of them without a history of clinical measles. Epidemiology and risk factors of SSPE did not differ from those reported in other countries. An exceptional cluster of four patients in one town, who had measles in the same year, is reported. Progression of SSPE appeared to be age related. A total of 28 patients was treated with Inosiplex; no significant effect on survival in stage 3 of the disease was found.

Adolescent↗

PubMed1993

Completeness of cancer registration in Limburg, The Netherlands.

The completeness of cancer registration in the IKL (Integraal Kankercentrum Limburg) cancer registry, Limburg, the Netherlands, was evaluated for the years 1988-1990 by means of the independent case ascertainment method. This study was performed in co-operation with the Registration Network of Family Practices (RNFP) of the University of Limburg. The RNFP is a centralized database used by general practitioners (GP), containing their patients' background variables and diagnoses. The contents of the two databases were compared using computerized record linkage. If the information from both databases differed, this was verified using the source forms of the cancer registry and the GP involved. By combining the information from both registries in this way it was determined which malignancies should have been registered by the cancer registry. The IKL cancer registry had recorded 307 of the 319 eligible malignancies (96.2%). Five of the 12 missed registrations could be attributed to systematic shortcomings in the notification procedures. The estimated completeness for all malignancies of the IKL cancer registry is comparable with the results from cancer registries outside the Netherlands which have been established for longer.

Adolescent↗

PubMed1996

Urban-rural differences in cancer incidence in The Netherlands 1989-1991.

BACKGROUND: Differences in cancer incidence have been observed between urban and rural communities for many decades. These differences have been attributed for the most part to lifestyle aspects. In Western populations, however, differences in lifestyle have diminished. This study addressed the question: For which cancer sites can differences in cancer occurrence still be demonstrated between urban and rural communities in the Netherlands? METHODS: Cancer incidence data from 1989 to 1991 inclusive, were obtained from the Netherlands Cancer Registry. Age-adjusted, site-specific incidence rates were calculated for five classes of municipalities classified by address density. RESULTS: With increasing urbanization, slightly higher incidence rates were observed for all cancer sites combined (rate ratio [RR] = 1.08 in males and 1.12 in females). Statistically significant RR of > 1.4 were observed for Kaposi's sarcoma (m), mesothelioma (m), cancer of the liver (m), mouth/pharynx (m + f), oesophagus (f), larynx (f), lung (f), other respiratory organs (f), cervix (f) and Hodgkin's disease (m). Significantly lower incidence rates were found in urban areas for non-melanoma skin (m + f) and lip cancer (m). CONCLUSIONS: In males, the urban excess of tobacco-related cancer has largely disappeared. However, urban-rural differences in cancer incidence still exist for other cancer sites and for tobacco-related cancer in females. Apparently, differences in the prevalence of lifestyle factors are still large enough to cause variation in cancer incidence.

Female↗