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[Disease burden of diabetes mellitus type II in the Netherlands: incidence, prevalence and mortality ].

A consistent estimate of the prevalence, mortality and incidence of diabetes mellitus type II in the Netherlands was obtained by combining data from several sources using statistical and modelling techniques. In the Netherlands, the prevalence of diabetes in the age-group 30-74 years is 2.7-3.2%. The prevalence increases with age: for men by 7% per year of age and for women by almost 8% per year of age. This age-related increase will give rise to a 36% increase in the prevalence of diabetes in the period 1993-2010. Diabetic patients account for 12% of the total mortality in men and 18% in women; in 2.5% and 5% of the cases respectively, diabetes is the cause of mortality. If this excess mortality could be eliminated then the life expectancy for men with diabetes would increase by 4.7 years at the age of 45 and for women the corresponding increase would be 6.3 years. The estimated incidence per year increases from 8 per 10,000 men (7 for women) in the age group 40-44 years to 80 per 10,000 men (86 for women) in the age group 75-79 years.

Age Distribution↗

[Practising the history of science in the Netherlands in the second half of the nineteenth century].

History of science as it was practised in the Netherlands in the second half of the nineteenth century in many respects differed from the way present day historians of science define their field. Whereas today only books and articles count as history of science, a century ago also statues, banquets and ceremonial speeches were regarded as serious ways of reviving the past. In addition, there is the fact that historical considerations were integrated quite naturally into many other activities, such as the teaching of science itself. This was both a measure of the importance of the history of science and an explanation of the invisibility of the history of science as we know it. The differences are illustrated by sketching the way history of science was practised by three leading scientists who were no historians of science: the professor of zoology and microscopy Pieter Harting, the physician and medical professor Barend Joseph Stokvis and the professor of chemistry Jan Willem Gunning. When all is taken in consideration, one might argue that the second half of the nineteenth century was a golden age for the history of science in the Netherlands.

Historiography↗

[Euthanasia in the Netherlands--and the debate in Norway].

The Netherlands is about to change the penal code so that starting in the autumn of 2001, euthanasia and physician-assisted suicide, will be lawful acts, provided that certain conditions are met. The concepts of "euthanasia" and "physician-assisted suicide" are defined in a detailed manner, congruent with Dutch theory and practice. In connection with these definitions, a sharp distinction is drawn between medicalized killing and withholding or withdrawing treatment, and it is demonstrated why so-called "active" and "passive" euthanasia are notions that make no sense in a Dutch context. The basic criteria for granting requests for euthanasia and physician-assisted suicide are introduced. The physician-patient relationship in the light of these practices is also a topic. It is pointed out that it is not uncommon that Dutch physicians find it emotionally burdensome to perform euthanasia. The claim that proper palliative treatment and care will work against patients' wish for euthanasia or physician-assisted suicide is discussed. From the public debate in Norway, one gets the impression that all humanists defend euthanasia and physician-assisted suicide. Yet there are prominent humanists amongst doctors who are distinctly opposed to these practices. On the other hand, in the Netherlands, we find hospital chaplains who defend euthanasia and physician-assisted suicide.

Ethics, Medical↗

[Bronchial symptoms and obstruction: recent prevalence and short-term trends (1993-1997) in adults in the Netherlands].

OBJECTIVE: To determine recent prevalences of, and short-term trends in, characteristics of chronic pulmonary disease amongst adults in the Netherlands. DESIGN: Long-term cross-sectional study. METHOD: An analysis was carried out on data collected from the 'Monitoring of risk factors and health in the Netherlands' study (Dutch acronym: MORGEN) in the period 1993-1997. The study involved 9791 men and 11,712 (non-pregnant) women aged 20-59 years from three Dutch cities, Amsterdam, Doetinchem and Maastricht. A written questionnaire was used to collect data on items such as respiratory symptoms, age, educational level and smoking habits. The presence of asthma symptoms was defined as: wheezing without a cold, nocturnal attacks of breathlessness or 'had ever suffered from asthma'. The presence of chronic obstructive pulmonary disease (COPD) symptoms was defined as: chronic cough, chronic phlegm or breathlessness when walking with people of the same age. Pulmonary function (FEV1) was measured only in 1994-1997 (n = 12,347). Bronchial obstruction was defined as FEV1 < 80% of predicted. Age standardisation was performed using the age distribution of the Dutch population in 1995 as standard. Changes over time were studied using linear regression analysis. RESULTS: The age-standardised prevalence of asthma symptoms (circa 14%), COPD symptoms (circa 14%) and obstruction (circa 8%) were comparable in men and women. The prevalence of respiratory symptoms and obstruction was clearly higher in subjects with a low versus a high educational level and this trend was also observed amongst those who had never smoked. After adjustment for age, education and city, the prevalence of respiratory symptoms increased during the study period in women (beta = 0.79% per year (95%-CI: 0.27-1.32)), but not in men. The strongest increase was observed in women aged 40-49 years and in those women with a low educational level. In both men and women no increase in the prevalence of bronchial obstruction was observed.

Adult↗

[1901-2001: 100 years of physicians of infant and toddler welfare centers in the Netherlands].

This year marks the centenary of infant welfare centres in the Netherlands. In 1901, Plantenga opened the first infant welfare centre in The Hague, the Netherlands. Initially, only advice about feeding was given and the growth of the infant was monitored. To support mothers, extra milk was supplied in so-called 'milk kitchens'. Over the years the tasks have been extended to include a wide range of preventive measures. At first the doctors in infant welfare clinics were predominantly paediatricians but later general practitioners and doctors specialised in infant primary health care followed. In their 100-years existence, infant welfare clinics have grown into an intricate network which sees 98% of Dutch infants.

Child Health Services↗

[Towards a system of quality care in dentistry in the Netherlands].

Monitoring and improving the quality of rendered health care in a systematic way has been laid down in Dutch legislation. In Dutch family health care particularly, many initiatives have already been taken to improve the quality of health care utilizing a pre-defined systematic approach. In recent years various groups in The Netherlands took initiatives to maintain and improve quality of care in dentistry. This publication reports on some of the frequently used constructs and the state of the art in The Netherlands. A proposition for the development of a system of quality monitoring and improvement is presented. It is furthermore suggested that all parties involved should collaborate to achieve the joint goal.

Dentistry↗

Medical abortion as an alternative to vacuum aspiration: first experiences with the 'abortion pill' in The Netherlands.

OBJECTIVE: To establish to what extent medical abortion is desired as a supplement to existing care provision in The Netherlands and to establish the (dis)advantages of medical abortion versus surgical vacuum aspiration. METHODS: The research project began in November 1999 and ended in September 2000. In two abortion clinics, the clients were asked to answer some questions about their expectations (before treatment) and their experiences with the treatment (at the post-treatment check-up). At the post-treatment check-up, the clients were also asked to fill out the Hopkin's Symptom Checklist (HSCL) which is an objective measure for the psychological and physical well-being of the clients during the previous week. RESULTS: One hundred and thirty-one clients who chose medical abortion and 131 clients who chose surgical vacuum aspiration participated in the study. The failure rate was 3.3% for medical abortion and 1.5% for surgical vacuum aspiration. Of the medical abortion clients, 80.2% reported they were satisfied with this treatment and 68.1% said they would choose the same treatment procedure in the future. For vacuum aspiration, these figures were 92.9% and 83.2%, respectively. The most reported advantage of medical abortion was the fact that it was a pill, and no surgical procedures were necessary. The most reported disadvantages of medical abortion were the amount of blood loss and insecurity concerning the time of abortion. CONCLUSIONS: Medical abortion seems to be a good supplement to the existing care provision in The Netherlands and should be offered in other clinics.

Abortifacient Agents↗

[Reported cases of Legionella pneumonia in the Netherlands, 1987-2000].

OBJECTIVE: To describe the incidence and mortality of legionnaires' disease (LD) in the Netherlands on the basis of registration, with a focus on possible sources of infection, and geographic and seasonal variations. DESIGN: Retrospective, descriptive. METHOD: The incidence and mortality rate of LD from July 1987 until December 2000 was described using registration data from the Dutch Health Inspectorate. Possible sources of infection were also listed (patients involved in the Bovenkarspel outbreak (1999) were excluded). Geographic variations in occurrence of LD were investigated by incidences computed per province. To gain insight into the possible existence of seasonal variations the mean numbers of patients per month were compared. RESULTS: During the period of interest a total of 806 persons with LD were reported, 36 of whom were excluded. The mean incidence rose from 0.27 cases per 100,000 inhabitants in the 1987-1998 period to 0.91 cases per 100,000 inhabitants in the 1999-2000 period. The male:female ratio was 2.6:1. A total of 96 persons (12.5%) died as a result of LD. There were more deaths in the group of patients with confirmed LD compared to the group of patients with probable LD. After 1998 the case fatality rate was lower than in the previous period (Fisher's exact test: p = 0.005). The potential source of infection was situated in the open population in 92.9% of cases. In 7.1% of cases the potential source was situated in a hospital. The incidence per province varied from 0.13 per 100,000 (Drente) to 0.66 per 100,000 (Limburg). During the summer months more patients were reported, most of whom had contracted the infection abroad. In contrast to the 1987-1998 period, after 1998 the incidence in the Netherlands was higher than the European mean and the incidence of confirmed LD was higher than in the United States.

Adolescent↗

Comparison of cohort smoking intensities in Denmark and the Netherlands.

OBJECTIVE: To assess the usefulness of the general framework of the smoking epidemic. METHODS: We use lung cancer mortality as an indicator for smoking intensity and employ an age-cohort model to accommodate the long-lasting and cumulative effects. RESULTS: Dutch males have higher risks than Danish males, but the risks for the younger cohorts have been declining faster in the Netherlands than in Denmark. Danish women have about twice the risk of Dutch women, and in both countries the risks for the younger cohorts are increasing. The smoking epidemic began at about the same time in Denmark and the Netherlands. Dutch males, however, seem to have smoked more but to have given up smoking more quickly than Danish males. Danish females were quicker to take up smoking than Dutch females. CONCLUSIONS: Within the general framework of the smoking epidemic, differences in timing and levels can produce large differences between countries. For the purposes of assessing smoking-related risks, including projections, the smoking epidemic framework therefore has to be tailored to each study population.

Adult↗

[Surgery and referral for subsequent 131I therapy for patients with differentiated thyroid carcinoma in the south-east of the Netherlands, 1983-1996, compared to the consensus guidelines from 1987].

OBJECTIVE: To evaluate the treatment of patients with differentiated (papillary or follicular) thyroid cancer in general hospitals in the south-east of the Netherlands during the period 1983-1996, in relation to the 1987 national consensus recommendations. DESIGN: Population-based, retrospective, descriptive. METHOD: For the period 1 January 1983-31 December 1996, data on the histology, TNM-stage and treatment (hospital, specialist, type of operation, referral for 131I therapy) of all 236 patients with differentiated thyroid cancer were obtained from the cancer registry of the Comprehensive Cancer Centre South, Eindhoven, the Netherlands. The treatment was compared with the recommendations from the consensus meeting in 1987. RESULTS: Data on 219 patients (137 papillary, 82 follicular thyroid carcinoma) treated in the general hospitals in the region were studied; the 17 remaining patients had been referred from outside the region. Patients were treated at all hospitals in the region; the number of specialists per hospital able to treat thyroid carcinoma (internist and/or surgeon) was limited. In total 79% of the patients underwent a (near-)total thyroidectomy, half of them in two phases, and in 12% of the cases combined with regional lymph node dissection. In the majority of cases, surgical treatment was in accordance with the consensus recommendations: 65-100% of the cases per hospital. The proportion of patients referred for 131I therapy varied from 17% to 90%; referral was more frequent in the case of larger tumours and/or metastases. Of the 24 patients with a small papillary carcinoma without metastases, 79% were not referred for 131I therapy. CONCLUSIONS: The recommendations laid down in the consensus meeting in 1987 were known and appeared to be followed for surgical treatment but for subsequent 131I therapy they appeared to be interpreted differently. A review of the consensus guidelines seems to be worthwhile.

Carcinoma↗

[The development of dental research in the Netherlands].

From the acquisition of an academic status (ius promovendi) in 1947 till now, dental research in the Netherlands has reached maturity. An even increasing body of PhD-theses and publications have found their way towards the international scientific dental community. Since the early nineties most research groups have been brought together in the 'Interuniversitaire Onderzoekschool Tandheelkunde' (Netherlands Institute for Dental Sciences), a collaboration of the academic dental institutions in Amsterdam, Nijmegen and Utrecht.

Dental Research↗

[Professional practice by female dentists in the Netherlands].

OBJECTIVE: Obtaining information about differences between male and female dentists in practising dentistry and about changes in practice arrangements. DESIGN: Descriptive analysis, using SPSS (CROSSTABS, ANOVA, HOMALS), based on information on the way(s) dentists practice their profession. SETTING: Department of Research of the Dutch Dental Association (NMT), Nieuwegien, The Netherlands. METHODS: A survey by means of a questionnaire, among a representative sample of 229 female dentists and a representative sample of 483 male dentists. RESULTS: Female dentists have on average fewer patients than male dentists, spend fewer working-hours weekly at their chair and practice more often in some form of partnership. Females have a spouse working in the dental practice less often than males and, while the spouse of males most often works as a dental assistant, the spouse of female dentists is most often also a dentist himself. Compared with male dentists, in 1994 female dentists more often had to arrange cover by a locum while in 1995 they had to take more days of leave due to personal illness or exceptional circumstances. CONCLUSION: In the Netherlands there are substantial differences in the practice of the profession by male and female dentists. This is important for the future policy of the NMT with regard to the required manpower in dentistry.

Absenteeism↗

[Universal vaccination against group C meningococci and pneumococci; advice from the Health Council of the Netherlands].

A committee of the Health Council of the Netherlands recently advised the Minister of Health on nationwide vaccination against group-C meningococci and pneumococci. They recommended the introduction of both vaccines into the national vaccination programme. The meningococcal C vaccine should be introduced as soon as possible, and the pneumococcal vaccine should be introduced as soon as a combined vaccine against diphtheria, tetanus, pertussis and polio and H. influenzae type B is available. In the meantime, due to various clusters of meningococcal disease caused by Neisseria meningitidis C in the Netherlands, parents have started to have their children vaccinated by buying vaccines and asking their general practitioners to perform the vaccination. This unfavourable situation must be controlled by the government through clear publicity to parents and healthcare workers.

Health Policy↗

[Universal vaccination against group-C meningococci and pneumococci; summary of the advice from the Health Counsil of the Netherlands].

The Health Council of the Netherlands (Gezondheidsraad) assessed the vaccination of infants against both group-C meningococci and pneumococci in terms of general criteria and basic principles for inclusion in the national vaccination programme. Vaccination against meningococci C in the Netherlands is expected to prevent about 300 cases of meningococcal disease (meningitis or sepsis), 22 deaths and 12 cases of severe lasting problems (neurological problems or amputations) per year. Vaccination against pneumococci may prevent about 100 cases of meningitis or sepsis, 3200 cases of pneumonia, 36,000 cases of acute otitis media, 11 deaths, 11 cases of severe permanent damage (neurological problems, deafness) per year. The Health Council advised implementing vaccination against group-C meningococci as soon as possible, through 2 injections at the ages of 5 and 6 months or through 1 injection shortly after the child's first birthday, and to carry out a catch-up programme for all children and adolescents up to and including 18 years of age. The council also advised starting a vaccination programme against pneumococci, at ages 2, 3 and 4 months, as soon as the current vaccinations against diphtheria, tetanus, pertussis and polio and against Haemophilus influenzae type b are combined into 1 injection (in 2002 or 2003). In view of the concentration of pneumococci disease in the first years of life, a catch-up programme is not indicated in this case. The Health Council emphasised the importance of microbiological and clinical monitoring of potential adverse effects and of public education programmes. The cost of vaccination against group-C meningococci is comparable to that of other accepted programmes for primary prevention. Compared to other programmes and at the current vaccine price, the cost of vaccination against pneumococci is high.

Adolescent↗

[Feminization of veterinary medicine in the Netherlands 1925-2000].

The feminisation of veterinary medicine occurred in The Netherlands, as elsewhere in the world, in the course of the twentieth century. In 1930, Jeannette Voet (1907-1979) was the first female veterinarian graduate of the Faculty of Veterinary Medicine of Utrecht University. In contrast with the first Dutch female physician who graduated in 1878, Jeannette Voet was not an active feminist. Instead, she concentrated on the development of various fields of veterinary medicine during her career. Nevertheless, she played an important role in the acceptance of women in Dutch veterinary medicine. The integration of women into all areas of the veterinary profession was a gradual process. Meat inspection, in particular, proved to be rather conservative in its acceptance of female veterinarians. The number of women veterinarians in the profession increased only gradually throughout the twentieth century. In 1970, women represented not more than 5 % of all veterinarians in The Netherlands. A significant increase in female students was first observed in the 1980s. The large influx of city girls who are primarily interested in companion animal and horse medicine is still quite remarkable. The average percentage of female first-year students between 1988 and 1992 was 60; over the last 5 years, this increased to 70%. Between 1988 and 1999, the average percentage of female graduates grew from 35 to 60%. Consequently, the proportion of Dutch female veterinarians increased from 5 to 25% between 1970 and 2000. In spite of this development, the representation of women veterinarians among policymaking officials, leading veterinary authorities and academic staff (particularly at the professor level) is still quite low. From this point of view, veterinary medicine could still be considered as 'a man's job'. Feminisation of veterinary medicine is often explained by an increase in the numbers of companion animals and horses and part-time jobs or by a different, gender-based attitude towards animals. Another, simpler, explanation is that fewer male students are attracted to veterinary medicine because they can make more money in other professions. More historical sociological research, including a comparison with feminisation in other sciences and broader society, is necessary to obtain a deeper insight into this phenomenon. Regardless, feminisation is likely to further change the veterinary profession in the near future.

History, 20th Century↗

[One hundred years of the Association of Surgeons in the Netherlands. IV. Thoracic surgery].

In the Netherlands, two disciplines are involved, in thoracic surgery. Firstly, general surgeons, since thoracic surgery initially consisted of surgical treatment for pulmonary tuberculosis, bronchiectasis and empyema. Once tuberculostatics became available, surgical treatment of pulmonary tuberculosis became less important and lung/thoracic operations were carried out primarily for lung cancer. Secondly, cardio-pulmonary surgeons (now known as 'cardiothoracic surgeons') also play a role in thoracic surgery. This discipline is also allowed to carry out heart surgery. Surgery for stage-I and -II lung cancer is the mainstay of the practice of general thoracic surgeons. Surgery after induction chemotherapy for stage-III tumours is under investigation to find out whether this will improve treatment results. Video-assisted thoracic surgery (VATS) is a most interesting development, and has led to the revival of volume-reduction surgery for lung emphysema. Education is of paramount importance in ensuring the quality of surgery. In the near future there will be a need for qualified thoracic surgeons in the Netherlands and organisational and financial measures should be taken to prevent a shortage.

History, 20th Century↗

[One hundred years of the Association of Surgeons in the Netherlands. IX. Pediatric surgery].

The Working Group 'Surgrey in Children and Newborns', founded in 1974, was the precursor of the first subsection of the Association of Surgeons in the Netherlands, founded in 1981: the Netherlands Association for Paediatric Surgrey. Around 1900, paediatric surgery acquired an identity on the basis of what took place in children's hospitals. All the admissions were then on social indications with a surgeon being called in as a consultant if necessary. Following the Second World War, the development in anaesthesia and analgesia and an increasing understanding of metabolic processes made ever larger operations possible. The required specific expertise and the need to bring it together were decisive arguments for the foundation of the subsection. Since then, the developmental biological and genetic aspects of severe congenital malformations have, inter alia, become new topics for investigation; the consequences for medical ethics continue to be a point for attention.

Ethics, Medical↗

[Eye problems due to contact lenses; an advisory report from the Health Council of the Netherlands].

In a recent report, the Committee on Health Risks of Contact Lenses from the Health Council of the Netherlands evaluated the health risks of contact lens wear in the Netherlands. Contact lens-related eye disease appears to be common, with an incidence of approximately 80,000 persons per year, who suffer from self-limiting or mild conditions. Such conditions are multifactorial, caused for example by chronic hypoxia, tear-film dysfunction or inadequate fit of the lens. They can range from ocular irritation to giant papillary conjunctivitis, a common cause of permanent lens intolerance. A very serious complication of contact lens wear is infectious keratitis, caused by bacteria or fungi. This is most common in users of permanent-wear soft lenses (20 per 10,000 persons per year) and can lead to a severe loss of vision. Therefore, the Committee has recommended that permanent-wear lenses should not be used. Moreover, lens fitting and follow-up of contact lens wearers should be a prerequisite for optometrists and ophthalmologists. However, the Dutch government has not taken action with respect to this last recommendation.

Contact Lenses↗