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PubMed2006

Differences in avoidable mortality between migrants and the native Dutch in The Netherlands.

BACKGROUND: The quality of the healthcare system and its role in influencing mortality of migrant groups can be explored by examining ethnic variations in 'avoidable' mortality. This study investigates the association between the level of mortality from 'avoidable' causes and ethnic origin in the Netherlands and identifies social factors that contribute to this association. METHODS: Data were obtained from cause of death and population registries in the period 1995-2000. We compared mortality rates for selected 'avoidable' conditions for Turkish, Moroccan, Surinamese and Antillean/Aruban groups to native Dutch. RESULTS: We found slightly elevated risk in total 'avoidable' mortality for migrant populations (RR = 1.13). Higher risks of death among migrants were observed from almost all infectious diseases (most RR > 3.00) and several chronic conditions including asthma, diabetes and cerebro-vascular disorders (most RR > 1.70). Migrant women experienced a higher risk of death from maternity-related conditions (RR = 3.37). Surinamese and Antillean/Aruban population had a higher mortality risk (RR = 1.65 and 1.31 respectively), while Turkish and Moroccans experienced a lower risk of death (RR = 0.93 and 0.77 respectively) from all 'avoidable' conditions compared to native Dutch. Control for demographic and socioeconomic factors explained a substantial part of ethnic differences in 'avoidable' mortality. CONCLUSION: Compared to the native Dutch population, total 'avoidable' mortality was slightly elevated for all migrants combined. Mortality risks varied greatly by cause of death and ethnic origin. The substantial differences in mortality for a few 'avoidable' conditions suggest opportunities for quality improvement within specific areas of the healthcare system targeted to disadvantaged groups.

Adolescent↗
PubMed2004

[The incidence and initial symptoms of diabetes mellitus type 1 in 0-14-year-olds in the Netherlands, 1996-1999].

OBJECTIVE: To determine the incidence and characteristics of type-1 diabetes mellitus (DM) in children aged 0-14 years during the period 1996-1999 and to compare this with previous measurements of the incidence. DESIGN: Descriptive. METHOD: Data were collected via reports from all practicing paediatricians to the Dutch Paediatric Surveillance Unit and a questionnaire among members of the Dutch Diabetes Association. The incidence was calculated by the capture-recapture method, and the characteristics and symptoms of the children were determined from the questionnaires. RESULTS: The incidence of DM type 1 among 0-14-year-olds increased to 18.6/100,000/year (95% CI: 17.7-19.4) compared to 11.1/100,000/year (10.5-11.7) in 1978-1980. The increase was highest in the youngest age group, 0-4 years. DM type 1 was diagnosed at an average age of 7.6 years (7.4-7.9) and in 1988-1990 at 9.2 years (9.0-9.5). The boy-girl ratio also increased. Children with a mother from Surinam, Turkey or The Netherlands Antilles had lower risk of DM type 1 while a higher risk was calculated for children from Moroccan and Somali mothers. In comparison with 1993-1994, there were less frequent lethargy or dehydration; lower average serum-glucose values, a better blood pH and less frequent ketonuria at the time of diagnosis. Treatment on an outpatient basis had increased. However, over the time span 1993-1999, Moroccan children (n = 108) showed dehydration, ketonuria and low blood-pH values more frequently than children of Dutch parents (n = 1825) and their hospital admission lasted longer. CONCLUSION: The incidence of DM type 1 had increased and the disease manifested itself at a younger age. The clinical condition at time of diagnosis, however, was better. The incidence and clinical characteristics differed between children of different ethnic origin.

Adolescent↗
PubMed1989

Dying with dignity: developments in the field of euthanasia in The Netherlands.

The development of the debate on euthanasia in The Netherlands, the role of the courts and proposals for legislation are discussed. In foreign newspapers and other publications an erroneous picture of the Dutch situation on euthanasia is sometimes given. In Parliament two proposals for legislation are pending. The parliamentary debate is expected to be reopened in 1989.

Advisory Committees↗
PubMed1992

Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis.

BACKGROUND: The reported frequency with which endocarditis is ascribed to an antecedent dental or medical procedure varies from 3% to 62%. METHODS: We performed a nationwide prospective study of the epidemiology of bacterial endocarditis in the Netherlands. During a 2-year period, all consecutively hospitalized patients suspected of having endocarditis were visited while still hospitalized for a review of the medical record and an in-person interview that focused on antecedent procedures and administered prophylaxis. All information was checked with pharmacists and dental and medical practitioners. RESULTS: Of 427 patients with late prosthetic or native valve endocarditis, 275 were eligible for antibiotic prophylaxis because of a previously known cardiac lesion (n = 197) or a prosthetic valve (n = 78). Of these 275 patients, 64 (23.3%) had undergone a procedure with an indication for prophylaxis within 180 days of onset; in 31 (11.3%) the procedures had been within 30 days of onset. Antibiotic prophylaxis had been administered to 17 (26.6%) of the 64 patients and to eight (25.8%) of the 31 patients. CONCLUSION: The results indicate that medical and dental procedures cause only a small fraction of endocarditis. The majority of patients develop the disease along other routes. For an incubation period of 180 days, full compliance with prophylaxis might have prevented endocarditis in 47 (17.1%) of 275 patients with late prosthetic or native valve endocarditis involving a previously known cardiac lesion who underwent a procedure with an indication for prophylaxis. For an incubation period of 30 days, prophylaxis might have prevented endocarditis in 23 (8.4%) of these 275 patients, or 5.3% of all patients with endocarditis (n = 427).

Anti-Bacterial Agents↗
PubMed2005

Symptoms, signs, problems, and diseases of terminally ill nursing home patients: a nationwide observational study in the Netherlands.

BACKGROUND: Nursing homes (NHs) are less well studied than hospices or hospitals as a setting for terminal care. For more targeted palliative care, more information is needed about the patient characteristics, symptoms, direct causes and underlying diseases, and incidence of terminally ill NH patients. These aspects are examined in this study. METHODS: Prospective observational cohort study in 16 NHs representative of the Netherlands. All long-term care patients assessed by an NH physician to have a life expectancy of 6 weeks or less were enrolled in our study. RESULTS: The terminal disease phase was marked with symptoms of low fluid and food intake, general weakness, and respiratory problems or dyspnea. Direct causes of these conditions were diseases of the respiratory system (mainly pneumonia) and general disorders (eg, cachexia). The 2 main underlying diseases of the terminal phase were mental and behavioral disorders and diseases of the circulatory system. Cancer was the underlying disease in only 12% of the patients. Patients with cancer showed a different pattern of symptoms than those without cancer. Per 100 beds per year, 34 NH patients entered the terminal phase. Most patients (82.9%) died within 7 days of inclusion. CONCLUSIONS: For patients without cancer in Dutch NHs, the terminal disease phase is difficult to predict, and once diagnosed, patient survival time is short. A better identification of the symptom burden might improve the prognostication of life expectancy in elderly patients.

Aged↗
PubMed2003

The cost-effectiveness of hearing-aid fitting in the Netherlands.

OBJECTIVE: To determine the cost-effectiveness of hearing-aid fitting. DESIGN: Cost-effectiveness analysis using a Markov model based on aggregate data and results from a prospective intervention study. SETTING: The cost-effectiveness study was based in the general community. The prospective study was hospital based, as 85% of the first-time hearing-aid users attend a hospital in the process of hearing-aid fitting. PATIENTS: The prospective intervention study included adult first-time hearing-aid users with no contraindications for hearing-aid use. INTERVENTION: The usual process of hearing-aid fitting in the Netherlands. MAIN OUTCOME MEASURE: Costs per quality-adjusted life-year (QALY). The QALYs were based on EuroQol scores. We included direct and indirect costs in the analysis. RESULTS: The mean improvement on the EuroQol measure was 0.03 (95% confidence interval [CI], -0.03 to 0.08), and on the hearing-specific visual analog scale, 0.27 (95% CI, 0.22-0.31). The base-case outcome based on the EuroQol was 15 807/QALY (US dollars 17 072/QALY) (CI, -24 239/QALY to 3718/QALY). CONCLUSIONS: On the basis of this base-case estimate, fitting of hearing aids is considered a cost-effective health care intervention. The CI indicates that the result is not unambiguously positive, probably because the EuroQol lacked sensitivity for the evaluation of hearing-aid fitting. Until now, no study has found an effect of hearing-aid fitting on generic quality of life. Therefore, measures are needed that are suitable for the evaluation of the effects of interventions for sensory disabilities, such as the fitting of hearing aids, on generic quality of life.

Adult↗
PubMed2005

Medical end-of-life decisions for children in the Netherlands.

BACKGROUND: Most end-of-life decision-making studies have, until now, involved either the general population or newborn infants. OBJECTIVE: To assess the frequency of end-of-life decisions preceding child death and the characteristics of the decision-making process in the Netherlands. METHODS: Two studies were performed. The first was a death certificate study in which all 129 physicians reporting the death of a child aged between 1 and 17 years in the period August to December 2001 received a written questionnaire; the second was an interview study in which face-to-face interviews were held with 63 physicians working in pediatric hospital departments. RESULTS: Some 36% of all deaths of children between the ages of 1 and 17 years during the relevant period were preceded by an end-of-life decision: 12% by a decision to refrain from potentially life-prolonging treatment; 21% by the alleviation of pain or symptoms with a possible life-shortening effect; and 2.7% by the use of drugs with the explicit intention of hastening death. The latter decision was made at the child's request in 0.7% and at the request of the family in 2% of cases. The interview study examined 76 cases of end-of-life decision making. End-of-life decisions were discussed with all 9 competent and 3 partly competent children, with the parents in all cases, with other physicians in 75 cases, and with nurses in 66 cases. CONCLUSIONS: While not inconsiderable, the percentage of end-of-life decisions was lower for children than for adults and newborn infants. Most children are not considered to be able to participate in the decision-making process. Decisions are generally discussed with parents and other caregivers and, if possible, with the child.

Adolescent↗
PubMed1995

Barriers to wearing bicycle safety helmets in The Netherlands.

OBJECTIVE: To explore behavioral factors that determine whether children (aged 7 to 13 years) wear bicycle safety helmets. DESIGN: Cross-sectional survey. SETTING: Three Dutch primary schools in Breda, Maastricht, and Terneuzen, the Netherlands. PARTICIPANTS: Two hundred fifty-nine children aged 7 to 13 years. INTERVENTION: Wearing a bicycle safety helmet for 6 consecutive weeks. RESULTS: Information about experiences with the bicycle safety helmet was gathered via questionnaires. Wearing a bicycle safety helmet was described as inconvenient, time-consuming, and uncomfortable. Children also perceived negative reactions from their social environment. CONCLUSIONS: Planned health promotion activities will be essential for the introduction of bicycle safety helmets to be successful. These activities should focus particularly on developing a comfortable bicycle safety helmet, creating facilities to store bicycle safety helmets, and changing negative social norms regarding wearing a bicycle safety helmet.

Adolescent↗
PubMed1998

High prevalence of codon 213Arg-->Stop mutations of the TP53 gene in human ovarian cancer in the southwestern part of The Netherlands.

As in many human malignancies, TP53 mutations are the most common genetic alterations in malignant human ovarian tumours. An approach often used in the determination of TP53 status is immunohistochemical staining of the protein. Non-missense mutations, especially those of the null type, causing premature termination codons and resulting in truncated proteins, may often not be detectable by immunohistochemistry. Therefore, current estimates of TP53 alterations in ovarian cancer may be inaccurate. By using polymerase chain reaction-single strand conformation polymorphism analysis and sequencing techniques, we have found a high prevalence of TP53 non-missense mutations in exons 5-8 in ovarian tumour specimens from patients from the southwestern part of The Netherlands. Twenty-nine of 64 tumours showed mutations, of which 10 were non-missense mutations. The majority (9 of 10) of these non-missense mutations, including 7 nonsense mutations and 2 frameshift deletions, were null type mutations and could not be detected by immunohistochemical staining. Five of the 7 nonsense mutations were mutations at codon 213 (Arg-->Stop). The nature of the high prevalence of this nonsense mutation in our series of ovarian carcinomas remains unknown. In addition to the 9 null type mutations, a splice junction mutation was encountered. In conclusion, we have observed a high prevalence (13%) of ovarian tumours with null type mutations in exons 5-8 that did not result in immunostaining. Our data suggest that, especially in ovarian cancer, immunological assessment of TP53 is not an adequate tool to study TP53 alteration. A frequent nonsense mutation at codon 213 in 5 (8%) of 64 tumour specimens represents an important finding.

Adult↗
PubMed1996

Prevalence of self-reported respiratory disease symptoms among veterinarians in the Southern Netherlands.

In June 1991, 831 veterinarians registered in the Southern Netherlands were mailed a questionnaire to obtain details of work practice and health problems. One hundred fifty-two veterinarians were not eligible (retired or not working regularly), 497 practitioners returned a complete questionnaire (73% response rate). The purpose was to assess the prevalence of respiratory disease symptoms (RDS) and to compare the prevalence of RDS between occupational specialties and with a group of swine farmers. The professional specialty of each veterinarian was grouped as: small-animal practice (17%), large-animal practice (51%), mixed-animal practice (14%), and other practice (i.e., government, industry) (18%). Adjusted for age, gender, smoking, history of atopy, and use of respiratory protective devices, large-animal practitioners had a two times higher odds of chronic cough (OR = 1.8, 95% CI 1.1-2.8) or chronic phlegm production (OR = 2.1, 95% CI 1.1-3.7) and a three times higher odds of chest wheezing (OR = 2.8, 95% CI 1.3-6.3) than veterinarians with another specialty. Modelling the occurrence of RDS in veterinarians with exposure variables indicated that working more than 20 hr per week in swine confinement buildings increased the odds of occurrence of chronic cough and chronic phlegm production approximately three times, in addition to a significant effect of smoking. Besides a significant effect of smoking and history of atopy, no exposure variables other than occupation were associated with occurrence of asthmatic attacks in swine farmers and large-animal practitioners. Large-animal practitioners had a two times higher odds of asthmatic attacks (OR = 1.8, 95% CI 1.1-2.9) than swine farmers. Large-animal practitioners have a considerably higher proportion of symptoms like cough, phlegm production, a stuffed up nose, sneezing, and tearing eyes than small-animal practitioners during, and 4-8 hr after, working with animals.

Adult↗
PubMed1996

Mortality and lung cancer in ceramic workers in The Netherlands: preliminary results.

A retrospective cohort study in 1794 male ceramic workers in the Netherlands was carried out to analyze the lung cancer risk in relation to crystalline silica exposure and silicosis. They had all been employed for two years or longer in ceramic industries between 1972 and 1982. During a health survey, 124 cases of simple pneumoconiosis were diagnosed; after 14 years of follow-up, 161 deaths had occurred. No increased overall and cause-specific mortality was found in the total group of ceramic workers, and a statistically significant cumulative dose-response relation for silica exposure and lung cancer did not emerge. An excess lung cancer mortality appeared among workers with simple pneumoconiosis. The authors conclude that the disease process resulting in silicosis in the ceramic industry carries an increased risk of lung cancer, which is supportive of a nongenotoxic pathway.

Adult↗
PubMed2001

Molecular epidemiology of human enteric caliciviruses in The Netherlands.

Caliciviruses are among the most common causes of gastroenteritis in people of all age groups. These antigenetically and genetically diverse viruses have been grouped into two genera within the family Caliciviridae, designated Norwalk-like viruses (NLV) and Sapporo-like viruses (SLV). To gain more insight in their epidemiology, we have developed a tentative genotyping scheme, which was used to differentiate the viruses detected in a set of epidemiological studies. NLVs and SLVs were detected by generic RT-PCR in stool specimens from 5.1% and 2.4% of cases with acute gastroenteritis for which a general practitioner was consulted, and in 16.5% and 6.3% of community cases of gastroenteritis. In addition, NLVs were associated with more than 80% of reported outbreaks of gastroenteritis from 1994-1999. Typically, several genotypes of NLV co-circulate in the community. Occasionally, however, several consecutive outbreaks were caused by essentially the same virus, although an epidemiological link had not previously been noted. This was most pronounced in 1995/1996, when a Lordsdale-like variant was detected that subsequently was found worldwide. This epidemic spread suggests differences in virulence or mode of transmission. In addition, we found that related NLVs are highly prevalent in calves in The Netherlands, raising questions about their potential for zoonotic transmission.

Animals↗
PubMed1977

Breast cancer incidence according to weight and height in two cities of the Netherlands and in Aichi prefecture, Japan.

A study was made in the cities of Rotterdam and The Hague, the Netherlands, and in Aichi prefecture, Japan, to assess the effect of weight and height (and their combinations) on the age-specific incidence of breast cancer. It is based on a comparison between 1006 cases of breast cancer and 4201 women from the general population, 33-69 years old. The results suggest that about one-half of the differences in incidence between the regions in Holland and Japan can be attributed to differences in body weight and height. In breast cancer patients in Rotterdam and The Hague those with metastases in axillary involvement. A hormonal factor related to body weight and/or height might be responsible for the increased incidence and the more rapid course of breast cancer in women with a large body mass.

Adult↗
PubMed1981

Cancer incidence in the Netherlands Antilles: a survey covering the period 1968--1979.

In 1977 a retrospective study was started into the cancer incidence in the Netherlands Antilles, simultaneously with the onset of a cancer registry. This paper presents the results of this study and of the running registry, together covering a period of 12 years. In total, 1496 cancer cases were registered in males, and 1480 in females. The resulting age-standardized cancer rate (World Standard Population) was 215 cases per 100,000 males and 164 cases per 100,000 females. The most frequently involved primary sites in males were, in order of frequency, lung, stomach, prostate, skin, and esophagus. Cancer in females was most frequently found in breast, uterine cervix, skin, stomach and esophagus. A comparison is made with countries inside and outside the Caribbean region, and a short comment is made on possibly etiologic factors.

Adolescent↗
PubMed1984

Long-term trends in the incidence rates of upper digestive tract cancer in the Netherlands Antilles.

Data from the Cancer Registry in the Netherlands Antilles made clear that the incidence rate of cancer of the upper digestive tract in this country was among the highest in the world. To study the long-term trends in the incidence rate a retrospective population-based case-finding survey was performed. The author presents the results of the period 1958 to 1981; data from earlier periods appeared to be incomplete. The highest incidence rates were found in the indigenous populations of Curaçao and Bonaire. In the period studied, the rates of oral and esophageal cancer dropped approximately 3% per year, while a shift was seen towards a later onset of the disease. A breakdown of the rates by island of residency showed that the decline was highly significant only for the population of Curaçao, the main island, with 89% of the total population studied. The presence of a downward trend on the other islands might be obscured by the small size of the populations. No significant change was found in the incidence rate of pharyngeal cancer, although a tendency toward lower rates was observed. Abuse of alcohol and tobacco, mineral deficiencies, malnutrition, the use of sorghum in the daily diet, and reverse smoking by females, are factors believed to be responsible for high rates in the past. With the exception of abuse of alcohol and tobacco, these factors have changed considerably in a favorable direction. It has been claimed that these changes have contributed to the sharp decrease in the incidence rates of oral and esophageal cancer.

Adolescent↗
PubMed1985

Testicular tumors in the Netherlands.

The data of 764 patients, registered with the Netherlands Committee for Testicular Tumors during the 1971-1978 period, were analyzed. To a large degree the results were in agreement with those in the literature. Chest x-rays and bipedal lymphangiograms were the most useful investigations for detection of metastases, with supplementation by lung planigraphy where indicated. Local invasion of extratesticular tissue by tumor had no relationship to prognosis. The survival figures were comparable to those of the better series in the literature. There was essentially no difference between the behavior and treatment of combined tumors and malignant teratomas, so these may be viewed as a single entity. Because recurrences occurred after 2 years in 21% of seminoma patients, and in 4% of nonseminoma patients, a minimum follow-up period of 5 years is desirable.

Adolescent↗
PubMed1992

Hepatic resections for colorectal metastases in The Netherlands. A multiinstitutional 10-year study.

BACKGROUND AND METHODS: The records of 118 patients who had hepatic resections for colorectal liver metastases were analyzed retrospectively. RESULTS: The patient group, from 15 institutions in The Netherlands, was found to have a 5-year actuarial survival rate of 21% and a 5-year actuarial disease-free survival rate of 19%. The postoperative mortality rate was 7.6%. In the remaining group, the morbidity rate was 34.7%. A number of factors were examined that were reported to be of prospective significance in other studies. In the multivariate proportional hazard model of Cox, the number of metastases (P = 0.001) and the amount of perioperative blood loss (P = 0.002) were related significantly to disease-free survival. A factor that may be considered a contraindication to resection is the presence of extrahepatic disease (whether nodal or visceral), even if resectable. CONCLUSIONS: Although the actual benefit of resection is limited, and it is associated with considerable morbidity, surgical therapy offers some patients a chance for cure. It is a valid expectation that improvement in techniques and a proper understanding of hepatic anatomy will improve the safety and efficacy of hepatic resections in the future. Future research should focus on defining better selection criteria and on study of the value of adjuvant treatment modalities.

Adult↗
PubMed1995

The importance of correct stage grouping in oncology. Results of a nationwide study of oropharyngeal carcinoma in The Netherlands.

BACKGROUND: In the frame of a nationwide study of oropharyngeal carcinoma in the Netherlands (1986-1990), the current International Union Against Cancer 1992/American Joint Committee on Cancer 1988 staging system was evaluated with respect to patient distribution and prognostic value. METHODS: Data related to epidemiology, treatment and survival from 640 patients referred for primary treatment were analyzed. Staging was first evaluated in a proportional-hazard regression analysis controlled for these data. Next, all possible combinations of T, N, and M were tested in a stepwise backward elimination model until all remaining indicator variables had a P value of less than 0.05. New stages were defined, based on the coefficients of the remaining indicator variables. RESULTS: The revised stages revealed two advantages compared with the UICC 1992/AJCC 1988 version: a more balanced distribution of patients (31% in Stage I, 31% in Stage II, 18% in Stage III, 14% in Stage IV, and 5% unknown in the revised staging system versus 7% in Stage I, 17% in Stage II, 24% in Stage III, 50% in Stage IV, and 2% unknown in the UICC 1992/AJCC 1988 staging system), and an improved prognostic discrimination for the disease specific survival (5-year results in the revised staging were 67% in Stage I, 42% in Stage II, 28% in Stage III, and 11% in Stage IV, versus 68% in Stage I, 64% in Stage II, 44% in Stage III and 27% in Stage IV in UICC 1992/AJCC 1988). CONCLUSION: Improvements in the current staging system in patient distribution in the stages in prognostic discrimination is feasible by regrouping the T, N, and M but without redefining the categories themselves.

Adult↗