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PubMed2001

Diverging breast cancer mortality rates in relation to screening? A comparison of Nijmegen to Arnhem and the Netherlands, 1969-1997.

Age-standardised breast cancer mortality rates have been stable for decades. However, rates have started to decline in several Western countries. In countries where population-based screening programmes for breast cancer were introduced in the late 1980s or early 1990s, the key question now is to what extent screening is responsible for the reported declines in mortality. This study compares breast cancer mortality rates in Nijmegen, where a screening programme for breast cancer was introduced in 1975, to a control city, Arnhem, and to the Netherlands as a whole over a 20-year period. Age-standardised breast cancer mortality rates as well as age-standardised mortality ratios were calculated for successive calendar years from 1969 to 1997. Further, a tailor-made period-cohort-group Poisson regression model was fitted. Figures displaying age-standardised mortality rates and ratios showed inconclusive patterns with regard to the expected impact of screening. Depending on when mortality rates were allowed to deviate between populations, the period-cohort-group analysis indicated a non-significant 6% to 16% reduction in breast cancer mortality after 2 decades in favour of the Nijmegen female population. Possible explanations are discussed as to why the mortality reductions reported by randomised trials might not be observed in a public health screening programme, such as the Nijmegen programme, evaluated by comparisons of geographical trends.

Aged↗
PubMed2000

Trends in live birth prevalence of down syndrome in the Northern Netherlands 1987-96: the impact of screening and prenatal diagnosis.

In the Northern Netherlands, we examined the live birth prevalence of Down syndrome (DS) and the impact of maternal serum screening (MSS) and prenatal cytogenetic diagnosis (PCD) during the period 1987-96. In this period the live birth prevalence, based on the maternal age distribution and the age specific risk of delivering a child with DS was expected to increase from 1.26 in 1987 to 1.62 in 1996. The introduction of MSS in 1991 made PCD available to women of all ages. Nevertheless, the utilization of PCD remained very stable. In 1991, 4.7% of pregnant women underwent a diagnostic test. In 1996 this percentage was 6.4%. As a result of MSS and PCD, the live birth prevalence of DS was 19% lower than expected (p<0.01). Despite utilization of PCD based on opting-in and a discouraging government policy regarding the offer of MSS, the percentage of DS cases detected by PCD increased from of 17% during the period 1987-90 to 27% in the period 1991-96 when MSS was available. The percentages have been corrected for spontaneous pregnancy loss. From a medical and financial point of view, MSS was the most cost-effective indication for PCD. However, the potential of reducing the birth prevalence of DS is limited by the low utilization of MSS and PCD by pregnant women.

Adult↗
PubMed2001

The introduction of the psychology of religion to The Netherlands: ambivalent reception, epistemological concerns, and persistent patterns.

Between 1905 and 1910, several Dutch scholars independently "discovered" the rapidly growing psychology of religion. The "empirical" character of this psychology as developed in America provoked very diverse reactions, the differences in which arose from the very different mentalities existing within religiously different segments of Dutch society. This paper focuses on an illustrative example: a dissertation by Johannes G. Geelkerken (1879-1960), which remains one of the best sources of information on the presuppositions and foundations of the early empirical psychology of religion. The ideological, institutional, and national context of Geelkerken's work is discussed. Although the pattern of early development of psychology of religion in The Netherlands was atypical for Europeanized cultures, it has persisted into the present.

History, 20th Century↗
PubMed1993

Occupational exposure to phenoxy herbicides and chlorophenols and cancer mortality in The Netherlands.

As part of the "IARC International Register of Persons Exposed to Phenoxy Herbicides and Contaminants," a cohort of workers who manufacture and prepare chlorophenoxy herbicides was recruited in The Netherlands. The cohort comprised 2,310 workers from two plants, operated by different companies, who were followed during the periods 1955-1985 and 1965-1986, respectively. In 1963, there had been an industrial accident in one factory with concomitant release of dioxin into the environment. Loss to follow-up was 3%. Mortality data on 963 exposed and 1,111 nonexposed men were evaluated by external and internal comparison. Compared with national rates, total mortality (94 deaths, standardized mortality ratio [SMR] = 101; 95% confidence interval [CI], 82-124) and cancer mortality (31 deaths, SMR = 107; 95% CI, 73-152) for exposed workers were not significantly increased. A statistically insignificant increase was observed for non-Hodgkin's lymphoma (2 deaths, SMR = 299; 95% CI, 36-1,078). No cases of soft-tissue sarcoma were encountered. There was no increase in either total mortality (25 deaths, SMR = 111; 95% CI, 72-163) or cancer mortality (10 deaths, SMR = 137; 95% CI, 66-252) among the 139 workers probably exposed to dioxins during the 2,4,5-trichlorophenol production accident or the subsequent clean-up operations. Compared with nonexposed workers, exposed workers did not exhibit a higher total mortality (rate ratio [RR] = 1.28; 95% CI, 0.89-1.82). Mortality due to all cancers (RR = 1.7; 95% CI, 0.9-3.4) and respiratory cancer (RR = 1.7; 95% CI, 0.5-6.3) was insignificantly elevated. These findings suggest that the increases in cancer mortality among workers exposed to phenoxy herbicides and chlorophenols may be attributable to chance. Lack of power prevented evaluation with respect to specific cancers.

Adult↗
PubMed2002

Referral for genetic counseling after the birth of a child with a congenital anomaly in the Northern Netherlands.

Children/fetuses born with a congenital anomaly are recorded in a local registry of congenital anomalies in the Northern Netherlands. Parents of these children/fetuses often have questions about cause, prognosis, and recurrence risk. Referral to a genetic clinic is one way to obtain information concerning these questions. We were interested in determining to what extent parents were referred for genetic counseling, and investigated the non-referred cases for the estimated need for referral. Furthermore, we measured whether referral rates had improved following the study carried out by Cornel et al. [1992] for the same region. We evaluated data on couples referred or not referred for 2,964 registered children/fetuses during the birth years 1992-1997. The parents of 528 cases (18%) had been referred for genetic counseling. Investigation of the 2,436 non-referred cases showed a high number (1287/53%) of cases with a supposedly "low need for referral." If we consider the remaining 1,149 cases with a moderate or high need for referral to the genetic clinic, the ideal uptake rate is 57% (1149 +/- 528 = 1677 cases) instead of the previously mentioned 18% (528 cases). We concluded that nearly four out of 10 parents of children/fetuses with a congenital anomaly who were considered suitable for referral to the genetic clinic did not make use of this option. Despite increased familiarity with genetics over the years among the community in general and health-care professionals in particular, the EUROCAT registry does not show an improvement in the uptake rate of cases registered with the genetic clinic.

Congenital Abnormalities↗
PubMed1990

Rubinstein-Taybi syndrome in The Netherlands.

This study reports the physical and radiographic characteristics of 45 patients with Rubinstein-Taybi syndrome living in The Netherlands. All had broad halluces, but only 39 patients had broad thumbs. Microcephaly was present in 35% of patients. In addition to the well-known characteristics, persistent fetal pads, a shawl scrotum, and a high frequency of fractures were found in several patients. Morbidity was mainly determined by the mental handicap, constipation, and recurrent upper respiratory infections, probably due to abnormal anatomy in the craniofacial region. Easy collapsible laryngeal walls may cause problems in sleep and anaesthesia.

Abnormalities, Multiple↗
PubMed1992

Comparison of couples referred and not referred for genetic counseling in a genetic clinic after the birth of a child with a congenital anomaly: a study in a population in the northeastern Netherlands.

After the birth of a child with a congenital anomaly, parents have many questions about cause, prognosis, and recurrence risk. An important means of transmitting such information is referral to a genetic clinic. We were interested in knowing what determines whether or not parents are referred for genetic counseling. Data from the local registration of congenital anomalies in the northeastern Netherlands (birth years 1981-1986; 1,217 children/fetuses) and data of the local genetic clinic were compared. The parents of 204 cases (16.8%) had been referred for genetic counseling. Of the couples referred, 76% were referred within one year after birth, usually by a pediatrician (48%). Parents of children with a single anomaly, recognized syndrome, or multiple anomalies not recognized as a syndrome were referred in 5%, 43%, and 26% of cases, respectively. Parents of liveborn children who died were referred in 38% of cases, parents of liveborn/still-alive and stillborn children in 13% and 22%, respectively. Previous affected sibs and absence of previous livebirths increased the likelihood of referral.

Congenital Abnormalities↗
PubMed2004

Familial Paget's disease in The Netherlands: occurrence, identification of new mutations in the sequestosome 1 gene, and their clinical associations.

OBJECTIVE: To estimate the occurrence of familial Paget's disease of bone in The Netherlands, to examine the prevalence of mutations of the sequestosome 1 gene (SQSTM1) in identified families, and to assess potential genotype-phenotype associations. METHODS: We performed a case-control study of patients with Paget's disease and a mutation analysis of the SQSTM1 gene of index patients with familial disease and of the relatives of those with a mutation. Serum alkaline phosphatase (AP) activity was assessed, and bone scintigraphy was performed. RESULTS: Five percent of patients had at least 1 first-degree relative with the disease, compared with 0.5% of the controls (relative risk 10; 95% confidence interval 1.3-75.6). In 38.9% of patients with familial disease, heterozygous mutations in the SQSTM1 gene were identified. These were the previously described P392L mutation, which was present in 22.2% of patients, and 3 new mutations, S399P, G425R, M404T, 9 of which were present in 3 different families. All mutations were located in the ubiquitin-associated domain of the gene. There was a relationship between serum AP activity, as a marker of the disease, and the presence or absence of the G425R and P392L mutations, the subject's age, and the presence of Paget's disease. CONCLUSION: Our data provide further evidence of a causal role of SQSTM1 gene mutations in the pathogenesis of Paget's disease and allow the design of a strategy based on measurements of serum AP activity and age for investigating asymptomatic relatives of patients with familial Paget's disease of bone.

Adaptor Proteins, Signal Transducing↗
PubMed1994

Mortality rates associated with operative treatment of infrarenal abdominal aortic aneurysm in The Netherlands.

Information on surgery for non-ruptured and ruptured infrarenal abdominal aortic aneurysm (AAA) in all hospitals in The Netherlands in 1990 was obtained from the Dutch National Medical Registration Foundation. The operation rate in the population over the age of 50 years was 30.3 per 100,000 for non-ruptured AAA and 16.8 per 100,000 for ruptured aneurysm. The hospital operative mortality rate for non-ruptured AAA surgery was 6.8 per cent in 1289 patients and for ruptured aneurysm 43.6 per cent in 709. For non-ruptured AAA the mortality rate almost doubled per age group of 10 years, whereas the influence of age was less significant for ruptured lesions. The operative mortality rate for non-ruptured aneurysm in university hospitals exceeded that in other hospitals, but no difference was found for emergency surgery on ruptured AAA. Nationwide results give a more representative picture of the true mortality rate associated with operation for aortic aneurysm. Such data are important for planning future treatment strategy and for evaluating the efficacy of screening.

Adolescent↗
PubMed2005

Adverse effects of radiofrequency ablation of liver tumours in the Netherlands.

BACKGROUND: Radiofrequency ablation (RFA) is a new treatment for liver tumours. Complications encountered after RFA in the Netherlands were evaluated in the present study. METHODS: Between June 1999 and November 2003 patients undergoing RFA of irresectable liver tumours in eight medical centres were registered prospectively. RESULTS: One hundred and forty-three RFA procedures were performed in 122 patients. RFA was combined with partial hepatectomy in 37 instances. Death occurred after two procedures (1.4 per cent), and was mainly due to concomitant partial hepatectomy. A total of 19 major complications occurred after ten procedures, including biliary tract damage (seven patients), liver failure (four), hepatic abscess (three), peritoneal infection (two), intrahepatic haematoma (one), hepatic artery aneurysm (one) and pulmonary embolism (one). Twenty-four minor complications were related to concomitant partial hepatectomy or laparotomy. The overall complication rate was 20.3 per cent and the rate of complications related directly to RFA was 9.8 per cent. CONCLUSION: The procedure-specific complication rate was almost 10 per cent and it is recommended that RFA should be performed only by an experienced team comprising a hepatobiliary surgeon, gastroenterologist, hepatologist and interventional radiologist. Biliary stricture, hepatic vascular damage and hepatic abscesses were the most common major complications.

Adult↗
PubMed2002

Intake of dietary folate vitamers and risk of colorectal carcinoma: results from The Netherlands Cohort Study.

BACKGROUND: Several studies have reported inverse associations between folate intake and colorectal carcinoma risk. Few were prospective studies and none evaluated the association between the intake of individual folate vitamers and colorectal carcinoma risk. METHODS: The aim of the current study was to investigate the relationship between dietary folate intake and the risk of colorectal carcinoma in a large prospective cohort study in The Netherlands comprising 120,852 men and women aged 55-69 years. After 7.3 years of follow-up, 760 colon and 411 rectal carcinoma cases were available for analysis. Data processing and analysis used the case-cohort approach. A new Dutch database was used to estimate intakes of total and individual folate vitamers. RESULTS: Analyses adjusted for age, energy intake, family history of colorectal carcinoma, alcohol, vitamin C, iron, and dietary fiber intake yielded an inverse association between colon carcinoma risk and total dietary folate intake (rate ratio [RR]highest vs. lowest quintile, men: 0.73; 95% confidence interval [CI], 0.46-1.17, P trend = 0.03; women: 0.68; 95% CI, 0.39-1.20, P trend = 0.18). An inverse association between rectal carcinoma and total dietary folate intake was found only among men (RR highest vs. lowest quintile, men: 0.66; 95% CI, 0.35-1.21, P trend = 0.03). Analyses showed no clear difference in colorectal carcinoma risk associated with intake of different folate vitamers. CONCLUSIONS: Dietary folate intake was related inversely to colon and male rectal carcinoma risk.

Aged↗
PubMed2003

Energy restriction early in life and colon carcinoma risk: results of The Netherlands Cohort Study after 7.3 years of follow-up.

BACKGROUND: This study evaluated the effects of severe undernutrition during adolescence and subsequent colon carcinoma risk. METHODS: The authors evaluated The Netherlands Cohort Study on Diet and Cancer (NLCS) among 62,573 women and 58,279 men aged 55-69 years at baseline. Information on diet and risk factors was collected by questionnaire in 1986. Additional information was collected concerning residence during the hunger winter (1944-1945), the World War II years (1940-1944), and father's employment status during the economic depression of 1932-1940, which were used as indicators of exposure. After 7.3 years of follow-up, 807 colon carcinoma cases (388 females and 419 males) were available for analysis. RESULTS: Multivariate analysis showed that both men and women who had lived in a western city in 1944-1945 had a decreased colon carcinoma risk (men: relative risk [RR] = 0.85, 95% confidence interval [CI] = 0.62-1.16; women: RR = 0.80, 95% CI = 0.59-1.09). No association between colon carcinoma risk and urban versus rural residence was found during the war years (1940-1944). Having an unemployed father during the economic depression (1932-1940) was also associated with a small decrease in colon carcinoma risk for men (RR = 0.90, 95% CI =0.62-1.31) and women (RR = 0.75, 95% CI 0.49-1.14). In subgroup analyses, a decreased colon carcinoma risk for men and women who were in their adolescent growth spurt and living in a western city during the hunger winter of 1944-1945 was noted (men: RR = 0.72, 95% CI = 0.31-1.65; women: RR = 0.88, 95% CI = 0.40-1.96). No associations were statistically significant because of the limited study size. CONCLUSIONS: In the current study, a weak inverse relation was found between energy restriction early in life and subsequent colon carcinoma risk for men and women. However, these findings need replication in a larger study.

Adolescent↗
PubMed1991

The impact of forecasting methodology on the accuracy of national population forecasts: evidence from the Netherlands and Czechoslovakia.

"This study considers the accuracy of national population forecasts of the Netherlands and the Czechoslovak Socialist Republic.... We look at the demographic components employed in each forecast, the procedure to extrapolate fertility and the level at which assumptions for each component are formulated. Errors in total population size, fertility, mortality and foreign migration, and age structure are considered. We discuss trends in errors and methodology since 1950 and compare the situations in the two countries. The findings suggest that methodology has only a very limited impact on the accuracy of national population forecasts."

Czechoslovakia↗
PubMed2004

Incidence and disease-free survival after surgical therapy of central giant cell granulomas of the jaw in The Netherlands: 1990-1995.

BACKGROUND: The central giant cell granuloma (CGCG) of the jaw is a rare benign tumor with an unknown etiology. Epidemiologic data on CGCGs in a general population are not available, nor are data on the overall outcome of surgical therapy. In this article, an overview of these aspects in the Dutch population from January 1, 1990, until January 1, 1995, is presented. METHODS: All CGCGs that were diagnosed and surgically treated in The Netherlands from 1990 until 1995 were evaluated. RESULTS: The incidence is 0.00011%, and the disease-free survival after surgical therapy after 5 years is 76.1%. There is a significantly higher recurrence rate in young males, which cannot be explained by clinical signs and symptoms of the lesion. CONCLUSION: The CGCG is a rare affliction with a high recurrence rate after surgical therapy, especially in young males.

Adolescent↗
PubMedDate not supplied

The importance of knowledge transfer between specialist and generic services in improving health care: a cross-national study of dementia care in England and The Netherlands.

Knowledge transfer (KT) between specialist and generic services is widely seen as an important strategy for improving the quality of integrated dementia care. This article elaborates on intra- and inter-organizational features associated with successful KT. A provisional conceptual framework is suggested, based on literature about inter-organizational networks and knowledge management. Professional and organizational cultures, domain perceptions, perceived dependency and the availability of resources are suggested as significant influences upon the motivation and perceived capacity to engage in KT. Personal and organizational continuity is identified as an important process quality. Data from four local case studies in England and The Netherlands are used to develop and specify the provisional framework. A conceptual model is built to explain the relative success or failure of KT.

Delivery of Health Care, Integrated↗
PubMed2005

Dietary folate intake and k-ras mutations in sporadic colon and rectal cancer in The Netherlands Cohort Study.

We studied the association between dietary folate and specific K-ras mutations in colon and rectal cancer in The Netherlands Cohort Study on diet and cancer. After 7.3 years of follow-up, 448 colon and 160 rectal cancer patients and 3,048 sub-cohort members (55-69 years at baseline) were available for data analyses. Mutation analysis of the K-ras gene was carried out on all archival adenocarcinoma specimens. Case-cohort analyses were used to compute adjusted incidence rate ratios (RR) and 95% confidence intervals (CI) for colon and rectal cancer overall and for K-ras mutation status subgroups according to 100 mug/day increased intake in dietary folate. Dietary folate intake was not significantly associated with colon cancer risk for men or women, neither overall nor with K-ras mutation status. For rectal cancer, folate intake was associated with a decreased disease risk in men and was most pronounced for K-ras mutated tumors, whereas an increased association was observed for women. Regarding the K-ras mutation status in women, an increased association was observed for both wild-type and mutated K-ras tumors. Specifically, folate intake was associated with an increased risk of G>T and G>C transversions in rectal tumors (RR = 2.69, 95% CI = 1.43-5.09), but inversely associated with G>A transitions (RR = 0.08, 95% CI = 0.01-0.53). Our data suggest that the effect of folate on rectal cancer risk is different for men and women and depends on the K-ras mutation status of the tumor.

Aged↗
PubMed2005

Vegetable and fruit consumption and risk of renal cell carcinoma: results from the Netherlands cohort study.

Vegetable and fruit consumption is generally inversely associated with various cancer types, including renal cell carcinoma (RCC). The Netherlands cohort study on diet and cancer (NLCS) consists of 120,852 men and women, aged 55-69 years, who filled out a self-administered questionnaire that includes 150-item food-frequency questions and additional questions on lifestyle factors, at baseline in 1986. A case-cohort approach was used. After 9.3 years of follow-up, 275 microscopically confirmed incident cases were identified. Subjects with incomplete or inconsistent dietary data were excluded, leaving 260 RCC cases for analyses on fruit consumption and 249 RCC cases for analyses on vegetable consumption. Incidence rate ratios (RR) and corresponding 95% confidence intervals (CI) were estimated using Cox proportional hazard models. RRs for exposure variables are expressed per increment of 25 g/day and are adjusted for age, sex, smoking, body mass index and history of hypertension at baseline. The RRs for vegetable consumption were further adjusted for fruit consumption and vice versa. Total vegetable and fruit consumption (RR: 1.00; 95% CI 0.97-1.02), vegetable (RR: 1.00, 95% CI 0.96-1.06) and fruit consumption (RR: 1.00; 95% CI 0.97-1.03) were not associated with RCC risk. Also, no association existed for botanical subgroups of vegetables and fruit. For 30 individual vegetables and fruits, we observed one that significantly increased RR (mandarin consumption, RR: 1.76; 95% CI 1.28-2.42), which must be regarded cautiously because of multiple testing. These results suggest the absence of an association between vegetable and/or fruit consumption and RCC risk.

Carcinoma, Renal Cell↗
PubMed2006

Nonattendance is still the main limitation for the effectiveness of screening for cervical cancer in the Netherlands.

Although mass screening for cervical cancer has been operational for more than 2 decades in the Netherlands, 700 women are still diagnosed with this cancer each year (9 per 100,000). We investigated these cases, in order to evaluate opportunities to further increase the effectiveness of the programme. We analyzed the screening history of women diagnosed with cervical cancer between 1994-1997 using the Dutch national pathology file that includes cervical cytology and histological results. More than half of the cases did not have previous preventive cervical smears, and another 30% had never been invited to the programme because of their age. In the future, we estimate that two thirds of all Dutch women with invasive cervical cancer will be unscreened or under-screened, based on current screening participation of more than 70%. We conclude that increasing screening participation has much more potential for further reducing cervical cancer incidence than reducing the screening interval, increasing the age range or having a screening test with higher sensitivity.

Age Factors↗