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PubMed2006

Cancer mortality rates among first and second generation migrants in the Netherlands: Convergence toward the rates of the native Dutch population.

This study investigates the difference in cancer mortality rates between migrant groups and the native Dutch population, and determines the extent of convergence of cancer mortality rates according to migrants' generation, age at migration and duration of residence. Data were obtained from the national cause of death and population registries in the period 1995-2000. We used Poisson regression to compare the cancer mortality rates of migrants originating from Turkey, Morocco, Surinam, Netherlands Antilles and Aruba to the rates for the native Dutch. All-cancer mortality among all migrant groups combined was significantly lower when compared to that of the native Dutch population (RR = 0.55, CI: 0.52-0.58). For a large number of cancers, migrants had more than 50% lower risk of death, while elevated risks were found for stomach and liver cancers. Mortality rates for all cancers combined were higher among second generation migrants, among those with younger age at migration, and those with longer duration of residence. This effect was particularly pronounced in lung cancer and colorectal cancer. For most cancers, mortality among second generation migrants remained lower compared to the native Dutch population. Surinamese migrants showed the most consistent pattern of convergence of cancer mortality. The generally low cancer mortality rates among migrants showed some degree of convergence but did not yet reach the levels of the native Dutch population. This convergence implies that current levels of cancer mortality among migrants will gradually increase in future years if no specific preventive measurements are taken.

Adolescent↗
PubMed1991

Intake of foods and nutrients and cancer of the exocrine pancreas: a population-based case-control study in The Netherlands.

During 1984-88 a population-based case-control study was carried out in the Netherlands in collaboration with the International Agency for Research on Cancer in order to investigate the role of diet in exocrine pancreatic carcinoma. A semi-quantitative food-frequency questionnaire was used to comprehensively assess usual diet about 1 year prior to diagnosis of 164 cases or interview of 480 controls. More than half of the cases were directly interviewed. After controlling for age, gender, response status, life-time cigarette consumption and dietary intake of total energy, monotonic, significantly inverse dose-response effects with estimates of daily consumption of vegetables were found. The significant inverse effect of total cooked vegetables was primarily concentrated in cruciferous vegetables. Consumption of fresh vegetables was also significantly and inversely related to risk. A monotonic, positive dose-response gradient was seen for the consumption of eggs, while consumption of fish was significantly related to risk as well. Among direct respondents, significantly inverse relationships were found for the consumption of legumes, tomatoes, cheese and fermented milk products. Inverse associations with consumption of (subgroups of) fruits were observed in women only. The monotonic, significantly inverse relationship for consumption of low-fibre vegetables and the somewhat weaker, inverse association for high-fibre vegetables in directly interviewed subjects only, may point to protective agents other than vegetable fibre. Although intake of dietary fibre and beta-carotene were both inversely related to risk, simultaneous estimation suggested that beta-carotene or other as yet unknown correlated constituents, rather than dietary fibre, might explain the inverse relationships. A significant protective effect of vitamin C was demonstrated in women but not in men. Our study suggests that, independent of smoking and dietary intake of total energy, low consumption of specific vegetables and possibly fermented milk products and high consumption of eggs and fish may have influenced the development of exocrine pancreatic cancer.

Adult↗
PubMed1991

Life-time history of smoking and exocrine carcinoma of the pancreas: a population-based case-control study in The Netherlands.

From 1984 to 1988 a population-based case-control study was carried out in the Netherlands in collaboration with the International Agency for Research on Cancer, to examine the possible relationship between habitual, life-time consumption of varieties of tobacco and exocrine pancreatic carcinoma in 176 cases and 487 controls. An interviewer-administered questionnaire was used to list major life events and obtain estimates of usual frequency of tobacco consumption throughout life. About 58% of patients were interviewed directly. After adjustment for age, gender, response status, energy intake and consumption of vegetables compared with never-smokers, a positive dose-response effect of smoking of life-time number of total cigarettes, i.e. non-filter and filter, emerged (OR 1.00, 1.35, 1.40 and 2.10, p-value trend less than 0.05). Results of simultaneous estimation of the effects of life-time smoking of non-filter and filter cigarettes suggest that the effect was present primarily in non-filter cigarettes. The dose-response relationship was present in current smokers only. Compared with never-smokers, the risk pattern among relatively recent quitters, i.e. 2 to 14 years previously, still suggested a positive effect of past smoking (OR for low smokers 1.99, 95% CI 0.79-4.99 and for high smokers 1.69, 95% CI 0.63-4.58). The risk of quitting 15 years or more could be examined in the low smoking group only and was no different from those who had never smoked (OR 1.02, 95% CI 0.47-2.20). In brief, our results suggest that, independent of usual past intake of energy and vegetables, life-time smoking of cigarettes influences the development of exocrine pancreatic cancer, whereas cessation of smoking of cigarettes for 15 years or more reduces the risk to the levels found among those who have never smoked.

Adult↗
PubMed1992

Lifetime consumption of alcoholic beverages, tea and coffee and exocrine carcinoma of the pancreas: a population-based case-control study in The Netherlands.

From 1984 to 1988 a population-based case-control study was carried out in the Netherlands, in collaboration with the International Agency for Research on Cancer, to examine the possible relationship between the habitual lifetime consumption of alcohol, coffee and tea and exocrine pancreatic carcinoma in 176 cases and 487 controls. An interviewer-administered questionnaire was used to ascertain major life events and obtain estimates of consumption (ever-never) and frequency of consumption throughout life. Logistic regression analyses yielded odds ratios adjusted for age, sex, response status, smoking, dietary intake of energy and vegetables and of alcoholic or non-alcoholic drinks. When compared with data from non-drinkers, the cumulative lifetime consumption of all types of alcohol in grams of ethanol (ORs 1.00, 0.97, 0.93, 1.25, p trend 0.55), beer, spirits, red wine and fortified wine was not related to risk. The consumption of white wine was inversely associated with risk (OR 0.41, 95% CI 0.24-0.70). The uniformly reduced risk estimates for the lifetime number of drinks of white wine were based on small numbers (ORs 1.00, 0.44, 0.25, 0.40, p trend 0.001). When compared with data from non-drinkers, our findings suggest an inverse dose-response relationship for the lifetime consumption of coffee (ORs 1.00, 0.72, 0.37, 0.58, p trend 0.06), whereas lifetime consumption of tea and of ground, instant and decaffeinated coffee was not associated with risk. The absence of an effect of lifetime consumption of decaffeinated coffee may be due to the small numbers of subjects. These results further strengthen existing evidence against a positive association between consumption as well as lifetime consumption of (sources of) alcohol, tea or coffee and the development of exocrine pancreatic cancer.

Alcohol Drinking↗
PubMed1994

Fermented dairy products, dietary calcium and colon cancer: a case-control study in The Netherlands.

To examine whether the consumption of fermented dairy products or the dietary intake of calcium decreases colon cancer risk, a case-control study was conducted in the The Netherlands. Dietary patterns were assessed in detail (for cases before diagnosis or symptoms occurred) using a structured dietary history questionnaire. After adjustment for potential confounding variables, consumption of fermented dairy products, hard cheese and unfermented dairy products was not significantly associated with risk of colon cancer: an odds ratio (OR) of 1.1 was found for individuals consuming more than one serving of fermented dairy products per day as compared to those consuming less than 10% of one serving a day. Adjustment for dietary calcium attenuated the associations. Total dietary calcium was positively but non-significantly associated with colon cancer risk after adjustment for age, gender, urbanization level and total energy intake. Additional adjustment for a positive family history of colorectal cancer, cholecystectomy and energy-adjusted intake of total fat, dietary fibre, vitamin C and alcohol increased the association. No differences were observed between calcium from fermented and from unfermented dairy sources. The observed associations for fermented dairy products and dietary calcium differed between men and women: positive significant associations were observed in men, while in women non-significant inverse associations were found. Our results do not support the hypothesis that an increased intake of commercially available, commonly used fermented dairy products or dietary calcium decreases the risk of colon cancer.

Aged↗
PubMed1995

Nation-wide breast cancer screening in The Netherlands: support for breast-cancer mortality reduction. National Evaluation Team for Breast Cancer Screening (NETB).

The nation-wide 2-yearly breast-cancer screening programme in The Netherlands, for women aged 50-69, started around 1988, and was predicted to result eventually in a 16% reduction in breast-cancer mortality in the total female population. We present the results of screening up to January 1, 1993, and compare these with the predicted results from the cost-effectiveness analysis, on which basis this mortality reduction has been calculated. At least 550,000 women aged 50-69 were invited to screening in 1990-1992, and 75% of these participated. Cancer was suspected from 5,162 examinations and further investigation was therefore required. Excision biopsy was done in 72% of referrals, and 2,515 breast cancers were detected. The results for 404,000 newly invited women compare favourably with expected values (in parentheses): 78% attendance rate (70%), 1.4% screen positive (1.6%), 6.8 cancers detected per 1,000 women screened (6.4) and 38% of these cancers were DCIS or invasive carcinomas smaller than 11 mm in diameter (36%). More data, e.g., on treatment and interval cancers, will follow in the years to come. These first results can be interpreted as strong early signs of a reduction in breast-cancer mortality of at least the predicted size. Screening has sufficiently advanced the diagnosis, as well as or better than expected. Breast cancers diagnosed in this age group without screening are diagnosed at a worse stage than expected. Unfavourable side-effects, especially false-positive referrals, might be kept lower than those reported in other countries.

Aged↗
PubMed1987

The registration of medicines in The Netherlands.

The working methods and the results of the system for registration of medicines in the Netherlands are reviewed. The new structure of the Committee for the Evaluation of Medicines is identified. The necessity for more international cooperation is emphasized. The authors propose the establishment of a European registration committee. The current system is discussed from the viewpoints of government and industry.

Drug Industry↗
PubMed1990

Prevalence of human T-cell leukemia virus antibody among heterosexuals living in Amsterdam, The Netherlands.

To determine the heterosexual spread of human T-cell leukemia virus (HTLV-I) infections, a cohort of 472 individuals with more than 5 heterosexual partners in the 6 months before entry was studied. They were recruited from visitors to the Clinic for Sexually Transmitted Diseases of the Municipal Health Service. Half of the study group was born in the Netherlands, 13% in Surinam or the Dutch Antilles, and 8% in Turkey or Morocco. Seventy percent were involved in commercial sex. Three persons were positive for HTLV-I, with serum antibodies against p19, p24, p28, gp46, and gp61 in Western immunoblot (WIB) and radio-immunoprecipitation assay (RIPA). Two of them originated from Surinam and the third was a Dutch woman. Two other individuals were HIV-positive, 19% had hepatitis B virus (HBV)-markers and 6% Treponema pallidum reacted in the hemagglutination assay (TPHA). It is concluded that HTLV-I circulates in the Surinamese population in Amsterdam and there was no evidence of appreciable heterosexual transmission.

Adult↗
PubMed2005

An outbreak of hepatitis A among homeless drug users in Rotterdam, The Netherlands.

From the end of January to mid-June 2004 (weeks 5-24) a hepatitis A virus (HAV) outbreak occurred among a homeless and drug user community in Rotterdam, The Netherlands. To prevent further spread of the virus within this group and to the general population, the Municipal Health Service of Rotterdam organized a mass vaccination campaign during which 83% (1,515/1,800) of the homeless people were vaccinated. As part of a national HAV typing study, blood and/or fecal samples of 30 Rotterdam HAV IgM+ patients who fell ill during the period of 1 September 2003-1 December 2004 were tested. The tests included RT-PCR and sequencing at the VP3-VP1 and VP1-P2a regions of the HAV genome. It was found that 12 homeless people, one family member of a homeless person and two people without a known risk were infected with a unique subtype 3a strain. Four of the homeless patients became ill after vaccination and were probably infected at the time. This study shows that Dutch homeless people and drug users involved in HAV outbreaks should be offered HAV vaccine actively to prevent further spread of the infection. Furthermore, it was shown by molecular techniques that the unique subtype 3a strain was not found before the Rotterdam outbreak or afterwards, indicating that the mass vaccination campaign was successful.

Disease Outbreaks↗
PubMed2002

Epidemiological survey of neonatal non-polio enterovirus infection in the Netherlands.

The epidemiological, virological, and clinical data of 119 infants less than 30 days of age with enteroviral infection collected from January 1993 to November 1995 by the diagnostic virology laboratories were analyzed retrospectively. Ninety-eight isolates (83%) were obtained in the period of May 1 to December 1 with a peak in the summer months. Sixty-five percent (n = 78) of neonates became ill within the first 2 weeks of life. Echoviruses and Coxsackie virus type B were isolated most frequently, in 77 (65%) and 29 (24%) infants, respectively. Diagnosis was made by viral isolation from stool, nasopharyngeal swab, cerebrospinal fluid, and blood. One hundred four (87%) infants developed fever and 25 (21%) infants had diarrhea. A clinical diagnosis of sepsis was made in 42 (35%) infants and meningitis was diagnosed in 28 (24%) cases. The great majority of sepsis cases (36/86%) occurred in infants less than 15 days of age. In conclusion, non-polio enteroviruses (especially echoviruses) are a common and underreported cause of neonatal infection in the Netherlands in the summer months and are associated with a clinical diagnosis of sepsis or meningitis cases in the first 2 weeks of life in a high proportion of cases.

Enterovirus B, Human↗
PubMed1991

Malignant lymphomas in children in The Netherlands in the period 1973-1985: incidence in relation to leukemia: a report from the Dutch Childhood Leukemia Study Group.

A retrospective study was done of the incidence of non-Hodgkin's lymphoma (NHL) in children in the Netherlands in the period 1973-85 in relation to that of acute lymphoblastic leukemia (ALL). Complete ascertainment of cases was most likely achieved through the network of cooperating pediatricians of the Dutch Childhood Leukemia Study Group (DCLSG). The incidence of NHL remained constant at 0.75 per 10(5) children per year; the boy/girl ratio was 2.5. In +/- 25% of cases the disease was localized at diagnosis. Of children with NHL who were not listed in the DCLSG leukemia register, 19% had greater than or equal to 25% lymphoblasts in the bone marrow at diagnosis, representing an overlap with ALL of +/- 5%. In 1% of the children with NHL an immuno-deficiency disorder preceded the diagnosis. The incidence of Hodgkin's disease (HD) was 0.3 per 10(5) children per year, with some fluctuation over time, the peak being 0.7 in 1983. The boy/girl ratio was 2.7. Age-specific incidence rates, clinical features of NHL and HD, as well as the ALL to NHL ratio corresponded with those in other European countries and for white children in the USA.

Adolescent↗
PubMed2005

The Netherlands XTC Toxicity (NeXT) study: objectives and methods of a study investigating causality, course, and clinical relevance.

This paper describes the objectives and methods of The Netherlands XTC Toxicity (NeXT) study focussing on the causality, course, and clinical relevance of ecstasy neurotoxicity. Previous studies suggest that ecstasy (3,4 methylene-dioxymethamphetamine, MDMA, XTC) is toxic toward brain serotonin axons, but most of these studies have serious methodological limitations. The current study is a combination of different approaches with three substudies: (1) a crosssectional substudy among heavy ecstasy users and controls with variation in drug use, which will provide information about potential neurotoxic consequences of ecstasy in relation to other drugs; (2) a prospective cohort substudy in ecstasy-naive subjects with high risk for future ecstasy use, which will provide information on the causality and short-term course of ecstasy use and potential neurotoxicity, and (3) a retrospective cohort substudy in lifetime ecstasy users and matched controls of an existing epidemiological sample that will provide information on long-term course and outcome of ecstasy use in the general population. Neurotoxicity is studied using (a) different imaging techniques (beta-CIT SPECT, 1H-MR spectroscopy, diffusion tensor imaging, perfusion weighted imaging and functional magnetic resonance imaging), and (b) neuropsychological and psychiatric assessments of memory, depression, and personality. The combined results will lead to conclusions that can be used in prevention messages, clinical decision making, and the development of an (inter)national ecstasy policy.

Adolescent↗
PubMed2006

Promoting autonomy of the client with persistent mental illness: a challenge for occupational therapists from The Netherlands, Germany and Belgium.

The aim of this study was to determine how occupational therapists from The Netherlands, Germany and Belgium promote the autonomy of clients with persistent mental illness. Sixty occupational therapists working in psychosocial mental health completed two semi-structured questionnaires. Data were analysed by applying the constant comparative method. The results of the study show the importance of handling motivation in relation to personal autonomy and the different strategies occupational therapists use in promoting autonomy. In conclusion, enhancing clients' personal autonomy will empower and help them to discover meaningful occupations. More in-depth information could have been obtained using an interview in combination with observations. Further research is needed to evaluate the effectiveness of strategies used by occupational therapists in promoting clients' autonomy.

Belgium↗
PubMed1994

Mortality trend from prostate cancer in The Netherlands (1950-1989).

The trend in prostate cancer mortality in The Netherlands was studied, using data from the National Causes of Death Registry of the Central Bureau of Statistics. During the period 1950-1989, the age-adjusted mortality rate showed a steady rise from 20.5 to 30.6 per 100,000 man-years. A multiplicative model was used to examine possible period effects and birth-cohort effects separately. This analysis demonstrated that the increase in prostate cancer mortality is largely due to a birth-cohort effect, though calendar time of death may have had a slight effect as well. Among Dutch men, a continuous increase of mortality from prostate cancer was found in consecutive birth cohorts. This finding is in contrast with that of comparable studies in other Western countries, in which a peak mortality rate was found for the cohort born at the end of the 19th century with stabilizing or declining rates for later birth cohorts.

Age Factors↗
PubMed2004

Weed control on hard surfaces in The Netherlands.

The non-agricultural use of pesticides in The Netherlands declined in the period 1986-2001 from 127000 to 40000 kg AI per annum. However use on pavements rose from 23% to 50% of the total non-agricultural use. To diminish the dependency on herbicides, both preventive and curative non-chemical weed control methods have been examined. In the future both mechanical and thermal methods can be improved. On a flat pavement mechanical methods are preferred because they are more effective. Two approaches are used by municipalities to lower the environmental impact of the use of herbicides on pavements. The first is to phase out the use of chemicals on hard surfaces and the second is the integrated approach in which herbicides are not prohibited, but used only on places and at times when the risk of run-off is below a mutually accepted level. Both approaches can be effective.

Agriculture↗
PubMed2003

Estimating the incidence of subclinical infections with Legionella Pneumonia using data augmentation: analysis of an outbreak in The Netherlands.

Infections with Legionella bacteria can cause a potentially lethal form of pneumonia known as legionnaires' disease. In 1999 a major outbreak, causing 31 deaths, occurred among visitors and exhibitors of a consumer fair in The Netherlands. The epidemiology of subclinical infections is largely unknown, as there is no reliable method to diagnose such infections. To explore the incidence of subclinical infections, IgG and IgM antibody levels among exhibitors were compared to those among a representative sample of the Dutch population. As exhibitors were assumed to comprise both infected and uninfected individuals, their antibody levels were modelled as a mixture distribution. As infected individuals are expected to cluster around a point source, the spatial aspect of the spread of infections was taken into account. To estimate the distribution of antibody levels among infected individuals and to impute infection status among exhibitors, data augmentation was used. Subclinical infection appeared to be very common and its frequency declined with the distance from the putative source of the outbreak.

Bayes Theorem↗
PubMed1993

Disease mapping using empirical Bayes and Bayes methods on mortality statistics in The Netherlands.

Data from the 64 public health service districts in the Netherlands, describing the health status of the Dutch population, were used to construct maps for several causes of deaths. The choice and estimation of the relative risk measure is described. The prior expected number of deaths was modelled using a Poisson regression approach based on a model with main effects of district and age. Desirable properties of risk parameters for disease mapping are that they both reflect the level of risk and cope with the instability in the observed measure caused by the numbers at risk in each district. Different techniques for estimation of parameters were applied: empirical Bayes estimation (EB) using a nonparametric prior and a gamma prior, and a Bayesian approach (B) with a uniform prior. For the parametric EB also a constrained estimator was used. The EB techniques studied in this paper shift or smooth the values of the risk parameter towards a global mean. In the Bayesian method applied here, spatial dependence among districts can be modelled, that is the estimates are smoothed towards a local mean. The three EB estimates gave by and large similar results, although the constrained EB estimate smoothed less, as was expected. The Bayesian estimates smoothed the estimates more or less similarly to the constrained EB.

Bayes Theorem↗
PubMed2000

Attendance to cervical cancer screening in family practices in The Netherlands.

BACKGROUND: The effectiveness of three different organizational approaches to cervical cancer screening (community based, family practice based, and a combination) was evaluated in nationally representative family practices. METHOD: We selected 122 family practices with a computerized sex-age register from a database of 1, 251 family practices, representative of all 4,758 family practices in The Netherlands. Approximately 40 practices were linked with each approach. We measured the attendance, the reasons for nonattendance, and the influence of a reminder on the attendance of women invited for cervical screening in September, October, and November 1996. The patients were grouped according to age. A cross-sectional design was used for the study. RESULTS: For younger women, the total attendance rate, coverage (percentage of women "protected" against cervical cancer), and control rate (percentage of women with medical reasons for nonattendance or postponement of the smear) were highest in practices using the family practice-based approach (68, 77, and 90%, respectively) and lowest in practices with the community-based approach (53, 62, and 68%, respectively). For older women, the family practice-based approach and the combination approach were associated with attendance rates significantly higher than those for the community-based approach (approximately 60, 80, and 80% vs 47, 67, and 70%, respectively). A reminder sent by the family physician to women not responding to an initial invitation increased the attendance rate by 7 to 11% in both age categories, depending on who had sent the first invitation. CONCLUSION: A family practice-based cervical screening approach appeared to be the most effective at a national level, achieving the highest attendance rate, coverage, and control rate.

Adult↗