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PubMed2003

Trends in social inequality in self-reported health in The Netherlands; does infant mortality in year of birth as a cohort indicator matter?

In this article, we study trends in self-reported health (general health and chronic conditions) and health inequality in the Netherlands between 1974 and 1998 using an age-period-cohort framework. We answer two questions: (1) to what extent can trends in self-reported health be explained by the current macro-context (period effect) and by infant mortality in year of birth (cohort effect)? And (2) do the effects of period and cohort differ for educational groups? Health indicators are self-reported poor health and chronic conditions. The use of 26 Dutch cross-sectional surveys makes it possible to estimate largely unbiased effects of period and cohort simultaneously (controlled for age effects) and thus to adequately describe trends in social inequality in health. Our results give rise to four conclusions. First, for men poor health has been more or less stable, for women there has been an increase. The prevalence of chronic conditions has increased for both sexes. Second, adding cohort specific experiences to a model including age and period effects is only relevant for women's poor health. Decreasing infant mortality in year of birth leads to better health and consequently the period effect initially found for women appears to be slightly underestimated. Third, we found no trends in social inequalities in self-reported health due to period effects. Fourth, our analyses do show socially unequal trends in health as a result of cohort specific experiences. Contrary to our hypothesis, we found that decreased infant mortality in year of birth makes for a stronger impact of educational differences on self-reported poor health. Concerning chronic conditions no trends for educational groups were found.

Adult↗
PubMed2002

Transnational industrial power, the medical profession and the regulatory state: adverse drug reactions and the crisis over the safety of Halcion in the Netherlands and the UK.

Taking the controversy over the safety of the hypnotic, Halcion, in the Netherlands and the UK, as a case study, this article examines the problems for public health associated with responses to warnings about drug hazards by regulatory agencies, governmental expert advisers, the pharmaceutical industry and the medical profession. It is argued that regulators and the medical profession rely too heavily on manufacturers to investigate warnings from doctors' spontaneous reporting of adverse effects of drug products on the market. It is demonstrated that a pharmaceutical firm's commitment to search effectively for evidence against the safety of its own product in order to confirm doctors' warnings can have severe limitations. Deficiencies in the socio-institutional responses to post-market 'early warning systems' about drug hazards imply that the regulatory policies of 'early licensing' and minimal pre-market checks for new drugs are misconceived and threaten public health. To improve public protection from drug injury, the regulators should abandon their conviction that compelling evidence of drug hazards are required to confirm doctors' warning signals prior to regulatory intervention. Instead, they should adopt a policy of measured regulatory intervention as an immediate response to warning signals, while investigators, independent of the manufacturers, assess the significance of the signal.

Adverse Drug Reaction Reporting Systems↗
PubMed1996

Dementia-free life expectancy (DemFLE) in The Netherlands.

To gain an insight into the burden of dementia in an aging society, life expectancy with dementia and its counterpart dementia-free life expectancy (DemFLE) in The Netherlands are presented. Sullivan's method was used to calculate DemFLE. For elderly living either independently or in homes for the elderly prevalence figures on dementia were obtained from the Rotterdam Elderly Study (RES; n = 7528); for elderly in nursing homes the SIG Nursing home Information System was used. Conforming to other authors only the prevalence data on moderate and severe dementia as diagnosed with DSM-III-R criteria are used. The prevalence of mild dementia was not taken into account. At 65 years DemFLE for men is 14.0 years, that is 96.4% of the total life expectancy (14.5 years at this age). At age 90, DemFLE for men is 2.5 years, equal to 77.5% of the total life expectancy (3.3 years). For women DemFLE at age 65 is 17.7 years, that is 93.2% of their life expectancy (19.0 years), and at the age of 90, DemFLE for women is 2.8 years, equal to 74.7% of their remaining life expectancy (3.8 years). The absolute number of years with dementia remains relatively constant with increasing age. About 20-25% of these years with dementia are spent in nursing homes, the other 75-80% living independently. At each age compared with men women have both a higher DemFLE and a higher expectancy of years with dementia. The percentage of life expectancy without dementia however, is always lower for women, because of their higher total life expectancy. This indicates that the burden of dementia in absolute and relative terms is higher for women. Most years with dementia are spent at home, indicating that the burden of dementia rests mainly on the shoulders of informal caregivers.

Aged↗
PubMed1997

Socio-economic differences in general practitioner and outpatient specialist care in The Netherlands: a matter of health insurance?

Equal treatment for equal needs, irrespective of socio-economic position, is a major issue in many countries. Although in the Netherlands differences in utilization of health care between population groups are less pronounced than in most other countries, some differences by socio-economic position do exist. Controlling for health status, individuals with a high socio-economic status have a higher probability of outpatient contacts with a specialist, but a lower probability of general practitioner contacts, compared with those with a low socioeconomic status. In this cross-sectional study, we studied whether socio-economic differences in GP and outpatient specialist care utilization that exist after health status is taken into account could be explained by different aspects of health insurance. The study population, in which people with asthma and chronic obstructive pulmonary disease (COPD), diabetes mellitus, severe back complaints, and heart diseases are overrepresented, consists of 2867 respondents. Multivariate analyses show that the socio-economic differences in outpatient specialist contacts cannot be explained by differences in health insurance, whereas differences in general practitioner contacts can partially be explained by the fact that individuals with higher socio-economic status more often have a private (instead of public) insurance. This is not owing to differences in deductible or insurance coverage between public and private insurance, but is more likely to be caused by differences in regulatory aspects between these two insurance schemes (such as the stronger gate-keeper role of the general practitioner in the public insurance scheme.

Adult↗
PubMed1997

The socio-economic distribution of heart diseases: changing gradients in The Netherlands.

Two different Dutch data-sets were used to examine trends in the association between socio-economic characteristics and the risk of heart disease. Data of the Dutch Quality of Life Surveys allowed the examination of trends in the association between educational level and self-reported heart disease during the period 1974-1993. For both the general Dutch population and the subpopulation of men aged 40 years and older, we found an inverse gradient during the whole period. The gradient climaxed at 1980-1983, and narrowed afterwards. Furthermore, ecological analyses, relating regional mean personal incomes to regional directly standardised mortality rates of coronary heart diseases (CHD) and all heart diseases, showed similar patterns of social differentials. The findings suggest that, in the Netherlands, there is a narrowing gradient of the association between socio-economic characteristics and heart disease in the late eighties and early nineties.

Adult↗
PubMed1997

The status of genetic material and genetic information in The Netherlands.

The moral status of genetic material and information, and the ethics of controlling and manipulating them, is a topic of hot debate in many European countries, including The Netherlands. That heat is due partly to the complexity of the topic, and partly to researchers' fear that their investigations will be hampered by restrictions on the use of personal data or body material. But there is little doubt that manifold diverging interpretations about the status of the human body, body materials, and personal information in Dutch law, written and unwritten, contribute to the intensity of the debates. This article intends to structure the debate by creating more clarity at the conceptual level. By carefully examining relevant articles of the Constitution and Civil Codes, as well as policy documents and authoritative publications, notably in reference to prominent legal concepts such as property, ownership and privacy, and answer should be provided to the following crucial question: is the status of genetic material and information in any sense special in comparison with other body parts and other kinds of information about a person? This paper first discusses the status of human body materials and personal information in general, and then continues with a more specific discussion about the status of genetic material and information. It concludes that the Dutch legislature had carefully avoided (or not felt the need to employ) the concept of ownership in regulating biomedical research; rather, privacy is found to be the prime regulatory concept.

Confidentiality↗
PubMed1997

Economic evaluation in support of national health policy: the case of The Netherlands.

This article focuses on economic evaluation as an instrument to support national health policy in the Netherlands. National health policy concerns decision-making on which technologies may enter the health care market, which health care services are included in the package of health care benefits and under what conditions, and what the geographical distribution of medical services and facilities should be. Regarding the latter two issues in particular, the actual and potential role of economic evaluation in health policy is discussed. From the Dutch experience we can learn that a close cooperation between researchers and policy-makers helps to enlarge the impact of economic appraisal on policy-making and that incorporation of the right (financial) incentives is vital to the use of economic appraisal in health care decision-making.

Adult↗
PubMed1998

Home birth or short-stay hospital birth in a low risk population in The Netherlands.

In The Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have chosen a hospital birth, leaving hospital with their baby shortly after delivery. As both this trend and its effects have not been extensively investigated, a study was designed to examine the determinants of the choice for home or hospital birth. It was hypothesized that the choice would be determined by a combination of personal and social factors. Structural equation modelling indicated that social factors, especially the confidence of significant others in home birth and the expectations of hospital care during childbirth, were by far the strongest predictors of choice. Personal factors, measured as perceived health status before and during pregnancy, the existence of minor symptoms and fear of pain or complications during birth, were found to play an indirect role. Demographic variables such as age, education and urbanization showed no effect. These findings indicate that emphasizing the good results and excellent quality of Dutch maternity care at home is likely to support and strengthen the general acceptance of home birth.

Adult↗
PubMed1999

The medical profession and alternative medicine in The Netherlands: its history and recent developments.

At the end of 1993, the Dutch parliament passed the Individual Health Care Professions Bill which replaced existing legislation. The new Act brings to an end the monopoly of the Dutch medical profession. The former prohibition on alternative practitioners to practice medicine was abolished. This article addresses the question of whether the Act affects the position of medical dominance in Dutch health care. It will be argued that the new Act preserves the present position of medical dominance to a large extent. Although alternative therapies have gained greater social recognition, there is little indication that the cultural and social authority of medicine is yet being challenged in the Netherlands. However, it could be argued that the Dutch health care system is moving in a more pluralistic direction.

Complementary Therapies↗
PubMed2000

Intake of butylated hydroxyanisole and butylated hydroxytoluene and stomach cancer risk: results from analyses in the Netherlands Cohort Study.

Both carcinogenic and anticarcinogenic properties have been reported for the synthetic antioxidants butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT). The association between dietary intake of BHA and BHT and stomach cancer risk was investigated in the Netherlands Cohort Study (NLCS) that started in 1986 among 120,852 men and women aged 55 to 69 years. A semi-quantitative food frequency questionnaire was used to assess food consumption. Information on BHA or BHT content of cooking fats, oils, mayonnaise and other creamy salad dressings and dried soups was obtained by chemical analysis, a Dutch database of food additives (ALBA) and the Dutch Compendium of Foods and Diet Products. After 6.3 years of follow-up, complete data on BHA and BHT intake of 192 incident stomach cancer cases and 2035 subcohort members were available for case-cohort analysis. Mean intake of BHA or BHT among subcohort members was 105 and 351 microg/day, respectively. For consumption of mayonnaise and other creamy salad dressings with BHA or BHT no association with stomach cancer risk was observed. A statistically non-significant decrease in stomach cancer risk was observed with increasing BHA and BHT intake [rate ratio (RR) highest/lowest intake of BHA = 0.57 (95% confidence interval (CI): 0.25-1.30] and BHT = 0.74 (95% CI: 0.38-1.43). In this study, no significant association with stomach cancer risk was found for usual intake of low levels of BHA and BHT.

Aged↗
PubMed2000

Survey of the management of deep vein thrombosis in general practice in the Netherlands.

BACKGROUND: To investigate the management of (suspected) deep vein thrombosis in general practice. METHODS: Self completing postal questionnaire among a random sample of 692 general practitioners in the Netherlands. RESULTS: The overall response rate was 58%. Eighty-nine percent of the respondents initiated objective evaluation. Less than 3% usually make the diagnosis on clinical grounds only. Ninety-two percent initiated adequate treatment for the last patient with deep vein thrombosis. No more than 4% usually treat patients with acenocoumarol alone. Respondents frequently referred a patient to a specialist, 41% to confirm the diagnosis and 85% for treatment. Already 44% feel that management of deep vein thrombosis is a mandate of the general practitioner. For those who do not, the availability of diagnostic and therapeutic facilities are the main obstacles. CONCLUSION: In general practice objective diagnostic methods to evaluate suspected deep vein thrombosis are routinely used and patients receive adequate treatment. Although patients are frequently referred to the hospital many general practitioners feel that they should be able to take care of these patients themselves. (See Editorial p. 133)

Acenocoumarol↗
PubMed1997

Risk factors for HCV infection in two haemodialysis units in The Netherlands.

BACKGROUND: In order to assess risk factors for HCV infection during haemodialysis, all patients receiving haemodialysis for more than 6 months in two separate units in the Netherlands were studied retrospectively. METHODS: Antibodies to HCV, HCV-RNA and HCV genotypes were determined. Risk factors were identified by analysis of an extensive collection of clinical data. RESULTS: In unit A, 8 out of 75 (11%) patients and in unit B 4 out of 122 (3%) patients had antibodies to HCV. Eleven out of the 12 anti-HCV-positive patients had detectable HCV-RNA. Genotyping showed the presence of 4 different genotypes in unit A (1, 1a, 2b, and 3a). Three patients in unit B were infected with the same genotype (1b), where one of these patients was also infected with genotype 1a. One patient in unit B did not have detectable HCV-RNA. The risk of acquiring a HCV infection in unit A was associated with the number of blood transfusions. However, in unit B this risk was associated with the duration of dialysis. Other factors such as the number of surgical procedures were not associated with HCV infection. CONCLUSIONS: Blood transfusions and the dialysis process itself are important and independent risk factors for HCV transmission in dialysis patients. Surgical events do not appear to be important risk factors. However, relative risks may vary considerably between different dialysis centres.

Female↗
PubMed1997

A survey of the diagnostic and therapeutic management of patients with suspected pulmonary embolism in the Netherlands.

BACKGROUND: Pulmonary embolism (PE) remains a complex diagnostic problem. Many diagnostic modalities are available. Several published guidelines have failed to yield a uniform approach. We have assessed the current diagnostic and therapeutic management of patients with clinically suspected PE in the Netherlands. METHODS: A questionnaire was sent to internists and pulmonologists, who were then asked to detail their diagnostic and therapeutic management in their last patient seen with suspected PE. RESULTS: 1571 questionnaires were sent out (response rate 64%). 95% of the patients with suspected PE underwent a perfusion scan (in 91% within 24 h). 1.6% of the respondents had no available perfusion scan facility. Of those who underwent a perfusion scan, 62% had ventilation scan (66% with segmental defects, 80% with subsegmental defects, 27% with a normal perfusion scan). Tests for deep vein thrombosis were performed in 58% of the patients and pulmonary angiography was carried out in 6.1%. Anticoagulant treatment was instituted in 73.2% of all patients. CONCLUSIONS: The perfusion lung scan is appropriately used as the initial step in the diagnostic workup of patients with suspected PE. Ventilation scanning is overused in patients with subsegmental perfusion defects and normal scan results, whereas it is underused in patients with segmental defects. Additional ventilation scan results had a limited influence on treatment decisions. There is still considerable overtreatment of patients with suspected PE.

Humans↗
PubMed1998

Clinical presentation of sarcoidosis in The Netherlands an epidemiological study.

BACKGROUND: Patients suffering from sarcoidosis may present with a wide range of symptoms. The aim of this study was to make an inventory of the clinical presentation of the sarcoidosis population in the Netherlands. METHODS: Symptom inventory questionnaires were sent to all members of the Dutch Sarcoidosis Society. Of these 1755 sarcoidosis patients, 1026 (58%), (age 46.7 +/- 11.6, female 63%) completed the questionnaire. RESULTS: Familial sarcoidosis was reported by 170 patients (16.3%). In 57% of the cases the first diagnosis was sarcoidosis. Other diagnosis included rheumatoid arthritis (5.1%) and tuberculosis (4.8%). Treatment with systemic corticosteroids was reported by 565 patients (55.1%). The most frequently reported symptom was fatigue (71%), followed by dyspnea (70%), arthralgia (52%), muscle pain (39), chest pain (27%), and general weakness (22%). Moreover, 26% of patients suffered from disease-related tension and strain. No relationship was found between the reported symptoms and treatment with corticosteroids. CONCLUSIONS: Sarcoidosis patients suffered from a broad range of persistent physical symptoms. In this study fatigue appeared to be the most commonly reported symptom. Intervention programs should focus on physical health as well as psychosocial aspects such as teaching patients how to cope with the disease.

Adult↗
PubMed1998

Continuous infusion of recombinant factor VIIa in patients with haemophilia and inhibitors. Experience in The Netherlands and Belgium.

BACKGROUND: Initial clinical experience with recombinant factor VIIa (rVIIa) for treatment of haemophilia patients with inhibitors against factor VIII or IX has been obtained by administration of rVIIa by repeated intravenous bolus injections. However, continuous infusion of rVIIa may be a more appropriate administration method if prolonged treatment is indicated. METHODS: We have surveyed and analysed the initial experience with continuous infusion of rVIIa in the Netherlands and Belgium. RESULTS: Five hospitals treated 7 haemophilia patients with inhibitors on 9 different occasions (4 bleedings, 5 surgical interventions) by continuous infusion of rVIIa over a total of 59 days. Haemostatic coverage was considered effective in 8 out of 9 cases and partially effective in 1 case. Continuous infusion of rVIIa was aimed at rVIIa target plasma levels of 10 U/ml and a decrease in prothrombin time (PT) of 3 s compared to control levels. This was obtained by an initial bolus injection of 90 micrograms/kg prior to continuous infusion of rVIIa at doses between 30-6 micrograms/kg/h (mean 17.5 micrograms/kg/h). A conventional one-stage factor VII coagulation assay, often used in combination with a PT, was satisfactory in monitoring rVIIa treatment. The additional clinical value of anti-fibrinolytic and anti-thrombophlebitic treatment was unclear. CONCLUSION: In our experience, rVIIa appeared to be efficacious and safe when administered by continuous infusion. Continuous infusion of rVIIa is more convenient than bolus injections or rVIIa, easy to monitor and provides a cost reduction of > 50%. These advantages make continuous infusion an attractive administration method for prolonged treatment with rVIIa.

Adult↗
PubMed1999

Cardiovascular diseases and risk factors in a population-based study in The Netherlands: agreement between questionnaire information and medical records.

BACKGROUND: Since 1987 the Monitoring Project on Cardiovascular Risk Factors has been carried out in The Netherlands. The purpose of the present study was to assess the agreement between the self-reported questionnaire information that was collected in this survey on cardiovascular diseases and risk factors and information from medical records. METHODS: From 1987 to 1991, over 36,000 men and women aged 20-59 years have participated in the Monitoring Project on Cardiovascular Disease Risk Factors, a cross-sectional population-based study. We compared self-reported information on cardiovascular diseases and risk factors with the general practitioners medical records from a sample of 899 hypertensive subjects. RESULTS: The highest proportion of positive self-reports could be confirmed by the medical records for diabetes conditional on self-report of medication use for this condition (100%), and a history of hypertension conditional on the presence of blood pressure recordings in the medical records (91%). The lowest percentage of positive self-reports confirmed by medical records was a family history of myocardial infarction (3-5%). More than 80% of the negative self-reports were confirmed by the medical records for most conditions, except for history of hypertension, conditional on the presence of blood pressure recordings in the medical records (40%). The overall agreement above chance was substantial for cerebrovascular disease (kappa = 0.78) and diabetes (kappa = 0.75), moderate for myocardial infarction (kappa = 0.55), poor for myocardial infarction of the respondents' father (kappa = 0.07) and mother (kappa = 0.05), and fair to moderate for all other self-reported conditions. CONCLUSION: Agreement between self-reported information and medical records was variable. For further studies, self-reports of cardiovascular diseases and risk factors should preferably be complemented with information from other sources such as medical records.

Adult↗
PubMed2003

Periconceptional folic acid use and the prevalence of neural tube defects in The Netherlands.

OBJECTIVE: To study the effect of increased folic acid intake on the prevalence of neural tube defects (NTD) in The Netherlands. STUDY DESIGN: Using the capture-recapture method, the prevalence of NTD was estimated on the basis of five different registries on births affected by NTD. RESULTS: Total prevalence over the 1988-1998 period varied between 1.43 and 1.96 per 1000 live and still births. No decrease in total prevalence was found to have taken place during that period. Scrutiny of the last 2 years, 1997 and 1998, in which increased folic acid intake might be expected to have had an effect, did not give any indication that the prevalence of NTD was falling. CONCLUSIONS: A decrease in the Dutch prevalence of NTD during the study period could not be demonstrated due to the relatively small number of women using folic acid periconceptionally. This does not mean automatically that periconceptional folic acid use is ineffective in reducing the Dutch prevalence of NTD. Further monitoring is needed.

Dietary Supplements↗
PubMed2004

Changes in perinatal care and survival in very preterm and extremely preterm infants in The Netherlands between 1983 and 1995.

OBJECTIVE: To evaluate changes in obstetrical and neonatal care for very preterm and extremely preterm infants between 1983 and 1995 in The Netherlands and to evaluate the effect of those changes. STUDY DESIGN: Data on all very preterm or VLBW infants from the linked national obstetrical and neonatal databases of 1995 (N=2066) were compared to data on similar infants from a nation-wide study of very preterm infants born in 1983 (N=1338). RESULTS: Obstetrical and neonatal management changed over time, with an increased number of deliveries in tertiary centres (35.7-60.7%), an increase in C-sections (43.7-56.8%) and prolonged artificial ventilation (3.4-9.5%). Survival until discharge increased from 75 to 90% and neonatal morbidity decreased in relative terms. CONCLUSIONS: The short-term outcome for these very preterm and extremely preterm infants has improved. Long-term follow-up through to school age and adulthood of preterm infants is needed to investigate the changes in the sequelae of intensive obstetrical and neonatal care.

Apgar Score↗