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PubMed1997

Local recurrence and survival in patients with rectal cancer, diagnosed 1981-86: a community hospital-based study in the south-east Netherlands.

We carried out a population-based audit of local recurrence rates in curatively resected patients with rectal cancer, diagnosed between 1981 and 1986. The study comprises 372 patients treated for rectal cancer in five community hospitals in the south-east of the Netherlands. The follow-up period was 7-12 years. We studied the medical records of these patients in the Eindhoven Cancer Registry, and by checking the endoscopical, surgical and pathological reports, we traced the following events: local recurrence, distant metastasis and (cause of) death. Curative resection was carried out in 232 of the 372 cases (62%); post-operative radiotherapy was administered to 27% of stage B2 and 50% of stage C (Astler-Coller) patients. Crude and net 5-year survival rates were 45% and 58%, respectively. Local recurrence rates were 18%, without much variation per hospital. After adjustment for age, gender, tumour site and type of surgery, local recurrence was primarily determined by tumour penetration of the muscularis propria and lymph node infiltration, the relative risks being 2.5 and 3.1, respectively (90% confidence intervals: 1.1-5.9 and 1.5-6.4). Although patients with cancer of the distal segment (0-6 cm) had shorter survival times than with proximal tumours, tumour site only weakly influenced local recurrence rates. These results confirm that the risk of recurrence for stage B2 and C patients can be reduced by more extensive surgical procedures. This study has contributed to the growing awareness of improved surgical treatment in rectal cancer.

Adult↗
PubMedDate not supplied

Isolation of swine-like influenza A(H1N1) viruses from man in Switzerland and The Netherlands.

Swine influenza A (H1N1) viruses were isolated from two people in Switzerland and one in the Netherlands in early 1986. In haemagglutination-inhibition and neuraminidase-inhibition assays, the three viruses were closely related to one another and to the A/New Jersey/8/76 strain. The Swiss patients showed only mild symptoms, whereas the Dutch patient suffered from severe pneumonia. Two of the patients had been in close contact with diseased pigs. No such contact could be established for the third patient. None of the three individuals was known to suffer from immunodeficiency. No man-to-man transmission of the virus has been detected.

Animals↗
PubMed1998

Prevalence of dementia in a rural Netherlands population and the influence of DSM-III-R and CAMDEX criteria for the prevalence of mild and more severe forms.

To obtain estimates of the prevalence of mild and moderate/severe dementia among people age 65 and over, applying criteria for severity of both DSM-III-R and CAMDEX, a two-stage community-based study was conducted in a rural area of the Netherlands. In the first stage, 2191 subjects (out of the target population of 2655) participated in an interview which included the Mini-Mental State Examination (MMSE). Based on MMSE score, a non-proportional random sample (n=496) was drawn for the second stage. A total of 421 subjects responded and were subsequently examined using the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). In determining the severity of dementia, criteria of both DSM-III-R and CAMDEX were applied. Overall prevalence for both classification systems was 6.5%. There was a large discrepancy between the two classification systems with regard to the criteria for rating severity. The prevalence of moderate/severe dementia using DSM-III-R criteria was twice as high as the prevalence using CAMDEX criteria. These findings reflect the differences between DSM-III-R and CAMDEX in descriptions of dementia severity. Rating according to CAMDEX predicts institutionalization in specialized nursing homes somewhat better than staging according to DSM-III-R. Both content analysis and institutionalization data suggest that the CAMDEX operationalization of rating severity seems preferable.

Aged↗
PubMed2000

Education, aging, and health: to what extent can the rise in educational level relieve the future health (care) burden associated with population aging in the Netherlands?

This article describes to what extent the expected rise in the educational level of the Dutch population can counterbalance the increases in the prevalence of ill-health and health care utilization based on the aging of the population for the period 1996-2020. Logistic regression models are used to estimate current differences in health (care utilization) by age, sex, and educational level, using data from the Netherlands Health Interview Survey. The current differences in health (care utilization) are applied to national projections of the composition of the population by age, sex, and educational level. Also, scenarios have been made in which the health differences by educational level are assumed to converge and diverge. The rise in the educational level counteracts the expected increases in ill-health based on population aging to a substantial degree (10-100%). We therefore recommend that in projections of ill-health also changes in educational level are taken into account.

Adult↗
PubMed2002

Long-term trends in sunshine duration and its association with schizophrenia birth rates and age at first registration--data from Australia and the Netherlands.

BACKGROUND: Based on the well-described excess of schizophrenia births in winter and spring, we hypothesised that individuals with schizophrenia (a) would be more likely to be born during periods of decreased perinatal sunshine, and (b) those born during periods of less sunshine would have an earlier age of first registration. METHODS: We undertook an ecological analysis of long-term trends in perinatal sunshine duration and schizophrenia birth rates based on two mental health registers (Queensland, Australia n=6630; The Netherlands n=24,474). For each of the 480 months between 1931 and 1970, the agreement between slopes of the trends in psychosis and long-term sunshine duration series were assessed. Age at first registration was assessed by quartiles of long-term trends in perinatal sunshine duration. Males and females were assessed separately. RESULTS: Both the Dutch and Australian data showed a statistically significant association between falling long-term trends in sunshine duration around the time of birth and rising schizophrenia birth rates for males only. In both the Dutch and Australian data there were significant associations between earlier age of first registration and reduced long-term trends in sunshine duration around the time of birth for both males and females. CONCLUSIONS: A measure of long-term trends in perinatal sunshine duration was associated with two epidemiological features of schizophrenia in two separate data sets. Exposures related to sunshine duration warrant further consideration in schizophrenia research.

Adolescent↗
PubMed2000

Seasonality of schizophrenia and stillbirths in The Netherlands.

Studies from Denmark and the USA have reported a strong correlation between the seasonal pattern for stillbirths and the seasonal birth pattern for people who develop schizophrenia. It has been suggested that the correlation could be caused by a common seasonal factor (e. g. intra-uterine infections during the third trimester of pregnancy), which produces death in some fetuses and nonfatal brain changes in others, changes that are manifested in later life as schizophrenia. The aims of our study were (i) to assess the seasonal patterns for stillbirths and for pre-schizophrenic births in The Netherlands and (ii) to examine their relationship. The Dutch psychiatric registry provided data on all Dutch-born subjects who had been hospitalized at least once with a diagnosis of schizophrenia in the period 1970-1994. We selected data on patients born in the period 1926-1970 (n=29891). The government provided monthly numbers of live births and stillbirths in the latter period. Seasonality of birth was examined using Poisson regression analysis. The risk of an admission for schizophrenia was highest for people born in the months of May and June and lowest for those born in August and September. When the risk for subjects born in June was compared with the risk for subjects born in September, the Relative Risk was 1.14 [95% confidence interval (CI): 1.07 to 1.22]. The seasonal pattern of stillbirths was different, in that it showed a peak in the month of January. The low, however, as in schizophrenia, occurred in the months of August and September. The two seasonal patterns were found to be weakly correlated: Spearman's rank correlation coefficient rho=0.41 (95% CI: -0.22 to 0.80). This was the largest European study on birth seasonality in schizophrenia. The hypothesis that a common factor is responsible for a seasonal excess of stillbirths and for a seasonal birth excess of people who develop schizophrenia was not supported. The possibility remains, however, that a common factor explains seasonal (birth rate) deficits in these disorders.

Birth Rate↗
PubMed1999

Dissociative identity disorder: diagnosis and treatment in the Netherlands.

Dissociative Identity Disorder (DID) is a controversial diagnosis and empirical data on the efficacy of treatment modalities are scanty. The objective of this study was to explore the frequency of the diagnosis, the types and efficacy of prevailing treatment practices, and to examine demographic data on patients in the Netherlands. A questionnaire, including questions on one selected DID patient, was mailed to 1,452 Dutch psychiatrists. The response rate was 46.7%. A total of 273 psychiatrists reported having made the diagnosis at least once. The diagnosis was made in a statistically significant manner more frequently by female psychiatrists, by psychiatrists aged 50 years or younger, and by those certified after 1982. No correlation was observed with primary theoretical orientation or the type or topography of work facility. The mean age of the selected patients was 33.2 and the male:female (M:F) ratio 1:9. The majority of patients were seen once a week in an outpatient setting. Individual psychotherapy and adjunctive anxiolytic or antidepressant medications were the most widely endorsed treatment modalities. Hypnosis was rarely used. We conclude that the diagnosis of DID is not to be dismissed as a local eccentricity. It is warranted as an explanatory framework in the context of a psychotherapeutic treatment.

Adult↗
PubMed1993

The woodmouse (Apodemus sylvaticus) as a reservoir of tick-transmitted spirochetes (Borrelia burgdorferi) in The Netherlands.

In three widely separated locations in the Netherlands, woodmice (Apodemus sylvaticus) were trapped, examined for ticks and subjected to xenodiagnosis for the detection of tick-transmitted spirochetes (Borrelia burgdorferi). During the spring and summer, an average of 2.4 Ixodes larvae/mouse (n = 170) was observed, but the true numbers were probably greater. The numbers of nymphs could be determined more accurately and amounted to 0.46 nymphs/mouse. The percentage of mice that were infected with tick-transmitted spirochetes was 47% (n = 45), 29% (n = 58) and 0% (n = 64) for the three locations respectively. The absence of spirochete-infected mice in location 3 is puzzling because spirochete-infected I. ricinus nymphs were collected (infection rate up to 11%) in the same location during the subsequent spring. Sexually active mice were more frequently infected with spirochetes than juveniles and non-sexually active ones. On location 1, the island of Texel, a sample of mice was also caught during the subsequent winter and subjected to xenodiagnosis. The results indicate that B. burgdorferi survives the winter in the vector tick rather than in the reservoir rodents.

Aging↗
PubMed2003

The burden of COPD in The Netherlands: results from the Confronting COPD survey.

Chronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation that is largely irreversible, with symptoms of dyspnoea, cough and sputum production. In The Netherlands, COPD tends to be underpresented to physicians, underdiagnosed and undertreated by healthcare professionals, and poorly recognized among the general population. Improving the diagnosis and management of COPD in this country may require raised awareness of the impact of the disease on society. This may be achieved by providing detailed information on the burden of COPD on the patient, healthcare system and the economy. This information has now become available from Confronting COPD in North America and Europe, the first international survey to quantify the country-specific impact of the disease. An economic analysis of the results of the Dutch survey revealed the high cost of COPD to the healthcare system and society, with direct costs estimated at Euro 614 per patient Indirect costs amounted to Euro 410, bringing the annual per patient cost of COPD to Euro 1024. Around 50% of the cost of COPD to the healthcare system was for prescription medication, including symptomatic medication and treatment for underlying airway inflammation. This contributed to effective symptom control in many patients, as shown by the low utilization of unscheduled healthcare (inpatient hospitalizations, emergency room visits, or contacts with healthcare professionals). However, the survey suggested that there was scope for improvement in the understanding of the origin and consequences of this disease among the general public, and the way COPD is managed by healthcare professionals, in order to increase the proportion of patients who are diagnosed with COPD and treated in accordance with management guidelines. In addition, smoking cessation intervention at the early stages of the disease could help to reduce the high costs associated with severe COPD in this country.

Absenteeism↗
PubMed1999

Prescription and usage of long-term oxygen therapy in patients with chronic obstructive pulmonary disease in The Netherlands.

Long-term oxygen therapy (LTOT) has been shown to improve survival in hypoxaemic patients with chronic obstructive pulmonary disease (COPD). This has resulted in recommending the prescription of oxygen for at least 15 h day-1 in most European countries. In order to examine the prescription and usage of LTOT and to assess the adherence to international recommendations for its prescription, a survey was set up in a random sample of clients of the largest oxygen company in the Netherlands. After patients had been visited for an interview, additional postal surveys were sent to the physician who had prescribed LTOT and to the oxygen company. For 175 COPD patients the mean oxygen prescription and mean oxygen usage were 15.6 +/- 5.8 and 14.1 +/- 6.8 h day-1, respectively. In 62 patients (35%) oxygen was prescribed < 15 h day-1, more often by non-chest physicians than by chest physicians (P < 0.0001), and 91 patients (52%) used oxygen < 15 h day-1. Of 113 patients with a prescription > or = 15 h day-1, 39 (35%) used oxygen < 15 h day-1 and 74 for > or = 15 h day-1. The latter were prescribed oxygen for more h day-1, had been longer on LTOT, had a higher resting flow rate, were prescribed a concentrator, employed portable cylinders and used oxygen in public significantly more often than the former. We conclude that in a selected group of LTOT patients with COPD both oxygen prescription and usage were often inadequate, particularly if LTOT was prescribed by non-chest physicians.

Aged↗
PubMed1999

Current and future medical costs of asthma and chronic obstructive pulmonary disease in The Netherlands.

The aim of this study was to estimate the healthcare costs of asthma and chronic obstructive pulmonary disease (COPD), in the Netherlands, in 1993. Also studied was the future development of these costs, as a result of ageing and possible changes in smoking behavior. A prevalence-based cost-of-illness approach was used to estimate direct medical costs. Age- and gender-specific data were obtained from representative national registries and large, representative surveys. To model future costs, cost estimates were linked to an epidemiological model based on a dynamic multi-state lifetable. It describes 1 yr changes, from one state to another, that result from ageing, birth, migration, incidence, recovery from asthma and death due to asthma, COPD or other causes, and starting or quitting smoking. Three different scenarios were modelled: 1) a reference scenario which primarily predicts the impact of ageing. 2) an 'attainable' smoking reduction scenario and 3) an 'extreme' smoking reduction scenario. Direct medical costs were estimated to be $US 346 million in 1993. With increasing age, the relative importance of asthma in total asthma and COPD costs decreased from 91% to less than 4%. Annual costs per patient were estimated to be $US 499 for asthma and $US 876 for COPD. The breakdown of costs differed considerably between asthma and COPD. The reference scenario predicted the costs to increase by 60% to reach $US 555 million by 2010, COPD prevention as modelled in the second and the third scenario reduced the projected cost increase from 60%, to 57% and 48%, respectively. Together, the direct costs of asthma and COPD represent 1.3% of the Dutch health care budget. The breakdown of the costs shows different patterns for asthma and COPD. The costs of these diseases are expected to increase by 60% in the near future. In the short run the impact of smoking reduction on reducing this increase is relatively small, but it will be greater in the long run.

Adolescent↗
PubMed2000

Cervical cancer screening in the Netherlands.

The Netherlands is among the European countries with low incidence and almost lowest mortality from cancer of the uterine cervix. Screening started around 1970, being a combination of local and regional invitational programmes and opportunistic screening. In 1996 screening activities have been structured to a new national and nationwide programme. The restructuring concerned the management and financing of the programme, organisation, target age-ranges and interval, follow-up of abnormal test results, and evaluation. At the moment short-term results of implementation of the new screening programme are becoming available. It will take many more years before long-term effects of the new programme will emerge.

Adult↗
PubMed2001

Cost comparison between stereotactic large-core-needle biopsy versus surgical excision biopsy in The Netherlands.

Yearly, approximately 7200 Dutch women with non-palpable breast lesions are referred for a diagnostic surgical excision biopsy. Recently, less invasive alternatives such as stereotactic large-core-needle biopsy have emerged. The aim of this study was to compare the costs of surgical excision biopsy and large-core-needle biopsy. As stereotactic equipment is expensive, the costs of large-core-needle biopsy depend on the extent of centralisation of this facility. Therefore, we assessed the extent of economies of scale in four different scenarios of (de)centralisation. We collected cost data in five Dutch hospitals. The cost of surgical excision biopsy amounted to 1184 Euros. In cases where large-core-needle biopsy would be employed decentralised in all 114 hospitals in The Netherlands, the average costs were estimated to be 1186 Euros compared with 572 Euros in a centralised scenario with involvement of 10 hospitals. Therefore, centralisation of stereotactic equipment for core-needle biopsies would be advisable from an economic perspective.

Biopsy↗
PubMed2002

Epidemiology of unknown primary tumours; incidence and population-based survival of 1285 patients in Southeast Netherlands, 1984-1992.

Patients with an unknown primary tumour (UPT) represent 5-10% of all new cancer patients. Data on survival and prognostic factors of UPTs are based on selected patient series from specialised institutions. Population-based data on incidence, histology and determinants of survival for patients with UPT are not available. All patients diagnosed with UPT between 1984 and 1992 and entered in the population-based Eindhoven Cancer Registry for Southeast Netherlands were included. Follow-up of vital status is complete up to 1999. 1285 patients were registered. In 1024 patients, the diagnosis was confirmed histopathologically: 479 (47%) had adenocarcinoma, 453 (44%) poorly differentiated carcinoma (PDC) or adenocarcinoma (PDA), 76 (7%) squamous cell carcinoma and 16 patients (2%) had an undifferentiated malignant neoplasm. In 26% of these patients with UPT, the tumour was already widely disseminated at presentation. The majority of patients (67%) received only supportive treatment. The median survival was 11 weeks and only 15% were still alive 1 year after diagnosis. Favourable subgroups comprised young patients and patients with metastases localised in lymph nodes. In 261 cases, the diagnosis was made clinically. These patients were evaluated separately. They were older than the biopsy-confirmed patients, received less cancer therapy and their prognosis was even worse (median survival of 7 weeks). In a comparison with data from a tertiary referral centre in the United States of America (USA), our patients were older, received less therapy and had a poorer prognosis. Demographics of our favourable subgroup resembled the patients from the American study. The differences were most likely caused by the differences in the patient populations. In conclusion, we have demonstrated in a population-based study that the prognosis for patients with UPT is more unfavourable than suggested in most clinical studies.

Adolescent↗
PubMed2002

Age-specific differences in treatment and survival of patients with cervical cancer in the southeast of The Netherlands, 1986-1996.

Age at diagnosis has been proven to be an important determinant of the choice of initial treatment for several sites of cancer. Elderly patients are more likely to receive no treatment or less intensive treatment modalities. This study analysed the influence of age on treatment choice and survival in patients diagnosed with cervical cancer. This population-based study used data on 1176 new cases of invasive cervical cancer diagnosed in the period of 1986-1996 from three regional cancer registries in the Netherlands. All available information on treatment and survival (on 1 January 1998) was recorded. Relative survival rates were calculated according to the Hakulinen method. Relative risks (RR) for excess mortality due to the diagnosis of cervical cancer were calculated with a regression model for relative survival rates. Only 5% of the patients aged 70 years and older (n=224) were diagnosed with stage IA disease, compared with 11 and 30% of the patients aged 50-69 years and 49 years and younger, respectively. Almost 50% of the 70+ patients with stage IB-IIA were treated with radiotherapy as a single treatment modality, whereas 64% of the patients aged < or =49 years were treated with surgery alone. In all age groups, treatment for advanced stage disease (stage > or =IIB) was radiotherapy alone. No treatment was given to 10% of the patients aged 70 years and older, 5% of those aged 50-69 years and 1% of those aged 49 years and younger. Five-year relative survival was 69% (95% Confidence Interval (CI): 66-72%) and differed significantly (P=0.001) with age (70+ years: 49%; 50-69 years 58%; < or =49 years: 81%). Multivariate analyses on a subset of patients showed that age was not an independent prognostic factor, whereas stage and treatment modality were very important prognostic factors. Although elderly cancer patients were sometimes treated differently from younger patients, this was in accordance with the guidelines. Relative survival rates differed significantly by age. The multivariate analyses on the subset of patients also revealed that excess mortality increased with age. However, when adjustment was made for stage and treatment, this difference disappeared. The influence of treatment on survival is likely to be due to the selection of patients based on other characteristics, such as tumour volume, comorbidity and performance status.

Age Distribution↗
PubMed1994

Is the peak in breast cancer incidence in sight? A study conducted in the southeastern Netherlands.

Breast cancer is the most frequent malignancy in the western world, and increases in the incidence have been observed worldwide. We investigated temporal trends in breast cancer incidence in the southeastern Netherlands between 1960 and 1989 by birth cohort analysis, using data of the Eindhoven Cancer Registry. An overall time-trend in incidence rate was estimated, based on age and year of diagnosis. Rate ratios were calculated, as the ratio of the observed versus the expected incidence rates, which was based on the estimated time-trend. In this unscreened population the age-specific incidence increased for every successive birth cohort in the period 1880-1949. Women born between 1940 and 1949 had the highest age-specific incidence rates with an excess of 10% (relative risk 1.10, 95% confidence interval 1.01-1.22). The incidence rates in women born after 1949 declined and were 21% lower than expected by the estimated secular trend (relative risk 0.79, 95% confidence interval 0.64-0.96). This decrease in incidence for women aged under 40 suggests that the peak in incidence of female breast cancer may be in sight. It remains unclear which risk factors are responsible for this changing trend.

Adult↗
PubMed1997

Improved survival of Hodgkin's patients in south-east Netherlands since 1972.

In the past 30 years, staging and treatment of Hodgkin's disease have changed dramatically, and prolonged remission can now be induced in the majority of patients. Our purpose was to assess improvement in long-term survival, previously reported for specific patient groups, among unselected patients diagnosed and treated between 1972 and 1993 in general hospitals in South-East Netherlands. Data on all 345 Hodgkin's patients were derived from the population-based Eindhoven Cancer Registry; histopathology and clinical records were reviewed. Follow-up was attained up to 1994. Relative survival rates, i.e. the ratio of observed to expected rates, were 80% after 5, 70% after 10 and 67% after 15 years. Independent prognostic factors for lower overall survival were (in decreasing order of significance): advanced age, histology (lymphocyte depletion), advanced stage and earlier period of diagnosis. Distribution of age and stage did not change over the study period, but there was a modest increase in the incidence of the nodular sclerosis histological subtype. Crude 5-year survival rates improved from 60% in the period 1972-1976 to 81% in the period of 1987-1992 (P < 0.005). The largest improvement occurred in the 1970s and was most prominent among those aged over 50 years. As previously reported, cured Hodgkin's patients exhibit a higher mortality rate, which can be explained by treatment-related long-term complications such as second malignancies and cardiovascular diseases. The relatively high survival rates compared to other population-based studies may be attributable to the existence of a regional network within the framework of a comprehensive cancer centre. Better staging, new combinations of chemotherapy, improved radiation technology, advances in supportive care as well as more frequent intensive treatment of the elderly could explain the improvement in prognosis.

Adult↗
PubMed1998

Organised cervical cancer screening still leads to higher coverage than spontaneous screening in The Netherlands.

In The Netherlands, early detection of cervical cancer by programme and spontaneous screening has been common practice for more than two decades. Both types of screening are mainly performed by general practitioners. Therefore, the question is raised of whether programme screening still enhances screening uptake. To answer this question, we analysed the national health interview survey in the years 1992-1996. The coverage rate, defined as the percentage of women with at least one smear taken in the previous 5 years, was 91% for women invited for programme screening compared with 68% for women not invited. The performance of the organised programme in reducing excessive screening, i.e. smears taken in excess of the recommended age and interval range, was not clear and the effect seemed small. Furthermore, we found that half the non-attenders were 'protected' by a recent smear or a hysterectomy, and of the unprotected women, 72% showed a positive attitude towards the programme. We conclude that even after a long history of cervical cancer screening, an organised programme is still required to ensure a high coverage.

Adult↗