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PubMed2005

Birth prevalence and survival in cystic fibrosis: a national cohort study in the Netherlands.

BACKGROUND: Birth prevalence and survival in patients with cystic fibrosis (CF) in the Netherlands were last investigated > 30 years ago. However, since then the birth prevalence may have decreased because of genetic counseling and an increased number of newborns of non-European descent. Although survival of CF patients has increased worldwide, a significantly lower median age at death was recently reported in the Netherlands compared with data from the United States. OBJECTIVES: To analyze birth prevalence and survival in CF patients in the Netherlands, and to compare this survival data with US CF data. DESIGN: Survey of all CF patients living in the Netherlands, and analysis of Dutch CF mortality statistics using data from the Dutch central statistics office, Statistics Netherlands (Voorburg, the Netherlands), and a comparison with Cystic Fibrosis Foundation (Bethesda, MD) patient registry data. SETTING: All CF centers in the Netherlands and the United States. PARTICIPANTS: All CF patients treated in the Netherlands on January 1, 2001, and all persons who died of CF between 1974 and 2000, and an equivalent US population. MEASUREMENTS: Birth prevalence and birth cohort-specific survival. RESULTS: The overall birth prevalence of CF for 1974 to 1994 was 1 in 4,750 live births, which is a considerable decrease compared with 1961 to 1965 (1 in 3,600 live births). Estimated survival to 30 years increased from 6% in the 1950-to-1954 cohort, to 36% in the 1970-to-1973 cohort. Exact survival could be calculated from 1974 onwards. Survival to 15 years increased from 72% from the 1974-to-1979 cohort, to 91% in the 1985-to-1989 cohort. Survival in the United States in the 1980-to-1984 cohort was better compared to the Netherlands, but this difference has disappeared over subsequent cohorts. CONCLUSIONS: The actual birth prevalence of CF in the Netherlands is clearly lower than it was 30 years ago. Survival in CF has dramatically improved. The difference in survival between the Netherlands and the United States, as observed in the cohorts born > 20 years ago, has disappeared.

Cohort Studies↗

PubMed2004

Experiences of foreign European nurses in The Netherlands.

As a result of the shortage of nurses, Dutch health care organizations want to recruit nurses from outside Europe (e.g. Indonesia, South Africa). The Dutch government, however, is not encouraging this policy and prefers to recruit within the European Union. In order to better support such nurses, it is important to know the problems European nurses encounter in The Netherlands. This study is about the experience of nurses from other European countries in The Netherlands. This paper addresses itself to three principal questions. First, how many nurses qualified in other EU or EU candidate states are starting to work in The Netherlands. Second, why do they come to The Netherlands. And finally what problems do they encounter when working in The Netherlands. A questionnaire has been send to all registered nurses trained in another EU or EU candidate state. The response has been 987 or 67%. Thus, far approximately 1500 nurses from other EU/candidate states have come to The Netherlands. Personal reasons, including marriage, are the most important reasons for their coming here. Half of the nurses took one or more courses before starting work in nursing in The Netherlands. These were often Dutch language courses. The nurses had to make a number of adjustments. Major difficulties were unfamiliarity with Dutch laws and the fiscal and social security systems, recognition of their qualifications and application for permits. Some basic issues, such as how to write a letter of application, caused problems. The language and unfamiliarity with the Dutch health care system made it difficult to find a job. When they had gained employment in nursing these problems remained the most serious. The conclusion is that international employment mobility in nursing is rather low in the case of The Netherlands. If the Dutch government decides to encourage the employment of nurses from abroad, several measures can be taken to make working in The Netherlands more attractive.

Adult↗

PubMed2001

Immigrants in the Netherlands: equal access for equal needs?

OBJECTIVE: This paper examines whether equal utilisation of health care services for first generation immigrant groups has been achieved in the Netherlands. DESIGN: Survey data were linked to an insurance register concerning people aged 16-64. Ethnic differences in the use of a broad range of health care services were examined in this group, with and without adjustment for health status and socioeconomic status, using logistic regression. SETTING: Publicly insured population in Amsterdam, the Netherlands. PARTICIPANTS: 1422 people from the indigenous population, and 378 people from the four largest immigrant groups in the Netherlands-that is, the Surinamese, the Netherlands Antilleans, and the Turkish and Moroccan. MAIN OUTCOME MEASURES: General practitioner service use (past two months), prescription drug use (past three months), outpatient specialist contact (past two months), hospital admission (past year), physiotherapist contact (past two months) and contact with other paramedics (past year). MAIN RESULTS: Ethnicity was found to be associated with the use of health care after controlling for health status as an indicator for need. The use of general practitioner care and the use of prescribed drugs was increased among people from Surinam, Turkey and Morocco as compared with the indigenous population. Compared with the indigenous group with corresponding health status, the use of all other more specialised services was relatively low among Turkish and Moroccan people. Among the Surinamese population, the use of more specialised care was highly similar to that found in the Dutch population after differences in need were controlled for. Among people from the Netherlands Antilles, we observed a relatively high use of hospital services in combination with underuse of general practitioner services. The lower socioeconomic status of immigrant groups explained most of the increased use of the general practitioner and prescribed drugs, but could not account for the lower use of the more specialised services. CONCLUSIONS: The results indicate that the utilisation of more specialised health care is lower for immigrant groups in the Netherlands, particularly for Turkish and Moroccan people and to a lesser extent, people from the Netherlands Antilles. Although underuse of more specialised services is also present among the lower socioeconomic groups in the Netherlands, the analyses indicate that this only partly explains the lower utilisation of these services among immigrant groups. This suggests that ethnic background in itself may account for patterns of consumption, potentially because of limited access.

Adolescent↗

PubMed2004

[Treatment of patients with acute coronary syndromes in the Netherlands in 2000-2001; a comparison with other European countries and with the guidelines].

OBJECTIVE: To determine whether the guidelines for the management of acute coronary syndrome (ACS) are being applied in daily clinical practice, and in what ways the management differs between the Netherlands and other member countries of the European Society of Cardiology (ESC). DESIGN: Prospective, observational study. METHOD: Patients with a confirmed diagnosis of ACS who were enrolled in 6 Dutch hospitals and in 97 hospitals in 24 other ESC member countries in the period from 4 September 2000 to 15 May 2001 were included. Data were collected on the acute treatment and secondary prevention in patients with ST-elevation and on the pharmacotherapy, risk stratification and secondary prevention in patients without ST-elevation. The findings were compared with the recommendations and guidelines of the ESC. RESULTS: A total of 223 patients with ST-elevation and 198 patients without ST-elevation were enrolled in the Netherlands, plus 4208 and 5169 patients, respectively, in the other European countries. The median age was 64-67 years and the percentage of males was 64-73. Of the patients with ST-elevation who arrived in the hospital within 12 hours after the onset of symptoms, 35% received neither thrombolysis nor primary percutaneus coronary intervention. In both the Netherlands and the rest of Europe, half of the ST-elevation patients received thrombolysis later than 40 minutes and primary percutaneous coronary intervention later than 90 minutes after arrival in the hospital. Risk stratification using troponin measurements was applied more often in the Netherlands. Of the high-risk patients without ST-elevation, over 50% in both the Netherlands and the rest of Europe underwent coronary angiography. Almost 70% and 80% of low-risk, non-ST-elevation patients underwent an exercise tolerance test or coronary angiography. In the Netherlands, clopidogrel, glycoprotein IIb/IIIa antagonists and statins were prescribed more often and ACE inhibitors less often. CONCLUSION: Guidelines for the management of ACS were followed to a moderate extent in both the Netherlands and the rest of Europe. The management differed in a number of ways between the Netherlands and the other countries.

Acute Disease↗

PubMed2001

Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly).

Older males are known to carry, more likely than younger people, one or more chronic diseases with an expected impact on mortality. This study was aimed at identifying the relationship of prevalent chronic diseases in elderly populations of different countries with all-cause mortality. Men aged 65-84 from defined areas were enrolled in Finland (N=716), the Netherlands (N=887) and Italy (N=682). They were survivors of cohorts studied for 25 years within the Seven Countries Study. Major chronic diseases were diagnosed at entry. Ten-year follow-up for mortality was completed. Entry prevalence of selected chronic diseases was higher in Finland (56%) than in Italy (51%) and the Netherlands (44%). Ten-year age-adjusted death rates from all causes were higher in Finland (565 per 1000) and lower in the Netherlands (478 per 1000) and Italy (445 per 1000). The absolute risk of death related to chronic disease was high in the three countries, but was higher in Finland than in the Netherlands and Italy. The most lethal condition was stroke, with 10-year death rates of 806 per 1000 in Finland and 707 and 729 per 1000 in the Netherlands and Italy, respectively. The relative risk of all-cause mortality for a set of seven chronic diseases (coronary heart disease, heart failure, claudicatio intermittens, cerebrovascular accidents, diabetes, COPD and cancer) adjusted by age, other diseases and cohort was less than two for each condition, except cerebrovascular accidents in the Netherlands (RR 2.20). In general, relative risk was higher in Finland, intermediate in the Netherlands and lower in Italy, where only cerebrovascular accidents, intermittent claudication, diabetes and the presence of any chronic condition had a significant relative risk. About one third of men had one chronic disease, and between 10% and 15% had two diseases. The coexistence of any two or three chronic conditions was associated with a relative risk of 2 or more in Finland and the Netherlands and less than 2 in Italy. In these elderly men prevalent morbidity and comorbidity was relatively common and it explained a large proportion of excess in all-cause mortality in 10 years of follow-up.

Aged↗

PubMed2000

Schizophrenia among Surinamese in the Netherlands: high admission rates not explained by high emigration rates.

BACKGROUND: A high risk of schizophrenia has been found among Caribbean immigrants in the Netherlands and Great Britain. One hypothesis to explain these findings is that patients with a diagnosis of schizophrenia or patients with symptoms of psychosis not specifically diagnosed, emigrate more than the general population. Such selection might account for high rates of Surinamese patients with a diagnosis of schizophrenia in Netherlands psychiatric hospitals. We examined this hypothesis. METHODS: The files of patients with schizophrenia or patients suffering from unspecified psychosis were selected from the archives of the National Psychiatric Hospital in Surinam. These patients were traced to investigate patterns of emigration. Data from the Central Bureau for Statistics in the Netherlands and from the Central Population Bureau in Surinam provided the percentage of the general Surinamese population that emigrated to the Netherlands. The difference between the two percentages was evaluated using the chi-squared test. Using the same method the percentage of remigration from the Netherlands among Surinamese patients was compared with the percentage of remigration among the general Surinamese population. RESULTS: Surinamese patients with schizophrenia or unspecified psychosis did not emigrate more frequently to the Netherlands compared with the general Surinamese population. They did remigrate significantly more frequently. CONCLUSION: High migration rates do not explain the high hospital admission rates for schizophrenia among Surinamese in the Netherlands.

Adolescent↗

PubMed1996

Outcomes associated with diabetes-related amputations in The Netherlands and in the state of California, USA.

OBJECTIVE: The purpose of this study is to compare the incidence, relative risk, in-hospital mortality and hospital stay of diabetes-related lower extremity amputations in the state of California and the Netherlands in the year 1991. RESEARCH DESIGN AND METHODS: We used established data obtained from the Office of Statewide Planning and Development for the state of California and from SIG Health Care Information in the Netherlands to identify all hospitalisations for lower extremity amputations. We used age- and sex-specific prevalence rates of diabetes mellitus from the National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey for the state of California and rates from the Central Bureau of Statistics for the Netherlands. A direct standardisation technique with the 1991 Netherlands population as the standard population was used to calculate age-adjusted incidence rates. Age was categorised into four different groups: 25-44, 45-64, 65-74 and 75+. Amputations were defined by four levels; toe, foot, leg and thigh. RESULTS: The age-adjusted incidence of diabetes-related lower extremity amputations was significantly higher in the state of California than in the Netherlands (49.9 vs. 36.1 per 10000 diabetics, P < 0.01). The relative risk, comparing the risk in the diabetic with that in the non-diabetic population, was California 23.7 vs. the Netherlands 19.7. The length of hospital stay was significantly higher in the Netherlands: 40.8 vs. 16.0 (P < 0.01). CONCLUSIONS: There are some significant differences in the outcomes associated with diabetes-related lower extremity amputations. Some of these differences may be explained by differences in access to health care.

Adult↗

PubMed2002

[A comparative study of the expenditures on health research in 7 western countries in 1997 places the Netherlands at the bottom of the list].

OBJECTIVE: To compare the expenditures on health research in the Netherlands with those in other Western countries. DESIGN: Descriptive. METHOD: The expenditures on health research in 1997 were determined for the Netherlands, the United Kingdom, Germany, Norway, Denmark, Sweden and the USA and subsequently classified into: governmental funding for research in medical faculties or clusters; grants from MHRCs and other bodies; and private funding from industry and charities. The sources of information were the total research budgets 2002 of the Dutch Ministry of Education, Culture and Science, annual reports from charities, the Dutch Central Statistical Bureau and, for foreign countries, MHRCs or comparable institutions. RESULTS: In 1997, the Netherlands spent the equivalent of 855 million US dollars on health research (extremes of the investigated countries: 382 (Norway)-32,283 (USA)). This was less than in the other countries, whether calculated per capita, in US dollars (55 (Netherlands)-159 (Sweden)), as a promillage of the gross national product (2.27 (Netherlands)-5.84 (Sweden)), or as a percentage of the total expenditures for health care (2.62 (Netherlands)-7.54 (UK)). Especially the industrial expenditures on health research in the Netherlands were low, but the governmental expenditures were also lower than in the other countries.

Budgets↗

PubMed2005

[Recognition of the threats caused by infectious diseases in The Netherlands in 2002 and 2003 by the weekly meetings of the early warning committee].

OBJECTIVE: To establish whether the meetings of the so-called 'early warning committee' recognise all the threats to the public health in the Netherlands caused by infectious diseases. DESIGN: Retrospective and descriptive evaluation. METHOD: The information about the outbreaks of infectious diseases in the Netherlands and about events in the area of infectious diseases in foreign countries was compared with the domestic and foreign reports discussed in the regular weekly meetings of the Dutch early warning committee. For this purpose, the authors summarized the outbreaks of infectious diseases in the Netherlands in 2002 and 2003 as reported in articles in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine). This summary was then compared with the domestic reports discussed in the meetings of the early warning committee. If an outbreak was not mentioned in the meetings of the early warning committee, the cause for this was established. For the same period, a summary was made of the foreign events in the area of infectious diseases and this was also compared with the foreign reports mentioned in the meetings of the early warning committee. When an event had not been discussed in the meetings of the early warning committee, it was established on the basis of criteria whether the event could have been a threat to public health in the Netherlands. RESULTS: All outbreaks of infectious diseases in the Netherlands had been discussed in the early warning committee. Of the foreign events in 2002, 3 had not been discussed in the committee although they should have been, based on the criteria for a potential threat to the Netherlands: the outbreak of avian influenza A/H5NI in domestic fowl in Hong Kong, the increase among hospitalised patients of carriers of extended-spectrum 3-lactamase producing micro-organisms in Scotland, and outbreaks of measles in several countries. In 2003, all foreign events that could have been a threat to the Netherlands were discussed in the early warning committee. CONCLUSION: In 2002 and 2003, the meetings of the early warning committee recognised practically all the outbreaks of and threats due to infectious diseases.

Communicable Disease Control↗

PubMed1998

[Genetic carrier screening for hemoglobinopathies in the Netherlands is not opportune].

OBJECTIVE: To investigate whether screening for carriership of sickle-cell anaemia and thalassaemia is desirable in the Netherlands, given the prevalence of the diseases, the possibilities of a screening test and the knowledge of the population at risk. DESIGN: Descriptive. SETTING: Wilhelmina Children's Hospital, Clinical Genetic Centre, Utrecht, the Netherlands. METHODS: In September 1992 Dutch paediatricians were treating 128 children with sickle-cell anaemia and 31 with thalassaemia major. Between October 1992 and December 1994, sickle-cell anaemia was diagnosed in 40 children and thalassaemia major in 14; of these, 16 and 4, respectively, had been born in the Netherlands. A protocol for the screening for carriership adjusted to the Dutch situation was drawn up in the past, with an estimate of the corresponding costs. Patients with sickle-cell anaemia or thalassaemia major, their families, care givers and persons without disease but originating from Surinam, the Netherlands Antilles, Turkey or Morocco were interviewed about their knowledge of these two diseases. RESULTS: The knowledge of the diseases was low among the Turkish and Moroccan populations, and very global among the Surinamese and Antillian populations. There was more belief in supernatural causes than in a genetic predisposition. CONCLUSION: Given the low number of newly diagnosed haemoglobinopathies in children born in the Netherlands, the poor knowledge of the disease of the population at risk, the difficulty in identifying the best moment in life for screening and the rather complicated screening method, a screening programme for carriership of haemoglobinopathies in the Netherlands is not opportune. Where sickle-cell anaemia is concerned, screening for this disease during the neonatal period might be considered.

Anemia, Sickle Cell↗

PubMed2005

Explaining differences in incidence rates of pleural mesothelioma between Sweden and the Netherlands.

In recent years in several countries a deceleration or leveling off of pleural mesothelioma rates has been observed. The impact of asbestos used was analysed by comparing a country with a relative modest incidence rate of mesothelioma (Sweden) and an early response to asbestos use with a country with one of the highest incidence rates of mesothelioma in Western Europe (The Netherlands). In Sweden the Cancer Register provided information on the annual incidence of pleural mesothelioma, whereas in The Netherlands mortality data were provided by Statistics Netherlands for the period 1969-2001. In The Netherlands among men the incidence rate was consistently higher (1.5-2 times) than in Sweden, whereas among women similar rates were observed. Assuming that none of the female cases was caused by occupational exposure to asbestos, minimum estimates of the etiologic fraction for occupational exposure to asbestos in men would be 82% in Sweden and 92% in The Netherlands. Possible explanations for the consistently higher incidence rates in the Netherlands than in Sweden include differences in exposure levels, the proportion of exposed subjects in the workforce and types of asbestos fibres used. Measures to decrease the exposure to asbestos seem to have decreased the risk of pleural mesothelioma in both countries among age groups below 60 years. This effect will result in a leveling off of the increase in pleural mesothelioma in both countries in the next decade.

Adult↗

PubMed1996

Regional variation in the incidence of diabetes-related amputations in The Netherlands.

The purpose of this study is to identify the incidence of diabetes-related lower extremity amputations in 27 health regions in the Netherlands. A secondary database was used that contains all hospitalizations for a lower extremity amputation in the Netherlands in 1991 and 1992, recorded separately for 27 health regions. The age-adjusted incidence lower extremity amputations per 10,000 diabetic patients in the Netherlands was 25.05, and among the regions it ranged from 10.15 to 44.64. In the non-diabetic population, the age-adjusted incidence in the Netherlands was 1.24 and ranged by region from 0.77 to 1.77. Overall, diabetic males had higher age-adjusted incidence rates than diabetic females, although in four health regions the situation was reversed. In the Netherlands, there was an increasing incidence of diabetes-related lower extremity amputation as age increased: < 45 years, 11.15; 45-64 years, 33.84; 65-74 years, 61.22; and 75 + years, 107.92 (P < 0.001). This continued to be a significant phenomenon for every health region (P < 0.001). This study found a wide range in the incidence of diabetes related lower extremity amputations in the 27 health regions in the Netherlands. A possible explanation could be differences in the severity of diabetes, in local treatment philosophies or the availability of subspecialties.

Adult↗

PubMed2003

Epidemiologic impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands.

BACKGROUND: Streptococcus pneumoniae is one of the main causes of bacterial meningitis, bacteremia, pneumonia, and otitis media in the Netherlands. These diseases lead to substantial mortality, morbidity, and costs. The societal impact is especially severe because most cases occur in very young infants. OBJECTIVE: The aim of this study was to estimate the epidemiological impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands. METHODS: Decision analysis was performed using epidemiological data and data on health care resource use from 1996 to 2001. A model was used to project the impact of pneumococcal vaccination on the incidence of pneumococcal infections in infants and children from birth to age 10 years. Costs, benefits, and health gains were estimated, and cost-effectiveness was calculated. All analyses were performed from a societal perspective. RESULTS: On average, 339 cases per year of invasive pneumococcal infection occurred in infants and children from birth to age 10 years in the Netherlands from 1996 to 2001. The model predicted that introduction of the 7-valent conjugated pneumococcal vaccine would prevent 48 cases of bacterial meningitis and 88 cases of pneumococcal bacteremia per year, as well as 42,695 cases of pneumococcal otitis media and 3411 cases of invasive pneumococcal pneumonia. The model also predicted that vaccination would save 13 lives per year and prevent 31 cases of lifelong sequelae, rendering 382 discounted quality-adjusted life-years (QALYs) gained or 329 discounted life-years gained per year. Considering these health gains, vaccination would prevent Euro 9,453,600 of direct and indirect medical costs of meningococcal and pneumococcal infections in the Netherlands, including acute medical care, management of sequelae, and lost time at work. With a vaccine price of Euro 40 per dose, the base-case cost-effectiveness ratio would be Euro 71,250 per QALY. The model was sensitive to changes in incidence of infections, vaccine effectiveness, and vaccine price. CONCLUSIONS: Our analytic model predicted that universal pneumococcal vaccination of infants in the Netherlands could prevent a large number of pneumococcal infections and considerably reduce related mortality and morbidity. However, the baseline cost-effectiveness ratio of such a vaccination program would be relatively unfavorable compared with other interventions implemented in the Netherlands.

Cost-Benefit Analysis↗

PubMed1999

Prevalence of antibodies against canine herpesvirus 1 in dogs in The Netherlands in 1997-1998.

Canine herpesvirus (CHV1) is found in dogs all over the world and may spread by oronasal or sexual contact. We developed an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against CHV1 in dogs. The antigen used for this ELISA was prepared by purifying CHV1 virions from the medium of infected A72 cells. To investigate the prevalence of CHV1 in The Netherlands, a panel of 145 sera of dogs boarding at a kennel in Lelystad, The Netherlands, was screened using this ELISA. The dogs originated from all parts of The Netherlands and represented many different breeds. The sera were collected both at the start and at the end of the boarding period. Of the 145 paired sera 61 (42.1%) were positive, 79 (54.5%) were negative and 5 (3.4%) could not be attributed to either group. None of the negative dogs became seropositive during the boarding period, which lasted normally two to three weeks. We also tested 79 individual sera taken from dogs at various other places in The Netherlands and found that 27 (34.2%) were positive. Hence, in total 224 dog sera, collected from April 1997 to March 1998, were tested and 88 (39.3%) were found positive. We conclude that the prevalence of CHV1 seropositive dogs in The Netherlands in this period was about 40%, and that boarding at a dogs kennel did not contribute to the spread of CHV1. In addition, CHV1 has been isolated from two clinical cases of fatal haemorrhagic disease in The Netherlands.

Animals↗

PubMed1999

Geographic clustering of testicular cancer incidence in the northern part of The Netherlands.

Geographic variations in testicular cancer incidence may be caused by differences in environmental factors, genetic factors, or both. In the present study, geographic patterns of age-adjusted testicular cancer incidence rates (IRs) in 12 provinces in The Netherlands in the period 1989-1995 were analysed. In addition, the age-adjusted IR of testicular cancer by degree of urbanization was evaluated. Cancer incidence data were obtained from the Netherlands Cancer Registry. The overall annual age-adjusted IR of testicular cancer in The Netherlands in the period 1989-1995 was 4.4 per 100000 men. The province Groningen in the north of the country showed the highest annual IR with 5.8 per 100000 men, which was higher (P < 0.05) than the overall IR in The Netherlands (incidence rate ratio (IRR) 1.3, 95% confidence interval (CI) 1.1-1.6). The highest IR in Groningen was seen for both seminomas and non-seminomas. In addition, Groningen showed the highest age-specific IRs in all relevant younger age groups (15-29, 30-44 and 45-59 years), illustrating the consistency of data. The province Friesland, also situated in the northern part of the country, showed the second highest IR of testicular cancer with 5.3 cases per 100000 men per year (IRR 1.2, 95% CI 1.0-1.5, not significant). This mainly resulted from the high IR of seminoma in Friesland. Analysis of age-adjusted IRs of testicular cancer by degree of urbanization in The Netherlands showed no urban-rural differences at analysis of all histological types combined, or at separate analyses of seminomas and non-seminomas. Geographic clustering of testicular cancer seems to be present in the rural north of The Netherlands with some stable founder populations, which are likely to share a relatively high frequency of genes from common ancestors including genes possibly related to testicular cancer. Although this finding does not exclude the involvement of shared environmental factors in the aetiology of testicular cancer, it may also lend support to a genetic susceptibility to testicular cancer development. Testicular cancer cases in stable founder populations seem particularly suitable for searching for testicular cancer susceptibility genes because such genes are likely to be more frequent among affected men in such populations.

Adolescent↗

PubMed2001

Pediatric surgery in The Netherlands.

Pediatric surgery in The Netherlands differs from pediatric surgery in other European countries. This article deals with the general structure of Dutch pediatric surgery and some of its particularities. Although pediatric surgery is not officially recognized in The Netherlands, the Dutch have found a way of selecting and centralizing children who need surgical therapy in 6 centers of excellence. This has been mainly achieved by agreements between scientific professional organizations. The limited number of academic pediatric surgical centers guarantees a high quality of skill and care, and a lot of clinical exposure for trainees. On the other hand, allowing general surgeons to do most of the surgery in children, albeit the less complicated procedures, may not be ideal. The limited number of trainees does not allow for a nation-wide training program. The small number of pediatric surgeons and trainees make pediatric surgery in The Netherlands vulnerable, both in field of care as well as in the field of research. As pediatric surgery in The Netherlands is not recognized as such, pediatric surgeons who have been trained in most of the other European countries but have not completed their general surgery training, cannot be employed as pediatric surgeons in The Netherlands. However, pediatric surgery in The Netherlands has found a comparatively clear way of defining its distinctive areas of clinical work. It cannot be overlooked and is well established in the academic centers of the country.

General Surgery↗

PubMed2002

The epidemiology of total hip replacement in The Netherlands and Sweden: present status and future needs.

By combining data from the Discharge registers and the census bureaus in The Netherlands and Sweden, we calculated the age-specific incidences of primary total hip replacement (THR), studied the demographic profile of the population receiving THR and predicted demands. In the period 1986-1997, the number of THRs increased by 20% in Sweden to 10,000 operations (113/100,000 inhabitants) and by 68% to 17,400 operations (112/100,000 inhabitants) in The Netherlands. Of this increase 3% and 15% could be explained by changes in the age-profile and size of the population, respectively. Although the overall incidence of THR was similar in both countries in 1997, we found that, after correction for differences in population structure, the incidence of THR was 20% higher in The Netherlands. In Sweden, relatively more men were operated on than in The Netherlands. We also found that in Sweden, but not in the Netherlands, relatively more older people were operated on in 1997 than in 1987. Assuming no further change in the age- and sex-specific arthroplasty rates, the predicted annual number of total hip replacements by the year 2020 will increase by at least one fourth in Sweden and almost one half in The Netherlands.

Adult↗

PubMed2003

Emergency medicine in the Netherlands, the necessity for changing the system: results from two questionnaires.

OBJECTIVE: To obtain information about patient, staff and organization characteristics of Emergency Departments in the Netherlands, and evaluate the changes between 1996 and 1999. METHODS: The heads of the Emergency Departments of all hospitals in the Netherlands were sent a questionnaire concerning patient, staff, and organization characteristics, as well as questions about intended future developments. The results were compared with data obtained from a comparable questionnaire in 1996. RESULTS: In the Netherlands, 113 hospitals (113/126) have an Emergency Department; 105/113 returned the questionnaire (93%). Ninety-two percent of the hospitals reported an increase in annual Emergency Department census and in the number of self-referred patients. The number of Emergency Departments staffed by only surgical residents decreased (52% in 1996 versus 41% in 1999), whereas the number of hospitals employing emergency physicians increased (24% in 1996 versus 45% in 1999). In 92% of the hospitals, nurses who work in the Emergency Department receive specific training. For emergency physicians, a specific training programme is not available, and in fact 30% of the physicians did not have any specific emergency medicine training. Therefore, none of the emergency physicians were fully trained in emergency medicine. According to 88% of all responders, there is a future for emergency medicine as an independent speciality in the Netherlands, and 35% of all hospitals intend to initiate a training programme for emergency physicians in the future. CONCLUSION: Almost all hospitals in the Netherlands reported an increase in the number of patients visiting the Emergency Department, especially in the number of self-referred patients. A majority of the Emergency Departments are now staffed by emergency physicians instead of surgical residents. Developing specific training programmes for emergency physicians should be a priority for the Netherlands in the future.

Emergency Medicine↗