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BACKGROUND: This study aims at identifying determinants of all-cause mortality in elderly populations of different countries. METHODS: Men ages 65-84 years from defined administrative areas were enrolled in Finland (rural areas of east and west Finland; N = 693), in the Netherlands (the town of Zutphen; N = 851), and in Italy (the rural areas of Crevalcore and Montegiorgio; N = 682). They were survivors of cohorts studies for 25 years within the Seven Countries Study with the addition of a subgroup of the same ages in the Netherlands. RESULTS: Five-year death rates from all causes were higher in Finland (297 per 1000), intermediate in the Netherlands (231 per 1000), and lower in Italy (191 per 1000). Five-year all-cause mortality was studied in relation to measurements taken at entry (age, systolic and diastolic blood pressure, non-high-density lipoprotein (HDL) and HDL cholesterol, body mass index, heart rate, smoking habits, and presence of coronary heart disease manifestations). Univariate and multivariate analyses were performed (in the latter models, both linear and quadratic terms were used for most variables) with all-cause mortality as endpoint. Results suggested significant predictive power of age (direct relationship) and, in most cases, U-shaped relationships of risk factors to mortality. Non-HDL cholesterol showed significant relationships with mortality in Finland and the Netherlands, HDL cholesterol in all three countries, systolic blood pressure only in Finland, body mass index in Finland and the Netherlands, smoking habits only in Finland, and heart rate in none. Levels of risk factors associated with the lowest death rate in the pool of all countries were 183.3 mg/dl for non-HDL cholesterol, 59.8 for HDL cholesterol, 177.5 mm Hg for blood pressure, and 30.2 kg/m square for body mass index. CONCLUSIONS: In these elderly men the association of traditional risk factors with all-cause mortality is reduced, U-shaped, or even inverted. This is probably due to selection due to previous mortality, to comorbidity, and to changes in homeostatic mechanisms.
OBJECTIVE: To inventory the difference in ambulance assistance in the Netherlands and the USA and to formulate recommendations to improve this assistance in the Netherlands. DESIGN: Study trip to the USA and enquiry. SETTING: USA and Central Post Ambulance Transportation (CPAs) in the Netherlands. METHOD: At 19 different ambulance and two helicopter services in the USA inventories were made of the training requirements, communication methods, logistics, methods of immobilization and extramural assistance. Questions on the same aspects were asked in an enquiry of 41 heads of Dutch CPAs. RESULTS: Thirty-seven questionnaires were returned. It appears that the American ambulance attendant is much better trained than his Dutch counterpart. In 81% of the Dutch ambulances this is compensated by presence of a qualified nurse. The requirements to be met by dispatchers vary in the two countries, but the American dispatchers work according to fixed protocols and special dispatcher training exists. In the Netherlands, communication is unnecessarily delayed by lack of equipment and because the ambulance attendants can only communicate with the hospital via the dispatcher. In the USA, the ambulance that is closest is always sent out, in 6 Dutch CPAs this is not the case. In the USA, use is being made according to protocol of better immobilization materials than those used in the Netherlands. CONCLUSION: The training requirements for ambulance attendants and dispatchers should be tightened up and dispatchers should be issued with protocols. In addition, the communication between the switchboard, the ambulance and the hospital and the means of immobilization used should be improved. Use of the scoop stretcher is considered inadvisable.
OBJECTIVES: Substantial increases in incidence and mortality rates for primary brain tumors have been reported in many, but not all, countries over the past several decades. We analyzed incidence rates for (potential) primary malignant central nervous system (CNS) tumors in an area (southeastern Netherlands) and during a period (1980-94) in which access to healthcare was good and computerized tomography (CT) was available. METHODS: Data were obtained from the Eindhoven and Maastricht cancer registries, representing a population of 936,000 and 847,000 inhabitants, respectively. Cases were identified of primary CNS tumors (ICD-0 codes 191, 192, excluding lymphomas) and brain metastases from an unknown primary site (code 199) and data on mortality according to gender and region were provided by Statistics Netherlands. RESULTS: Incidence rates in three-year periods of primary CNS cancer remained stable, also for patients aged 60 years and older. Mortality/incidence ratios ranged from 0.6 to 0.9. Although more CNS cancers were histologically verified in recent years, especially in the Eindhoven region, changes in diagnosis probably did not influence the overall trend of primary CNS cancer. CONCLUSIONS: Major changes in the incidence of the most common types of primary CNS cancers (i.e., high-grade astrocytomas) were unlikely in southeastern Netherlands.
The first results are presented of the newly established Netherlands Cancer Registry, which covers the whole Dutch population (approximately 15 million people). The registry receives data on incident cancer cases from nine autonomous regional cancer registries. Notification occurs primarily through the national registry of all pathology and haematology departments, with additional reporting by medical records' departments of all hospitals. Data on cancer patients are abstracted directly from the medical records by trained registration clerks. In the years 1989-1990, the most common cancer sites among males were cancers of the lung, prostate and colon. For females, breast cancer ranked first, followed by cancer of the colon and lung. A comparison with age-adjusted (world standard population) incidence rates reported by other western cancer registries showed a relatively high incidence of lung cancer among males (72.9 per 100,000) and breast cancer among females (76.2 per 100,000). Through its near completeness and the high quality of the registered data, the Netherlands Cancer Registry offers excellent opportunities for epidemiological and clinical research.
BACKGROUND: Little is known about the prevalence of bipolar disorder in the general population, what proportion is receiving care and what factors motivate people to seek help. METHOD: Data were derived from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in the general population in The Netherlands. DSM-III-R diagnoses were based on the Composite International Diagnostic Interview (CIDI). RESULTS: Lifetime prevalence of bipolar disorder was 1.9%. Compared to other mental disorders, people with bipolar disorder were more often incapacitated were more likely to have attempted suicide and reported a poorer quality of life 82.8% had experienced an additional mental disorder in their lifetime; 25.5% had never sought help for their emotional problems, not even primary, informal or alternative care. LIMITATIONS: Three limitations of the study are: (1) the CIDI prevalence estimates for bipolar disorder may be inflated; (2) personality disorders were not recorded in the NEMESIS dataset; (3) in NEMESIS certain groups have not been reached. CONCLUSION: Three-quarters of the bipolar respondents do not benefit sufficiently from the treatment methods now available. In view of the serious consequences of this condition, greater efforts are needed to reach people with bipolar disorder, to get them into treatment.
A working party of the Netherlands Heart Foundation has formulated guidelines which are simple and uniform in order to encourage maximum compliance. They have been widely publicised among medical and dental practitioners as well as patients. Cardiac conditions requiring or not requiring prophylaxis have been identified. Specific regimens for dental procedures, genito-urinary and gastrointestinal procedures, and drainage of infected tissue have been recommended. A case-control study revealed that compliance with recommendations was low even though patients were aware of the need. While prophylaxis may be worthwhile for the individual, it is concluded that even strict adherence will do little to decrease the incidence of endocarditis in the Netherlands.
Since the early 1980s a new set-up for a nation-wide cancer registry in the Netherlands has been developed. Recently, the 1989 incidence rates were published in the first national report. A total of 55,500 invasive tumours were registered (29,500 in males and 26,000 in females). After correction for age according to the European standard population figures, the incidence rates for all malignancies were 443 per 100,000 males and 309 per 100,000 females (excluding basal cell carcinomas of skin). Over 70% of all patients were 60 years of age or older. The most common cancers were lung cancer in males and breast cancer in females, accounting for 24% and 31% of the total cancer incidence by sex, respectively. The incidence rates of lung cancer and other tobacco related cancers in males were relatively high, as compared to those in other Western European countries. The Netherlands Cancer Registry offers new opportunities for clinical and epidemiological research.
OBJECTIVE: To determine the prevalence of psychiatric disorders in non-institutionalised Dutch adults. DESIGN: Cross-sectional. SETTING: Trimbos Institute, Utrecht, the Netherlands. METHODS: A representative sample of 7076 adults (18-64 years) in the Netherlands' population were interviewed in 1996 to determine the prevalence of mental disorders ever, in the previous 12 months and in the previous month. Objectives and study design are described in the previous article (1997: 2448-52). The 'Composite international diagnostic interview' (CIDI) was used to assess the following mental disorders according to Diagnostic and statistical manual of mental disorders, 3rd revised edition (DSM-III-R): affective disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, substance dependence and substance abuse. RESULTS: Mental disorders were common in the general population: the prevalence 'ever' of all disorders was 41.2%, the 12-month prevalence 23.5%, without sex differences. Depression, anxiety disorders and alcohol abuse and dependence showed high prevalence and comorbidity. The prevalence 'ever' of schizophrenia and other non-affective psychoses was low (0.4%).
The worldwide problem of antibiotic resistance of bacteria is a point of concern in the Netherlands as well. Responsible use of existing antibiotics was the incentive to establish a foundation, with the acronym SWAB, the primary goal of which is to optimize the use of antibiotics in the Netherlands in order to diminish the development of antibiotic resistance. One of the SWAB projects is the development of national guidelines for the use of antibiotics in hospitals. These guidelines are prepared by a committee of experts and reviewed by external consultants: infectious disease specialists, medical microbiologists and pharmacists. The revised version of the guidelines is submitted for publication in this journal. The SWAB hopes that these guidelines will make the prevention of antibiotic resistance a major factor in the choice of the antibiotic. Streamlining antibiotic therapy is an important tool in this respect.
Plasma vitamin D metabolites and parathyroid hormone concentrations of two groups of white women, aged 26-46 and 63-83 y, in Curaçao were studied to evaluate the effect of yearlong abundant sunlight on frequency of vertebral compression fractures in elderly women. 25-Hydroxyvitamin D of the younger group (median, 116 nmol/L) was higher than that of the older group (75 nmol/L). Both groups had higher 25-hydroxyvitamin D compared with approximately age-matched counterparts in The Netherlands during autumn and winter (50 and 25 nmol/L, respectively). Similar differences were found for 1,25-dihydroxyvitamin D, although to a lesser extent. Parathyroid hormone concentrations of older women in Curaçao (4.3 pmol/L) were higher than those of the younger women (2.3 pmol/L). Roentgenographic analyses of the spines of the older women did not show vertebral compression fractures commonly encountered in women living at higher latitudes. Uninterrupted high plasma concentrations of vitamin D metabolites may reduce vertebral compression fractures in postmenopausal white women.
Patients with monoclonal gammopathies comprise a heterogenous group. The few studies on incidence and follow-up are single-centre-based and may reflect referral bias. To avoid this, all patients (n=1275) in midwestern Netherlands with a newly discovered paraproteinaemia in 1991, 1992 and 1993 were included in a population-based registry and divided into four major diagnostic groups: multiple myeloma and plasmacytoma (n=230, 18%), other haematological diseases (n=141, 11%), paraprotein-related internal diseases (n=191, 15%) and monoclonal gammopathy of undetermined significance (MGUS, n=713, 56%). To avoid a possibly erroneous diagnosis, patients who were classified as having MGUS but who did not undergo confirmatory bone marrow examination were included in a separate group 'provisional MGUS' (n=524, 41%), whereas patients who did were classified as having 'definite MGUS' (n=189, 15%). The 'provisional MGUS' patients were relatively older and had more often a poor performance status, but differences between this and the 'definite MGUS' group were otherwise small. Patients complaining of general malaise more often had a full work-up of their paraproteinaemia. Bone pain, hypercalcaemia, high total protein, and high ESR occurred predominantly in the myeloma group, whereas fever or infection was less often seen in these patients. This registry of patients with paraproteinaemias provided valuable data related to all different diseases associated with paraproteinaemia.
In The Netherlands, quality assurance activities in hospitals began in 1976 with a formal declaration of the National Specialists Organization that quality assurance is a task of the medical profession. It was also recognized that physicians in hospitals were as yet unable to execute the various tasks that come with formal quality assurance. Hence the creation of a support organization that would assist clinicians in taking up and fulfilling their commitment to quality assurance. The creation of CBO took place in 1979; its role has been expanded to encompass such functions as technical assistance, education and training, research and development, acting as a clearing-house, and providing a forum. CBO has recently obtained an additional function; acting as a role model for similar structures in other countries in Europe and on other continents. A network of support organizations has been formed through which the development of quality assurance in health care is furthered.
BACKGROUND: The unadjusted annual mortality rate among prevalent Dutch dialysis patients increased from 1981 to 1992. Part of this increase may be attributed to the ageing of the dialysis population, but hardly any data were available on other important prognostic features of new Dutch dialysis patients, such as co-morbidity and other aspects of their clinical condition. The aim of the present study was to obtain these data and to put them into a European perspective. METHODS: Two hundred and fifty consecutive new patients were included in this prospective multi-centre study. Data were collected 3 months after start of dialysis. Multivariate linear regression analysis was used to explain the variability of parameters of nutritional state and blood pressure. RESULTS: Mean age was 57 years, co-morbid conditions were present in 51%, diabetes mellitus in 18%, and cardiovascular disease in 28%. Decreased protein intake was related to diminished residual renal function. Our patients did not have more co-morbidity than Dutch patients participating in a European study some years earlier. Comparison with other studies was complicated by the use of different definitions of co-morbidity and of selected patient populations. CONCLUSIONS: Despite the fact that Dutch dialysis patients have become older and the incidence of diabetic nephropathy has increased, no conclusions could be drawn on a concomitant increase in co-morbidity. This patient group may serve as a reference population to study future changes in patient case-mix within the Netherlands. Furthermore, the use of common international definitions of co-morbidity is needed to be able to make comparisons of survival data.
BACKGROUND: Many guidelines on the management of Helicobacter pylori (HP)-related dyspepsia have been launched over the past decade. The suggested policies in these guidelines are often more consensus- than evidence-based (test-and-treat policy, test and endoscope), which may cause confusion among primary-care physicians. AIM: To determine the current management of HP-related dyspepsia by Dutch general practitioners (GPs). METHODS: A random sample of 5% of all Dutch GPs (n = 355) were sent a questionnaire on the diagnosis and treatment of HP infections in dyspepsia management. RESULTS: The response rate was 66.2% (n = 235). Almost 80% of the responding GPs stated they had conducted HP testing (via endoscopy or serology) during the previous 12 months. In the same time period, more than 94% had actually prescribed a HP eradication therapy. A total of 70% of the GPs stated that they used endoscopy to test for HP infection, 54% used serology (ELISA); whole-blood tests and carbon urea breath tests were not used. Patients with a history of peptic ulcer disease, those on chronic acid-suppressive drugs and patients with recurrent ulcer-like complaints were most frequently tested for HP infection. CONCLUSIONS: Given the frequency of consultations for dyspepsia in primary care in the Netherlands (150 new dyspeptic patients per average practice per year), and the reported average number of HP tests performed (1-5 per GP per year), HP diagnosis plays a modest role in the management of dyspepsia in Dutch general practices. Neither the 'test-and-treat' policy recommended in the Maastricht guidelines, nor its advice regarding the choice of diagnostic tests (carbon urea breath test or serology), is being followed. The majority of GPs uses endoscopy for the detection of HP infection.
The introduction of the automatic external defibrillator could become an important improvement in the treatment of sudden cardiac arrest in the Netherlands, if the legal regulations for the treatment of sudden cardiac death in the Individual Healthcare Professions Act are modified. The time gained in the recovery of the cardial function is considerable. The use of this device by patrolling police teams and its installation at places where a lot of people congregate would seem to be particularly promising. However, whether the presence of an automatic external defibrillator in the home situation would provide any benefits remains questionable.
What do scientific advisory boards such as the Health Council of the Netherlands get their authority from? How does the Council ensure that its advice is incorporated into policy and into the practices at which the advice is directed? A frequently heard answer to this question is: by describing 'the state of knowledge' as optimally as possible. However, case studies on advisory work by the Health Council have shown that this explanation is too simplistic. It is more likely that the explanation lies in the use of 'co-ordination tools'--such as problem definition, the committee process and a specific use of language--that enable the Council to both separate and bridge science and policy. The authority of the Council is based on the hybrid nature of its work.