Determinants of regional differences in lung cancer mortality in the Netherlands

Although regional differences in lung cancer mortality are likely to be attributable to regional differences in tobacco smoking, studies in various countries found only weak relationships. This paper aimed at explaining regional differences in lung cancer mortality in the Netherlands. In a first step, clues for the role of smoking were obtained from a detailed description of regional mortality differences. These differences were found to be strongly determined by cohort effects: they vary between birth cohorts, and have been stable for over 30 years. Regional mortality differences reflect a diffusion of the lung cancer epidemic from high-income regions to low-income regions. These findings are suggestive of a relationship with regional differences in trends in cigarette smoking. In a second step, by means of multiple regression analysis, mortality differences in 1980–84 were related to available data on cigarette smoking and two other possible risk factors: work in transport and manufacturing industry, and air contamination. The independent variables referred to the 1970s. Positive associations with various smoking measures were found for women, but for men the associations were weak or non-existent. Mortality differences among men 45–64 years were associated with work in transport and manufacturing industry. Strong associations w

Mortality due to unintentional injuries in The Netherlands, 1950-1995

OBJECTIVE: To detect and explain changing trends in incidence, case fatality rates, and mortality for unintentional injuries in the Netherlands for the years 1950 through 1995. METHODS: Using national registry data, the authors analyzed trends in traffic injuries, occupational injuries, and home and leisure injuries. RESULTS: Between 1950 and 1970, mortality from unintentional injuries rose, reflecting an increasing incidence of injuries. This was followed by a sharp decline in mortality due to a decreasing incidence combined with a rapidly falling case fatality rate. Starting in the second half of the 1980s, the decline in mortality leveled off as the incidence of several injury subclasses once again rose. The observed trends reflect several background factors, including economic fluctuations (influencing exposure), preventive measures (reducing injury risk and injury severity), and improvements in trauma care (lowering the severity-adjusted case fatality rate). CONCLUSIONS: Injury mortality can be reduced through measures that lowe

Differences in the misreporting of chronic conditions, by level of education: the effect on inequalities in prevalence rates

OBJECTIVES: Many studies of socio-economic inequalities in the prevalence of chronic conditions rely on self-reports. For chronic nonspecific lung disease, heart disease, and diabetes mellitus, we studied the effects of misreporting on variations in prevalence rates by respondents' level of education. METHODS: In 1991, a health interview survey was conducted in the southeastern Netherlands with 2867 respondents. Respondents' answers were compared with validated diagnostic questionnaires in the same survey and the diagnoses given by the respondents' general practitioners. RESULTS: Misreporting of chronic lung disease, heart disease, and diabetes may be extensive. Depending on the condition and the reference data used, the confirmation fractions ranged between .61 and .96 and the detection fractions between .13 and .93. Misreporting varied by level of education, and although various patterns were observed, the dominant pattern was that of more underreporting among less educated persons. The effects on prevalence rates were to underestimate differences by level of education to a sometimes considerable degree. CONCLUSIONS: Misreporting of chronic conditions differs by respondents' level of education. Health interview survey data underestimate socioeconomic inequalities in the prevalence of chronic conditions

Factors that determine the effectiveness of screening for congenital heart malformations at child health centres

BACKGROUND: The actual yield from current screening for clinically significant congenital heart malformations in Dutch child health care is far from optimal. In this study factors that determine the effectiveness of this screening are identified and recommendations for the optimization of the screening programme are formulated. METHODS: Eighty-two patients with a clinically significant congenital heart malformation were consecutively included in this study. Parents and child health centre physicians were interviewed in order to establish the screening, detection and referral history. Paediatric cardiologists established whether these patients were diagnosed 'in time' or 'too late'. RESULTS: Incomplete performance of the screening examination has more influence on the occurrence of delayed diagnoses than failure by parents to adhere to the complete visit schedule. Adequate screening advances detection of congenital heart malformations. Severity, however, is the most predominant determinant of the age at referral and diagnosis, as well as of the risk of complications. In only 7 out of 39 patients diagnosed 'too late', could no avoidable cause for an adverse outcome be found. In 10 cases (25%) there was a prolonged interval between first referral and diagnosis. CONCLUSION: To optimize the yield of the screening programme, improvement in the performance of the child health centre physicians and the co-operation of other physicians involved in reducing the interval between referral and diagnosis are required. Thus a considerable improvement in the prevention of complications of congenital heart malformations can be obtained

The rise of mortality from mental and neurological diseases in Europe, 1979-2009: Observational study

Background: We studied recent trends in mortality from seven mental and neurological conditions and their determinants in 41 European countries. Methods. Age-standardized mortality rates were analysed using standard methods of descriptive epidemiology, and were related to cultural, economic and health care indicators using regression analysis. Results: Rising mortality from mental and neurological conditions is seen in most European countries, and is mainly due to rising mortality from dementias. Mortality from psychoactive substance use and Parkinson's disease has also risen in several countries. Mortality from dementias has risen particularly strongly in Finland, Iceland, Malta, Netherlands, Spain, Sweden and the United Kingdom, and is positively associated with self-expression values, average income, health care expenditure and life expectancy, but only the first has an independent effect. Conclusions: Although trends in mortality from dementias have probably been affected by changes in cause-of-death classification, the high level of mortality from these conditions in a number of vanguard countries suggests that it is now among the most frequent causes of death in high-income countries. Recognition of dementias as a cause of death, and/or refraining from life-saving treatment for patients with dementia, appear to be strongly dependent on cultural values

Impact of repeated antral follicle counts on the prediction of poor ovarian response in women undergoing in vitro fertilization

Objective: To study the value of a single antral follicle count and the additional value of repeated counts in different cycles for the prediction of poor ovarian response in IVF. Design: Prospective. Setting: Tertiary fertility center. Patient(s): One hundred twenty women undergoing their first IVF cycle. Intervention(s): Measurement of the number of antral follicles on cycle day 3 in two spontaneous cycles. Main Outcome Measure(s): Ovarian response. Result(s): A single antral follicle count is clearly predictive of poor ovarian response and there is good agreement between repeated measurements in subsequent cycles (area under the receiver operating characteristic curve [ROCAUC]; cycle 1: 0.87, cycle 2: 0.85). In a logistic regression analysis, information obtained after the second cycle contributed significantly to the prediction of poor response by the antral follicle count of the first cycle. The predictive accuracy of the highest of two counts (ROCAUC 0.89) was slightly better than that of each single count. The predictive model with the highest count yielded slightly higher values of specificity and positive predictive value. Sensitivity, negative predictive value, and error rates were slightly lower. Conclusion(s): A single antral follicle count is a good predictor of poor ovarian response in IVF. Although the impact of a second antral follicle count on ovarian response predictions in IVF is statistically significant, clinical relevance is very limited. Repeating an antral follicle count in a subsequent cycle is not recommended

Individual differences in the use of the response scale determine valuations of hypothetical health states: an empirical study

ABSTRACT: BACKGROUND: The literature remains inconclusive about the effects of socio-demographic characteristics of the respondent, including age, on valuation scores of hypothetical health states. We analyzed data from a study designed to discriminate between the effects of respondents age and time preference on valuations of health states to get insight in the contribution of individual response patterns to the variance in valuation scores. METHODS: 212 respondents from different age groups valued six hypothetical health states with three methods: a Visual Analogue Scale (VAS) and two variants of the Time trade-off (TTO). Analyses included a generalizability study, principal components analysis and cluster analysis. RESULTS: Valuation scores differed significantly but not systematically between valuation methods. A total of 36.8% of variance was explained by health states, 1.6% by elicitation method and 0.2% by age group. Individual differences in the use of the response scales, e.g. a tendency to give either high or low TTO-scores, or a high or low scoring tendency on the VAS were the main source of remaining variance. These response patterns were not related to age or other identifiable respondent characteristics. CONCLUSIONS: We conclude that individual response patterns were more important determinants of TTO or VAS valuations of health states than age or other measured respondent characteristics. Further valuation research should focus on explaining individual response patterns as a possible key to understanding the determinants of health state valuations

Screening for congenital heart malformation in child health centres

BACKGROUND: Although screening for congenital heart malformations is part of the child health care programme in several countries, there are very few published evaluations of these activities. This report is concerned with the evaluation of this screening at the Dutch Child Health Centres (CHC). METHODS: All consecutive patients, aged between 32 days and 4 years, presented at the Sophia Children's Hospital Rotterdam throughout a period of 2 years, with a congenital heart malformation were included in this study. Paediatric cardiologists established whether or not these patients were diagnosed after haemodynamic complications had already developed (diagnosed 'too late'). Parents and CHC-physicians were interviewed in order to establish the screening and detection history. Test properties were established for all patients with a congenital heart malformation (n = 290), intended effects of screening were established in patients with clinically significant malformations (n = 82). RESULTS: The sensitivity of the actual screening programme was 0.57 (95% CI : 0.51-0.62), the specificity 0.985 (95% CI : 0.981-0.990) and the predictive value of a positive test result 0.13 (95% CI: 0.10-0.19). Sensitivity in a subpopulation of patients adequately screened was 0.89 (95% CI: 0.74-0.96). Adequately screened patients were less likely to be diagnosed 'too late' than inadequately screened patients (odds ratio [OR] = 0.20, 95% CI: 0.04-1.05). The actual risk of being diagnosed 'too late' in the study-population (48%) was only slightly less than the estimated risk for patients not exposed to CHC-screening (58%, 95% CI: 43%-72%). Adequately screened patients however were at considerably less risk (17%, 95% CI: 4%-48%). CONCLUSION: Screening for congenital heart malformations in CHC contributes to the timely detection of these disorders. The actual yield, however, is far from optimal, and the screening programme should be improved