RESUMEN
BACKGROUND: Smoking contributes to socioeconomic inequalities in mortality, but the extent to which this contribution has changed over time and driven widening or narrowing inequalities in total mortality remains unknown. We studied socioeconomic inequalities in smoking-attributable mortality and their contribution to inequalities in total mortality in 1990-1994 and 2000-2004 in 14 European countries. METHODS: We collected, harmonised and standardised population-wide data on all-cause and lung-cancer mortality by age, gender, educational and occupational level in 14 European populations in 1990-1994 and 2000-2004. Smoking-attributable mortality was indirectly estimated using the Preston-Glei-Wilmoth method. RESULTS: In 2000-2004, smoking-attributable mortality was higher in lower socioeconomic groups in all countries among men, and in all countries except Spain, Italy and Slovenia, among women, and the contribution of smoking to socioeconomic inequalities in mortality varied between 19% and 55% among men, and between -1% and 56% among women. Since 1990-1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women. CONCLUSIONS: In many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men, but not among women. Inequalities in smoking remain one of the most important entry points for reducing inequalities in mortality.
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Disparidades en el Estado de Salud , Neoplasias Pulmonares/epidemiología , Fumar/epidemiología , Adulto , Anciano , Causas de Muerte , Europa (Continente)/epidemiología , Femenino , Humanos , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Factores Sexuales , Fumar/economía , Fumar/mortalidad , Factores SocioeconómicosRESUMEN
OBJECTIVE: Surveillance is recommended for Barrett's oesophagus (BO) to detect early oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the cost-effectiveness of surveillance. DESIGN: We included 714 patients with long-segment BO in a multicentre prospective cohort study and used a multistate Markov model to calculate progression rates from no dysplasia (ND) to low-grade dysplasia (LGD), high-grade dysplasia (HGD) and OAC. Progression rates were incorporated in a decision-analytic model, including costs and quality of life data. We evaluated different surveillance intervals for ND and LGD, endoscopic mucosal resection (EMR), radiofrequency ablation (RFA) and oesophagectomy for HGD or early OAC and oesophagectomy for advanced OAC. The incremental cost-effectiveness ratio (ICER) was calculated in costs per quality-adjusted life-year (QALY). RESULTS: The annual progression rate was 2% for ND to LGD, 4% for LGD to HGD or early OAC and 25% for HGD or early OAC to advanced OAC. Surveillance every 5 or 4â years with RFA for HGD or early OAC and oesophagectomy for advanced OAC had ICERs of 5.283 and 62.619 per QALY for ND. Surveillance every five to one year had ICERs of 4.922, 30.067, 32.531, 41.499 and 75.601 per QALY for LGD. EMR prior to RFA was slightly more expensive, but important for tumour staging. CONCLUSIONS: Based on a Dutch healthcare perspective and assuming a willingness-to-pay threshold of 35.000 per QALY, surveillance with EMR and RFA for HGD or early OAC, and oesophagectomy for advanced OAC is cost-effective every 5 years for ND and every 3 years for LGD.
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Adenocarcinoma/patología , Esófago de Barrett/patología , Neoplasias Esofágicas/patología , Esofagoscopía/economía , Lesiones Precancerosas/patología , Adenocarcinoma/epidemiología , Adenocarcinoma/cirugía , Esófago de Barrett/epidemiología , Esófago de Barrett/psicología , Ablación por Catéter/economía , Causalidad , Estudios de Cohortes , Análisis Costo-Beneficio , Progresión de la Enfermedad , Diagnóstico Precoz , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/cirugía , Esofagectomía/economía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Cadenas de Markov , Persona de Mediana Edad , Estadificación de Neoplasias , Vigilancia de la Población/métodos , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/cirugía , Estudios Prospectivos , Calidad de VidaRESUMEN
BACKGROUND: Exocrine insufficiency frequently develops in patients with pancreatic cancer owing to tumour ingrowth and pancreatic duct obstruction. Surgery might restore this function by removing the primary disease and restoring duct patency, but it may also have the opposite effect, as a result of resection of functional parenchyma and anatomical changes. This study evaluated the course of pancreatic function, before and after pancreatic resection. METHODS: This prospective cohort study included patients with tumours in the pancreatic region requiring pancreatic resection in a tertiary referral centre between March 2010 and August 2012. Starting before surgery, exocrine function was determined monthly by measuring faecal elastase 1 levels (normal value over 0.200 µg per g faeces). Endocrine function, steatorrhoea-related symptoms and bodyweight were also evaluated before and after surgery. Subjects were followed from diagnosis until 6 months after surgery, or until death. RESULTS: Twenty-nine patients were included, 12 with pancreatic cancer, 14 with ampullary carcinoma and three with bile duct carcinoma (median tumour size 2.6 cm). Twenty-six patients underwent pancreaticoduodenectomy and three distal pancreatectomy. Thirteen patients had exocrine insufficiency at preoperative diagnosis. After a median follow-up of 6 months, this had increased to 24 patients. Diabetes was present in seven patients at diagnosis, and developed in one additional patient within 1 month after surgery. CONCLUSION: Most patients with tumours in the pancreatic region requiring pancreatic resection either had exocrine insufficiency at diagnosis or became exocrine-insufficient soon after surgical resection.
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Insuficiencia Pancreática Exocrina/etiología , Páncreas Exocrino/fisiopatología , Pancreatectomía/efectos adversos , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Conductos Biliares/fisiopatología , Neoplasias de los Conductos Biliares/cirugía , Insuficiencia Pancreática Exocrina/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/fisiopatología , Cuidados Posoperatorios , Cuidados Preoperatorios , Estudios ProspectivosRESUMEN
OBJECTIVE: To assess the health-related quality of life (HRQoL) impact of cervical cancer screening in women with normal test results. DESIGN: Questionnaire study. SETTING: Maastricht, the Netherlands. POPULATION: A cohort of 789 women were followed from screening invitation until after the receipt of screening results. A female age-matched reference group (n=567) was included. METHODS: Questionnaires were sent to the home address of the women before screening, after screening, and again with the screening results. MAIN OUTCOME MEASURES: Generic HRQoL (SF-12, EQ-5D), generic anxiety (STAI-6), screen-specific anxiety (PCQ), and potential symptoms and feelings related to the smear-taking procedure. RESULTS: A total of 60% of screening participants completed questionnaire 1(n=924): 803 of these women granted permission to access their files; 789 of these 803 women had normal test results (Pap 1), and were included in the analyses. Generic HRQoL (SF-12, EQ-5D) and anxiety (STAI-6) scores were similar in the study and reference groups. Before screening, after screening, and also after the receipt of test results, screening participants reported less screen-specific anxiety (PCQ, P<0.001) than the reference group (n=567), with differences indicating clinical relevance. 19% of screening participants were bothered by feelings of shame, pain, inconvenience, or nervousness during smear taking, and 8 and 5% of women experienced lower abdominal pain, vaginal bleeding, discharge, or urinary problems for 2-3 and 4-7 days, respectively, following the Pap smear. CONCLUSION: The reduced levels of screen-specific anxiety in screening participants, possibly indicating reassurance, are worthwhile addressing in more depth. We conclude that although considerable numbers of women reported unpleasant effects, there were no adverse HRQoL consequences of cervical screening in women with normal test results.
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Ansiedad/etiología , Detección Precoz del Cáncer/psicología , Prueba de Papanicolaou , Calidad de Vida , Neoplasias del Cuello Uterino/psicología , Frotis Vaginal/psicología , Adulto , Factores de Edad , Ansiedad/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Países Bajos/epidemiología , Proteínas Asociadas a Pancreatitis , Satisfacción del Paciente , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Encuestas y Cuestionarios , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiologíaRESUMEN
OBJECTIVES: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors. METHODS: We included 713 patients with BE (≥ 2 cm) with no dysplasia (ND) or low-grade dysplasia (LGD) in a multicenter, prospective cohort study. Data on age, gender, body mass index (BMI), reflux symptoms, tobacco and alcohol use, medication use, upper gastrointestinal (GI) endoscopy findings, and histology were prospectively collected. As part of this study, patients with ND underwent surveillance every 2 years, whereas those with LGD were followed on a yearly basis. Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance. RESULTS: After 4 years of follow-up, 26/713 (3.4%) patients developed HGD or EAC, with the remaining 687 patients remaining stable with ND or LGD. Multivariable analysis showed that a known duration of BE of ≥ 10 years (risk ratio (RR) 3.2; 95% confidence interval (CI) 1.3-7.8), length of BE (RR 1.11 per cm increase in length; 95% CI 1.01-1.2), esophagitis (RR 3.5; 95% CI 1.3-9.5), and LGD (RR 9.7; 95% CI 4.4-21.5) were significant predictors of progression to HGD or EAC. In a prediction model, we found that the annual risk of developing HGD or EAC in BE varied between 0.3% and up to 40%. Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC (<1%), whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression (18-40%). CONCLUSIONS: In patients with BE, the risk of developing HGD or EAC is predominantly determined by the presence of LGD, a known duration of BE of ≥10 years, longer length of BE, and presence of esophagitis. One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE.
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Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Esófago de Barrett/patología , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/patología , Lesiones Precancerosas/patología , Adulto , Anciano , Anciano de 80 o más Años , Esofagitis/patología , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Espera Vigilante , Adulto JovenRESUMEN
PURPOSE: Distal radius and carpal fractures in children and adolescents represent approximately 25% of all pediatric fractures. Incidence rates and causes of these fractures change over time owing to changes in activities and risk factors. The purpose of this study was to examine recent population-based trends in incidence and causes of wrist fractures in children and adolescents. METHODS: We obtained data from the Dutch Injury Surveillance System of emergency department visits of 15 geographically distributed hospitals, and from the National Hospital Discharge Registry. This included a representative sample of outpatients and inpatients, respectively. We calculated incidence rates of wrist fractures per 100,000 person-years for each year between 1997 and 2009. Using Poisson's regression, we analyzed trends for children and adolescents 5 to 9, 10 to 14, and 15 to 19 years of age separately for boys and girls. RESULTS: During the study period, incidence rates increased significantly in boys and girls 5 to 9 and 10 to 14 years of age, with the strongest increase in the age group 10 to 14 years. The observed increases were mainly due to increased incidence rates during soccer and gymnastics at school. CONCLUSIONS: This population-based study revealed a substantial sports-related increase in the incidence rate of wrist fractures in boys and girls aged 5 to 9 and 10 to 14 years in the period 1997 to 2009. CLINICAL RELEVANCE: With knowledge of the epidemiology of wrist fractures, prevention programs can be improved. From this study, we know that the incidence rate of wrist fractures in childhood is increasing, mainly as a result of soccer and gymnastics at school. Future sport injury research and surveillance data are necessary to develop new prevention programs based on identifying and addressing specific risk factors, especially in young athletes.
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Huesos del Carpo/lesiones , Fracturas del Radio/epidemiología , Fracturas del Cúbito/epidemiología , Traumatismos de la Muñeca/epidemiología , Adolescente , Distribución por Edad , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/epidemiología , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Países Bajos/epidemiología , Radiografía , Fracturas del Radio/diagnóstico por imagen , Sistema de Registros , Estudios Retrospectivos , Distribución por Sexo , Fracturas del Cúbito/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVES: Achalasia patients are considered at increased risk for esophageal cancer, but the reported relative risks vary. Identification of this risk is relevant for patient management. We performed a prospective evaluation of the esophageal cancer risk in a large cohort of achalasia patients with long-term follow-up. METHODS: Between 1975 and 2006, all patients diagnosed with primary achalasia in our hospital were treated and followed by the same protocol. After graded pneumatic dilatation, all patients were offered a fixed surveillance protocol including gastrointestinal endoscopy with esophageal biopsy sampling. RESULTS: We surveyed a cohort of 448 achalasia patients (218 men, mean age 51 years at diagnosis, range 4-92 years) for a mean follow-up of 9.6 years (range 0.1-32). Overall, 15 (3.3%) patients (10 men) developed esophageal cancer (annual incidence 0.34 (95% confidence interval 0.20-0.56)). The mean age at cancer diagnosis was 71 years (range 36-90) after a mean of 11 years (range 2-23) following initial presentation, and a mean of 24 years (range 10-43) after symptom onset. The relative hazard rate of esophageal cancer was 28 (confidence interval 17-46) compared with an age- and sex-identical population in the same timeframe. Five patients received a potential curative treatment. CONCLUSIONS: Although the gastro-esophageal cancer risk in patients with longstanding achalasia is much higher than in the general population, the absolute risk is rather low. Despite structured endoscopical surveillance, most neoplastic lesions remain undetected until an advanced stage. Efforts should be made to identify high-risk groups and develop adequate surveillance strategies.
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Acalasia del Esófago/epidemiología , Neoplasias Esofágicas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cateterismo , Niño , Preescolar , Estudios de Cohortes , Acalasia del Esófago/terapia , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Riesgo , Medición de RiesgoRESUMEN
Little is known about psychological distress and quality of life (QoL) in patients with Peutz-Jeghers syndrome (PJS), a rare hereditary disorder. We aimed to assess QoL and psychological distress in PJS patients compared to the general population, and to evaluate determinants of QoL and psychological distress in a cross-sectional study. PJS patients completed a questionnaire on QoL, psychological distress, and illness perceptions. The questionnaire was returned by 52 patients (85% response rate, 56% females, median age 44.5 years). PJS patients reported similar anxiety (p = 0.57) and depression (p = 0.61) scores as the general population. They reported a lower general health perception (p = 0.003), more limitations due to emotional problems (p = 0.045) and a lower mental well-being (p = 0.036). Strong beliefs in negative consequences of PJS on daily life, a relapsing course of the disease, strong emotional reactions to PJS, and female gender were major determinants for a lower QoL. PJS patients experience a similar level of psychological distress as the general population, but a poorer general health perception, more limitations due to emotional problems, and a poorer mental QoL. Illness perceptions and female gender were major predictors for this lower QoL. These results may help to recognize PJS patients who might benefit from psychological support.
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Adaptación Psicológica , Síndrome de Peutz-Jeghers/psicología , Calidad de Vida/psicología , Estrés Psicológico/psicología , Quinasas de la Proteína-Quinasa Activada por el AMP , Adolescente , Adulto , Anciano , Análisis de Varianza , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Mutación , Proteínas Serina-Treonina Quinasas/genética , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The antral follicle count (AFC) and anti-Müllerian hormone (AMH) both represent age-related follicular decline quite accurately, although long-term follow-up studies are still lacking. The best ovarian reserve test would need only a single, cycle-independent measurement to be representative. METHODS: To compare the inter- and intra-cycle stability of AFC and AMH, we used age-adjusted intra-class correlation coefficients (ICCs). To measure inter-cycle stability across a number of up to four menstrual cycles, we used data, prospectively collected for the purpose of an other study, from 77 regularly cycling, infertile women aged 24-40 years. AMH and AFC values were measured on cycle day 3. To study intra-cycle variability, we used data from a prospective cohort study of 44 regularly cycling volunteers, aged 25-46 years and measured AMH and assessed the AFC (2-10 mm) every 1-3 cycle days. RESULTS: Between menstrual cycles, AFC and AMH varied between 0 and 25 follicles (median 10), and 0.3 and 27.1 ng/ml (median 4.64). The difference in age-adjusted ICC between AMH [ICC, 0.89 (95% CI, 0.84-0.94)] and AFC [ICC, 0.71 (95% CI, 0.63-0.77)] was 0.18 (95% CI, 0.12-0.27). For the intra-cycle variation, 0-43 antral follicles (median 7) were counted per volunteer. The difference in age-adjusted ICC between AMH [ICC, 0.87 (95% CI, 0.82-0.91)] and AFC [ICC, 0.69 (95% CI, 0.46-0.82)] was 0.18 (95% CI, 0.034-0.42). CONCLUSIONS: Serum AMH demonstrated less individual intra- and inter-cycle variation than AFCs and may therefore be considered a more reliable and robust means of assessing ovarian reserve in subfertile women.
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Hormona Antimülleriana/sangre , Ciclo Menstrual/sangre , Folículo Ovárico/anatomía & histología , Adulto , Factores de Edad , Femenino , Humanos , Persona de Mediana Edad , Folículo Ovárico/fisiologíaRESUMEN
PURPOSE: Augmented survival of childhood nephroblastoma and neuroblastoma has increased long-term side effects such as metabolic syndrome (MetS). Risk stratification is difficult after abdominal radiation because waist circumference underestimates adiposity. We aimed to develop a strategy for determining MetS in irradiated survivors using an integrated biomarker profile and vascular ultrasonography. METHODS: The NCEP-ATPIII MetS-components, 14 additional serum biomarkers and 9 vascular measurements were assessed in a single-centre cohort of childhood nephroblastoma (n = 67) and neuroblastoma (n = 36) survivors and controls (n = 61). Multivariable regression models were used to study treatment effects. Principal component analysis (PCA) was used to study all biomarkers in a combined analysis, to identify patterns and correlations. RESULTS: After 27.5 years of follow-up, MetS occurred more often in survivors (14%) than controls (3%). Abdominal radiotherapy and nephrectomy, to a lesser extent, were associated with MetS and separate components and with several biomarker abnormalities. PCA of biomarkers revealed a pattern on PC1 from favourable lipid markers (HDL-cholesterol, adiponectin) towards unfavourable markers (triglycerides, LDL-cholesterol, apoB, uric acid). Abdominal radiotherapy was associated with the unfavourable biomarker profile (ß = 1.45, P = 0.001). Vascular measurements were not of added diagnostic value. CONCLUSIONS: Long-term childhood nephro- and neuroblastoma survivors frequently develop MetS. Additional assessment of biomarkers identified in PCA - adiponectin, LDL, apoB, and uric acid - may be used especially in abdominally irradiated survivors, to classify MetS as alternative for waist circumference. Vascular ultrasonography was not of added value.
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BACKGROUND: Development of both basal cell carcinoma (BCC) and cutaneous malignant melanoma (MM) is associated with acute and intermittent sun exposure. In contrast to MM, the association between socioeconomic status (SES) and BCC is not well documented. OBJECTIVES: To investigate the incidence of BCC according to SES, stratifying by age and tumour localization in a large population-based cohort. To assess changes over time in the distribution of the patients with BCC across the SES categories. METHODS: All patients with a histologically confirmed first primary BCC (n = 27,027) diagnosed between 1988 and 2005 in the Southeast of The Netherlands were stratified by sex, age (25-44, 45-64 and > or = 65 years), period of diagnosis, SES category (based on income and value of housing) and localization of the BCC. Age-standardized BCC incidence rates were calculated for the year 2004 by SES category and localization. Ordinal regression was used to assess changes over time in the proportion of patients with BCC by sex, age and SES. RESULTS: For men in all age groups higher BCC incidence in the highest SES category was observed, which remained significant after stratification for tumour localization. For women a consistent relationship was found only in younger women (< 65 years) for truncal BCCs, which occurred more frequently in high SES groups. Between 1990 and 2004, the proportion of BCC patients with high SES increased (+6%) and the proportion with low SES decreased (-7%). CONCLUSIONS: High SES is associated with increased incidence of BCC among men. Our data suggest that BCC is changing from a disease of the poor to a disease of the rich.
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Carcinoma Basocelular/epidemiología , Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Clase Social , Quemadura Solar/epidemiología , Luz Solar/efectos adversos , Adulto , Distribución por Edad , Anciano , Carcinoma Basocelular/etiología , Femenino , Humanos , Incidencia , Masculino , Registros Médicos , Melanoma/etiología , Persona de Mediana Edad , Países Bajos/epidemiología , Sistema de Registros , Medición de Riesgo , Neoplasias Cutáneas/etiología , Quemadura Solar/complicacionesRESUMEN
OBJECTIVES: To evaluate the feasibility and effectiveness of a postpartum lifestyle intervention after pregnancies complicated by preeclampsia, fetal growth restriction (FGR) and/or gestational diabetes mellitus (GDM) to improve maternal risk factors for future cardiometabolic disease. METHODS: Women following a complicated pregnancy were included six months postpartum in this specific pre-post controlled designed study. It has been conducted in one tertiary and three secondary care hospitals (intervention group) and one secondary care hospital (control group). The program consisted of a computer-tailored health education program combined with three individual counselling sessions during seven months. Primary outcome measures were the proportion of eligible women and weight change during the intervention. RESULTS: Two hundred and six women were willing to participate. The proportion of eligible women who complied with the intervention was 23%. Major barrier was lack of time. Adjusted weight change attributed to lifestyle intervention was -1.9â¯kg (95%-CI -4.3 to -0.3). Further changes were BMI (-0.9â¯kg/m2 (95%-CI -1.4 to -0.3)), waist-to-hip ratio (-0.04â¯cm/cm (95%-CI -0.06 to -0.03)), blood pressure medication use (19% (95%-CI 9% to 28%)), HOMA2-score (59 %S (95%-CI 18 to 99)) and total fat intake (-2.9 gr (95%-CI -4.6 to -1.2)). CONCLUSIONS: The results support feasibility and effectiveness of a lifestyle intervention after complicated pregnancies to improve maternal cardiometabolic risk factors. Further randomized controlled studies are needed with longer follow-up to evaluate durability. In the meantime, we suggest health care professionals to offer lifestyle interventions to women after complicated pregnancies.
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Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus/prevención & control , Estilo de Vida Saludable , Periodo Posparto , Diabetes Gestacional/terapia , Estudios de Factibilidad , Femenino , Retardo del Crecimiento Fetal/terapia , Humanos , Ensayos Clínicos Controlados no Aleatorios como Asunto , Atención Posnatal/métodos , Preeclampsia/terapia , Embarazo , Factores de RiesgoRESUMEN
BACKGROUND: The pre-malignant gastric lesions atrophic gastritis (AG), intestinal metaplasia (IM) and dysplasia (DYS) have long been identified as principal risk factors for gastric cancer. OBJECTIVE: To evaluate epidemiological time trends of pre-malignant gastric lesions in the Netherlands. METHODS: Patients with a first diagnosis of AG, IM or DYS between 1991 and 2005 were identified in the Dutch nationwide histopathology registry. The number of new diagnoses per year were evaluated relative to the total number of patients with a first gastric biopsy. Time trends were evaluated with age-period-cohort models using logistic regression analysis. RESULTS: In total, 23 278 patients were newly diagnosed with AG, 65 937 patients with IM, and 8517 patients with DYS. The incidence of AG declined similarly in men and women with 8.2% per year [95% CI 7.9% to 8.6%], and DYS with 8.1% per year [95% CI 7.5% to 8.6%]. The proportional number of new IM cases declined with 2.9% per year [95% CI 2.7% to 3.1%] in men and 2.4% [95% CI 2.2% to 2.6%] in women. With age-period-cohort models a cohort phenomenon was demonstrated for all categories of pre-malignant gastric lesions in men and in women with IM and DYS. Period phenomena with a larger decline in number of diagnoses after 1996 were also demonstrated for AG and IM. CONCLUSIONS: The incidence of pre-malignant gastric lesions is declining. Period and cohort phenomena were demonstrated for diagnoses of AG and IM. These findings imply that a further decrease of at least 24% in the incidence of gastric cancer in the coming decade may be anticipated in Western countries without specific intervention.
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Lesiones Precancerosas/epidemiología , Neoplasias Gástricas/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Métodos Epidemiológicos , Femenino , Mucosa Gástrica/patología , Gastritis Atrófica/epidemiología , Humanos , Masculino , Metaplasia , Persona de Mediana Edad , Países Bajos/epidemiología , Distribución por SexoRESUMEN
OBJECTIVE: To examine whether differences in birthweight of various ethnic groups residing in The Netherlands can be explained by determinants of birthweight. DESIGN: Population-based birth cohort study. SETTING: Data of pregnant women and their partners in Rotterdam, The Netherlands. POPULATION: We examined data of 6044 pregnant women with a Dutch, Moroccan, Turkish, Capeverdean, Antillean, Surinamese-Creole, Surinamese-Hindustani and Surinamese-other ethnic background. METHODS: Regression analyses were used to assess the impact of biomedical, socio-demographic and lifestyle-related determinants on birthweight differences. MAIN OUTCOME MEASURE: Birthweight was established immediately after delivery in grams. RESULTS: Compared with mean birthweight of offspring of Dutch women (3485 g, SD 555), the mean birthweight was lower in all non-Dutch populations, except in Moroccans. Differences ranged from an 88-g lower birthweight in offspring of the Turkish women to a 424-g lower birthweight in offspring of Surinamese-Hindustani women. Differences in gestational age, maternal and paternal height largely explained the lower birthweight in the Turkish, Antillean, Surinamese-Creole and Surinamese-other populations. Differences in birthweight between the Dutch and the Capeverdean and Surinamese-Hindustani populations could only partly be explained by the studied determinants. CONCLUSIONS: These results confirm significant differences in birthweight between ethnic populations that can only partly be understood from established determinants of birthweight. The part that is understood points to the importance of determinants that cannot easily be modified, such as parental height. Further study is necessary to obtain a fuller understanding.
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Peso al Nacer/fisiología , Etnicidad/etnología , Adulto , Estatura/etnología , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Estilo de Vida/etnología , Masculino , Países Bajos/etnología , Estudios ProspectivosRESUMEN
The aim of this study was to compare the anatomical differences in the skull base between the affected and non-affected side in patients with craniofacial microsomia (CFM), and to compare the affected and non-affected sides with measurements from a normal population. Three-dimensional computed tomography scans of 13 patients with unilateral CFM and 19 normal patients (age range 7-12 years) were marked manually with reliable homologous landmarks. Principal component analysis (PCA), as part of a point distribution model (PDM), was used to analyse the variability within the normal and preoperative CFM patient groups. Through analysis of the differences in the principal components calculated for the two groups, a model was created to describe the differences between CFM patients and normal age-matched controls. The PDMs were also used to describe the shape changes in the skull base between the cohorts and validated this model. Using thin-plate splines as a means of interpolation, videos were created to visualize the transformation from CFM skull to normal skull, and to display the variability in shape changes within the groups themselves. In CFM cases, the skull base showed significant asymmetry. Anatomical areas around the glenoid fossa and mastoid process showed the most asymmetry and restriction of growth, suggesting a pathology involving the first and second pharyngeal arches.
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Síndrome de Goldenhar/diagnóstico por imagen , Análisis de Componente Principal , Base del Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Puntos Anatómicos de Referencia , Estudios de Casos y Controles , Niño , Femenino , Humanos , MasculinoRESUMEN
AIM: To evaluate causes and consequences of not adhering to the clinical practice guideline for cutaneous malignant melanoma. METHODS: We conducted a retrospective cohort study of the clinical records of 454 subjects whose pathological reports were obtained from a population-based cancer registry to assess determinants and effects of non-compliance of physicians with the excision policy and the related clinical practice guideline for patients with primary localized cutaneous malignant melanoma (CMM). A comparative analysis was performed of patients who did and did not undergo re-excision (compliance versus non-compliance with the guideline). Subjects diagnosed in 1988, 1993 and 1997, just 1 year after publication of the (adapted) guideline, were followed until death due to any cause or until July 1st 2003. RESULTS: Old age was the most important determinant of non-compliance. After adjusting for age at diagnosis, gender, subsite and Breslow thickness there was no significant difference in overall survival between the compliance group and the non-compliance group. CONCLUSIONS: Non-compliance to the guideline is more common in older patients and in patients with melanoma in the head and neck region. After adjusting for confounders, a significant effect of complying with the guidelines on overall survival could not be observed.
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Adhesión a Directriz , Melanoma/cirugía , Guías de Práctica Clínica como Asunto , Neoplasias Cutáneas/cirugía , Factores de Edad , Competencia Clínica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Melanoma/mortalidad , Persona de Mediana Edad , Reoperación/normas , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Tasa de Supervivencia/tendenciasRESUMEN
OBJECTIVE: To quantify the medical consequences of the tobacco use in the Netherlands for the past 50 years and the near future. DESIGN: Theoretical study based on the national death records and published risks by cause of death of tobacco use. METHOD: Observed lung cancer mortality (1950-1999) was related to birth cohort and age by a statistical model (according to Peto), and then projected into the near future. The smoking intensity was defined as the difference between the expected lung-cancer mortality if no one smoked and the observed lung-cancer mortality. Using this smoking intensity and published risks for other smoking-related causes of death, the model provided estimates of smoking-related mortality by age, sex and cause of death. RESULTS: In 1999, 18% (women) and 32% (men) of all mortality before the age of 70 was attributable to smoking. If no one had smoked, Dutch life expectancy for men and women would have been 3 years and 1 year higher, respectively. Between 1950 and 1999, 13% of all deaths were caused by smoking, the large majority (> 90%) of which occurred among men. Between 2000 and 2015, slightly more deaths are to be attributed to smoking (14%), 62% of which will be among men. In 2015, women will have caught up with men in terms of absolute numbers of lung-cancer mortality. CONCLUSION: Around one quarter of premature deaths were caused by smoking. In the near future, women of the baby-boom generation will have reached middle age and the highest (relative) smoking-related risks. It is important that clinical practice takes this increased risk of disease into account among middle-aged women who smoke.
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Neoplasias Pulmonares/mortalidad , Fumar/mortalidad , Tabaquismo/mortalidad , Adulto , Anciano , Causas de Muerte/tendencias , Estudios de Cohortes , Femenino , Humanos , Esperanza de Vida , Neoplasias Pulmonares/etiología , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Sistema de Registros , Factores de Riesgo , Fumar/efectos adversos , Fumar/tendenciasRESUMEN
Hepatitis B virus (HBV) is an important health problem in the Turkish Dutch. Screening is necessary for detection and prevention of HBV. We aimed to identify social-cognitive and socio-cultural determinants of HBV-screening intention among Turkish Dutch. A cross-sectional survey was carried out amongst 335 Turkish Dutch, aged 16-40 years. Respondents showed favorable scores for the potential determinants of HBV-screening. Attitude, perceived behaviour control, social support and social norm, and the level of satisfaction with Dutch health care proved to be directly associated with screening intention. Relevant socio-cultural beliefs were shame, stigma, the association of screening with sexuality and family values. Persons with lower screening intentions had lower scores for attitude, perceived behaviour control, social support and subjective norms, but scored higher for feelings of shame and stigma regarding hepatitis B. This study shows how cultural values and social-cognitive factors are related to HBV-screening intention.
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Emigrantes e Inmigrantes/estadística & datos numéricos , Hepatitis B/diagnóstico , Adolescente , Adulto , Estudios Transversales , Cultura , Emigrantes e Inmigrantes/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hepatitis B/etnología , Humanos , Masculino , Países Bajos/epidemiología , Psicología , Pruebas Serológicas/psicología , Pruebas Serológicas/estadística & datos numéricos , Estereotipo , Turquía/etnología , Adulto JovenRESUMEN
Little is known about drug knowledge of patients, which is relevant for both the compliance and quality of pharmacotherapy. Drug knowledge was quantified in 160 patients in the outpatient clinics of the departments of Internal and Geriatric Medicine. Medication knowledge was generally poor, especially among older patients. Better knowledge was associated with the use of fewer drugs. Caregivers of dementia patients performed as well as younger patients, indicating that older people can perform well, if well-instructed.
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Cuidadores/estadística & datos numéricos , Quimioterapia , Conocimientos, Actitudes y Práctica en Salud , Pacientes Ambulatorios/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Demencia/tratamiento farmacológico , Demencia/epidemiología , Femenino , Humanos , Medicina Interna , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Cooperación del Paciente , Educación del Paciente como Asunto , Encuestas y CuestionariosRESUMEN
INTRODUCTION: The role of transparency in quality of care is becoming ever more important. Various indicators are used to assess hospital performance. Judging hospitals using rank order takes no account of disturbing factors such as random variation and case-mix differences. The purpose of this article is to compare displays for the influence of random variation on the apparent differences in the quality of care between the Dutch hospitals. METHOD: The authors analysed the official 2005 data of all 97 hospitals on the following performance indicators: pressure ulcer, cerebro-vascular accident and acute myocardial infarction. The authors calculated CIs of the point estimate and the simulated CIs of the ranks with bootstrap sampling, and visualised the influence of random variation with three modern graphical techniques: forest plot, funnel plot and rank plot. RESULTS: Statistically significant differences between hospitals were found for nearly all performance indicators (p<0.001). However, the CIs in the forest plot revealed that only a small number of hospitals performed significantly better or worse. The funnel plot provides a representation of differences between hospitals compared with a target value and allows for the uncertainty of these differences. The rank plot showed that ranking hospitals was very uncertain. CONCLUSION: Despite statistically significant differences between hospitals, random variation is a crucial factor that must be taken into account when judging individual hospitals. The funnel plot provides easily interpretable information on hospital performance, including the influence of random variation.