Repository hosted by TU Delft Library

Objective: The incidence of maternal mortality due to hypertensive disorders of pregnancy in the Netherlands is greater than in other Western countries. We aimed to confirm and explain this difference by assessing incidence, risk factors, and substandard care of eclampsia in the Netherlands. Methods: In a nationwide population-based cohort study, all cases of eclampsia were prospectively collected during a 2-year period (2004-2006). All pregnant women in the Netherlands in the same period acted as reference cohort (n=371,021). Substandard care was assessed in all cases. A selection of cases was extensively audited by an expert panel. Main outcome measures were incidence, case fatality rate, possible risk factors, and substandard care. Results: All 98 Dutch maternity units participated (100%). There were 222 cases of eclampsia, for an incidence of 6.2 per 10,000 deliveries. Three maternal deaths occurred; the case fatality rate was 1 in 74. Risk factors in univariable analysis included multiple pregnancy, primiparity, young age, ethnicity, and overweight. Prophylactic magnesium sulfate was given in 10.4% of women, and antihypertensive medication was given in 39.6% of women with a blood pressure on admission at or above 170/110 mm Hg. Additionally, substandard care was judged to be present by an expert panel in 15 of 18 audited cases (83%). Conclusion: The incidence of eclampsia in the Netherlands is markedly increased as compared with other Western European countries. Substandard care was identified in many cases, indicating the need for critical evaluation of the management of hypertensive disease in the Netherlands.

SIDS and ALTE are different entities that somehow show some similarities. Both constitute heterogeneous conditions. The Netherlands is a low-incidence country for SIDS. To study whether the same would hold for ALTE, we studied the incidence, etiology, and current treatment of ALTE in The Netherlands. Using the Dutch Pediatric Surveillance Unit, pediatricians working in second- and third-level hospitals in the Netherlands were asked to report any case of ALTE presented in their hospital from January 2002 to January 2003. A questionnaire was subsequently sent to collect personal data, data on pregnancy and birth, condition preceding the incident, the incident itself, condition after the incident, investigations performed, monitoring or treatment initiated during admission, any diagnosis made at discharge, and treatment or parental support offered after discharge. A total of 115 cases of ALTE were reported, of which 110 questionnaires were filled in and returned (response rate 97%). Based on the national birth rate of 200,000, the incidence of ALTE amounted 0.58/1,000 live born infants. No deaths occurred. Clinical diagnoses could be assessed in 58.2%. Most frequent diagnoses were (percentages of the total of 110 cases) gastro-esophageal reflux and respiratory tract infection (37.3% and 8.2%, respectively); main symptoms were change of color and muscle tone, choking, and gagging. The differences in diagnoses are heterogeneous. In 34%, parents shook their infants, which is alarmingly high. Pre- and postmature infants were overrepresented in this survey (29.5% and 8.2%, respectively). Ten percent had recurrent ALTE. In total, 15.5% of the infants were discharged with a home monitor. In conclusion, ALTE has a low incidence in second- and third-level hospitals in the Netherlands. Parents should be systematically informed about the possible devastating effects of shaking an infant. Careful history taking and targeted additional investigations are of utmost importance. © The Author(s) 2009.

Purpose: As part of a larger nationwide enquiry into severe maternal morbidity, our aim was to assess the incidence and possible risk factors of obstetric intensive care unit (ICU) admission in the Netherlands. Methods: In a 2-year nationwide prospective population-based cohort study, all ICU admissions during pregnancy, delivery and puerperium (up to 42 days postpartum) were prospectively collected. Incidence, case fatality rate and possible risk factors were assessed, with special attention to the ethnic background of women. Results: All 98 Dutch maternity units participated in the study. There were 847 obstetric ICU admissions in 358,874 deliveries, the incidence being 2.4 per 1,000 deliveries. Twenty-nine maternal deaths occurred, resulting in a case fatality rate of 1 in 29 (3.5%). Incidence of ICU admission varied largely across the country. Thirty-three percent of all cases of severe maternal morbidity were admitted to an ICU. Most frequent reasons for ICU admission were major obstetric haemorrhage (48.6%), hypertensive disorders of pregnancy (29.3%) and sepsis (8.1%). Assisted ventilation was needed in 34.8%, inotropic support in 8.8%. In univariable analysis, non-Western immigrant women had a 1.4-fold (95% CI 1.2-1.7) increased risk of ICU admission as compared to Western women. Initial antenatal care by an obstetrician was associated with a higher risk and home delivery with a lower risk of ICU admission. Conclusions: Population-based incidence of obstetric ICU admission in the Netherlands was 2.4 per 1,000 deliveries. Obstetric ICU admission accounts for only one-third of all cases of severe maternal morbidity in the Netherlands. © 2009 The Author(s).

Objective. Survey of changes in the number of preterm and very low birth weight infants in the Netherlands in ten years. Design. Descriptive. Setting. TNO Preventie en Gezondheid, sector Jeugd, Leiden, the Netherlands. Method. All infants with a gestational age less than 32 weeks and (or) a birth weight less than 1500 g from the National Neonatal Register born in 1993 were selected, supplemented with data from a questionnaire for hospitals not taking part in the register. The data were compared with those on similar infants from the 'Project on preterm and small for gestational age' infants born in 1983. Results. The total number of preterm and very low birth weight infants increased from 1423 in 1983 to approximately 1882 in 1993. There was also an increase in terms of proportion, from 8.4 per thousand to 9.6 per thousand. The proportion of preterm infants never treated in a neonatal intensive care unit decreased from 40% in 1983 to 14% in 1993, probably due to increased centralization of neonatal intensive care facilities. In the same time mortality decreased for all gestational age categories. Conclusion. Both the total number and the survival of preterm and very low birth weight infants increased considerably over a decade. This caused a considerable increase in intensive care days and is therefore an important reason for the increased requirement of neonatal intensive care cots.

An association between high intake of folate and reduced risk of cancer has been suggested by previous research. However, epidemiologic data from cohort studies regarding the relationship between dietary folate and pancreatic cancer are sparse and inconsistent. We examined the association between dietary folate intake and risk of pancreatic cancer within the Netherlands Cohort Study on diet and cancer. Men and women (120,852), ages 55 to 69 years, were recruited. Information on diet was collected at baseline by means of food frequency questionnaires, and the cohort was followed for 13.3 years. Total folate and vitamer intake were calculated using folate contents of food items derived from a validated liquid chromatography trienzyme method. Cases (n = 363) were identified by record linkage with regional cancer registries and the Dutch National Database of Pathology Reports. A casecohort approach was used using the follow-up data of a random subcohort (n = 5,000) identified at the onset of the cohort. Multivariable hazard ratios with 95% confidence intervals were estimated using Cox proportional hazards model. After adjusting for age, gender, smoking status, number of years smoked, number of cigarettes smoked per day, and intake of added sugar multivariate hazard ratio comparing the highest and lowest quintiles of folate intake for pancreatic cancer risk was 1.37 (confidence interval, 0.97-1.94; Ptrend = 0.07). When folate vitamers were analyzed separately, results did not show a difference in association. Our results do not support a protective association of total dietary folate or individual folate vitamers on the risk of pancreatic cancer. Copyright © 2009 American Association for Cancer Research.

Zoonoses can be defined as infectious diseases that are transmitted from vertebrate animals to man under natural conditions. Applying this definition, a review is presented of zoonoses, occurring in the Netherlands. Data about this group of infectious diseases were collected from public health and veterinary data sources. From the results of the inventory it can be concluded that the major part of the zoonoses is caused by foodborne infections. It has been estimated that yearly a total number of 420,000 persons suffer from Salmonella and Campylobacter infections. The remaining zoonoses under study were found to be of limited importance for the general population; because of their concentration in some professional groups and because of the availability of preventive measures, these infections are important in certain subgroups of the population.

The incidence of Type 1 (insulin-dependent) diabetes mellitus among Moroccan children aged (0-19 years) in The Netherlands was determined. Point of reference was the data derived from the second nationwide incidence study on Type 1 diabetes among children under 20 years of age. In that study the incidence among Dutch children was 13.2 100000-1 year-1. To scrutinize the data and to obtain more information a questionnaire was sent in 1993 to all specialists who had reported that they had diagnosed a patient with Type 1 diabetes during the years 1988-1990 whose parents originated from Morocco, Turkey or other foreign countries. The questionnaire requested information on origin and migration of child and parents. The response to the questionnaire was 86% for the Moroccan children, 75% for the Turkish children and 100% for the children from other countries. In only one case a wrong country had been recorded. None of the patients had been in The Netherlands for less than 6 months before the diagnosis. The incidence for Moroccan children was 20.0 (95% CI 14.6-26.9) and for Turkish children 4.5 (95% CI 2.2-8.0) 100000-1 year-1. It is concluded that the incidence of Type 1 diabetes in Moroccan children (0-19 years) is 1.5 times higher than in Dutch children and 4.5 times higher than in Turkish children.

Objective. To assess the incidence of childhood coeliac disease in the Netherlands and to study the clinical features. Design. Prospective. Setting. Leiden University Medical Centre, Leiden, the Netherlands. Method. Cases of childhood coeliac disease in the Netherlands in 1993-1995 were identified by means of the Dutch Paediatric Surveillance Unit. Inclusion criteria were: birth in the Netherlands, diagnosis with at least one small bowel biopsy in 1993-1995 and age at diagnosis 0-14 years. The data were cross checked with the Dutch Network and National Database of Pathology and compared with data from a previous study on childhood coeliac disease, 1975-1990. Results. 297 Coeliac patients were identified by means of the Surveillance Unit, another 32 through the National Database of Pathology. The mean crude incidence rate of diagnosed childhood coeliac disease was 0.15/1000 live births, which was in the range of rates found in other West European countries and significantly higher than the mean crude incidence rate of 0.18/1000 live births found in the Netherlands in 1975-1990. The clinical presentation was classic up to 1990: chronic diarrhoea, abdominal distention and growth failure. From 1993 onward, however, the number of children with chronic diarrhoea and abdominal distention decreased significantly and the number with weight loss, anaemia and abdominal pain increased. Associated disorders were present in 13.7% of the cases. Conclusions. The incidence of diagnosed childhood coeliac disease in the Netherlands showed a tendency to increase significantly during the past decade. In a period of 20 years a significant trend toward change in the clinical presentation of coeliac disease in Dutch children was observed.

Background: Back pain (including neck pain) is one of the most prevalent health problems for which physicians are consulted. Back pain can decrease the quality of life considerably during a great part of the lives of those who suffer from it. At the same time it has an enormous economic impact, mainly through sickness absence and long-term disability. The objective of this paper is to compare the incidence of occupational disability as a result of back and neck pain in 1980-1985 to 1999-2000 and to explain the findings. Methods: A descriptive study was performed at population level of changes in incidence of occupational disability as a result of back and neck pain. Statistics from the National Institute of Social Insurance in the Netherlands are used to calculate age and gender specific incidence rates for back pain diagnoses based on the ICD-classification. Incidence rate ratios stratified according to gender and adjusted for age were calculated to indicate changes over time. Results: The incidence of occupational disability as a result of back pain decreased significantly by 37% (95% CI 37%-38%) in men and with 21% (95% CI 20%-24%) in women, after adjustment for age. For overall occupational disability as a result of all diagnoses this was 18% (95% CI 18%-19%) and 34% (95% CI 33%-35%) respectively. Changes were not homogeneous over diagnostic subcategories and age groups. Spondylosis decreased most in men by 59% (95% CI 57%-61%). The incidence of non-specific back pain and neck pain increased most by 196% (95% CI 164%-215%). Post-laminectomy syndrome increased over all age categories both for men (85%, 95% CI 61%-113%) and women (113%, 95% CI 65%-179%). Conclusion: The decrease in occupational disability as a result of back pain was larger than the decrease in occupational disability over all diagnoses. However, time trends were not homogeneous over age-, nor over sex- nor back pain categories. Most of this decrease was due to general changes such as legal and economic changes. One of several additional explanations for a decrease is the changed view on management of back pain. © 2006 Steenstra et al; licensee BioMed Central Ltd.

We investigated breast cancer incidence in migrants in the Netherlands in 1988-1998. The standardised incidence ratio for breast cancer in Northwest-Netherlands was statistically significantly reduced for women born in Surinam (0.56), Turkey (0.29) and Morocco (0.22). The proportion of women with advanced stages (III and IV) did not differ significantly between migrants and women born in the Netherlands. © 2004 Cancer Research UK.

Background: The aim of this study was to evaluate the incidence, disease presentation, treatment and cardiac outcome of Kawasaki disease (KD) in The Netherlands. Methods: The national Dutch Pediatric Surveillance Unit was used to prospectively register new KD cases from 2008 through 2012. Questionnaires were sent to pediatricians to obtain clinical information. Results: Nationwide 341 cases were reported during the 5-year study period, of which 319 questionnaires (93.0%) were returned. The mean incidence of KD was estimated to be 5.8/100,000 children <5 years of age. The median age at disease onset was 2.4 years (range 0.1-14.6 years) and 79.2% of cases were <5 years of age. The male-to-female ratio was 1.5 to 1. Incomplete KD was diagnosed in 22.3% of cases and these cases were significantly younger than complete cases [median: 1.1 (0.1-13.7) vs. 2.8 (0.2-14.6) years, P < 0.001]. In total, 308 patients (96.6%) received intravenous immunoglobulins (IVIG). Retreatment with IVIG was given in 71 (23.1%) and additional steroid treatment in 17 patients (5.5%). During the acute phase, coronary artery aneurysms developed in 43 cases (13.5%). Multivariate logistic regression analysis showed that male gender, delay of treatment (>10 days) and IVIG retreatment were independent risk factors for coronary artery aneurysms development. Conclusions: This prospective study of KD in The Netherlands revealed a mean annual incidence of 5.8/100,000 children <5 years of age. Clinicians should consider the diagnosis of KD in young (male) children with persistent inexplicable fever to start IVIG treatment within 10 days to prevent development of coronary artery aneurysms. Copyright © 2014 by Lippincott Williams & Wilkins.

Acquired demyelinating syndromes (ADS) can be a first presentation of multiple sclerosis (MS) in children. The incidence of these disorders in Europe is currently unknown. Children (<18 years old) living in the Netherlands who presented with ADS were included from January 1, 2007 to December 31, 2010 by the Dutch pediatric MS study group and the Dutch surveillance of rare pediatric disorders. Demographic and clinical data were collected. Eighty-six patients were identified over 4 years, resulting in an incidence of 0.66/1,00,000 per year. Most patients presented with polyfocal ADS without encephalopathy (30%), followed by polyfocal ADS with encephalopathy (24%), optic neuritis (ON, 22%), monofocal ADS (16%), transverse myelitis (3%), and neuromyelitis optica (3%). Patients with polyfocal ADS with encephalopathy were younger (median 3.9 years) than patients with ON (median 14.6 years, p<0.001) or monofocal ADS (median 16.0 years, p<0.001). Patients with polyfocal ADS without encephalopathy (median 9.2 years) were also younger than monofocal ADS patients (median 16.0 years, p<0.001). There was a slight female preponderance in all groups except the ON group, and a relatively large number of ADS patients (29%) reported a non-European ancestry. Familial autoimmune diseases were reported in 23%, more often in patients with relapsing disease than monophasic disease (46 vs. 15%, p = 0.002) and occurring most often in the maternal family (84%, p<0.001). During the study period, 23% of patients were subsequently diagnosed with MS. The annual incidence of ADS in the Netherlands is 0.66/1,00,000 children/year. A polyfocal disease onset of ADS was most common. © The Author(s) 2012.

Soccer causes the largest number of injuries each year (18% of all sports injuries) in the Netherlands. The aim of this dissertation is to contribute to the body of evidence on injury prevention for adult male soccer players. Chapter 1 is a general introduction and presents the “sequence of prevention” model proposed by Van Mechelen et al. (1992). From the review described in chapter 2 we concluded that there is conflicting evidence for the effectiveness of exercise-based programmes to prevent soccer injuries. These generic preventive training programmes involve different exercises focusing on multiple joints and/or muscle groups and aim to prevent of the most common soccer injuries. We believe that the general structure of such programmes can be useful for numerous adult male soccer teams, because they are cost-free and can often be easily incorporated in regular training sessions. Chapters 3 to 5 then describe the study design and results of our randomized controlled trial (RCT) investigating the effectiveness and cost-effectiveness of FIFA’s “The11” programme for Dutch adult male amateur soccer players. After one season, we did not find significant differences in the overall injury incidence or injury severity between the intervention and control groups, although the intervention did result in a cost-saving effect. In conclusion, there are doubts that The11 is an effective programme to prevent soccer injuries in this particular population of adult male amateur soccer players. Based on the model by Van Mechelen et al., and having found no preventive effect of The11 on injury incidence among male amateur players, we used the data we had collected to establish the extent of the injury problem for this particular group and to gain more insight into injury characteristics. Chapter 6 presents the main findings of this study: almost 60% of Dutch amateur soccer players sustained at least one injury during one competitive soccer season, and approximately one third of these injuries resulted in absence from soccer play for at least one month. Chapter 7 provides information on injuries in Dutch professional soccer players. In chapter 8, the injury data from the professional and amateur cohorts are compared. The overall injury incidence was higher in the amateur cohort, as was the incidence during training. In contrast, the injury incidence during matches was higher among the professional players. Soccer injuries result from a complex interaction of multiple risk factors and events. Many risk factors are mentioned in the literature, but the findings are contradictory. We therefore conducted a literature review to study risk factors for hamstring injuries in male adult soccer players (chapter 9). We concluded that previous hamstring injury is the strongest predictive factor for hamstring injury. Conflicting evidence was found for age and hamstring length or flexibility as risk factors for hamstring injuries. Finally, chapter 10 offers a general discussion, reflecting on the main findings of our studies. The chapter ends with several recommendations for future research.

Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in children are relatively rare and the exact incidence is still unknown. There is great variability in clinical presentation and disease course. It is yet unclear which clinical and biological parameters can predict a chronic disease course and progression to multiple sclerosis. The diagnostic difficulties in distinguishing ADEM, MS and related disorders will be discussed. A review of the differential diagnosis, diagnostic tests, treatment and prognosis is given.

The rapidly increasing power conversion efficiencies of organic solar cells are an important prerequisite towards low cost photovoltaic fabricated in high throughput. In this work we suggest indane as a non-halogenated replacement for the commonly used halogenated solvent o-dichlorobenzene. Indane was blended with the higher volatile solvents chloroform or toluene or o-xylene in order to improve wettability and to reduce drying time. The combination of high volatile solvents with the less volatile host solvent indane allows for an increased fabrication speed due to a reduction of the overall drying time and provides films with good light absorption behavior and high polymer crystallinity. For the solvent mixture tolueneindane, solar cell performance is comparable to the o-dichlorobenzene reference device indicating this mixture as a suitable replacement for increased productivity without drawbacks in nanomorphology as investigated by atomic force microscopy (AFM) and grazing incidence X-ray diffraction (GIXD). This study provides a fundamental understanding on solvent mixture drying kinetics and can aid the ink formulation. © 2011 Elsevier B.V. All rights reserved.

Context : Injuries are a major adverse event in a soccer player's career. Reducing injury incidence requires a thorough knowledge of the epidemiology of soccer injuries. Objective : To investigate the incidence and characteristics of injuries in the Dutch premier soccer league. Design : Cohort study. Setting : The Dutch premier soccer league. Patients or Other Participants : During the 2009-2010 soccer season, a total of 217 professional soccer players from 8 teams were prospectively followed. Main Outcome Measure(s) : The medical staff recorded time-loss injuries, including information on injuries (ie, type, body part, duration) and exposure data for training sessions and matches. Results : A6 total of 286 injuries were recorded, affecting 62.7% of the players. The overall injury incidence was 6.2 injuries per 1000 player-hours, 2.8 in training sessions and 32.8 in matches. Most of the recorded injuries were acute (68.5%). Eight percent of the injuries were classified as recurrent. Injuries were most likely to be located in the lower extremities (82.9%). Injury time loss ranged from 1 to 752 days, with a median of 8 days. Knee injuries had the greatest consequences in terms of days of absence from soccer play (on average, 45 days). The most common diagnosis was muscle/tendon injury of the lower extremities (32.9%). Conclusions : Injury risk in the Dutch premier soccer league is high, especially during matches. Preventive measures should focus on the most common diagnoses, namely, muscle/tendon injuries of the lower extremities.

Although several epidemiologic studies have been conducted on alcohol consumption and bladder cancer risk, the risk according to quantity and type of alcohol consumed is not clear. The authors investigated these associations in a large prospective cohort study on diet and cancer among 120,852 subjects in the Netherlands aged 55-69 years at baseline (1986). Subjects completed a questionnaire on risk factors for cancer, including alcohol consumption. Follow-up for incident cancer was established by record linkage to cancer registries. The case-cohort analysis was restricted to a follow-up period of 6.3 years and was based on 594 cases with bladder cancer and 3,170 subcohort members. The authors corrected for age and smoking in multivariable analyses. The incidence rate ratios for men who consumed <5, 5-<15, 15-<30, and ≥30 grams of alcohol per day were 1.49, 1.52, 1.16, and 1.63 compared with nondrinkers, respectively (p for trend = 0.13). Alcohol consumed from beer, wine, and liquor was associated with moderately elevated risks, although most were not statistically significant. The incidence rate ratios for women varied around unity. The results of this study do not suggest an important association between alcohol consumption and bladder cancer risk.

Vitamin K prophylaxis is recommended to prevent the hazard of haemorrhage caused by vitamin K deficiency in newborns. The present Dutch guideline recommends 1 mg of vitamin K1 orally at birth, followed by a daily dose of 25 μg of vitamin K1 from 1 to 13 weeks of age for breastfed infants. Since the introduction of this prophylaxis, the incidence of vitamin K deficiency bleeding (VKDB) has decreased; however, late VKDB is still reported. From 1 January to 31 December 2005, a nationwide active surveillance was performed by the Netherlands Paediatric Surveillance Unit (NSCK) to study the current incidence and aetiology of late VKDB in infants. Six cases could be validated as late VKDB: all were breastfed, one fatal idiopathic intracranial haemorrhage at the age of 5 weeks and five bleedings secondary to an underlying cholestatic liver disease between the age of 3 and 7 weeks. The total incidence of late VKDB and idiopathic late VKDB was calculated to be 3.2 (95% CI: 1.2-6.9) and 0.5 (95% CI: 0-2.9) per 100,000 live births, respectively. With the current Dutch guideline, idiopathic late VKDB is rare but late VKDB secondary to cholestasis still occurs in breastfed infants. Doubling the daily dose of vitamin K1 to 50 μg, as is comparable to formula-feeding, may possibly prevent VKDB in this group. Further research, however, is needed to prove this hypothesis. © 2007 Springer-Verlag. Chemicals / CAS: phytomenadione, 11104-38-4, 84-80-0; Vitamin K, 12001-79-5