Dutch Central Bureau Of Statistics Research Articles

Cardiovascular mortality in women in their forties after hypertensive disorders of pregnancy in the Netherlands: a national cohort study

Hypertensive disorders of pregnancy are associated with cardiovascular disease later in life. Given that hypertensive disorders of pregnancy often occur at a relatively young age, there might be an opportunity to use preventive measures to reduce the risk of early cardiovascular disease and mortality. The aim of this study was to assess the risk of cardiovascular mortality in women after a hypertensive disorder of pregnancy. In this population-based cohort study, the Netherlands Perinatal Registry (PRN) and the national death registry at the Dutch Central Bureau for Statistics were linked. We analysed women in the Netherlands with a first birth during 1995-2015 to determine the association between cardiovascular mortality and hypertensive disorders of pregnancy (based on recorded diastolic blood pressure or proteinuria, or both). We analysed the association between the highest diastolic blood pressure measured in pregnancy and cardiovascular mortality and constructed survival curves to assess cardiovascular mortality after hypertensive disorders of pregnancy, specifically pre-eclampsia and gestational hypertension. To differentiate between the severity of hypertensive disorders of pregnancy, cardiovascular mortality was assessed in women with a combination of hypertensive disorders of pregnancy with preterm birth (gestational age <37 weeks) and growth restriction (birthweight in the 10th percentile or less). All hazard ratios (HRs)were adjusted for maternal age. Between Jan 1, 1995, and Dec 31, 2015, the PRN contained 2 462 931 deliveries and 1 625 246 women. In 1 243 890 women data on their first pregnancy were available and were included in this analysis after linkage, with a median follow-up time of 11·2 years (IQR 6·1-16·3). 259 177 (20·8%) women had hypertensive disorders of pregnancy, and of these 45 482 (3·7%) women had pre-eclampsia and 213 695 (17·2%) women had gestational hypertension; 984 713 (79·2%) women did not develop hypertension in their first pregnancy. Compared with women without hypertensive disorders of pregnancy, the risk of death from any cause was higher in women who had hypertensive disorders (HR 1·30 [95% CI 1·23-1·37], p<0·001), pre-eclampsia (1·65 [1·48-1·83]; p<0·0001), and gestational hypertension (1·23 [1·16-1·30]; p<0·0001). Those women with pre-eclampsia had a higher risk of cardiovascular mortality compared with those without any hypertensive disorders of pregnancy (adjusted HR 3·39 [95% CI 2·67-4·29]), as did those with gestational hypertension (2·22 [1·91-2·57]). For women with a history of hypertensive disorders of pregnancy combined with preterm birth (gestational age <37 weeks) and birthweight in the 10th percentile or less, the adjusted HR for cardiovascular mortality was 6·43 (95% CI 4·36-9·47), compared with women without a hypertensive disorder of pregnancy. The highest diastolic blood pressure measured during pregnancy was the strongest risk factor for cardiovascular mortality (for 80-89 mm Hg: adjusted HR 1·47 [95% CI 1·00-2·17]; for 130 mm Hg and higher: 14·70 [7·31-29·52]). Women with a history of hypertensive disorders of pregnancy have a risk of cardiovascular mortality that is 2-3 times higher than that of women with normal blood pressure during pregnancy. The highest measured diastolic blood pressure during pregnancy is an important predictor for cardiovascular mortality later in life; therefore, women who have hypertensive disorders of pregnancy should be given personalised cardiovascular follow-up plans to reduce their risk of cardiovascular mortality. None.

Inventory

Inventory Karen Kao (bio) The security guard assumes that I am a tourist. I'm in a queue awaiting my timed entry into the Rijksmuseum, the Dutch national repository for art and history. He speaks kindly to me in his charmingly mangled version of English. I do not venture to correct him, nor do I disclose my command of his language. The guard recommends that I take the audio tour of the Slavery exhibit. Many years ago, when I was a newly minted lawyer in Washington, D.C., I found myself near the courthouse in need of lunch. The street vendor recommended a chili hot dog, then complimented me on my mastery of the English language. He asked, where did you learn to speak so well? I said, at the Montebello Unified School District in Los Angeles, California. Not long after, I married a Dutchman, and when we married, I knew already that we would be leaving D.C. for Amsterdam. Inside the Slavery exhibit at the Rijksmuseum, I stand out. Of the hundred or so visitors allowed in that space at any one time, I can count the people of color on my fingers. No exotic garb or loud language identifies them as outsiders. They are, I suspect, as Dutch as I am. When I moved to the Netherlands three decades ago, the Dutch stared at me in the street. In Amsterdam, where I live, the interest has always seemed to me to be commercially motivated. Shopkeepers hope that I am a wealthy Asian tourist and are disappointed to find I am not. But the Netherlands is a civilized country. No one attempts to touch my straight black hair or rub my nose or take my photograph on the sly. ________ A photograph hangs in the Slavery exhibit. Six women and a baby pose against a matte background, framed on either side by large bushes. The photograph known as Inventory No. RP-F-1994-12-3 is printed in sepia tones. I can see neither the green of the bushes nor the ubiquitous red brick wall against which they stand. My imagination supplies the electric blue, the blush rose, the ochre yellow of the dresses, and the exact tint of the darkness of their skin. Since the Netherlands is a largely racially homogenous nation, I am often the only person of color in the room. The Netherlands favors a Talmudic approach towards its migrants. We are classified as first or second generation, west versus east. My Chinese parents might be surprised to learn that here I am considered a person with a western migration background. This category includes migrants from Europe (but not Turkey), North America, Oceania, Indonesia, and Japan. According to the Dutch Central Bureau for Statistics, the socioeconomic and cultural position enjoyed by people from Indonesia and Japan warrant their inclusion into the panoply of the west. I wonder how the ancestors of migrants born in the former Dutch East Indies would regard this modern label. Iron brands once marked enslaved persons as the property of the Dutch East or West Indies Company. In the former Dutch colony of Batavia, the most valuable enslaved persons were [End Page 225] Balinese women renown for their beauty. Balinese men, on the other hand, were generally shunned for their unaccountably angry nature and propensity toward violence. ________ In the photograph known as Inventory No. RP-F-1994-12-3, six women and a baby pose on a lawn. The women wear voluminous skirts, fussy short jackets, and fancifully folded headscarves. Their backs are erect and their faces set. Perhaps they're cold, standing as they are on the frigid Dutch earth so far away from home. Perhaps they have been told to stop squirming so that the photographer might take his shot. The six women and the baby in the photograph live in a human zoo known as the Surinam Pavilion. From May to October 1883, over one million visitors will peek into their reconstructed huts, watch the women pound cassava, and the baby sleep through the first International Colonial and Export Exhibition in Amsterdam. The Netherlands abolished slavery in 1863. And yet, twenty years later, six women and a...

Long Term Outcomes of Post-Implantation Syndrome After Endovascular Aneurysm Repair

The aim of this study was to investigate the association between post-implantation syndrome (PIS) and long term outcomes, with emphasis on cardiovascular prognosis. One hundred and forty-nine consecutive patients undergoing EVAR in a tertiary institution were previously included in a study investigating the risk factors and short term consequences of PIS (defined as tympanic temperature ≥ 38°C and CRP > 10 mg/L, after excluding complications with an effect on inflammatory markers). This study was based on a prospectively maintained database. Survival status was derived from inquiry of civil registry database information and causes of death from the Dutch Central Bureau of Statistics. The primary endpoint was cardiovascular events. Secondary endpoints were overall and specific cause mortality (cardiovascular, ischaemic heart disease, AAA, and cancer related mortality). Aneurysm sac dynamics and occurrence of endoleaks were also analysed. Survival estimates were obtained using Kaplan–Meier plots and a multivariable model was constructed to correct for confounders. The PIS incidence was 39% (58/149). At the time of surgery, patients had a mean age of 73 ± 7 years and were predominantly male. There were no baseline differences between the PIS and non-PIS groups. The median follow up was 6.4 years (3.2 – 8.3), similar in both groups (p = .81). There was no difference in cardiovascular events for PIS and non-PIS patients (p = .63). However, Kaplan–Meier plots suggest a trend towards a higher rate of cardiovascular events in PIS patients during the first years: freedom from cardiovascular events at one year was 94% vs. 89% and at three years 90% vs. 82%. No differences were found in overall and specific cause mortality. There was a higher rate of type II endoleaks for non-PIS patients (28% vs. 9%, p = .005). Sac dynamics were similar in both groups. The results suggest that PIS is not associated with a statistically significantly higher risk of cardiovascular events. PIS had no impact on mortality. Lastly, PIS patients had fewer type II endoleaks, but sac dynamics were analogous.

Long Term Outcomes of Post-Implantation Syndrome After Endovascular Aneurysm Repair

The aim of this study was to investigate the association between post-implantation syndrome (PIS) and long term outcomes, with emphasis on cardiovascular prognosis. One hundred and forty-nine consecutive patients undergoing EVAR in a tertiary institution were previously included in a study investigating the risk factors and short term consequences of PIS (defined as tympanic temperature ≥ 38°C and CRP > 10 mg/L, after excluding complications with an effect on inflammatory markers). This study was based on a prospectively maintained database. Survival status was derived from inquiry of civil registry database information and causes of death from the Dutch Central Bureau of Statistics. The primary endpoint was cardiovascular events. Secondary endpoints were overall and specific cause mortality (cardiovascular, ischaemic heart disease, AAA, and cancer related mortality). Aneurysm sac dynamics and occurrence of endoleaks were also analysed. Survival estimates were obtained using Kaplan-Meier plots and a multivariable model was constructed to correct for confounders. The PIS incidence was 39% (58/149). At the time of surgery, patients had a mean age of 73 ± 7 years and were predominantly male. There were no baseline differences between the PIS and non-PIS groups. The median follow up was 6.4 years (3.2 - 8.3), similar in both groups (p= .81). There was no difference in cardiovascular events for PIS and non-PIS patients (p= .63). However, Kaplan-Meier plots suggest a trend towards a higher rate of cardiovascular events in PIS patients during the first years: freedom from cardiovascular events at one year was 94% vs. 89% and at three years 90% vs. 82%. No differences were found in overall and specific cause mortality. There was a higher rate of type II endoleaks for non-PIS patients (28% vs. 9%, p= .005). Sac dynamics were similar in both groups. The results suggest that PIS is not associated with a statistically significantly higher risk of cardiovascular events. PIS had no impact on mortality. Lastly, PIS patients had fewer type II endoleaks, but sac dynamics were analogous.

No Evidence of Association between Childhood Urban Environment and Cortical Thinning in Psychotic Disorder.

BackgroundThe alterations in cortical morphology, such as cortical thinning, observed in psychotic disorder, may be the outcome of interacting genetic and environmental effects. It has been suggested that urban upbringing may represent a proxy environmental effect impacting cortical thickness (CT). Therefore, the current study examined whether the association between group as a proxy genetic variable (patients with psychotic disorder [high genetic risk], healthy siblings of patients [intermediate risk] and healthy control subjects [average risk]) and CT was conditional on different levels of the childhood urban environment and whether this was sex-dependent.MethodsT1-weighted MRI scans were acquired from 89 patients with a psychotic disorder, 95 non-psychotic siblings of patients with psychotic disorder and 87 healthy control subjects. Freesurfer software was used to measure CT. Developmental urban exposure was classified as low, medium, and high, reflecting the population density and the number of moves between birth and the 15th birthday, using data from the Dutch Central Bureau of Statistics and the equivalent database in Belgium. Multilevel regression analyses were used to examine the association between group, sex, and urban upbringing (as well as their interactions) and cortical CT as the dependent variable.ResultsCT was significantly smaller in the patient group compared to the controls (B = -0.043, p <0.001), but not in the siblings compared to the controls (B = -0.013, p = 0.31). There was no main effect of developmental urbanicity on CT (B = 0.001, p = 0.91). Neither the three-way group × urbanicity × sex interaction (χ2 = 3.73, p = 0.16), nor the two-way group × urbanicity interaction was significant (χ2 = 0.51, p = 0.77).ConclusionThe negative association between (familial risk for) psychotic disorder and CT was not moderated by developmental urbanicity, suggesting that reduced CT is not the outcome of familial sensitivity to the proxy environmental factor ‘urban upbringing’.

No evidence for increased mortality in SDHD variant carriers compared with the general population.

Germline variants in subunit D of the succinate dehydrogenase gene (SDHD variants) are associated with an increased risk of developing paragangliomas. The aim of this study was to compare mortality rates and survival in a Dutch cohort of SDHD variant carriers with those in the general population. The study was conducted at the Leiden University Medical Center, a tertiary referral center for patients with paragangliomas. Included subjects all tested positive for SDHD variants before 1 July 2012 and visited the departments of Otorhinolaryngology or Endocrinology at least once or had a diagnosed paraganglioma and a SDHD variant-positive family history. Clinical data were retrieved from medical records, information on mortality was obtained from the Municipal Personal Records Database, and mortality rates for the Dutch population were obtained from the Dutch Central Bureau of Statistics, stratified by sex, age and date. SDHD variant carriers were followed from the date of first SDHD variant-related contact until death, emigration or 12 December 2012 and the standardized mortality ratio (SMR) was calculated. Two-hundred and seventy-five SDHD variant carriers were included in the study, of which 80% carried the c.274G>T, p.(Asp92Tyr) variant, had a mean duration of follow-up of 7.6 years, yielding 2242 person-years of observation for analysis. There were 18 deaths in the SDHD variant carrier group; two were paraganglioma related. The SMR for the whole cohort was 1.07 (95% confidence interval 0.67-1.73). In conclusion, mortality in SDHD variant carriers is not substantially increased. Additional studies are required to confirm these findings.

Increasing trends in the incidence and prevalence rates of type 1 diabetes among children and adolescents in the Netherlands.

To assess the trends in the incidence and prevalence rates of type 1 diabetes (T1D) among children and adolescents in the Netherlands. A population-based cohort study was conducted in the Dutch PHARMO record linkage system (1998-2011). All children and adolescents aged ≤19 yr with at least one insulin dispensing (as a proxy for T1D) were identified and the numbers of incident and prevalent cases (numerators) were calculated. Overall age-adjusted (0-19 yr) incidence and prevalence rates together with age- and sex-specific rates of T1D and their 95% confidence intervals (CI) were calculated using data from the Dutch Central Bureau of Statistics as denominator. Trends over time were assessed using Joinpoint regression software (National Cancer Institute, Bethesda, MD, USA). In 2011, the overall age-adjusted incidence and prevalence rates of T1D were 25.2/100 000 (95% CI, 23.7-26.8) person-years (PY) and 174.4/100 000 (95% CI, 170.2-178.5) children, respectively. The average annual percentage change (AAPC) in the overall age-adjusted incidence and prevalence rate was 3.7% (95% CI, 1.8-5.7) and 3.8% (95% CI, 2.4-5.2), respectively. While during the study period the largest increases in the incidence and prevalence rates of T1D were observed for the oldest age groups (10-14 and 15-19 yr), a decreasing trend was detected for the 0- to 4-yr-old category (with AAPCs of -1.8 (95% CI, -9.9 to 7.1) and -6.9% (95% CI, -11.5 to -2.1) for incidence and prevalence, respectively). Age-adjusted incidence (1999-2011) and prevalence rates (1998-2011) of T1D in Dutch children (aged 0-19 yr) continued to increase and a shift was observed to a later onset of the disease.

Evidence that childhood urban environment is associated with blunted stress reactivity across groups of patients with psychosis, relatives of patients and controls

Psychosis is associated with urban upbringing, and increased emotional reactivity is associated with psychosis. The aim of this study was to examine to what degree urban upbringing impacts emotional reactivity, and how this may be relevant for psychotic disorder and familial risk of psychotic disorder. Patients with a diagnosis of non-affective psychotic disorder (n = 57), 59 first degree relatives of patients and 75 healthy comparison subjects were studied with the experience sampling method (a random time sampling technique to assess affective experience in relation to fluctuating stressors in the flow of daily life), to measure a change in negative affect in relation to subjective stress. Urban exposure was defined at 5 levels, considering the population density and the number of moves between birth and the 15th birthday, using data from the Dutch Central Bureau of Statistics and the equivalent database in Belgium. Multilevel random regression analyses showed that urban upbringing was consistently and strongly associated with a reduced increase in negative affect in relation to SS in adulthood in a dose-response fashion in all three groups. Regression coefficients in the patient group decreased from 0.148 (p < 0.001) in the lowest urbanicity level to 0.094 (p < 0.001) in the highest urbanicity level. The findings suggest that urban upbringing may occasion "habituation" rather than "sensitization" across groups, which may or may not be relevant for the onset of psychotic disorder.

Modelling community, family, and individual determinants of childhood dental caries

This cross-sectional study empirically tested a theoretical model of pathways and inter-relationships among community, family, and individual determinants of childhood dental caries in a sample of 630, 6-year-old children from the Netherlands. Children's decayed, missing, and filled teeth (dmft) scores were extracted from dental records. A validated parental questionnaire was used to collect data on sociodemographic characteristics, psychosocial factors, and oral hygiene behaviours. Data on neighbourhood quality were obtained from the Dutch Central Bureau of Statistics. Structural equation modelling indicated that the model was valid after applying a few modifications. In the revised model, lower maternal education level was related to poorer family organization, lower levels of social support, lower dental self-efficacy, and an external dental health locus of control. These, in turn, were associated with poorer oral hygiene behaviours, which were linked to higher levels of childhood dental caries. In addition, lower maternal education level and poorer neighbourhood quality were directly associated with higher caries levels in children. This model advances our understanding of determinants of childhood dental caries and the pathways in which they operate. Conception of these pathways is essential for guiding the development of caries-preventive programmes for children. Clues for further development of the model are suggested.

Implications and management of anemia in cardiac surgery: Current state of knowledge

Decreasing oxygen delivery during and after cardiopulmonary bypass (CPB) can adversely affect patient outcomes. Balancing morbidities associated with anemia, red blood cell (RBC) transfusion, pharmaceuticals to prevent fibrinolysis, and reoperations for bleeding poses a dilemma. One would optimally balance these factors to minimize patient risk. Uncertainty in defining an optimal transfusion threshold, a trigger for reoperation, and a strategy for use of pharmaceuticals is evidenced by the considerable variability in clinical practice worldwide. 1,2 Therefore, to gain insight to inform surgical practice, we have brought together current knowledge of the association of preoperative anemia, intraoperative anemia, blood transfusion, and measures to address blood loss with adverse outcomes after cardiac surgery. PREOPERATIVE ANEMIA AND OUTCOMES The World Health Organization defines anemia as a hemoglobin level less than 13 g/dL in men and less than 12 g/dL in women. By that measure, prevalence of preoperative anemia in patients undergoing cardiac surgery ranges from 16% to 54%, with severe anemia (hemoglobin < 10 g/dL) in 5.5%. 3-5 Patients presenting with low hemoglobin are more susceptible to end-organ ischemia; however, oxygen demands on CPB vary, and it is unclear what hemoglobin level is adequate. Nonetheless, several large observational studies suggest that preoperative anemia is associated with increased noncardiac morbidity and mortality after CPB (Table 1). Zindrou and colleagues 6 performed an observational study of 2059 patients undergoing isolated coronary artery bypassgrafting(CABG)thatshowedthatpatientswithapreoperative hemoglobin of 10 g/dL or less had a 5-fold higher in-hospital mortality than those with a greater hemoglobin concentration.Thiswasconfirmedbymultivariableanalysis. However, this study may have been confounded by RBC transfusion, which was not considered in the analysis. Likewise, van Straten and colleagues 5 from the Dutch Central Bureau for Statistics performed an observational study of 10,626 patients who underwent CABG. Preoperative anemia, as defined by the World Health Organization, was an independent risk factor for increased early (<30 days) mortality and higher degree of preoperative anemia for higher late mortality. Preoperative hemoglobin of 14.5 g/dL or greater in men and 13.5 g/dL in women was associated with an 88% survival at 8 years, whereas a value less than 12 g/dL in men and less than 11 g/dL in women was associated with a 55% survival at 8 years. This study did not factor intraoperative anemia or use of RBC transfusion into the analysis. To account for transfusion as a potential confounder, Ranucci and colleagues 7 reviewed 3003 consecutive patients undergoing isolated CABG without perioperative RBC transfusion and found no association between preoperative anemia and postoperative mortality. However, they reported a 5-fold greater unadjusted occurrence of major morbidity in patients with a preoperative hematocrit (HCT) of 33% or less versus 42% or greater. After risk adjustment, preoperative HCT and lowest HCT on CPB were associated with an increased postoperative occurrence of prolonged ventilation, renal insufficiency, stroke, and reoperation. Several additional studies have identified an association between preoperative anemia and postoperative morbidity. A multicenter observational study by Kulier and colleagues 4 demonstrated that preoperative anemia (hemoglobin <13 g/dL) was associated with increased neurologic, renal, and gastrointestinal complications. Anemia was not associated with more cardiac complications, although these events were related to perioperative RBC transfusion. De Santo and colleagues 8 studied a co

Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

BackgroundPreoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting.MethodsEarly and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation.Results and DiscussionOne hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of < 50%. In subjects with a preoperative ejection fraction of > 50%, long-term survival exceeded expected survival.ConclusionsThe severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%.

Socioeconomic differences in health over the life cycle in an Egalitarian country

A strong cross-sectional relationship between health and socioeconomic status is firmly established. This paper adopts a life cycle perspective to investigate whether the socioeconomically disadvantaged, on top of a lower health level, experience a sharper deterioration of health over time. Data are drawn from the Dutch Central Bureau of Statistics (CBS) Health Interview Surveys covering the period 1983-2000. The analysis focuses on the self-rated health and disability of persons aged 16-80. We show that in the Netherlands, as in the US, the socioeconomic gradient in health widens until late-middle age and narrows thereafter. The analysis and the available evidence suggests that the widening gradient is attributable both to health-related withdrawal from the labor force, resulting in lower incomes, and the cumulative protective effect of education on health outcomes. The less educated appear to suffer a double health penalty in that they begin adult life with a slightly lower health level, which subsequently declines at a faster rate.

The Amsterdam Studies of Acute Psychiatry - II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands

BackgroundThe number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and reports it has become evident that important dissimilarities exist between PICU's. The current study seeks to describe organisational as well as clinical and patient related factors across ten PICU's in and outside the Amsterdam region, adjusted for or stratified by level of urbanization.Method/DesignThis paper describes the design of the Amsterdam Studies of Acute Psychiatry II (ASAP-II). This study is a prospective observational cohort study comparing PICU's in and outside the Amsterdam region on various patient characteristics, treatment aspects and recovery related variables. Dissimilarities were measured by means of collecting standardized forms which were filled out in the framework of care as usual, by means of questionnaires filled out by mental health care professionals and by means of extracting data from patient files for every consecutive patient admitted at participating PICU's during a specific time period. Urbanization levels for every PICU were calculated conform procedures as proposed by the Dutch Central Bureau for Statistics (CBS).DiscussionThe current study may provide a deeper understanding of the differences between psychiatric intensive care units that can be used to promote best practice and benchmarking procedures, and thus improve the standard of care.

Preoperative renal function as a predictor of survival after coronary artery bypass grafting: Comparison with a matched general population

Preoperative renal dysfunction is an established risk factor for early and late mortality after revascularization. We studied how renal function affects long-term survival of patients after coronary artery bypass grafting. Early and late mortality were determined retrospectively among consecutive patients having isolated coronary bypass at a single Dutch institution between January 1998 and December 2007. Patients were stratified into 4 groups according to preoperative renal function. Expected survival was gauged using a general Dutch population group that was obtained from the database of the Dutch Central Bureau for Statistics; for each of our renal function groups, a general population group was assembled by matching for age, gender, and year of operation. After excluding 122 patients lost to follow-up, 10,626 patients were studied; in 10,359, preoperative creatinine clearance could be calculated. Multivariate logistic regression and Cox regression analysis identified renal dysfunction as a predictor for early and late mortality. When long-term survival of patient groups was compared with expected survival, only patients with a creatinine clearance less than 30 mL x min(-1) showed a worse outcome. Patients with a creatinine clearance between 60 and 90 mL x min(-1) had a long-term survival exceeding the expected survival. Severity of renal dysfunction was related to poor survival. When compared with expected survival, however, patients having coronary bypass had a worse outcome only when severe preoperative renal dysfunction was present.

Preoperative Hemoglobin Level as a Predictor of Survival After Coronary Artery Bypass Grafting

The predictive value of the preoperative hemoglobin value after coronary artery bypass grafting (CABG) has not been well established. We studied how the preoperative hemoglobin level affects the survival of patients after CABG. Late mortality was compared with that of a general population. Early and late mortality of all consecutive patients undergoing isolated CABG between January 1998 and December 2007 were determined. Patients were classified into 4 groups stratified by preoperative hemoglobin level. The cutoff point for anemia was 13 g/dL for men and 12 g/dL for women. Expected survival of a matched general Dutch population cohort was obtained from the database of the Dutch Central Bureau for Statistics. After the exclusion of 122 patients who were lost to follow-up and 481 patients with missing preoperative hemoglobin levels, complete data were obtained in 10,025 patients. Multivariate logistic regression analyses revealed anemia to be an independent risk factor for higher early mortality. Cox regression analyses revealed low hemoglobin level, both as a continuous variable and as a dichotomous variable (anemia), to be a predictor of higher late mortality. Compared with expected survival, patients with the lowest preoperative hemoglobin levels had a worse outcome, whereas patients with the highest hemoglobin levels had a better outcome. A lower preoperative hemoglobin level is an independent predictor of late mortality in patients undergoing CABG, whereas anemia is a risk factor for early and late mortality. Compared with the general population, anemic patients had worse survival than expected, whereas nonanemic patients had better survival than expected.

266 Academic Achievement in 19 Year Old Adolescents, Born As Preterm Infants (Ga &lt; 32 Weeks and/or Bw &lt; 1500 Gram)

Background: In view of the increasing survival rate of very preterm and very low birth weight infants, long term outcome of these infants born in 1980's is of interest not only in terms of handicaps and disabilities but also of educational achievement. Objective: The purpose of this study was to determine the highest level of completed or current education at age 19 in adolescents born as very preterm or very low birth weight. Methods: In 1983 94% of the infants born alive in the Netherlands with a gestational age less than 32 weeks or a birth weight less than 1500 grams were included in the POPS-study (Project on Preterm and Small for gestational age infants). All 959 surviving adolescents (72% of original cohort) were invited for a full examination (including physical, mental, behavioral and educational development and social participation) in a hospital at the age of 19 years. If the adolescents refused to take part in the full assessment, they were invited to complete postal questionnaires only. Education was assessed using the same categories as the Dutch Central Bureau of Statistics (CBS) in the total population at the same age (reference category). Results: There were 596 (62%) full-responders, 109 (11%) postal responders and 254 (26%) non-responders. In non-responders we found (based on previous assessments) significantly more adolescents of non-Dutch origin and of low educated mothers, and more severe handicaps. Of 705 responders, data on education were available in 688. Of POPS-adolescents, 17% had completed special education or lower vocational training (CBS: 6%) and 9% primary school only (CBS: 6%). Secondary education had been completed or was being attended by 60% (CBS: 81%) of which 21% (CBS: 29%) was currently at university. Conclusions: Academic achievement in adolescents born very preterm or very low birth weight is significantly lower than that in the general population of the same age in the Netherlands. In view of probable positive selection bias in responders, the level of completed education in non-responders will be even lower. Social participation, future employment and independency may be difficult to achieve for many of these survivors of neonatal intensive care.

First admissions for mood disorders in immigrants to the Netherlands.

The risk of developing schizophrenia is increased for immigrants to the Netherlands from Surinam, the Netherlands Antilles and Morocco, but not for immigrants from Turkey. We examined, in these groups, the risks of a first admission for manic-depressive psychosis. The Dutch Psychiatric Registry provided two datasets. The first referred to first admissions for manic-depressive psychosis (MDP), manic or circular type, in the period 1990-1996, the second to first admissions for MDP, depressed type. MDP, depressed type, corresponds (broadly) to the DSM-IV category of major depressive disorder and MDP, manic or circular type, to the DSM-IV category of bipolar I disorder. The Dutch Central Bureau for Statistics provided yearly population figures. There were only small increases in the risks of a first admission for MDP, manic or circular type, for immigrants from Surinam (age- and sex-adjusted RR = 1.14; 95% CI: 0.97-1.33) and the Netherlands Antilles (RR = 1.41; 1.10-1.80). This risk was not clearly increased for immigrants from Morocco. The risks for MDP, depressed type, were increased for males from Morocco (age-adjusted RR = 2.17; 1.72-2.72) and Turkey (RR = 1.83; 1.46-2.30), and significantly decreased for females in all of the immigrant groups. We found no evidence for a large increase in the incidence of MDP, manic or circular type, in the immigrant groups, whereas an increase in MDP, depressed type, was observed only in selected groups. Female immigrants suffering from MDP, depressed type, may be underserved.

Making Women Count

This article is a longitudinal analysis of the relation between gendered labour divisions and new data processing technologies at the Dutch Central Bureau of Statistics (CBS). Following social-constructivist and evolutionary economic approaches, the authors hold that the relation between technology and work organization is a two-way process. This means that technology does not only affect the relations between men and women at work, but that these relations also influence technological choices. The proportional numbers of men and women on the labour market and changing conceptions of which work is deemed appropriate for women have been important factors in the strongly varying extent to which women participated in office work. They have also been important factors in determining the course of technological development. Shortages of women on the labour market have even determined search heuristics for new technological solutions in specific directions.

Perinatal Audit on Avoidable Mortality in a Dutch Rural Region: A Retrospective Study

Abstract Objective: To analyse the mode and cause of perinatal mortality. Setting: a rural Dutch region. Study design: Over a two-year period (1994–1995), data were collected in the ’s Hertogenbosch region. A perinatal audit group investigated and classified the cause of death in an “intention to treat” and concensus model. We then analyzed who was responsible for the patient at the moment perinatal death occurred, or became inevitable. Results: Out of 8509 newborns, 73 died between the 24th week of pregnancy till the 7th day post-partum (8.58 promille). Twenty-three cases (31.50%) were classified as probably or possibly avoidable. In the primary health care group (midwives, general practitioners) 6 out of 32 (18.75%), in the secondary care group (obstetricians) 15 out of 35 (44.86%) and in the tertiary care group 1 out of 4 (25.00%) were judged as probably or possibly avoidable. The degree of concensus in the perinatal audit committee was high (Kappa=0.9). Impact: The analysis of perinatal mortality identifies the cause of death and may help to improve perinatal health care. Conclusion: In this study, 31.55% of perinatal mortality was avoidable in the three levels of care. Intra-uterine growth retardation, congenital malformations and antepartum haemorrhage were the most determinant factors for perinatal mortality. The Dutch obstetrical care system as such, for example home deliveries, did not effect the perinatal mortality rate. Perinatal mortality rates presented by the Dutch Central Bureau of Statistics still shows a slight underregistration.

Perinatal audit on avoidable mortality in a Dutch rural region: a retrospective study

Objective: To analyse the mode and cause of perinatal mortality. Setting: a rural Dutch region. Study design: Over a two-year period (1994–1995), data were collected in the ’s Hertogenbosch region. A perinatal audit group investigated and classified the cause of death in an “intention to treat” and concensus model. We then analyzed who was responsible for the patient at the moment perinatal death occurred, or became inevitable. Results: Out of 8509 newborns, 73 died between the 24th week of pregnancy till the 7th day post-partum (8.58 promille). Twenty-three cases (31.50%) were classified as probably or possibly avoidable. In the primary health care group (midwives, general practitioners) 6 out of 32 (18.75%), in the secondary care group (obstetricians) 15 out of 35 (44.86%) and in the tertiary care group 1 out of 4 (25.00%) were judged as probably or possibly avoidable. The degree of concensus in the perinatal audit committee was high (Kappa=0.9). Impact: The analysis of perinatal mortality identifies the cause of death and may help to improve perinatal health care. Conclusion: In this study, 31.55% of perinatal mortality was avoidable in the three levels of care. Intra-uterine growth retardation, congenital malformations and antepartum haemorrhage were the most determinant factors for perinatal mortality. The Dutch obstetrical care system as such, for example home deliveries, did not effect the perinatal mortality rate. Perinatal mortality rates presented by the Dutch Central Bureau of Statistics still shows a slight underregistration.