Determinants of regional differences in lung cancer mortality in The Netherlands.

Although regional differences in lung cancer mortality are likely to be attributable to regional differences in tobacco smoking, studies in various countries found only weak relationships. This paper aimed at explaining regional differences in lung cancer mortality in the Netherlands. In a first step, clues for the role of smoking were obtained from a detailed description of regional mortality differences.

Life-terminating acts without explicit request of patient.

In the Dutch nationwide study on medical decisions concerning the end of life (MDEL) life-terminating acts without the explicit request of the patient (LAWER) were noted in 0.8% of all deaths. We present here quantitative information and a discussion of the main issues raised by LAWER.

Air pollution, lagged effects of temperature, and mortality: The Netherlands 1979-87.

Objective: To explore whether the apparent low threshold for the mortality effects of air pollution could be the result of confounding.

Design: The associations between mortality and sulphur dioxide (SO2) were analysed taking into account potential confounding factors.

Setting: The Netherlands, 1979-87.

Prevalence of smoking in physicians and medical students, and the generation effect in The Netherlands.

This study investigates smoking habits and attitudes towards smoking in general practitioners, consultants at a university hospital, medical students and students of health policy and management (H.P.M.

Outdoor air temperature and mortality in The Netherlands: a time-series analysis.

Death rates become progressively higher when outdoor air temperature rises above or falls below 20-25 degrees C. This study addresses the question of whether this relation is largely attributable to the direct effects of exposure to heat and cold on the human body in general, and on the circulatory system in particular. The association between daily mortality and daily temperatures in the Netherlands in the period 1979-1987 was examined by controlling for influenza incidence, air pollution, and "season"; distinguishing lag periods; examining effect modification by wind speed and relative humidity; and distinguishing causes of death.

Seasonal variation in mortality in The Netherlands.

Study Objective: The aim was to describe the pattern of seasonal variation in all cause mortality in The Netherlands, and to analyse the contribution of specific causes of death to the winter excess of all cause mortality.

Design: Daily numbers of deaths in The Netherlands, by cause, were obtained for the period 1979-1987. Patterns of variation were analysed using Poisson regression.

The decline in winter excess mortality in The Netherlands.

In most countries, numbers of deaths rise considerably during the winter season. This winter excess in mortality has, however, been declining during recent decades. The causes of this decline are hardly known.

Euthanasia and other medical decisions concerning the end of life.

This article presents the first results of the Dutch nationwide study on euthanasia and other medical decisions concerning the end of life (MDEL). The study was done at the request of the Dutch government in preparation for a discussion about legislation on euthanasia. Three studies were undertaken: detailed interviews with 405 physicians, the mailing of questionnaires to the physicians of a sample of 7000 deceased persons, and the collecting of information about 2250 deaths by a prospective survey among the respondents to the interviews.

Determinants of traffic accident mortality in The Netherlands: a geographical analysis.

In the Netherlands, a country with one of the lowest levels of traffic accident mortality in the world, large regional mortality differences can be observed. An analysis was performed of the contribution of regional differences in traffic mobility (kilometers travelled/person-years), injury rate (injured people/kilometre travelled) and case fatality (traffic deaths/injured people). Subsequently, possible determinants of regional differences in traffic accident mortality and its constituent parts were investigated.

Cultural and economic determinants of geographical mortality patterns in The Netherlands.

Study Objective: The geographical pattern of mortality in The Netherlands is dominated by an area of relatively high mortality in the southern part of the country. The aim was to analyse the background of this geographical mortality pattern in the early 1980s, and its evolution over time since the early 1950s.

Design: Mortality data by district (n = 39), cause of death (13 large causes, "symptoms and ill defined conditions", all other causes), and time period (1950-54, 1960-64, 1970-74, 1980-84) were available from the Netherlands Central Bureau of Statistics.

Delaying childbearing: effect of age on fecundity and outcome of pregnancy.

Objectives: To study the age of the start of the fall (critical age) in fecundity; the probability of a pregnancy leading to a healthy baby taking into account the age of the woman; and, combining these results, to determine the age dependent probability of getting a healthy baby.

Design: Cohort study of all women who had entered a donor insemination programme.

Setting: Two fertility clinics serving a large part of The Netherlands.

[Smoking behavior of family physicians, specialists and students in Rotterdam, 1989].

In a survey of smoking habits and attitudes among general practitioners of the Rotterdam area, consultants at the University Hospital of Rotterdam, medical students and students of the Department of Health Policy and Management (HPM) at the Erasmus University of Rotterdam, it was found that 30 percent of this population smoked. Among the male general practitioners and the male HPM students more smokers were found than in the general male population. Smoking prevalence among female doctors and students is lower than among their male counterparts and also lower than that among the general female population.

Factors influencing success or failure after reversal of sterilization: a multivariate approach.

Reversal of sterilization was performed in 215 patients after unipolar coagulation, Fallope ring or clip sterilization, or bipolar coagulation or a Pomeroy sterilization. All patients had a follow-up of at least 1 year. Prognostic variables were derived from the previous history, the preoperative fertility assessment, and the actual operation.

[Regional differences in mortality from ischemic heart disease].

The geographical distribution of mortality from ischaemic heart disease in the Netherlands has changed dramatically since 1950. In 1950-1954 mortality was highest in high-income, urbanized areas, in 1980-1984 the reverse was true. This development resembles the one observed in the United States of America.

Socio-economic mortality differences in The Netherlands in 1950-1984: a regional study of cause-specific mortality.

The finding that mortality differences between occupational classes in England and Wales have widened during the postwar period raises the question whether a similar development has occurred in other industrialised countries. In this paper, a comparison is made with results from a geographical study on the Netherlands. This study compares four periods between 1950 and 1984 by means of a standard regional division, a single socio-economic index, uniform cause-of-death groups and a standard regression procedure.

Geographic variation in the onset of decline of male ischemic heart disease mortality in The Netherlands.

We studied variation in the year of onset of ischemic heart disease mortality decline among regions (n = 39) in the Netherlands. Using loglinear regression methods, a quadratic regression model was fitted to the observed numbers of male deaths in each region in the period 1950-84, controlling for changes in age-structure of populations. The quadratic regression model proved inadequate to describe the mortality experience of females.

Mortality after nasopharyngeal radium irradiation for eustachian tube dysfunction.

Cause-specific mortality of 2,510 persons treated before 1965 by nasopharyngeal radium irradiation (average exposure, 1,200 mg/min), followed to 1985, was compared to that of 2,199 nonexposed comparison subjects. No excess was found for the exposed group in overall mortality, cancer mortality, or in mortality of cancer of specific sites. A marginal excess (p = .

Regional differences in mortality from conditions amenable to medical intervention in The Netherlands: a comparison of four time periods.

In The Netherlands, as in many other countries, important geographical variation in mortality from conditions amenable to medical intervention exists. Associations with a number of simple medical care supply characteristics (general practitioner density, hospital bed density, and percentage of regional hospital beds located in university and small hospitals) are generally weak and inconsistent, both before and after controlling for possible confounding factors. We explored one of the possible reasons for this lack of consistency, which is the time dependency of the relationship between medical care supply and avoidable mortality.

Regional differences in decline of mortality from selected conditions: The Netherlands, 1969-1984.

In The Netherlands, as in many other industrialized countries, recent mortality developments have been characterized by rapid declines for a number of important causes of death. The results of an analysis of regional variation in mortality decline within The Netherlands are reported, covering the period 1969-1984. The causes of death included in this analysis are Perinatal mortality, Cerebrovascular disease, a more global 'Amenable' selection (formed by aggregating a number of causes of death considered to be amenable to medical intervention), Cancer of the stomach, Ischaemic heart disease and Traffic accidents.

Secular trends of infectious disease mortality in The Netherlands, 1911-1978: quantitative estimates of changes coinciding with the introduction of antibiotics.

Secular trends of mortality from 21 infectious diseases in the Netherlands were studied by inspection of age/sex-standardized mortality curves and by log-linear regression analysis. An attempt was made to obtain quantitative estimates for changes coinciding with the introduction of antibiotics. Two possible types of effect were considered: a sharp reduction of mortality at the moment of the introduction of antibiotics, and a longer lasting (acceleration of) mortality decline after the introduction.

Medical care and regional mortality differences within the countries of the European community.

"This paper addresses the question whether regional mortality differences within developed countries reflect differences in characteristics of medical care service. It adds two new elements to previous studies on this subject: it concentrates on selected 'avoidable' causes of death, and it makes parallel analyses for ten [European Community] countries. The results show that levels of medical care supply contribute little to the explanation of regional differences in mortality from the selected conditions.

Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in The Netherlands.

In order to assess the impact of medical care innovations on post-1950 mortality in The Netherlands, we analysed trends in mortality from a selection of conditions suggested by Rutstein et al.'s lists of "unnecessary untimely mortality". This selection covers 11 types of innovation, and includes 35 conditions which have become amenable to medical care.