Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.T...Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.展开更多
The use ofrenewable energyisan important way toachieve sustainable agriculturalandeconomic development.However,there are differences in accessto renewable energy between the Global North and Global South.This study ut...The use ofrenewable energyisan important way toachieve sustainable agriculturalandeconomic development.However,there are differences in accessto renewable energy between the Global North and Global South.This study utilisedan autoregressive distributed lag-error correctionmodel and thedata spanning from 1991to 2021 to comparatively analyse the dynamic relationship amongrenewable energy consumption,the value of agricultural production,gross domestic product(GDP),economic diversificationindex,urban population,the total water extraction for agricultural withdrawal,and trade balancein the Netherlands and South Africa.In the shortrun,renewable energy consumption was increased by the value of agricultural productionbut decreased by GDPin South Africa.In the longrun,renewable energy consumption and GDP increased the value of agricultural production,while the value of agricultural production also increased GDP in South Africa.However,in the Netherlands,there was no short-and long-run relationship betweenrenewable energy consumption and agricultural and economic development.The results revealedthat there was a short-and long-run relationship in South Africa.Moreover,in the Netherlands,the adjustment speed was-1.46 forrenewable energy consumption with an error correction of 0.68 a(8.22 months).In South Africa,the adjustment speedwas-1.28 forrenewable energy consumption with an error correction of 0.78 a(9.38 months).Therefore,compared to South Africa,renewable energy consumptionin the Netherlands takes less time to return to balance after a shock.Thesefindings signify different trajectories on sectoral and economic transition initiatives spurred usingrenewable energy between the Netherlands and South Africa.Policy relating to initiatives such as“agro-energy communities”in Global South countries such as South Africa should be emphasised to promote the use of renewable energy in the agricultural sector.展开更多
AIM:To analyze trends in incidence and mortality of acute pancreatitis(AP) and chronic pancreatitis(CP) in the Netherlands and for international standard populations.METHODS:A nationwide cohort is identified through r...AIM:To analyze trends in incidence and mortality of acute pancreatitis(AP) and chronic pancreatitis(CP) in the Netherlands and for international standard populations.METHODS:A nationwide cohort is identified through record linkage of hospital data for AP and CP,accumulated from three nationwide Dutch registries:the hospital discharge register,the population register,and the death certificate register.Sex-and age-group specific incidence rates of AP and CP are defined for the period 2000-2005 and mortality rates of AP and CP for the period 1995-2005.Additionally,incidence and mortality rates over time are reported for Dutch and international(European and World Health Organization) standard populations.RESULTS:Incidence of AP per 100000 persons per year increased between 2000 and 2005 from 13.2(95%CI:12.6-13.8) to 14.7(95%CI:14.1-15.3).Incidence of AP for males increased from 13.8(95%CI:12.9-14.7) to 15.2(95%CI:14.3-16.1),for females from 12.7(95%CI:11.9-13.5) to 14.2(95%CI:13.4-15.1).Irregular patterns over time emerged for CP.Overall mean incidence per 100000 persons per year was 1.77,for males 2.16,and for females 1.4.Mortality for AP fluctuated during 1995-2005 between 6.9 and 11.7 per million persons per year and was almost similar for males and females.Concerning CP,mortality for males fluctuated between 1.1(95%CI:0.6-2.3) and 4.0(95%CI:2.8-5.8),for females between 0.7(95%CI:0.3-1.6) and 2.0(95%CI:1.2-3.2).Incidence and mortality of AP and CP increased markedly with age.Standardized rates were lowest for World Health Organization standard population.CONCLUSION:Incidence of AP steadily increased while incidence of CP fluctuated.Mortality for both AP and CP remained fairly stable.Patient burden and health care costs probably will increase because of an ageing Dutch population.展开更多
AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. R...AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS: The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION: Most Dutch gastroenterologists performendoscopic surveillance without following international recommended guidelines. This practice potentially leads to a decreased sensitivity for dysplasia, rendering screening for colorectal cancer in this population highly ineffective.展开更多
Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is the most common genetic disorder predisposing to colorectal cancer. As regular colonoscopic surveillance has been shown to reduce the incidence ...Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is the most common genetic disorder predisposing to colorectal cancer. As regular colonoscopic surveillance has been shown to reduce the incidence of colorectal cancer, this strategy is recommended worldwide. Recently, several advances in colonoscopic techniques have improved detection rates of neoplasia in Lynch syndrome. In this nationwide survey, we evaluated current surveillance colonoscopy practices for Lynch syndrome in the Netherlands and the extent to which advanced techniques have been adopted in routine clinical practice.展开更多
This paper reviews the use of fiber-reinforced polymers （FRPs） in architectural and structural bridge design in the Netherlands. The challenges and opportunities of this relatively new material, both for the archite...This paper reviews the use of fiber-reinforced polymers （FRPs） in architectural and structural bridge design in the Netherlands. The challenges and opportunities of this relatively new material, both for the architect and the engineer, are discussed. An inventory of recent structural solutions in FRP is included, followed by a discussion on architectural FRP applications derived from the architectural practice of the author and of other pioneers.展开更多
Semen analysis is characterized by high levels of intra-and inter-laboratory variability,due to a low level of standardization,high subjectivity of the assessments,and problems with automated procedures.To improve con...Semen analysis is characterized by high levels of intra-and inter-laboratory variability,due to a low level of standardization,high subjectivity of the assessments,and problems with automated procedures.To improve consistency of laboratory results,quality control and training of technicians are important requisites.The goals of this study are to evaluate the results of an external quality control(EQC)program and standardized training by ESHRE Basic Semen Analysis Courses(BSAC)on the variability in manual assessments of semen parameters.We performed retrospective analyses of(1)the interlaboratory variability in the Dutch EQC program and(2)the interobserver variability in BSACs for concentration,motility,and morphology assessments.EQC data showed that the interlaboratory coefficient of variation(CV)for concentration assessment decreased(range from 24.0%–97.5%to 12.7%–20.9%)but not for morphology and motility assessments.Concentration variability was lower if improved Neubauer hemocytometers were used.Morphology assessment showed highest CVs(up to 375.0%),with many outliers in the period of 2007–2014.During BSAC,a significant reduction of interobserver variability could be established for all parameters(P<0.05).The absence of an effect in the EQC program for motility and morphology might be explained by respectively the facts that motility assessment was introduced relatively late in the EQC program(since 2013)and that criteria for morphology assessment changed in time.BSAC results might have been influenced by the pretraining level of participants and the influence of external factors.Both EQC and training show positive effects on reducing variability.Increased willingness by laboratories to change their methods toward standards may lead to further improvements.展开更多
Cities in deltas are vulnerable to climate change, especially their unembanked neighborhoods that are not protected by dikes. Rising sea levels and extreme water levels in the rivers can lead to the flooding of these ...Cities in deltas are vulnerable to climate change, especially their unembanked neighborhoods that are not protected by dikes. Rising sea levels and extreme water levels in the rivers can lead to the flooding of these urban areas. The Netherlands has a long history in water management. However, building dikes and the elevation of land are traditionally treated as rather stand-alone measures. Attention is rarely paid to the surrounding area, let alone to the complex context of cities and certainly not to disadvantaged neighborhoods. Yet, inner-city area redevelopment may provide opportunities to integrate flood management in these planning processes. In order to investigate the support of stakeholders for risk-reducing adaptive measures and more resilient measures, we did research in an unembanked inner-city area in the city of Rotterdam (The Netherlands), in which we conducted in-depth interviews with the central stakeholders. The main conclusion is that the most important barriers for integrating climate adaptation measures into that neighborhood are the fragmentation of water-safety policy (e.g. elevation of rebuilding locations) and the hierarchical governance arrangement in water management. This type of fragmentation led on its turn to fragmentation with other policy goals for the neighborhood. It also led to fragmentation between different areas in the same neighborhood that received political attention and those that are excluded from water-safety policy. This questions the approach in terms of social justice. An important side effect is that this governance arrangement also restricted innovation towards climate adaptation. Therefore, integrating water-safety policies in urban planning (in its capacity as a more integrative and comprehensive spatial approach) should be considered the best option to increase the adaptive capacity in delta cities. Not only can the negative effects in terms of policy fragmentation be dealt with effectively, but also spatial fragmentation can be tackled.展开更多
BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in...BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.展开更多
Operating an international archive for digital information resources by a relatively small organization as the Koninklijke Bibliotheek (KB) asks for a firm foundation of its policy. Continuing research and development...Operating an international archive for digital information resources by a relatively small organization as the Koninklijke Bibliotheek (KB) asks for a firm foundation of its policy. Continuing research and development efforts to secure permanent preservation and access to electronic information on a national and international scale require substantial financial, technical and staffing commitments. Cooperation in sharing resources and knowledge is called for. In the national context of the Netherlands the KB recently took the initiative to build the National Digital Preservation Coalition. All relevant sectors of Dutch society are represented. Its aim is to develop a national infrastructure and to assign clear responsibilities. In the European arena the KB, together with the British Library, started the European Alliance for Permanent Access to the Records of Science. The Alliance works towards the widespread and joint responsibility for maintaining the records of science by all major stakeholders, including national governments and the EU. In the global context the KB developed the concept of the "Safe Places Network" . This Network will include a limited number of institutions with certified digital archives for scientific publications, sharing responsibility for complete, world-wide coverage and allocate tasks accordingly.展开更多
The sprawl-versus-containment debate relates to many different aspects of the broad concept of sustainability, and as such the answers found by research are rarely decisive, compact cities have advantages in some resp...The sprawl-versus-containment debate relates to many different aspects of the broad concept of sustainability, and as such the answers found by research are rarely decisive, compact cities have advantages in some respects, but disadvantages in others. The present study focuses on the patterns of urbanization process in Netherlands as a whole and within the “Green Heart” in particular. The present study finds over the last decades, the Green Heart is under attack from suburbanization of larger and smaller settlements as several political concessions have been made to local development needs. The Green Heart is also affected by the construction of new roads and railway lines. This infrastructure is built for tangential transport of an increasing volume of commuters. The spatial policies for preserving green spaces suffer from a dilemma between two contradicting functions of green space in a regional context: to be a separator of urban and rural areas and to be an integrator towards the Regional City of “Green Metropolis”.展开更多
Resilient infrastructure is critical to a sustainable and functioning society.Infrastructure management and(re)development are highly complex processes encompassing various stakeholders’interests while they are pres-...Resilient infrastructure is critical to a sustainable and functioning society.Infrastructure management and(re)development are highly complex processes encompassing various stakeholders’interests while they are pres-sured by the uncertainty of climate change and social transition.In response to these challenges,various resilience initiatives emerged with different motivations and approaches.The purpose of this research is to understand the interplay between motivations and organizational approaches as well as resilience conceptualization.This can provide insights into which domains of resilience have been focused on and what needs to be improved in their or-ganizational approaches to realize motivations.This research specifically investigates ten resilient infrastructure initiatives in the Netherlands.By using scoping review and content analysis,our results highlight that resilience initiatives conceptualize resilience in different ways,mainly focusing on built and organizational resilience with a focus on long-term and wider geographic scope.Each initiative had several motivations,including 1)creat-ing innovative solutions,2)sharing knowledge,3)promoting commitment and cooperation,and 4)promoting resilience.These motivations are reflected in the organizational approach.For example,there was a strong link between the motivation‘creating shared knowledge’and the organizational approach‘research collaboration.’Generic motivation such as‘promoting resilience’does not have one mainstreaming approach,which shows promoting resilience in practice is still in the exploration stage.This research provides major motivations and organizational approaches and their link within the resilient infrastructure initiatives which can contribute to better organizing similar initiatives aiming for resilient infrastructure.展开更多
AIM： To find out whether there are differences in attitudes about colorectal cancer （CRC） screening among gastrointestinal （GI） specialists and general practitioners （GPs） and which method is preferred in a nat...AIM： To find out whether there are differences in attitudes about colorectal cancer （CRC） screening among gastrointestinal （GI） specialists and general practitioners （GPs） and which method is preferred in a national screening program METHODS： Four hundred and twenty Dutch GI specialists in the Netherlands and 400 GPs in Amsterdam were questioned in 2004. Questions included demographics, affiliation, attitude towards screening both for the general population and themselves, methods of screening, family history and individual risk. RESULTS： Eighty-four percent of the GI specialists returned the questionnaire in comparison to 32% of the GPs （P〈0.001）. Among the GI specialists, 92% favoured population screening whereas 51% of GPs supported population screening （P〈0.001）. Of the GI specialists 95% planned to be screened themselves, while 30% of GPs intended to do so （P〈0.001）. Regarding the general population, 72% of the GI specialists preferred colonoscopy as the screening method compared to 27% of the GPs （P〈0.001）. The method preferred for personal screening was colonoscopy in 97% of the GI specialists, while 29% of the GPs favoured colonoscopy （P〈0.001）. CONCLUSION： Screening for CRC is strongly supported by Dutch GI specialists and less by GPs. The major health issue is possibly misjudged by GPs. Since GPs play a crucial role in a successful national screening program, CRC awareness should be realized by increasing knowledge about the incidence and mortality, thus increasing awareness of the need for screening among GPs.展开更多
Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number o...Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.展开更多
Three-dimensional technologies have matured over the years.At the same time,3D information is becoming increasingly important in many applications.Still it is not straightforward to apply the solutions that work on pr...Three-dimensional technologies have matured over the years.At the same time,3D information is becoming increasingly important in many applications.Still it is not straightforward to apply the solutions that work on prototypes,small areas or for specific projects to 3D modeling of a whole nation.In the Netherlands,two initiatives are ongoing to address the issues of nation-wide 3D modeling.First,the initiative that aims at establishing and implementing a national 3D standard for large-scale topography with support of all stakeholders.Collecting and maintaining the large-scale data are the responsibility of local governments(mainly municipalities).The second initiative is led by the Kadaster(the organization responsible for topographic mapping in the Netherlands)and aims at automatically generating a 3D version of the 1:10 k object-oriented data-set based on a smart combination of the two-dimensional data with high-resolution laser data.Both initiatives are presented in this paper including results,open issues,and future plans.展开更多
AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underw...AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underwent surgery for DD in three Dutch hospitals. All hospitals used the same standardized data base. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into two groups, one undergoing elective surgery (elective group) and the other undergoing acute surgery (acute group). RESULTS: Two hundred and ninety-nine patients were admitted between 2000 and 2007. One hundred and seventy-eight patients underwent acute surgery and 121 patients received elective operations. The median age of the 121 patients was 69 years (range: 28-94 years), significantly higher in acute patients (P = 0.010). Laparoscopic resection was performed in 31% of elective patients. In the acute setting, 61% underwent a Hartmann procedure. The overall morbidity and mortality were 51% and 10%, and 60% and 16% in the acute group, which were significantly higher than in the elective group (36% and 1%). Only 35% of the temporary ostomies were restored. CONCLUSION: This study gives a picture of current surgical practice for DD in the Netherlands. New developments are implemented in daily practice, resulting in acceptable morbidity and mortality rates.展开更多
Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insura...Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health insurance system aimed to create a more competitive market in which consumers would switch health plans, thereby stimulating insurers to price competition and quality improvement. This article evaluates the switching behavior of Dutch consumers and evaluates whether this behavior is advantageous to the goals of the reform. Methods: Three surveys were conducted: from 2005-2006 (n = 478), 2008-2009 (n = 389), and 2010-2011 (n = 191). Results: In 2005-2006, almost 20 percent of the Dutch consumers switched their insurance company. In between 2006 and 2012, however, the percentage of switchers decreased to less than four percent. The main cause of this decrease is that consumers no longer perceive sufficient differences between insurance companies in terms of premium and service. In addition, consumers have difficulties finding the proper information making the right decision and believe they may not be accepted for the supplementary insurance. Consequently, insurance companies only perceive limited incentives to create a more competitive market. Conclusion: Clear and unambiguous information, combined with an obligatory acceptance for the supplementary insurance might help to improve the potential mobility of Dutch consumers.展开更多
Migration continues to serve as platform for financial and social empowerment in many countries including Ghana.There are many constraints associated with the life of migrants;however,the quest to be socially acknowle...Migration continues to serve as platform for financial and social empowerment in many countries including Ghana.There are many constraints associated with the life of migrants;however,the quest to be socially acknowledged enables them to adopt certain survival strategies.Using qualitative methodology,this paper examines Ghanaians migration to the Netherlands using the concept of“burger”.This research work highlights that some Ghanaian migrants travel with the goal of earning money to meet their personal and family needs,and so engage in any available job to build and maintain their new burger status.As burgers,they have to obtain enough money to maintain their elevated social status but need to ensure that relatives and friends in Ghana do not know how this money is obtained.To maintain the new“privilege”social status often ascribed to Ghanaians living abroad,migrants are compelled to juggle their work,income,and lifestyle in the Netherlands and(mis)-representation of themselves in Ghana.展开更多
Objectives. It is unclear whether and to what extent purportedly empowering practices in mental health care, like rehabilitation programs, recovery-supporting mental health care environments and peer-run services, con...Objectives. It is unclear whether and to what extent purportedly empowering practices in mental health care, like rehabilitation programs, recovery-supporting mental health care environments and peer-run services, contribute to the process of empowerment. Several American empowerment questionnaires have been developed in recent years, facilitating the measurement of empowerment outcomes. Given likely major transatlantic cultural differences in a value-sensitive concept such as empowerment, this article describes the development of the Netherlands Empowerment List (NEL) and its psychometric properties. Methods. Patients in Dutch mental health services provided meaning to the empowerment concept from which the NEL was derived. Based on 531 completed questionnaires, analyses in agreement with COSMIN criteria examined aspects of internal consistency, content validity, structural validity, convergent validity, discriminant validity, reproducibility and responsiveness of the NEL. Results. The NEL is a 40-item self-report questionnaire with six subscales: Social support, Professional help, Connectedness, Confidence and purpose, Self-management and Caring community. Internal consistency (Cronbach’s alpha = 0.94), aspects of validity, reproducibility (intraclass correlation = 0.79) and responsiveness were good. Correlation with existing scales was the highest for the Mental Health Confidence Scale (r = 0.78) and the lowest for the Boston Empowerment Scale (r = 0.61). Conclusion. The NEL appears to be a suitable instrument to capture the dimension of empowerment in European mental health settings.展开更多
Ⅰ.Enforcement of foreign judgments? Article 431 DCCP In the absence of a treaty in w hich the mutual recognition and enforcement of judgments in civil and commercial matters is regulated,the recognition and enforceme...Ⅰ.Enforcement of foreign judgments? Article 431 DCCP In the absence of a treaty in w hich the mutual recognition and enforcement of judgments in civil and commercial matters is regulated,the recognition and enforcement of a foreign judgment in the Netherlands is governed by general private international law.展开更多
文摘Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.
基金research supported wholly by the National Research Foundation (NRF) of South Africathe Dutch Research Council (NWO) Project (UID 129352)
文摘The use ofrenewable energyisan important way toachieve sustainable agriculturalandeconomic development.However,there are differences in accessto renewable energy between the Global North and Global South.This study utilisedan autoregressive distributed lag-error correctionmodel and thedata spanning from 1991to 2021 to comparatively analyse the dynamic relationship amongrenewable energy consumption,the value of agricultural production,gross domestic product(GDP),economic diversificationindex,urban population,the total water extraction for agricultural withdrawal,and trade balancein the Netherlands and South Africa.In the shortrun,renewable energy consumption was increased by the value of agricultural productionbut decreased by GDPin South Africa.In the longrun,renewable energy consumption and GDP increased the value of agricultural production,while the value of agricultural production also increased GDP in South Africa.However,in the Netherlands,there was no short-and long-run relationship betweenrenewable energy consumption and agricultural and economic development.The results revealedthat there was a short-and long-run relationship in South Africa.Moreover,in the Netherlands,the adjustment speed was-1.46 forrenewable energy consumption with an error correction of 0.68 a(8.22 months).In South Africa,the adjustment speedwas-1.28 forrenewable energy consumption with an error correction of 0.78 a(9.38 months).Therefore,compared to South Africa,renewable energy consumptionin the Netherlands takes less time to return to balance after a shock.Thesefindings signify different trajectories on sectoral and economic transition initiatives spurred usingrenewable energy between the Netherlands and South Africa.Policy relating to initiatives such as“agro-energy communities”in Global South countries such as South Africa should be emphasised to promote the use of renewable energy in the agricultural sector.
基金Supported by Unrestricted Grant from Axcan Pharma Incorporate,Canada,to Spanier BWMDutch Society of Gastroenterology,Gastrostart Project Number 2007-7
文摘AIM:To analyze trends in incidence and mortality of acute pancreatitis(AP) and chronic pancreatitis(CP) in the Netherlands and for international standard populations.METHODS:A nationwide cohort is identified through record linkage of hospital data for AP and CP,accumulated from three nationwide Dutch registries:the hospital discharge register,the population register,and the death certificate register.Sex-and age-group specific incidence rates of AP and CP are defined for the period 2000-2005 and mortality rates of AP and CP for the period 1995-2005.Additionally,incidence and mortality rates over time are reported for Dutch and international(European and World Health Organization) standard populations.RESULTS:Incidence of AP per 100000 persons per year increased between 2000 and 2005 from 13.2(95%CI:12.6-13.8) to 14.7(95%CI:14.1-15.3).Incidence of AP for males increased from 13.8(95%CI:12.9-14.7) to 15.2(95%CI:14.3-16.1),for females from 12.7(95%CI:11.9-13.5) to 14.2(95%CI:13.4-15.1).Irregular patterns over time emerged for CP.Overall mean incidence per 100000 persons per year was 1.77,for males 2.16,and for females 1.4.Mortality for AP fluctuated during 1995-2005 between 6.9 and 11.7 per million persons per year and was almost similar for males and females.Concerning CP,mortality for males fluctuated between 1.1(95%CI:0.6-2.3) and 4.0(95%CI:2.8-5.8),for females between 0.7(95%CI:0.3-1.6) and 2.0(95%CI:1.2-3.2).Incidence and mortality of AP and CP increased markedly with age.Standardized rates were lowest for World Health Organization standard population.CONCLUSION:Incidence of AP steadily increased while incidence of CP fluctuated.Mortality for both AP and CP remained fairly stable.Patient burden and health care costs probably will increase because of an ageing Dutch population.
文摘AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS: The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION: Most Dutch gastroenterologists performendoscopic surveillance without following international recommended guidelines. This practice potentially leads to a decreased sensitivity for dysplasia, rendering screening for colorectal cancer in this population highly ineffective.
文摘Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is the most common genetic disorder predisposing to colorectal cancer. As regular colonoscopic surveillance has been shown to reduce the incidence of colorectal cancer, this strategy is recommended worldwide. Recently, several advances in colonoscopic techniques have improved detection rates of neoplasia in Lynch syndrome. In this nationwide survey, we evaluated current surveillance colonoscopy practices for Lynch syndrome in the Netherlands and the extent to which advanced techniques have been adopted in routine clinical practice.
文摘This paper reviews the use of fiber-reinforced polymers （FRPs） in architectural and structural bridge design in the Netherlands. The challenges and opportunities of this relatively new material, both for the architect and the engineer, are discussed. An inventory of recent structural solutions in FRP is included, followed by a discussion on architectural FRP applications derived from the architectural practice of the author and of other pioneers.
基金This study was supported by an unrestricted grant from the Dutch Foundation for Quality Assessment in Medical Laboratories(SKML),Nijmegen,the NetherlandsSKML is a nonprofit organization for external quality control for medical laboratories.
文摘Semen analysis is characterized by high levels of intra-and inter-laboratory variability,due to a low level of standardization,high subjectivity of the assessments,and problems with automated procedures.To improve consistency of laboratory results,quality control and training of technicians are important requisites.The goals of this study are to evaluate the results of an external quality control(EQC)program and standardized training by ESHRE Basic Semen Analysis Courses(BSAC)on the variability in manual assessments of semen parameters.We performed retrospective analyses of(1)the interlaboratory variability in the Dutch EQC program and(2)the interobserver variability in BSACs for concentration,motility,and morphology assessments.EQC data showed that the interlaboratory coefficient of variation(CV)for concentration assessment decreased(range from 24.0%–97.5%to 12.7%–20.9%)but not for morphology and motility assessments.Concentration variability was lower if improved Neubauer hemocytometers were used.Morphology assessment showed highest CVs(up to 375.0%),with many outliers in the period of 2007–2014.During BSAC,a significant reduction of interobserver variability could be established for all parameters(P<0.05).The absence of an effect in the EQC program for motility and morphology might be explained by respectively the facts that motility assessment was introduced relatively late in the EQC program(since 2013)and that criteria for morphology assessment changed in time.BSAC results might have been influenced by the pretraining level of participants and the influence of external factors.Both EQC and training show positive effects on reducing variability.Increased willingness by laboratories to change their methods toward standards may lead to further improvements.
文摘Cities in deltas are vulnerable to climate change, especially their unembanked neighborhoods that are not protected by dikes. Rising sea levels and extreme water levels in the rivers can lead to the flooding of these urban areas. The Netherlands has a long history in water management. However, building dikes and the elevation of land are traditionally treated as rather stand-alone measures. Attention is rarely paid to the surrounding area, let alone to the complex context of cities and certainly not to disadvantaged neighborhoods. Yet, inner-city area redevelopment may provide opportunities to integrate flood management in these planning processes. In order to investigate the support of stakeholders for risk-reducing adaptive measures and more resilient measures, we did research in an unembanked inner-city area in the city of Rotterdam (The Netherlands), in which we conducted in-depth interviews with the central stakeholders. The main conclusion is that the most important barriers for integrating climate adaptation measures into that neighborhood are the fragmentation of water-safety policy (e.g. elevation of rebuilding locations) and the hierarchical governance arrangement in water management. This type of fragmentation led on its turn to fragmentation with other policy goals for the neighborhood. It also led to fragmentation between different areas in the same neighborhood that received political attention and those that are excluded from water-safety policy. This questions the approach in terms of social justice. An important side effect is that this governance arrangement also restricted innovation towards climate adaptation. Therefore, integrating water-safety policies in urban planning (in its capacity as a more integrative and comprehensive spatial approach) should be considered the best option to increase the adaptive capacity in delta cities. Not only can the negative effects in terms of policy fragmentation be dealt with effectively, but also spatial fragmentation can be tackled.
文摘BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.
文摘Operating an international archive for digital information resources by a relatively small organization as the Koninklijke Bibliotheek (KB) asks for a firm foundation of its policy. Continuing research and development efforts to secure permanent preservation and access to electronic information on a national and international scale require substantial financial, technical and staffing commitments. Cooperation in sharing resources and knowledge is called for. In the national context of the Netherlands the KB recently took the initiative to build the National Digital Preservation Coalition. All relevant sectors of Dutch society are represented. Its aim is to develop a national infrastructure and to assign clear responsibilities. In the European arena the KB, together with the British Library, started the European Alliance for Permanent Access to the Records of Science. The Alliance works towards the widespread and joint responsibility for maintaining the records of science by all major stakeholders, including national governments and the EU. In the global context the KB developed the concept of the "Safe Places Network" . This Network will include a limited number of institutions with certified digital archives for scientific publications, sharing responsibility for complete, world-wide coverage and allocate tasks accordingly.
文摘The sprawl-versus-containment debate relates to many different aspects of the broad concept of sustainability, and as such the answers found by research are rarely decisive, compact cities have advantages in some respects, but disadvantages in others. The present study focuses on the patterns of urbanization process in Netherlands as a whole and within the “Green Heart” in particular. The present study finds over the last decades, the Green Heart is under attack from suburbanization of larger and smaller settlements as several political concessions have been made to local development needs. The Green Heart is also affected by the construction of new roads and railway lines. This infrastructure is built for tangential transport of an increasing volume of commuters. The spatial policies for preserving green spaces suffer from a dilemma between two contradicting functions of green space in a regional context: to be a separator of urban and rural areas and to be an integrator towards the Regional City of “Green Metropolis”.
文摘Resilient infrastructure is critical to a sustainable and functioning society.Infrastructure management and(re)development are highly complex processes encompassing various stakeholders’interests while they are pres-sured by the uncertainty of climate change and social transition.In response to these challenges,various resilience initiatives emerged with different motivations and approaches.The purpose of this research is to understand the interplay between motivations and organizational approaches as well as resilience conceptualization.This can provide insights into which domains of resilience have been focused on and what needs to be improved in their or-ganizational approaches to realize motivations.This research specifically investigates ten resilient infrastructure initiatives in the Netherlands.By using scoping review and content analysis,our results highlight that resilience initiatives conceptualize resilience in different ways,mainly focusing on built and organizational resilience with a focus on long-term and wider geographic scope.Each initiative had several motivations,including 1)creat-ing innovative solutions,2)sharing knowledge,3)promoting commitment and cooperation,and 4)promoting resilience.These motivations are reflected in the organizational approach.For example,there was a strong link between the motivation‘creating shared knowledge’and the organizational approach‘research collaboration.’Generic motivation such as‘promoting resilience’does not have one mainstreaming approach,which shows promoting resilience in practice is still in the exploration stage.This research provides major motivations and organizational approaches and their link within the resilient infrastructure initiatives which can contribute to better organizing similar initiatives aiming for resilient infrastructure.
文摘AIM： To find out whether there are differences in attitudes about colorectal cancer （CRC） screening among gastrointestinal （GI） specialists and general practitioners （GPs） and which method is preferred in a national screening program METHODS： Four hundred and twenty Dutch GI specialists in the Netherlands and 400 GPs in Amsterdam were questioned in 2004. Questions included demographics, affiliation, attitude towards screening both for the general population and themselves, methods of screening, family history and individual risk. RESULTS： Eighty-four percent of the GI specialists returned the questionnaire in comparison to 32% of the GPs （P〈0.001）. Among the GI specialists, 92% favoured population screening whereas 51% of GPs supported population screening （P〈0.001）. Of the GI specialists 95% planned to be screened themselves, while 30% of GPs intended to do so （P〈0.001）. Regarding the general population, 72% of the GI specialists preferred colonoscopy as the screening method compared to 27% of the GPs （P〈0.001）. The method preferred for personal screening was colonoscopy in 97% of the GI specialists, while 29% of the GPs favoured colonoscopy （P〈0.001）. CONCLUSION： Screening for CRC is strongly supported by Dutch GI specialists and less by GPs. The major health issue is possibly misjudged by GPs. Since GPs play a crucial role in a successful national screening program, CRC awareness should be realized by increasing knowledge about the incidence and mortality, thus increasing awareness of the need for screening among GPs.
文摘Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.
基金This research is supported by the Dutch Technology Foundation STW,which is part of the Netherlands Organization for Scientific Research(NWO),and which is partly funded by the Ministry of Economic Affairs(project code:11300).
文摘Three-dimensional technologies have matured over the years.At the same time,3D information is becoming increasingly important in many applications.Still it is not straightforward to apply the solutions that work on prototypes,small areas or for specific projects to 3D modeling of a whole nation.In the Netherlands,two initiatives are ongoing to address the issues of nation-wide 3D modeling.First,the initiative that aims at establishing and implementing a national 3D standard for large-scale topography with support of all stakeholders.Collecting and maintaining the large-scale data are the responsibility of local governments(mainly municipalities).The second initiative is led by the Kadaster(the organization responsible for topographic mapping in the Netherlands)and aims at automatically generating a 3D version of the 1:10 k object-oriented data-set based on a smart combination of the two-dimensional data with high-resolution laser data.Both initiatives are presented in this paper including results,open issues,and future plans.
基金Supported by Reinier de Graaf Gasthuis, VU University Medical Center and Deventer Ziekenhuis
文摘AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underwent surgery for DD in three Dutch hospitals. All hospitals used the same standardized data base. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into two groups, one undergoing elective surgery (elective group) and the other undergoing acute surgery (acute group). RESULTS: Two hundred and ninety-nine patients were admitted between 2000 and 2007. One hundred and seventy-eight patients underwent acute surgery and 121 patients received elective operations. The median age of the 121 patients was 69 years (range: 28-94 years), significantly higher in acute patients (P = 0.010). Laparoscopic resection was performed in 31% of elective patients. In the acute setting, 61% underwent a Hartmann procedure. The overall morbidity and mortality were 51% and 10%, and 60% and 16% in the acute group, which were significantly higher than in the elective group (36% and 1%). Only 35% of the temporary ostomies were restored. CONCLUSION: This study gives a picture of current surgical practice for DD in the Netherlands. New developments are implemented in daily practice, resulting in acceptable morbidity and mortality rates.
文摘Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health insurance system aimed to create a more competitive market in which consumers would switch health plans, thereby stimulating insurers to price competition and quality improvement. This article evaluates the switching behavior of Dutch consumers and evaluates whether this behavior is advantageous to the goals of the reform. Methods: Three surveys were conducted: from 2005-2006 (n = 478), 2008-2009 (n = 389), and 2010-2011 (n = 191). Results: In 2005-2006, almost 20 percent of the Dutch consumers switched their insurance company. In between 2006 and 2012, however, the percentage of switchers decreased to less than four percent. The main cause of this decrease is that consumers no longer perceive sufficient differences between insurance companies in terms of premium and service. In addition, consumers have difficulties finding the proper information making the right decision and believe they may not be accepted for the supplementary insurance. Consequently, insurance companies only perceive limited incentives to create a more competitive market. Conclusion: Clear and unambiguous information, combined with an obligatory acceptance for the supplementary insurance might help to improve the potential mobility of Dutch consumers.
文摘Migration continues to serve as platform for financial and social empowerment in many countries including Ghana.There are many constraints associated with the life of migrants;however,the quest to be socially acknowledged enables them to adopt certain survival strategies.Using qualitative methodology,this paper examines Ghanaians migration to the Netherlands using the concept of“burger”.This research work highlights that some Ghanaian migrants travel with the goal of earning money to meet their personal and family needs,and so engage in any available job to build and maintain their new burger status.As burgers,they have to obtain enough money to maintain their elevated social status but need to ensure that relatives and friends in Ghana do not know how this money is obtained.To maintain the new“privilege”social status often ascribed to Ghanaians living abroad,migrants are compelled to juggle their work,income,and lifestyle in the Netherlands and(mis)-representation of themselves in Ghana.
文摘Objectives. It is unclear whether and to what extent purportedly empowering practices in mental health care, like rehabilitation programs, recovery-supporting mental health care environments and peer-run services, contribute to the process of empowerment. Several American empowerment questionnaires have been developed in recent years, facilitating the measurement of empowerment outcomes. Given likely major transatlantic cultural differences in a value-sensitive concept such as empowerment, this article describes the development of the Netherlands Empowerment List (NEL) and its psychometric properties. Methods. Patients in Dutch mental health services provided meaning to the empowerment concept from which the NEL was derived. Based on 531 completed questionnaires, analyses in agreement with COSMIN criteria examined aspects of internal consistency, content validity, structural validity, convergent validity, discriminant validity, reproducibility and responsiveness of the NEL. Results. The NEL is a 40-item self-report questionnaire with six subscales: Social support, Professional help, Connectedness, Confidence and purpose, Self-management and Caring community. Internal consistency (Cronbach’s alpha = 0.94), aspects of validity, reproducibility (intraclass correlation = 0.79) and responsiveness were good. Correlation with existing scales was the highest for the Mental Health Confidence Scale (r = 0.78) and the lowest for the Boston Empowerment Scale (r = 0.61). Conclusion. The NEL appears to be a suitable instrument to capture the dimension of empowerment in European mental health settings.
文摘Ⅰ.Enforcement of foreign judgments? Article 431 DCCP In the absence of a treaty in w hich the mutual recognition and enforcement of judgments in civil and commercial matters is regulated,the recognition and enforcement of a foreign judgment in the Netherlands is governed by general private international law.
