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Background: Public health policy is increasingly concerned with the care for victims of a disaster. This article describes the design and implementation of an epidemiological study, which seeks to match care services to the specific problems of persons affected by a large scale incident. The study was prompted by the explosion of a firework depot in Enschede, the Netherlands. Study population: All those directly affected by this incident (residents, emergency services personnel, and people who happened to be in the area at the time), some of whom suffered personal loss or injury. The project investigates both the physical and psychological effects of the disaster, as well as the target group’s subsequent call on healthcare services. Study design: A questionnaire based follow up survey of those directly affected and an ongoing monitoring of health problems relying on reports from healthcare professionals. The follow up survey started three weeks after the incident and was repeated 18 months and almost four years after the incident. The monitoring is conducted over a four year period by general practitioners, the local mental health services department, occupational health services, and the youth healthcare services department. It provides ongoing information. Results and Conclusions: The results of the study are regularly discussed with healthcare professionals and policy makers, and are made known to the research participants. The paper also explains the considerations that were made in designing the study to help others making up their research plans when confronted with possible health effects of a disaster.

This study was initiated to identify the incidence, risk factors and outcome predictors of patients admitted to hospital in the Netherlands because of accidental hypothermia. Information about these patients was available for study through the National Health Care Data Bank. Between 1987 and 1990, 612 accidental hypothermic patients were admitted: 185 hypothermic patients also suffered from submersion (HYPSUBS), but this was not the case in the remaining 427 patients (HYPNOTSUBS). Patients in the HYPNOTSUBS group were older (average age 55.2 years versus 38.9 years; p < 0.001), remained longer in hospital (average 20.8 days versus 9.2 days; p < 0.001) and had a higher death rate than those in the HYPSUBS group (16.9% versus 5.9%; p < 0.001). In HYPNOTSUBS, increasing age correlated with increases in the length of hospital stay and death rate. This relationship was not found in HYPSUBS. Trauma was the major associated problem in both groups; these patients had the highest death rate (22.8% versus 16.7%; not significant). Death occurred within 2 days in 54% of HYPNOTSUBS non-survivors and 73% of HYPSUB non-survivors. HYPNOTSUBS admitted to university hospitals showed a lower death rate (5.9%) compared with HYPNOTSUBS admitted to non-university hospitals with less than 400 beds (13.4%) or more than 400 beds (21.7%). In contrast, the death rate in HYPSUB was higher in university hospitals (14.3%) than in non-university hospitals with less than 400 beds (5.2%) or more than 400 beds (3.6%). We observed that the incidence of accidental hypothermia is low at 1.1 per 100,000 inhabitants per year. We concluded that HYPNOTSUBS and HYPSUB are different groups of patients with respect to demographic data, risk factors and prognostic factors. Old age is an important unfavourable prognostic factor in HYPNOTSUB but not in HYPSUB. Hypothermia with trauma is an unfavourable combination in both groups. Almost half of the HYPNOTSUBS non-survivors died after more than 2 days. Because body temperature will have returned to normal by then, this must be the result of late complications. Most HYPSUB non-survivors died during the first 2 days, probably as a direct result of the submersion injury.

Objective: This study documented the number of people seeking help for mental health problems after a fireworks disaster in Enschede, the Netherlands. It describes their diagnostic characteristics, interventions provided, and their results. Methods: Researchers coded data from in- takes and medical charts of all patients who sought help (N=1,659) and entered treatment (N=663) at a disaster relief service between May 13, 2000 (day of the disaster), and June 1, 2004. Patients who received more than eight treatment sessions (N=394) and were in treatment one year after the disaster were interviewed with the Composite International Diagnostic Interview (CIDI) (N=228, response rate, 58%) and other questionnaires (N=271, response rate, 69%). Results: In the population probably exposed, the cumulative referral-incidence for disaster-relat- ed mental health problems over four years was approximately 10%; in terms of referrals to the mental health facility over five years, the pro- portion of disaster-related referrals was 5.7%. Among adults, posttrau- matic stress disorder (PTSD) was the most common clinical diagnosis (53%, chart sample). However, depression was the most common CIDI diagnosis (58%, CIDI interview sample). The recovery rate was about 50% on the basis of clinical judgment (chart sample), between 69% and 76% on the basis of "healthy" scores on symptoms, and between 39% and 60% in social and physical functioning (interview sample). Conclusions: Apart from persons seeking support during the first weeks postdisaster, the largest influx occurred after about one year and was limited in size. Clinicians in specialized services should be aware that conditions other than PTSD, such as depression, anxiety, substance abuse, and somatoform disorders, are also quite common after disas- ters. (Psychiatric Services 61:1138-1143, 2010)

The paper describes the four steps that have to be taken in the process of using a hospital information system as sampling frame: step 1, description of the medical routine and registrations related to the study population; step 2, defining the design and criteria for selection; step 3, creating the datafile and step 4, validating the datafile. To illustrate these four steps a detailed description of the selection of patients with a percutaneous renal biopsy is given, using the central database of Leiden University Hospital. All registrations relating to patients undergoing a percutaneous renal biopsy in 1985 and 1986 were taken into account and combined in defining the design and criteria for selection. The selection resulted in 182 patient-records, of which 177 were compared with the medical file. Overall 150 percutaneous biopsies were confirmed. Hospital Information Systems are in principle useful as sampling frames for clinical research. However, to use these systems successfully in selecting a study population intensive mutual consultation between clinicians, clinical epidemiologists, database experts and administrative personnel is required.

Objectives Despite advances in BSC, European CF patients still experience reduced life-expectancy, impaired lung function (FEV 1 ) and frequent pulmonary exacerbations requiring hospital admission. Airway clearance is critical to improve outcomes but options remain limited. In pooled analysis of 2 Phase III RCTs substantiating the EU adult license, inhaled dry-powder mannitol (Bronchitol®) improved FEV1 (p Methods A decision-analytic microsimulation framework assessed the incremental cost-effectiveness ratio (ICER) of BSC plus mannitol versus BSC alone. A life-long time horizon from the perspective of the publicly-funded Health Service Executive (HSE) was adopted. Model inputs included RCT, expert opinion, local unit-cost and tabulated anonymised CF Registry data. Results Compared to BSC alone, simulated patients receiving BSC plus mannitol had a lower estimated exacerbation rate, lived longer and gained 0.54 QALYs. The resulting ICER was €33,772 per QALY gained. Additional net costs (€18,370) were driven by drugs and prolonged life. Lung transplant costs were 5% lower. The ICER was relatively robust in deterministic sensitivity analysis with most variation from assumptions on the impact of mannitol on exacerbations. In probabilistic analysis, 74% of ICERs were below a €45,000 willingness to pay threshold. Conclusion In adults with CF, mannitol added to BSC is clinically beneficial and a cost-effective option for the HSE in Ireland.

To determine whether an increased familial risk for coronary artery disease in young adult men is related to changes in postprandial lipoprotein metabolism.Cross-sectional study.Coronary angiography departments of four central general hospitals in the Netherlands.80 sons (mean age, 24.8 years) of men with severe coronary artery disease and 55 sons (mean age, 23.2 years) of controls.Postprandial levels of serum triglycerides, retinyl palmitate, and total cholesterol were measured during a 12-hour period after a standardized oral lipid load.Both groups showed a marked increase in levels of serum triglyceride and retinyl palmitate after lipid loading, reaching a maximum 4 to 6 hours postprandially. No changes in postprandial total cholesterol levels were observed in either group. Sons of men with coronary artery disease had prolonged postprandial hypertriglyceridemia when compared with sons of controls. Significant differences in postprandial triglyceride levels were found at 8 hours (difference, 0.35 mmol/L; 95% CI, 0.07 to 0.62 mmol/L), at 10 hours (difference, 0.21 mmol/L; CI, 0.06 to 0.36 mmol/L), and at 12 hours after lipid loading (difference, 0.13 mmol/L; CI, 0.01 to 0.26 mmol/L). Levels of postprandial retinyl palmitate were also slightly, but not statistically, different (mainly after 6 hours).Healthy young adult sons, whose fathers have established coronary artery disease, have prolonged postprandial hypertriglyceridemia. Changes in postprandial lipoprotein metabolism appear to be associated with familial risk for coronary atherosclerosis.

Between January 1969 and December 1988, 482 patients were treated for Hodgkin's disease at the Leiden University Hospital. All cases were routinely recorded in the Hospital Information System, which has an active annual follow-up. Of all patients, 57% remained relapse free. According to the kinds of treatment they received, the following major categories were established: radiotherapy only (28.2%), chemotherapy only (20.1%), only initial combination of radiotherapy and chemotherapy (34.2%), all other combinations of radio- and chemotherapy (15.4%), or not registered (2.1%). Twenty-seven second cancers were observed; six leukemias, five non-Hodgkin lymphomas, and 16 solid tumors. Of all solid tumors only nine occurred in relapse-free patients. The overall relative risk of second cancers increased with the duration of follow-up. Using general population incidence rates to calculate expected numbers, the risk for developing leukemia, non-Hodgkin lymphoma, and solid tumors was increased 36-fold, 31-fold, and 2.4-fold, respectively. The cumulative risk of developing a second cancer 10 years after diagnosis of Hodgkin's disease was 7% for both the radiotherapy-only and the initial combination of radio- and chemotherapy group. It was 16% and 17% for the chemotherapy-only and the other combinations of radio- and chemotherapy group, respectively. Multivariate analysis (using the Cox regression model) show an increased risk of second cancers (RR = 0.7) when a relapse of Hodgkin's disease resulting in increasing cumulative therapy occurred. Age at diagnosis of Hodgkin's disease was an important determinant for the risk of non-Hodgkin lymphoma and solid tumors. Cumulative chemotherapy intensity was an important factor in increasing leukemic risk in a dose-response fashion. Apart from this, the stage of Hodgkin's disease, although closely related to the kind of therapy, seemed to have an independent effect on leukemic risk.

The associations between pregnancy and serum lipids were investigated in a cohort of 831 Dutch women, initially aged 5-19 years. These women were examined yearly from 1975 to 1985 for an average period of six years, as part of a longitudinal survey of risk factors for coronary heart disease. During this period, 62 women became pregnant, and their serum total and high density lipoprotein (HDL) cholesterol levels were compared with those of an age-matched reference series of nonpregnant women, derived from the same cohort. Pregnant women showed higher total cholesterol levels (235 +/- 7.4 mg/100 ml) than nonpregnant women (205 +/- 2.7 mg/100 ml). Pregnant women also had higher levels of HDL cholesterol (66 +/- 2.1 mg/100 ml) than their referents (57 +/- 1.0 mg/100 ml). Total and HDL cholesterol increased with duration of pregnancy. When serum lipid levels of pregnant women were compared with the levels one year before and one year after pregnancy, it was observed that the year after pregnancy, HDL cholesterol levels dropped below pre-pregnancy concentrations. At the final examination, women who had ever been pregnant showed lower HDL cholesterol levels than those who had never been pregnant. The difference was most marked in users of oral contraceptives. These observations suggest that serum total and HDL cholesterol levels are elevated during pregnancy, probably because of hormonal changes. Furthermore, they point to a possibly lowering effect of parity on HDL cholesterol. These findings may help to explain the reported positive association between parity and the occurrence of cardiovascular diseases.

It is unknown which lipoprotein in childhood is the best predictor of atherosclerosis later on in life. We measured serum triglycerides, total cholesterol, its subfractions (LDL, HDL, HDL2, HDL3) and apoproteins (A-I, A-II, B) in two groups of children. They were offspring of fathers who had severe coronary atherosclerosis or no coronary sclerosis, as determined by coronary angiography. Fasting blood lipids were measured in 49 children of fathers with severe sclerosis, and in 37 children of fathers without sclerosis. Sons of fathers with severe coronary atherosclerosis had higher levels of apo B and of the ratio apo B/apo A-I than sons of fathers free of atherosclerosis. No differences in lipid levels in daughters were observed. These observations suggest that apolipoproteins play a part in early atherogenesis. They further indicate that it may be possible to detect children who have a high probability of developing severe coronary atherosclerosis later in life.