BACKGROUND & AIMS: BACKGROUND:The objective of this study was to update the registry of women in the Netherlands with clear cell adenocarcinoma (CCAC) of the cervix or vagina with or without intrauterine exposure to diethylstilbestrol (DES). METHODS:From a nationwide search in PALGA, the automated pathology registry in the Netherlands, data were gathered on women with CCAC born after 1947. Information obtained from the clinical files of the patients included reported exposure to DES, patterns of complaints previous to diagnosis, the current status of the patients, and the results of cytopathologic examinations previous to histopathologic diagnosis. After review of the histopathologic slides, the specific pathologic characteristics of CCAC were determined. The age distribution of women born after 1947 was compared with that of women born before 1947. RESULTS:Information about possible exposure to DES during pregnancy was available for 73 of 88 women with CCAC born after 1947. Exposure to DES was reported for 47 (64%) of these women. The DES medication was most often reported as having started before the 18th week of pregnancy. Cytopathologic examination was informative in 81% of the cases of CCAC of the cervix, but only in 41% of the cases of CCAC of the vagina. Most patients had Stage I or II tumors at diagnosis. Tumor Stage III and IV and a high grade of nuclear atypia were related to unfavorable outcome. The age distribution of all patients with CCAC showed two distinct peaks; one at young age, (a mean age of 26 years), and one at older age (a mean age of 71 years). This bimodal age distribution still applied when the cases in which DES exposure was reported had been excluded. CONCLUSIONS:Despite the fact that DES has not been prescribed to pregnant women in the Netherlands in the last 20 years, CCAC is still relevant in our times. It is important to stay alert and periodically to update and evaluate the data of this registry, including data on women born outside the DES exposure period. The bimodal age distribution in this study of women without intrauterine exposure to DES suggests a carcinogenesis-promoting role of menarche and menopause and/ or the existence of a subpopulation with genetic risk factors or exogenous risk factors other than exposure to DES. Postmenopausal observation of women exposed to DES must be encouraged for clinical reasons and may help facilitate differentiation between these two hypotheses. If these risk factors of CCAC were better documented and their interrelationships better defined, CCAC could become an important model of multistep carcinogenesis in tissues sensitive to sex hormones.

背景与目标： 摘要背景：这项研究的目的是更新荷兰妇女宫颈或阴道透明细胞腺癌（CCAC）宫腔内或不暴露于己烯雌酚（DES）的女性登记资料。
方法：通过在荷兰的自动病理注册机构PALGA进行的全国性搜索，收集了1947年以后出生的CCAC妇女的数据。从患者的临床档案中获得的信息包括报告的DES暴露，诊断前的投诉模式，患者的当前状况以及组织病理学诊断之前的细胞病理学检查结果。在回顾了组织病理学切片之后，确定了CCAC的具体病理学特征。比较了1947年以后出生的妇女和1947年之前出生的妇女的年龄分布。
结果：1947年后出生的88例CCAC妇女中有73例可获得有关怀孕期间可能暴露于DES的信息。据报道，这些女性中有47例（64％）接触DES。据报道，DES药物是在怀孕第18周之前开始服用的。在81％的子宫颈CCAC病例中，细胞病理学检查是有益的，但在阴道的CCAC病例中仅41％。大多数患者在诊断时患有I期或II期肿瘤。肿瘤的第三和第四阶段以及高度的核非典型性与不良预后有关。所有CCAC患者的年龄分布均出现两个明显的高峰。一位年龄较小（平均年龄26岁），一位年龄较大（平均年龄71岁）。当排除了报道有DES暴露的病例时，这种双峰年龄分布仍然适用。
结论：尽管在过去的20年中荷兰没有为孕妇开具DES，但CCAC在我们这个时代仍然具有现实意义。重要的是要保持警惕，并定期更新和评估该注册表的数据，包括有关DES暴露期以外出生的妇女的数据。在这项研究中，没有宫内暴露于DES的妇女的双峰年龄分布表明，月经初潮和更年期的致癌作用和/或除了暴露于DES之外，还存在具有遗传危险因素或外源危险因素的亚群。出于临床原因，必须鼓励对接受DES的妇女进行绝经后观察，这可能有助于促进这两种假说之间的区分。如果更好地记录CCAC的这些危险因素并更好地定义它们之间的相互关系，CCAC可能会成为对性激素敏感的组织中多步骤癌变的重要模型。

BACKGROUND & AIMS: :Individuals at 50% risk of Huntington's disease (HD) who prefer not to know their carrier status, might opt for exclusion prenatal diagnosis (ePND) or exclusion preimplantation genetic diagnosis (ePGD). This study aims to provide a better understanding of couples' motives for choosing ePND or ePND, and surveys couples' experiences in order to make recommendations for the improvement of counselling for exclusion testing. This qualitative retrospective interview study focussed on couples who underwent ePND or ePGD for HD in the period 1996-2010. Seventeen couples were included of which 13 had experienced ePND and 6 ePGD. Mean time-interval since exclusion-testing was 3.9 years. Couples' moral reservations regarding termination of pregnancy (TOP) or discarding healthy embryos were counterbalanced by the wish to protect their future child against HD. Seven couples had terminated a total of 11 pregnancies with a 50% HD risk, none showed regret. ePGD was used by couples who wanted to avoid (another) TOP. ePND and ePGD are acceptable reproductive options for a specific group of counsellees. To guarantee sound standards of care, it is imperative that candidate couples be given in-depth non-directive counselling about all possible scenarios, and adequate professional and psychological support prior to, during and after ePND/ePGD.

背景与目标： ：那些不知道自己的携带者状况，患亨廷顿氏病（HD）风险为50％的个体，可能会选择排除产前诊断（ePND）或排除植入前遗传学诊断（ePGD）。这项研究旨在更好地了解夫妻选择ePND或ePND的动机，并调查夫妻的经历，以便为改善排除测试的咨询意见提供建议。这项定性的回顾性访谈研究的重点是在1996-2010年期间接受HD的ePND或ePGD的夫妇。其中包括17对夫妇，其中13对有ePND经历和6对ePGD。自排除测试以来的平均时间间隔为3.9年。保护夫妻免于高清的愿望抵消了夫妻在终止妊娠（TOP）或丢弃健康胚胎方面的道德保留。 7对夫妇共终止了11例妊娠，HD风险为50％，没有人表示遗憾。希望避免使用（另一种）TOP的夫妇使用了ePGD。 ePND和ePGD是特定人群的可接受的生殖选择。为了保证合理的护理标准，在ePND / ePGD之前，之中和之后，必须为候选夫妇提供有关所有可能情况的深入非指导性咨询，并提供足够的专业和心理支持。

BACKGROUND & AIMS: BACKGROUND:Recent studies of pancreatic cancer suggest a role for hyperinsulinemia in carcinogenesis. Because insulin is secreted in response to elevated blood glucose concentrations, dietary factors that increase these concentrations may be important in pancreatic carcinogenesis. OBJECTIVE:The objective was to examine prospectively the relation between pancreatic cancer risk and dietary glycemic load (GL), overall glycemic index (GI), and intake of total carbohydrates and mono- and disaccharides. DESIGN:The Netherlands Cohort Study consisted of 120,852 men and women who completed a baseline questionnaire in 1986. After 13.3 y of follow-up, 408 pancreatic cancer cases were detected, 66% of which were microscopically confirmed. A validated 150-item food-frequency questionnaire, completed at baseline, was used to calculate carbohydrate and mono- and disaccharide intakes and the GL and GI of the diet. RESULTS:Dietary GL, GI, or intake of carbohydrates and mono- and disaccharides were not associated with pancreatic cancer risk in this cohort. Also, the associations were not modified by sex. Our results did not change after the analysis was restricted to microscopically confirmed pancreatic cancer cases or after individuals who reported a history of diabetes at baseline were excluded from the analyses. CONCLUSIONS:Overall, our findings do not support the hypothesis that GL, GI, or intake of carbohydrates and mono- and disaccharides are positively associated with pancreatic cancer risk. This is in agreement with previous prospective studies that investigated the relation between GL and GI and pancreatic cancer risk.

背景与目标： 背景：胰腺癌的最新研究表明高胰岛素血症在致癌作用中的作用。由于胰岛素是对血糖浓度升高的反应而分泌的，因此增加这些浓度的饮食因素在胰腺癌发生中可能很重要。
目的：前瞻性检查胰腺癌风险与饮食中血糖负荷（GL），总血糖指数（GI）以及总碳水化合物，单糖和二糖摄入量之间的关系。
设计：荷兰队列研究由120,852名男性和女性组成，他们于1986年完成了基线调查问卷。在进行了13.3年的随访之后，发现了408例胰腺癌病例，其中66％被镜检确诊。在基线完成的经过验证的150个食物的食物频率调查表用于计算碳水化合物和单糖和双糖的摄入量以及饮食的GL和GI。
结果：在这个队列中，饮食中的GL，GI或碳水化合物，单糖和双糖的摄入与胰腺癌的风险无关。此外，该协会没有按性别进行修改。在将分析仅限于显微镜下确认的胰腺癌病例之后或在基线时报告糖尿病史的个体从分析中排除之后，我们的结果没有改变。
结论：总的来说，我们的发现不支持GL，GI或碳水化合物，单糖和双糖摄入与胰腺癌风险呈正相关的假说。这与以前的前瞻性研究一致，前瞻性研究调查了GL和GI与胰腺癌风险之间的关系。

BACKGROUND & AIMS: PURPOSE:Outcomes after different treatment strategies for ductal carcinoma in situ (DCIS) of the breast were analyzed for a geographically defined population in the East Netherlands. METHODS AND MATERIALS:A total of 798 patients with a first diagnosis of DCIS between January 1989 and December 2003 were included and their medical records were reviewed. Survival rates for ipsilateral recurrences were calculated by the Kaplan-Meier method and a multivariate Cox proportional hazards regression model was used to evaluate the prognostic significance of different variables. RESULTS:The 5-year recurrence-free survival was 75% for breast conserving surgery (BCS) alone (237 patients) compared with 91% for BCS followed by radiation therapy (RT; 153 patients) and 99% for mastectomy (408 patients, p < 0.01). Independent risk factors for local recurrences were treatment strategy, symptomatically detected DCIS, and presence of comedo necrosis. Margin status reached statistical significance only for patients treated by BCS (hazard ratio, 2.0; 95% confidence interval, 1.1-4.0) whereas significance of other prognostic variables did not change. CONCLUSIONS:In a defined population outside a trial setting, RT after BCS for DCIS lowered recurrence rates. Besides the use of RT, a microscopically complete excision of DCIS is essential. This is especially true for patients with symptomatically detected DCIS and with tumors that contain comedo necrosis, as these groups are at particular high risk for recurrent disease.

背景与目标： 目的：分析了荷兰东部地理上特定人群的乳腺导管原位癌（DCIS）不同治疗策略后的结果。
方法和材料：纳入了1989年1月至2003年12月首次诊断为DCIS的798例患者，并对其病历进行了回顾。通过Kaplan-Meier方法计算同侧复发的生存率，并使用多变量Cox比例风险回归模型评估不同变量的预后意义。
结果：仅保乳手术（BCS）的5年无复发生存率为75％（237例），而放化疗的BCS为91％（RT； 153例），乳腺切除术为99％（408例， p <0.01）。局部复发的独立危险因素是治疗策略，对症检测到的DCIS和粉刺坏死的存在。边缘状态仅在接受BCS治疗的患者中达到统计学显着性（危险比2.0； 95％置信区间1.1-4.0），而其他预后变量的显着性不变。
结论：在试验环境之外的特定人群中，BCS后进行DCIS的RT降低了复发率。除了使用RT，在显微镜下完整切除DCIS也是必不可少的。对于有症状检测到的DCIS且肿瘤含有粉刺坏死的患者，尤其如此，因为这些人群复发疾病的风险特别高。

BACKGROUND & AIMS: :Psychiatry and mental healthcare in the Netherlands has a long history of institutional care, slowly more adapted to the community, but differentiated from mainstream healthcare in terms of organization and remuneration. It is in a crucial phase of reconsideration. Along with harsh cuts on the budgets in healthcare, the field is in transition where training is concerned. The good news is that in fruitful cooperation the government and all spcialist parties involved in mental healthcare are on the verge of reaching an important agreement that should make mental healthcare more patient centred, affordable and accessible for those who need it. The bad news that needs serious consideration and ongoing action is that mental health problems are still highly stigmatized and that as a result the government could impose an unjust and unfair own financial contribution for users in mental care as a means of lowering the costs in the field.

背景与目标： ：荷兰的精神病学和精神卫生保健机构护理历史悠久，逐渐适应社区发展，但在组织和薪酬方面与主流卫生保健有所不同。它处于重新考虑的关键阶段。随着医疗保健预算的大幅度削减，与培训有关的领域正在过渡。好消息是，在富有成果的合作中，政府和参与精神保健的所有社会主义党派即将达成一项重要协议，该协议应使精神保健更加以患者为中心，负担得起且对需要的人可用。需要认真考虑并采取持续行动的坏消息是，精神健康问题仍然受到高度污名化，因此，政府可能向精神保健使用者施加不公正和不公平的自身财政捐助，以降低现场医疗费用。

BACKGROUND & AIMS: BACKGROUND:The Dutch multi-ethnic Healthy Life in an Urban Setting study recently showed that alcohol consumption was lower in ethnic minority groups than those of Dutch origin, but that binge drinking in drinkers of Turkish and Moroccan origin was relatively high. The aim of the current study is to examine factors that may contribute to the differences in drinking patterns and how they relate to the relationship between drinking patterns and alcohol dependence (AD) across ethnic groups. METHODS:The rate of last year alcohol use, alcohol use patterns and AD was assessed in 4,635 Dutch, 4,317 Moroccan, 4,036 Turkish, 2,459 Ghanaian, 4,426 African Surinamese and 3,357 South-Asian Surinamese participants (both men and women) born in Amsterdam, the Netherlands. RESULTS:Compared to the Dutch, the prevalence of (regular) drinking is substantially lower in all ethnic minority groups and regular drinkers among most ethnic minority groups have a lower adjusted risk to develop binge drinking and AD than the Dutch. For the prevalence of regular drinking, the ethnic differences are bigger than for the prevalence of current drinking. However, regular drinkers of Moroccan origin have a risk similar to the Dutch to develop binge drinking and AD; a finding that could not be explained by group differences in age, sex, religiosity, perceived discrimination, depression or guilt feelings about drinking. DISCUSSION:The prevalence data show that current drinking is lower and that regular drinking is much lower in ethnic minorities and - with the exception of those of Moroccan origin - ethnic minority regular drinkers also have a significant lower risk to develop binge drinking or AD than regular drinkers of Dutch origin. This implies that the magnitude of problematic alcohol use is substantially smaller in ethnic minorities than in the ethnic Dutch population of Amsterdam. Unfortunately, no explanation was found for the special risk situation of regular drinkers of Moroccan origin.

背景与目标： 背景：荷兰城市环境中的多种族健康生活研究​​最近显示，少数民族人群的酒精消费量低于荷兰裔，但土耳其和摩洛哥裔饮酒者的酗酒相对较高。当前研究的目的是研究可能导致饮酒方式差异的因素，以及它们如何与跨族裔的饮酒方式与酒精依赖（AD）之间的关系相关。
方法：评估了在阿姆斯特丹出生的4,635荷兰人，4,317摩洛哥人，4,036土耳其人，2,459加纳人，4,426非洲苏里南人和3,357南亚苏里南人（男性和女性）的去年酒精使用率，酒精使用方式和AD的发生率，荷兰人。
结果：与荷兰人相比，在所有少数族裔人群中，（正常）饮酒的患病率要低得多，并且大多数少数民族人群中的经常饮酒者与荷兰人相比，发生暴饮和AD的调整后风险较低。就经常饮酒的患病率而言，种族差异要大于目前饮酒的患病率。但是，经常饮用摩洛哥起源的饮酒者与荷兰人有类似的发展狂饮和AD的风险。这一发现无法通过年龄，性别，宗教信仰，感知的歧视，沮丧或内drinking的饮酒感的群体差异来解释。
讨论：患病率数据显示，少数民族中的当前饮酒量较低，经常饮酒的比例要低得多-除了摩洛哥血统的少数民族-与正常人相比，少数族裔经常饮酒者发生暴饮或AD的风险也要低得多荷兰裔饮酒者。这意味着在少数民族中，有问题的酒精消费量要比在阿姆斯特丹的荷兰族裔人口要小得多。不幸的是，没有找到关于摩洛哥普通饮酒者特殊危险情况的解释。

BACKGROUND & AIMS: Background:Routinely, the first measles, mumps, and rubella (MMR) vaccine dose is given at 14 months of age in the Netherlands. However, during a measles epidemic in 2013-2014, MMR vaccination was also offered to 6-14-month-olds in municipalities with <90% MMR vaccination coverage. We studied the effectiveness of the early MMR vaccination schedule. Methods:Parents of all infants targeted for early MMR vaccination were asked to participate. When parent(s) suspected measles, their infant's saliva was tested for measles-specific antibodies. The vaccine effectiveness (VE) against laboratory-confirmed and self-reported measles was estimated using Cox regression, with VE calculated as 1 minus the hazard ratio. Results:Three vaccinated and 10 unvaccinated laboratory-confirmed cases occurred over observation times of 106631 and 23769 days, respectively. The unadjusted VE against laboratory-confirmed measles was 94% (95% confidence interval [CI], 79%-98%). After adjustment for religion and sibling's vaccination status, the VE decreased to 71% (-72%-95%). For self-reported measles, the unadjusted and adjusted VE was 67% (40%-82%) and 43% (-12%-71%), respectively. Conclusions:Infants vaccinated between 6 and 14 months of age had a lower risk of measles than unvaccinated infants. However, part of the effect was caused by herd immunity, since vaccinated infants were more likely to be surrounded by other vaccinated individuals.

背景与目标： 背景：在荷兰，常规的第一个麻疹，腮腺炎和风疹（MMR）疫苗剂量是在14个月大时接种的。然而，在2013-2014年的麻疹流行期间，还向市镇6-14个月大的婴儿提供了MMR疫苗接种，接种率不到90％。我们研究了早期MMR疫苗接种计划的有效性。
方法：要求所有接受早期MMR疫苗接种的婴儿的父母参加。当父母怀疑麻疹时，对婴儿的唾液进行麻疹特异性抗体检测。使用Cox回归评估了针对实验室确诊和自行报告的麻疹的疫苗效力（VE），计算得出的VE为1减去危险比。
结果：分别在106631和23769天的观察时间内发生了3例疫苗接种和10例未经实验室确认的疫苗接种病例。针对实验室确认的麻疹的未经调整的VE为94％（95％置信区间[CI]，79％-98％）。在对宗教和兄弟姐妹的疫苗接种状况进行调整之后，VE降至71％（-72％-95％）。对于自我报告的麻疹，未经调整和调整的VE分别为67％（40％-82％）和43％（-12％-71％）。
结论：在6至14个月大的年龄中接种疫苗的婴儿比未接种疫苗的婴儿患麻疹的风险更低。但是，部分影响是由于牛群免疫引起的，因为接种疫苗的婴儿更有可能被其他接种疫苗的个体包围。

BACKGROUND & AIMS: :In the nineteenth century, there was a continuous debate on the structure and function of the brain, focusing on localization of function and on epilepsy. France, Germany, and England played a leading role. This article addresses the question of what happened with respect to the study of epilepsy in the Netherlands in that period. A systematic search of the literature has been performed and papers by Schroeder van der Kolk, Huet, Jelgersma, and Niermeijer are discussed. Also two dissertations were selected for discussion, those of Kroon and Langelaan. It is concluded that from a scientific point of view, only the paper by Schroeder van der Kolk deserved and received international attention.

背景与目标： ：在19世纪，关于大脑的结构和功能的争论一直在持续，主要集中在功能的定位和癫痫病上。法国，德国和英国起了主导作用。本文讨论了那个时期在荷兰进行的癫痫研究中发生了什么问题。对文献进行了系统的检索，并对Schroeder van der Kolk，Huet，Jelgersma和Niermeijer的论文进行了讨论。还选择了两篇论文进行讨论，即Kroon和Langelaan。结论是，从科学的角度来看，只有Schroeder van der Kolk的论文才应受到国际关注。

BACKGROUND & AIMS: PURPOSE:The purpose of this paper is to describe an inventory of the strategic responses of institutional providers of mental handicapped care to the strengthening of consumer choice through a personal care budget (PCB). DESIGN/METHODOLOGY/APPROACH:Semi structured interviews were conducted among 26 providers covering 52 per cent of the total market volume of about 100,000 clients annually. FINDINGS:A representative number of providers was included; on average a percentage below the national average of PCB users was found to be served. Of the 26 providers, 16 indicated adaption to their strategy in response to expected consumer empowerment The actual deployment of this response in the organisations seemed not to be very thorough or explicit. Surprisingly, as a growing part of PCB-clients choose alternative providers, no concerns were raised concerning the possible emergence of new service providers. ORIGINALITY/VALUE:Although the market share of PCB users is growing fast and existing providers do not seem to absorb this accordingly, a lack of market analysis and strategic behaviour of the traditional providers in response to this development was found. Based on this research growth of market shares of disruptive service providers can very well be anticipated.

背景与目标： 目的：本文的目的是描述精神残疾护理机构提供者通过个人护理预算（PCB）加强消费者选择的战略对策清单。
设计/方法/方法：对26家提供商进行了半结构化访谈，涵盖了每年约100,000个客户的总市场量的52％。
结果：包括代表性的提供者数量；平均而言，发现服务于全国PCB用户平均水平以下的百分比。在26个提供者中，有16个表示响应预期的消费者授权来适应其策略。在组织中对此响应的实际部署似乎并不十分彻底或明确。出乎意料的是，随着越来越多的PCB客户选择替代供应商，对新服务供应商可能出现的担忧也没有引起任何关注。
原创性/价值：尽管PCB用户的市场份额正在快速增长，而现有供应商似乎并没有相应地吸收这一点，但发现传统供应商缺乏针对这种发展的市场分析和战略行为。根据这项研究，可以很好地预期破坏性服务提供商的市场份额增长。

BACKGROUND & AIMS: BACKGROUND:The widespread use of antibiotics for prophylaxis and treatment of bacterial infections has lead to the emergence of resistant human pathogens. Great differences have been documented between European countries in the use of systemic antibiotics. In parallel, significant differences in levels of resistant pathogens have been documented. AIM:To investigate whether differences in antibiotic use influence the level of antimicrobial resistance of the subgingival microflora of untreated patients with adult periodontitis in The Netherlands and Spain. METHOD:Blood agar plates containing breakpoint concentrations of penicillin, amoxicillin, amoxicillin and clavunalate, metronidazole, erythromycin, azithromycin, clindamycin and tetracycline were used to determine the proportion of bacteria from the subgingival plaque that was resistant to these antibiotics. In the Spanish patients, statistically significant higher mean levels of resistance were found for penicillin, amoxicillin, metronidazole, clindamycin and tetracycline. The mean number of different bacterial species growing on the selective plates was higher in the Spanish patients, as was the % of resistant strains of most periodontal pathogens. A striking difference was observed in the frequency of occurrence of tetracycline-resistant periodontal pathogens. In Spain, 5 patients had > or =3 tetracycline resistant periodontal pathogens, whereas this was not observed in any of the Dutch patients. CONCLUSIONS:The widespread use of antibiotics in Spain is reflected in the level of resistance of the subgingival microflora of adult patients with periodontitis.

背景与目标： 背景：抗生素在预防和治疗细菌感染中的广泛应用已导致耐药性人类病原体的出现。欧洲国家之间在使用系统性抗生素方面存在巨大差异。同时，已经证明了耐药病原体水平的显着差异。
目的：探讨在荷兰和西班牙，未经治疗的成人牙周炎患者使用抗生素的差异是否会影响牙龈下菌群的​​抗药性水平。
方法：使用琼脂，断点浓度为青霉素，阿莫西林，阿莫西林和克拉维酸盐，甲硝唑，红霉素，阿奇霉素，克林霉素和四环素的断点琼脂平板测定龈下菌斑对这些抗生素具有抗药性的细菌的比例。在西班牙患者中，发现青霉素，阿莫西林，甲硝唑，克林霉素和四环素的平均耐药水平在统计学上较高。在西班牙患者中，在选择性平板上生长的不同细菌种类的平均数量更高，大多数牙周病原体的耐药菌株所占的百分比也更高。在四环素抗性牙周病原体的发生频率上观察到显着差异。在西班牙，有5名患者的四环素耐药性牙周病菌≥3种，而在荷兰的任何患者中均未观察到。
结论：在西班牙，抗生素的广泛使用反映在成年牙周炎患者龈下菌群的​​抗药性水平上。

BACKGROUND & AIMS: :The aim of our study was to interpret the changing incidence, and to describe the mortality of patients with testicular cancer in the south of the Netherlands between 1970 and 2004. On the basis of data from the Eindhoven Cancer Registry and Statistics Netherlands, 5-year moving average standardised incidence and mortality rates were calculated. An age-period-cohort (APC) Poisson regression analysis was performed to disentangle time and birth cohort effects on incidence. The incidence rate remained stable for all ages at about 3 per 100,000 person-years until 1989 but increased annually thereafter by 4% to 6 in 2004. This increase can almost completely be attributed to an increase in localised tumours. The largest increase was found for seminoma testicular cancer (TC) patients aged 35-39 and non-seminoma TC patients aged 20-24 years. Relatively more localised and tumours with lymph node metastases were detected in the later periods. APC analysis showed the best fit with an age-cohort model. An increase in incidence of TC was found for birth cohorts since 1950. The mortality rate dropped from 1.0 per 100,000 person-years in 1970 to 0.3 in 2005, with a steep annual decline of 12% in the period 1979-1986. In conclusion, the increase in incidence of TC was strongly correlated with birth cohorts since 1945. The increase in incidence is possibly caused by in utero or early life exposure to a yet unknown risk factor. There was a steep decline in mortality in the period 1979-1986.

背景与目标： ：我们研究的目的是解释变化的发生率，并描述1970年至2004年之间荷兰南部睾丸癌患者的死亡率。根据荷兰埃因霍温癌症登记与统计局提供的数据，5-计算了年度移动平均标准化发病率和死亡率。进行年龄-年龄组（APC）Poisson回归分析，以弄清时间和出生队列对发病率的影响。到1989年，所有年龄段的发病率一直保持稳定，大约为每100,000人年3例，但此后每年以4％的速度增加，到2004年增加到6个。这种增加几乎可以完全归因于局部肿瘤的增加。发现增加最大的是年龄在35-39岁的精原细胞睾丸癌（TC）患者和年龄在20-24岁的非精原细胞TC患者。相对较局限的是在后期发现有淋巴结转移的肿瘤。 APC分析显示最适合年龄组模型。自1950年以来，出生队列的TC发病率有所增加。死亡率从1970年的每100,000人年1.0下降到2005年的0.3，在1979-1986年期间每年急剧下降12％。总之，自1945年以来，TC发病率的增加与出生队列密切相关。发病率的增加可能是由于子宫内或生命早期暴露于未知的危险因素引起的。 1979-1986年期间死亡率急剧下降。

BACKGROUND & AIMS: INTRODUCTION:Insight in epidemiologic data of extremity fractures is relevant to identify people at risk. By analyzing age- and gender specific fracture incidence and treatment patterns we may adjust future policy, take preventive measures and optimize health care management. Current epidemiologic data on extremity fractures and their treatment are scarce, outdated or aiming at a small spectrum of fractures. The aim of this study was to assess trends in incidence and treatment of extremity fractures between 2004 and 2012 in relation to gender and age. METHODS:We used a combination of national registries of patients aged ≥ 16 years with extremity fractures. Fractures were coded by the International Classification of Diseases (ICD) 10, and allocated to an anatomic region. ICD-10 codes were used for combining the data of the registries. Absolute numbers, incidences, number of patients treated in university hospitals and surgically treated patients were reported. A binary logistic regression was used to calculate trends during the study period. RESULTS:From 2004 to 2012 the Dutch population aged ≥16 years grew from 13,047,018 to 13,639,412 inhabitants, particularly in the higher age groups of 46 years and older. The absolute number of extremity fractures increased significantly from 129,188 to 176,129 (OR 1.308 [1.299-1.318]), except for forearm and lower leg fractures. Incidences increased significantly (3-4%) for wrist, hand/finger, hip/upper leg, ankle and foot/toe fractures. In contrast to the older age categories from 66 years and older, in younger age categories from 16 to 35 years, fractures of the extremities were more frequent in men than in women. Treatments gradually moved towards non-university hospitals for all except forearm fractures. Both relative and absolute numbers increased for surgical treatments of clavicle/shoulder, forearm, wrist and hand/finger fractures. Contrarily, lower extremity fractures showed an increase in non-surgical treatment, except for lower leg fractures. CONCLUSION:During the study period, we observed an increasing incidence of extremity fractures and a shift towards surgical treatment. Patient numbers in university hospitals declined. If these trends continue, policy makers would be well advised to consider the changing demands in extremity fracture treatment and pro-actively increase capacity and resources.

背景与目标： 简介：对四肢骨折的流行病学数据的了解与识别高危人群有关。通过分析特定年龄和性别的骨折发生率和治疗方式，我们可以调整未来的政策，采取预防措施并优化医疗保健管理。目前关于四肢骨折及其治疗的流行病学数据很少，已经过时或针对的是一小部分骨折。这项研究的目的是评估2004年至2012年间肢体骨折的发病率和治疗趋势与性别和年龄的关系。
方法：我们对年龄≥16岁的四肢骨折患者进行了国家注册。骨折由国际疾病分类（ICD）10编码，并分配到解剖区域。 ICD-10代码用于合并注册表数据。报告了绝对数量，发病率，在大学医院中接受治疗的患者和通过手术治疗过的患者的数量。在研究期间，使用二元逻辑回归来计算趋势。
结果：从2004年到2012年，年龄在16岁以上的荷兰人口从13047018增至13639412，特别是在46岁及以上的较高年龄段。除前臂和小腿骨折外，四肢骨折的绝对数量从129,188个显着增加至176,129个（OR 1.308 [1.299-1.318]）。手腕，手/手指，臀部/大腿，脚踝和脚/脚趾骨折的发生率显着增加（3-4％）。与66岁及以上的老年人相比，在16至35岁的年轻人中，男性上肢骨折的发生率高于女性。除前臂骨折外，其他所有患者的治疗方法都逐渐转向非大学医院。锁骨/肩膀，前臂，腕部和手/手指骨折的手术治疗的相对和绝对数量均增加。相反，下肢骨折除小腿骨折外，非手术治疗有所增加。
结论：在研究期间，我们观察到四肢骨折的发生率增加，并且转向外科治疗。大学医院的患者人数有所下降。如果这些趋势继续下去，将建议政策制定者考虑对四肢骨折治疗不断变化的需求，并积极增加能力和资源。

BACKGROUND & AIMS: BACKGROUND:Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. AIM:To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. DESIGN:A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. PARTICIPANTS/SETTING:Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. RESULTS:Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. CONCLUSIONS:A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.

背景与目标： 背景：自2002年以来，大头菜已在荷兰合法地进行。尊重患者的自主权是道德原则的基础。但是，患者没有安乐死的权利，医生也没有义务提供安乐死。尽管荷兰每年进行3000多例，但对于如何进行决策知之甚少，也没有指导来支持这一临床实践的困难方面。
目的：探讨患者需要安乐死的情况下的决策过程，并了解与优化该决策过程相关的不同主题。
设计：对明确要求安乐死，涉及最多的亲属和主治医师的患者进行访谈的定性主题分析。
参加者/地点：32例，31名亲属和28名主治医师。设置地点是患者和亲戚的住所以及医生的办公室。
结果：出现了五个主要主题：（1）开始就安乐死分享观点和价值;（2）建立关系作为谈判的一部分;（3）满足法律要求;（4）准备和执行安乐死的详细工作;（5） ）的善后服务和关闭。
结论：患者对安乐死的要求涉及一个复杂的过程，需要所有参与者进行情感上的努力。它的特点是需要长时间共享信息，建立关系和进行谈判以达成协议。我们假设，关于安乐死的决策需要采取积极的方法来对待参与者关于生命终结的偏好和价值观，亲戚的需要，医生的负担以及对共同决策的认真关注。未来的研究应解决专业人员进行此类复杂决策所需的沟通技巧。

BACKGROUND & AIMS: PURPOSE:To determine the incidence of retained lens fragments after phacoemulsification in The Netherlands and to evaluate the effect of vitrectomy on this complication.

SETTING:Eleven vitreoretinal centers in The Netherlands.

METHODS:We performed a retrospective analysis of all patients with retained lens fragments (N = 70) who were referred for vitreoretinal surgery to 11 specialized centers. Seven patients (10%) were treated with medication alone, and 63 (90%) had pars plana vitrectomy. Minimum follow-up after vitrectomy was 3 months.

RESULTS:The incidence of retained lens fragments in The Netherlands was calculated at 0.9/1000 cataract operations. Retained lens fragments occurred during the learning curve and with experienced surgeons. After medical or surgical treatment, visual acuity was 20/40 or better in 43 of 70 patients (61%). Uveitis disappeared in all cases. Retinal detachment occurred in 10 patients (14%). Attached retinal breaks were treated in an additional 5 patients. Corneal grafting was performed in 2 patients. Patients who had immediate vitrectomy did not have better functional results than patients in whom vitrectomy was delayed. The iris-fixated claw lens was implanted successfully when capsular support was insufficient.

CONCLUSIONS:The introduction of phacoemulsification in The Netherlands is associated with an increase of patients with retained lens fragments. Retained lens fragments are complicated by an increased risk for retinal detachment and corneal decompensation. Vitrectomy resulted in a marked improvement of visual acuity and clearing of uveitis.

背景与目标： 目的：确定荷兰超声乳化术后保留晶状体碎片的发生率，并评估玻璃体切除术对这种并发症的影响。

设置：11个玻璃体视网膜

方法：我们对11个专门中心进行玻璃体视网膜手术的所有保留晶状体碎片（N = 70）的患者进行了回顾性分析。 7例（10％）患者仅接受药物治疗，而63例（90％）进行了pars平板玻璃体切除术。玻璃体切除术后的最小随访时间为3个月。

结果：荷兰的保留晶状体碎片发生率为0.9 / 1000白内障手术。保留的晶状体碎片在学习曲线期间和经验丰富的外科医生中出现。经过药物或手术治疗后，在70例患者中有43例（61％）的视敏度为20/40或更高。葡萄膜炎在所有情况下均消失。视网膜脱离发生在10例患者中（14％）。附加的视网膜断裂在另外5名患者中得到了治疗。 2例患者进行了角膜移植。立即进行玻璃体切割术的患者没有比延迟玻璃体切割术的患者更好的功能结果。虹膜固定的爪状晶状体在囊膜支撑不足时成功植入。

结论：荷兰超声乳化术的引入与保留晶状体碎片的患者增加有关。保留的晶状体碎片因视网膜脱离和角膜代偿失调的风险增加而变得复杂。玻璃体切除术可明显改善视力并清除葡萄膜炎。