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Objective: Aims of the study were to assess, among clients receiving an outpatient treatment program (OTP), whether female crack abusers have more severe problems and/or different service needs than men.Methods: A total of 63 chronic crack abusers (34 women) participated in the study at baseline. Follow-up data were available for 33 subjects (21 women). Outcome measures included general condition at intake, and treatment compliance, outcome and satisfaction. Data were collected by means of monthly registrations, EuropAsi interviews and an evaluation form. OTP consisted of assertive outreach, a time-out provision, and intensive case management.Results: The vast majority of women were involved in street prostitution and were extremely vulnerable to deterioration. Compared to men, women who entered treatment had poorer physical health, higher rates of previous physical/sexual abuse, and more anxiety symptoms. Women reported a longer episode of cocaine abstinence than men. At discharge from OTP men reported a significantly better treatment outcome than women. Both genders gained most improvement in general living conditions. No gender differences emerged in treatment compliance. Although both men and women were satisfied with the service items offered by OTP, an outpatient walk-in service best served the needs of men, whereas women preferred a 24-hour care service including medical treatment and motivational outreach.Conclusions: Due to the harshness of street prostitution, treatment for female crack abusers should address areas of severe impairment. Integrated treatment services, tailored to the lifestyle of these women, are required to improve their general situation and safety. [ABSTRACT FROM AUTHOR]

Many scales have been developed to describe the functional status of geriatric patients. These scales are of limited use for describing the functional status of elderly people living at home, because of their poor capacity for differentiation. This article reports the results of a postal questionnaire among elderly people living at home. The findings will be analysed to see whether the inventory on performance of household and daily living activities describes the functional status of elderly people in a useful manner. A combined scale was constructed, which has satisfactory Guttman coefficients when applied to elderly people living at home. In addition, the scale is informative for those providing home care with regard to the elderly person's quantitative and qualitative needs for assistance. As such, it could be an instrument to be applied in community nursing. The applicability of the scale to institutionalized elderly people remains to be investigated. [ABSTRACT FROM AUTHOR]

A cross-sectional study was conducted to evaluate possible interregional differences in respiratory health in primary school children living in two different towns of the Netherlands, Melick/Herkenbosch Asenray (MHA) ( n=511) and Leek (LK) ( n=612). The prevalence of respiratory symptoms was determined by means of a questionnaire and respiratory impedance was measured using the forced oscillation technique (FOT). Respiratory symptoms were reported consistently more often in MHA than in LK; chronic cough (17% MHA vs 5% LK), shortness of breath (15% vs 8%), wheeze (16% vs 13%) and attacks of shortness of breath with wheeze (10% vs 7%). However, doctor-diagnosed asthma was reported as 7% in MHA and 6% in LK. The prevalence rates expressed as odds ratios of MHA versus LK were all >1 even when adjusted for known indoor environmental factors. Living in MHA appeared to be a statistically significant determinant of the reported symptom prevalence. Furthermore, the child's age, maternal smoking (> 10 cigarettes/day), and having had domestic animals were positively associated with one or more respiratory symptoms. Calculating adjusted differences in respiratory impedance between the regions resulted in a small but statistically significant difference in resonant frequency, LK being slightly at a disadvantage. Measured outdoor air pollution levels of SO, NO, O and PM were in general higher in MHA. In both regions however, the average levels remained below the present WHO guidelines, except for NO in MHA where the guideline was slightly exceeded. Conclusion: In this study prevalence rates of key symptoms of asthma were found to be significantly higher in children living in one region of the Netherlands (MHA) compared to another (LK). Known (indoor) risk factors for respiratory disease could not explain the observed differences in symptom prevalence between the regions. However, statistically but not clinically significant interregional differences in respiratory impedance values were found between children living in MHA and children living in LK. Further research will have to incorporate techniques to evaluate the potential influence of information bias. [ABSTRACT FROM AUTHOR]

Background: Various animal studies and ecologic studies suggest an inverse association between low dietary selenium intake and risk of various types of cancer.Purpose: The goal of this prospective cohort study was to investigate the association between toenail selenium levels and risks of stomach cancer and colorectal cancer.Methods: Our cohort study on diet and cancer started in The Netherlands in 1986 with enrollment of 120,852 subjects aged 55-69 years. Of this number, 58,279 were men and 62,573 were women. Following the case-cohort approach for analysis of the data, we randomly selected from the cohort a subcohort of 3500 subjects (1688 men and 1812 women). After 3.3 years of follow-up, 155 incident cases of microscopically confirmed stomach cancer, 313 cases of colon cancer, and 166 cases of rectal cancer had been detected in the cohort. Toenail selenium data were available for 104 patients with stomach cancer, 234 with colon cancer, and 113 with rectal cancer and for 2459 subjects from the subcohort.Results: In a multivariate analysis, the relative rates (RRs) of stomach cancer for subjects in increasing quintiles of toenail selenium level were 1.00, 0.44, 0.59, 0.84, and 0.64 (trend, P = .491). For men, there was some evidence for an inverse association between toenail selenium levels and stomach cancer: The RR for those in the highest compared with the lowest quintile of toenail selenium was 0.40 (95% confidence interval = 0.17-0.96), but the trend was not statistically significant (P = .136). For stomach cancer in women, there was no negative association with toenail selenium levels. Toenail selenium level was not associated with the risk of colon or rectal cancer. After exclusion of cases diagnosed in the 1st year of follow-up, the RRs of colon cancer for increasing quintiles of toenail selenium were 1.00, 1.27, 1.17, 0.75, and 1.07 (trend, P = .544); for rectal cancer, RR estimates were 1.00, 1.73, 0.83, 1.58, and 1.12 (trend, P = .890).Conclusions: These data support a suggestive but inconsistent inverse association between selenium levels and risk of stomach cancer. Our findings, like those of other studies, do not suggest an inverse association with risk of colorectal cancer. [ABSTRACT FROM AUTHOR]

A study was conducted to investigate the existence of a 'specific' neurotoxic effect due to long-term exposure to organic solvents. A comparison was made regarding diagnoses, symptoms and other relevant medical data between persons receiving a disability pension on the basis of a neuropsychiatric disorder selected from an exposed (painters) and non-exposed (construction workers) trade organization. Information was collected from their medical files at the occupational health department. Concerning diagnoses and symptoms, no significant differences were found between exposed and non-exposed patients. No indications were found for the existence of a 'typical' complex of symptoms associated with exposure to organic solvents among painters in The Netherlands. The number of reported symptoms was not related to the duration of exposure, thus lending no support for a dose-effect relationship. If a neurotoxic effect does exist among Dutch painters, it is of a non-specific type and not clearly distinguishable from other mental disorders. [ABSTRACT FROM AUTHOR]

For policy purposes as well as for the provision of individual care, it is relevant lo know which individual characteristics have an impact upon the level of care dependence. For policy purposes, it is preferable to predict the level of care dependence as efficiently as possible. This study of residents of institutions and group homes for people with mental handicap showed that profoundly mentally handicapped residents are almost all totally dependent upon care: additional information about the individual characteristics of this group is superfluous. The results of logistic regression analyses for residents with severe or mild mental handicap showed that age, gender and aetiological diagnosis (Down's syndrome or other) do not have significant predictive power. For the level of care dependence, adding the score on Activities of Daily Life (ADL) to the various models improved the predictive power. It depends on the level of mental handicap and on the level of care dependence which one wants to predict which other individual characteristics have to be included in order to improve predictive power. [ABSTRACT FROM AUTHOR]

Within the framework of a study on the ageing process of people with mental handicap in the Netherlands, information about visual and hearing impairments in 1583 people with mental handicap living in group homes or institutions was obtained from their physicians by means of a written questionnaire. Of the people with Down's syndrome (DS) who were older than 50 years of age, 46% had a visual impairment, whereas approximately 13% of subjects with other causes of mental handicap at the same age experienced similar visual impairment. Hearing loss in this age group was reported in 28% of people with DS, but only in 8% of subjects with other causes of mental handicap. The most common eye condition was cataracts, and the most frequent cause of hearing impairment was infection. In people with severe and profound mental handicap of all ages, sensory impairments were more frequent than in persons with mild or moderate mental handicap. Glasses or hearing aids were rarely used by people with severe or profound mental handicap. Assessment of visual and hearing impairments in people with mental handicap seemed clearly indicated, especially in those aged 50 years and older, in those with DS, and in those with severe or profound mental handicap. [ABSTRACT FROM AUTHOR]

The effect of sexual behaviour on the risk for cervical dysplasia was evaluated in a case-control study. Cases (n=257) had a histologically confirmed diagnosis of cervical dysplasia. Controls (n=705) were sampled from the general population. A postal questionnaire was used to obtain information about, among other things, age at first sexual intercourse, number of sexual partners, current frequency of intercourse and contraceptive use. Information was also collected about other risk factors for cervical dysplasia, in order to adjust for possible confounding. We observed higher risks for cervical dysplasia (mild, moderate and severe) with increasing number of sexual partners. This effect appeared to be dependent on smoking behaviour. For women who reported more than six sexual partners, the adjusted odds ratio (aOR) was 9.1 (95%CI : 3.5–23.7) for non-smokers, and 26.4 (95%CI:11 8–58.8) for women who smoked ≥20 igarettes per day. The effects of age at first sexual intercourse and current frequency of intercourse disappeared after adjustment for other risk factors. Use of oral contraceptives for >10 years increased the risk (aOR=2.3; 95% CI:1.2–4.6). Thus, the number of sexual partners, especially in combination with smoking behaviour, appeared to be the most important risk factor for cervical dysplasia. [ABSTRACT FROM PUBLISHER]

Several studies in recent years have raised the possibility that exposure to extreme low frequency (ELF) electromagnetic fields may be hazardous to human health, in particular by the promotion or initiation of leukaemia and other cancers. To determine if this exposure creates a long-term hazard to the public, the mortality of a group of people identified as having lived in an urban quarter of Maastricht in which two 150 kiloVolt (kV) powerlines and one transformer substation are located was investigated. Using the Dutch population registry it was possible to identify retrospectively 3549 inhabitants of the quarter who lived there for at least 5 years between 1956 and 1981. Of these 1552 study subjects lived within 100 m of the electricity transmission equipment and were exposed to magnetic field intensity of 1.0–11.0 milliGauss. The overall standardized mortality ratio and cancer mortality ratios were either not or only slightly elevated. The study does not support previously reported associations of exposure to ELF electromagnetic fields with leukaemia, brain cancer and breast cancer. [ABSTRACT FROM PUBLISHER]