Pendiente resbaladiza de la muerte asistida en los Países Bajos, Bélgica y Colombia / An analysis of the "slippery slope" of assisted death

The study analyzes the phenomenon of the "slippery slope" of assisted death in The Netherlands, Belgium, and Colombia after the depenalization or legalization of this practice. Data analysis was performed reviewing the evidence published in scientific journals and in the governments' official reports. We verified a progressive broadening of the limits initially established by the law for the practice of assisted death in these three countries. This confirms the occurrence of the "slippery slope". Also, the exponential increase in the number of assisted deaths in these three countries after the legalization indirectly suggests the presence of the "slippery slope". An analysis of the anthropological and ethical implications of assisted death highlights that its moral assessment should not be exclusively based on consequentialist arguments. Also, a prudential interpretation of the slippery slope argument in the legal debate about assisted death should be incorporated. We conclude that the moral evaluation of assisted death cannot be exclusively grounded on its negative social consequences, but rather on the lack of respect for basic human values such as life and the intrinsic dignity of a person. The verification of the "slippery slope" in these three countries should be regarded as an alarm for an eventual legalization of euthanasia in Chile.

Why Using Religious Arguments in the Euthanasia Discussion is Problematic / Por qué hacer uso de argumentos religiosos en el debate sobre la eutanasia es un tema problemático / Por que usar argumentos religiosos no debate sobre a eutanásia é um tema problemático

Abstract: In discussions about assisted dying (euthanasia, assisted suicide), those who argue 'against' legalisation often reason from a religious angle, whereas those 'in favour' adopt a secular stance. The Dutch experience is more nuanced: here, euthanasia advocacy largely originated from protestant religious believers. In this contribution, I criticise the use of religious arguments favouring any specific position. Religion may provide a heuristic context to explore norms relevant in the discussion, and religion may help us formulate our personal stance. But when it comes to societal debates (often focusing on whether or not to legalise euthanasia), we should concentrate on legal, societal, empirical, and ethical arguments that are understandable to all.

Resumen: en discusiones sobre la muerte asistida (eutanasia, suicidio asistido), aquellos que argumentan estar "en contra" de la legalización a menudo razonan desde un ángulo religioso, mientras que los que están "a favor" adoptan una postura secular. La experiencia holandesa es más matizada: aquí, la defensa de la eutanasia se originó en gran medida por creyentes religiosos protestantes. En esta contribución, critico el uso de argumentos religiosos que favorezcan cualquier posición específica. La religión puede proveer un contexto heurístico para explorar normas relevantes en la discusión, y la religión puede ayudarnos a formular nuestra postura personal. Pero cuando se trata de debates sociales (a menudo enfocados en la legalización o no de la eutanasia), debemos concentrarnos en argumentos jurídicos, sociales, empíricos y éticos que sean comprensibles para todos.

Resumo: Em discussões sobre a morte assistida (eutanásia, suicidio assistido), os que argumentam estar "contra" a legalização com frequência pensam a partir de um ângulo religioso, enquanto os que estão "a favor" adotam um posicionamento secular. A experiência holandesa é mais fusionada: aqui, a defesa da eutanásia foi originada em grande medida por crentes religiosos protestantes. Nesta contribuição, critico o uso de argumentos religiosos que favoreçam qualquer posicionamento específico. A religião pode promover um contexto heurístico para explorar normas relevantes na discussão, e a religiao pode ajudarnos a formular nosso posicionamento pessoal. Contudo, quando é tratado de debates sociais (às vezes focados na legalização ou não da eutanásia), devemos concentrar-nos em argumentos jurídicos, sociais, empíricos e éticos que sejam compreensíveis para todos.

Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands / Contribución de la mortalidad por causas evitables mediante la atención de salud a la diferencia de la esperanza de vida entre las islas del Caribe holandés de Aruba y Curaçao y los Países Bajos / Contribuição da mortalidade evitável para as diferenças na expectativa de vida entre as ilhas de Aruba e Curaçao, no Caribe holandês, e os Países Baixos

ABSTRACT Objective. To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods. Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988-2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005-2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga's method. Results. During the period 1988-2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005-2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). Conclusions. Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.(AU)

RESUMEN Objetivo. Determinar las áreas específicas de atención de salud cuya optimización podría mejorar la salud de la población en las islas del Caribe holandés de Aruba y Curaçao. Métodos. Estudio de observación comparativo en el que se utilizaron datos demográficos y de mortalidad de las islas del Caribe holandés y de los Países Bajos. Se calcularon las tendencias de mortalidad y luego se analizaron con programas de computación Jointpoint de regresión lineal segmentada, para el período 1988-2014. La esperanza de vida se calculó utilizando tablas de mortalidad abreviadas con los datos más recientes disponibles de todos los territorios (2005-2007). Las diferencias de esperanza de vida entre el Caribe holandés y los Países Bajos se desglosaron, usando el método de Arriaga, en contribuciones por causas específicas. Resultados. En el período 1988-2014, los niveles de mortalidad por causas evitables mediante la atención de salud han sido sistemáticamente mayores en Aruba y Curaçao que en los Países Bajos. En el caso de Aruba, la brecha en la mortalidad por causas evitables mediante la atención de salud con respecto a los Países Bajos no varió significativamente durante el período de estudio; en el caso de Curaçao, la brecha fue mayor. Si la mortalidad por causas evitables mediante la atención de salud se redujese a un nivel similar al de los Países Bajos, los hombres y las mujeres en Aruba habrían sumado, respectivamente, 1,19 años y 0,72 años a su esperanza de vida en el período 2005-2007. En Curaçao, el aumento hubiese sido de 2,06 años y de 2,33 años. Según el estudio, las causas específicas que más contribuyen a esta diferencia son las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis (estas últimas dos causas solamente en Curaçao). Conclusiones. Una mejora en los servicios de salud en relación con las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis en el Caribe holandés podría contribuir sustancialmente a la reducción de la brecha en la esperanza de vida con respecto a los Países Bajos. Por tanto, con base en nuestro estudio, recomendamos que se realicen más estudios exhaustivos a fin de determinar las intervenciones específicas y los recursos que se necesitan para optimizar las áreas de atención de salud involucradas.(AU)

RESUMO Objetivo. Identificar áreas específicas da atenção à saúde cuja otimização poderia melhorar a saúde da população nas ilhas de Aruba e Curaçao, no Caribe holandês. Métodos. Estudo observacional comparativo baseado em dados de mortalidade e populacionais das ilhas do Caribe holandês e dos Países Baixos. As tendências de mortalidade foram calculadas e então analisadas com o software Joinpoint, no período de 1988 a 2014. As expectativas de vida foram computadas usando tábuas de mortalidade resumidas com os dados disponíveis mais recentes de todos os territórios (2005-2007). As diferenças na expectativa de vida entre o Caribe holandês e os Países Baixos foram desagregadas segundo as contribuições específicas por causa usando o método de Arriaga. Resultados. No período de 1988 a 2014, os níveis de mortalidade evitável foram consistentemente mais elevados em Aruba e Curaçao do que nos Países Baixos. Em Aruba, a diferença na mortalidade evitável em comparação com os Países Baixos não mudou significativamente durante o período do estudo, enquanto que em Curaçao a diferença aumentou. Se a mortalidade por causas evitáveis fosse reduzida a níveis semelhantes aos dos Países Baixos, os homens e mulheres de Aruba teriam aumentos respectivos de 1,19 e 0,72 anos nas suas expectativas de vida durante o período 2005-2007. Em Curaçao, o aumento seria de 2,06 e 2,33 anos. As maiores contribuições de causas específicas foram as de doenças circulatórias, câncer de mama, causas perinatais e nefrite/nefrose (estas duas últimas causas somente em Curaçao). Conclusões. Melhorias nos serviços de saúde relacionados com doenças circulatórias, câncer de mama, mortes perinatais e nefrite/nefrose no Caribe holandês poderiam contribuir substancialmente para reduzir as disparidades na expectativa de vida em comparação com os Países Baixos. Com base neste trabalho, recomendamos estudos mais aprofundados para identificar as intervenções e recursos específicos necessários para otimizar estas áreas da atenção à saúde.(AU)

EQA-based evaluation of metrological traceability of clinical chemistry test results in Argentina / EQA-based evaluation of metrological traceability of clinical chemistry test results in Argentina

Equivalence of results among laboratories is a major mission for medical laboratories. In the Netherlands, medical laboratories only use homogenous, commercial for general chemistry analytes, whereas in Argentina heterogenous, home brew test applications are common. The effect of this practice difference on test accuracy is studied using key features of the accuracy-based EQA program of the Netherlands. Six frozen, human-based, commutable poolsera, covering the (patho) physiological measuring range for 17 general chemistry analytes, were assayed by ~75 Argentinian labs and ~200 Dutch laboratories in 2014. After removal of outliers, harmonization status among laboratories was evaluated by calculating overall mean interlaboratory coefficients of variation (CVs, %) per analyte and per country for all 6 levels. Evenso, standardization status was evaluated after removal of outliers by calculating overall mean recoveries (%) as compared to the assigned target values per analyte per country for all 6 levels. Absolute median biases were compared to (minimal/desirable) biases derived from biological variation criteria. For serum enzymes interlaboratory CVs in the Argentinian laboratories ranged between 10 and 22%, as compared to 3-6% in the Netherlands. For serum uric acid, creatinine, glucose and total protein, interlaboratory CVs varied between 4.3 and 13.1% in Argentinian labs, as compared to <3.5% in the Netherlands. For serum electrolytes, interlaboratory CVs ranged between 1.8 and 3.8% for Na+; 2.9-5.8% for Cl-; 3.8-7.5% for K+; 9.4-10.4% for Ca2+ and 16.2-22.3% for Mg2+ as compared to ≤2% (Na+, K+, Cl-, Ca2+) and ≤3% (Mg2+) in the Netherlands. Mean recoveries in Argentinian laboratories for e.g. serum creatinine, glucose, CK, Ca2+ and Na+ were 95-119%; 95-104%; 98-102%; 98-102% and 96-100% respectively, whereas min-max recovery ranges were 65-155%; 58-126%; 47-132%; 66-132% and 85-115%. In the Netherlands, absolute mean recoveries were overall 98.9% with a SD of 2.0%. Median biases in Argentinian laboratories ranged from -2.9 to 18.2%; -3.1 - 2.6%; -3.3 - 0.5%; -1.1 - 3.8% and -4.3-0% for serum creatinine, glucose, CK, Ca2+ and Na+. In the Netherlands overall mean/median biases were 1.1% (SD=2.0%). Exchange of commutable, value- assigned EQA-materials was helpful for studying the harmonization and standardization status of medical tests in Argentina, and for revealing the future harmonization and standardization potential. The results clearly demonstrate that metrological traceability of test results in Argentina is on average in line with what is expected; yet, the spreading among laboratories is far too high and should be improved.

La equivalencia de resultados entre laboratorios es una mision importante para los laboratorios medicos. En los Paises Bajos, los laboratorios medicos solo usan aplicaciones comerciales homogeneas, regulatoriamente aprobadas (CE-IVD) para analitos quimicos, mientras que en la Argentina son comunes las aplicaciones heterogeneas caseras. El efecto de esta diferencia practica en la precision de la prueba se estudia utilizando caracteristicas clave del programa EQA, basado en la precision, de los Paises Bajos. Se ensayaron seis pools de sueros, congelados, de origen humano, conmutables, que cubrian el rango de medidas (pato)fisiologicas para 17 analitos de quimica clinica. Estos analitos de quimica clinica fueron analizados por ~75 laboratorios argentinos y ~200 laboratorios holandeses en 2014. Despues de eliminar los valores atipicos, el estado de armonizacion entre los laboratorios fue evaluado calculando los coeficientes de variacion interlaboratorios medios globales (CV%) por analito y por pais para los 6 niveles. No obstante, el estado de estandarizacion se evaluo despues de la eliminacion de valores atipicos mediante el calculo de recuperaciones medias generales (%) en comparacion con los valores asignados por analito por pais para los 6 niveles. Los sesgos medios absolutos se compararon con los sesgos (minimos / deseables) derivados de los criterios de variacion biologica. Para enzimas sericas los CV interlaboratorio en los laboratorios argentinos oscilaron entre 10 y 22%, en comparacion con 3-6% en los Paises Bajos. Para el acido urico serico, creatinina, glucosa y proteinas totales, los CV entre laboratorios variaron entre 4,3 y 13,1% en los laboratorios argentinos, en comparacion con <3,5% en los Paises Bajos. Para los electrolitos sericos, los CV interlaboratorios oscilaron entre 1,8 y 3,8% para Na+; 2,9-5,8% para Cl-; 3,8-7,5% para K+; 9,4-10,4% para Ca2+ y 16,2-22,3% para Mg2+ en comparacion a ≤2% (Na+, K+, Cl-, Ca2+) y ≤3% (Mg2+) en los Paises Bajos. Las recuperaciones medias en laboratorios argentinos para, p.ej. la creatinina serica, glucosa, CK, Ca2+ y Na+ fueron 95-119%; 95-104%; 98-102%; 98-102% y 96-100% respectivamente, mientras que los rangos de recuperacion min-max fueron 65-155%; 58-126%; 47-132%; 66-132% y 85-115%. En los Paises Bajos, las recuperaciones medias absolutas fueron en general del 98,9% con una desviacion estandar (DE) del 2,0%. La mediana de los sesgos medios de los laboratorios argentinos oscilo entre -2,9 y 18,2%; -3,1 - 2,6%; -3,3 - 0,5%; -1,1 - 3,8% y -4,3-0% para creatinina serica, glucosa, CK, Ca2+ y Na+. En los Paises Bajos, las medias / medianas en general fueron de 1,1% (DE=2,0%). El intercambio de los valores asignados a los materiales EQA, conmutables fue de gran ayuda para la armonizacion y estandarizacion de los ensayos medicos en la Argentina y para revelar el potencial futuro de armonizacion y estandarizacion. Estos resultados claramente demuestran que la trazabilidad metrologica de los resultados de las pruebas en la Argentina esta, en promedio, de acuerdo con lo esperable; sin embargo, la dispersion entre laboratorios es muy grande y deberia ser mejorada.

A equivalencia de resultados entre laboratorios e uma missao importante para os laboratorios medicos. Nos Paises Baixos, os laboratorios medicos so utilizam aplicacoes comerciais homogeneas, aprovadas por regulacoes (CE-IVD) para analitos quimicos, ao passo que na Argentina sao comuns as aplicacoes heterogeneas caseiras. O efeito desta diferenca pratica na exatidao do teste e estudado utilizando caracteristicas essenciais do programa EQA, dos Paises Baixos, baseado na exatidao. Foram ensaiados seis pools de soros, congelados, de origem humana, comutaveis, que abrangiam a faixa de medidas (pato)fisiologicas para 17 analitos quimicos gerais. Esses analitos quimicos foram analisados por ~75 laboratorios argentinos e ~200 laboratorios holandeses em 2014. Apos eliminar os valores atipicos, o estado de harmonizacao entre os laboratorios foi avaliado atraves do calculo dos coeficientes de variacao interlaboratorio meios globais (CV%) por analito e por pais para os 6 niveis. Nao obstante, o estado de padronizacao foi avaliado depois da eliminacao de valores atipicos pelo calculo de recuperacoes medias gerais (%) se comparados com os valores atribuidos por analito por pais para os 6 niveis. Os vieses medios absolutos foram comparados com os vieses (minimos / desejaveis) decorrentes dos criterios de variacao biologica. Para enzimas sericas, os CV interlaboratorio nos laboratorios argentinos oscilaram entre 10 e 22%, em comparacao com 3-6% nos Paises Baixos. Para o acido urico serico, creatinina, glicose e proteinas totais, os CV entre laboratorios variaram entre 4,3 e 13,1% nos laboratorios argentinos, em comparacao com <3,5% nos Paises Baixos para os eletrolitos sericos, os CV interlaboratorios oscilaram entre 1,8 e 3,8% para Na+; 2,9-5,8% para Cl-; 3,8-7,5% para K+; 9,4-10,4% para Ca2+ e 16,2-22,3% para Mg2+ em comparacao com ≤2% (Na+, K+, Cl-, Ca2+) e ≤3% (Mg2+) nos Paises Baixos. As recuperacoes medias em laboratorios argentinos para, p.ex. a creatinina serica, glicose, CK, Ca2+ e Na+ foram 95-119%; 95-104%; 98-102%; 98-102% e 96-100% respectivamente, enquanto que os intervalos de recuperacao min-max. foram 65-155%; 58-126%; 47-132%; 66-132% e 85-115%. Nos Paises Baixos, as recuperacoes medias absolutas foram em geral de 98,9% com um desvio padrao (DE) de 2,0%. A mediana dos vieses medios dos laboratorios argentinos oscilou entre -2,9 e 18,2%; -3,1 - 2,6%; -3,3 - 0,5%; -1,1 - 3,8% e -4,3-0% para creatinina serica, glicose, CK, Ca2+ e Na+. Nos Paises Baixos, as medias / medianas em geral foram de 1,1% (DE=2,0%). O intercambio dos valores atribuidos aos materiais EQA, comutaveis, foi de grande ajuda para a harmonizacao e padronizacao dos ensaios medicos na Argentina e para revelar o potencial futuro de harmonizacao e padronizacao. Esses resultados demonstram as claras que a rastreabilidade metrologica dos resultados dos testes na Argentina esta de acordo com o esperavel; a dispersao entre laboratorios ainda e muito grande e deveria ser melhorada.

Comparison of the level of cognitive processing between case-based items and non-case-based items on the Interuniversity Progress Test of Medicine in the Netherlands / 보건의료교육평가

PURPOSE: It is assumed that case-based questions require higher-order cognitive processing, whereas questions that are not case-based require lower-order cognitive processing. In this study, we investigated to what extent case-based and non-case-based questions followed this assumption based on Bloom's taxonomy. METHODS: In this article, 4,800 questions from the Interuniversity Progress Test of Medicine were classified based on whether they were case-based and on the level of Bloom's taxonomy that they involved. Lower-order questions require students to remember or/and have a basic understanding of knowledge. Higher-order questions require students to apply, analyze, or/and evaluate. The phi coefficient was calculated to investigate the relationship between whether questions were case-based and the required level of cognitive processing. RESULTS: Our results demonstrated that 98.1% of case-based questions required higher-level cognitive processing. Of the non-case-based questions, 33.7% required higher-level cognitive processing. The phi coefficient demonstrated a significant, but moderate correlation between the presence of a patient case in a question and its required level of cognitive processing (phi coefficient= 0.55, P< 0.001). CONCLUSION: Medical instructors should be aware of the association between item format (case-based versus non-case-based) and the cognitive processes they elicit in order to meet the desired balance in a test, taking the learning objectives and the test difficulty into account.

Chronic disease management in European countries — based on the case of Germany and the Netherlands / 中华医学教育探索杂志

In response to the increasing burden of chronic diseases, many countries have launched the reform of the health system. Based on the Diagnoses Treatment Combination (DTC) and Healthy Kinzig-tal Gesundes Kinzigtal (GK), this paper elaborates on the experience of chronic diseases management during different populations in Germany and the Netherlands. Based on the scientific decision-making and system integration, the DTC builds a multidisciplinary team to achieve individualized and continuous integrated disease management. The GK model focuses on health promotion, extensively integrated social resources, to achieve the goal of reducing the incidence of chronic diseases and controlling the cost. This provides a useful reference for the building of Healthy China: integrating resources from the supply side and the demand side, strengthening the integration of the health service system, promoting citizen engagement and improving individual health literacy, so as to achieve universal health.

Consumption of barracuda in the Caribbean Sea linked to ciguatera fish poisoning among Filipino seafarers

Introduction@#Ciguatera fish poisoning (CFP) is common in tropical and subtropical waters. On 13 November 2015, eight Filipino seafarers from a cargo ship sailing in the Caribbean Sea experienced a range of symptoms after consuming a barracuda. Upon their return to the Philippines, an investigation was conducted to describe the cases.@*Methods@#A case-series was conducted. A CFP case was defined as a previously well individual on the ship who developed at least one gastrointestinal symptom and at least one neurologic manifestation after eating barracuda on 13 November 2015. All cases were admitted to hospital in Manila, Philippines and were interviewed using a standard questionnaire. Urine and serum samples of cases were collected for ciguatoxin (CTX) testing by radiological and receptor-binding assay.@*Results@#Eight of the 25 seafarers on the ship ate the barracuda; all eight met the CFP case definition. The age of cases ranged from 37 to 58 years (median: 47 years) and all were males. Onset of symptoms ranged from 1 to 3 hours (median: 2 hours) from the time of ingestion of the barracuda. All cases experienced gastrointestinal (nausea, vomiting, diarrhoea) and neurologic (temperature allodynia, itchiness) symptoms but no cardiovascular manifestations. Urine and serum specimens of all eight cases showed CTX below the detection limit.@*Discussion@#The Philippines Epidemiology Bureau recommended that the Philippine Maritime Authority include CTX poisoning and its health risks in seafarers’ training to prevent future cases of CFP. The Event-based Surveillance and Response system will continue to provide a mechanism for the reporting and appropriate management of CFP cases.

Present situation and development of acupuncture in the Netherlands / 中国针灸

The development, present situation, educational institution and association, legislation and application of acupuncture therapy in the Netherlands are introduced. Acupuncture was introduced into the Netherlands about 400 years ago. At present, being one of the complementary and alternative medicine, acupuncture has not passed the national legislation yet. The nongovernmental source is given priority to the development of acupuncture and the educational institution is private. Even though acupuncture has not been listed in the basic medical insurance in the Netherlands, it becomes one of the additional items of the insurance company and its expenditure is reimbursed partially. The field of TCM in the Netherlands now is facing to the issues to be solved, including constructing the official medical institution, educating high-quality acupuncturists, promoting national legislation and adopting acupuncture into the basic medical insurance.

Neuroradiologist education training：the enlightenment from Vrije University Medical Center / 中华医学教育探索杂志

By taking Vrije University Medical Center as an example, this paper introduced the cur-rent Neuroradiologist education training system which had the characteristics of training in a comprehen-sive and focused way, multi-disciplinary integration and paying attention to the combination of academic and clinical research. Through the comparison of the status quo of China's sub specialist training, Neuro-radiologist education training system in the Netherlands provided an important reference for China's sub specialty training.

Dutch Erasmus University's medical humanities education and its enlightenment / 中华医学教育探索杂志

Dutch medical humanities education curriculum framework covers many disciplines which satisfies the professional requirements. The design and materials for teaching are based on re-search and practice driven; teachers' cooperation is full of experts from transnational, trans-regional, interdisciplinary, theory and practice. the Dutch university medical humanities provide a reference for China's medical humanities education curriculum reform as follows:the goal of medical humanities ed-ucation is for the medical practice but not intriguing sideline; the whole process of the students' par-ticipation mechanism should be full of support, supervision and examination;and the source of teachers should be multi-interdisciplinary and also from practice.

Food Composition Data in the Netherlands: NEVO Online 2013 Updated Version Released.

Background and Aim: The Dutch national food composition database (NEVO database) is used for all food and nutrition related work in the Netherlands. The database is managed at the National Institute for Public Health and the Environment. Recently the updated version of NEVO online 2013 was launched. NEVO online now contains food composition data on nearly 2200 foods and 130 nutrients, including individual fatty acids. The data can be searched both in English and Dutch. Background documents are also available in English. The NEVO online dataset can be downloaded directly from the website. Approach: NEVO online contains data on foods frequently consumed and contributing significantly to energy and nutrient intake in the Netherlands. All published values from NEVO come with a reference specifying the source of the value. After publication of the previous version of NEVO online (2011), the information in the database was completed and/or revised for a large number of foods. The changes and additions pertain in particular to the addition or removal of foods and to the update of nutrient data. NEVO online provides data on energy and macronutrients (protein, fat plus SFA, MUFA, PUFA, TFA and individual fatty acids, carbohydrates plus mono- di- and polysaccharides, dietary fibre, water, alcohol), minerals and trace elements (Na, K, Ca, P, Mg, Fe, Cu, Se, Zn, I and ash), water soluble vitamins (B1, B2, B6, B12, niacin, folate, dietary folate equivalents, folic acid and C) and fat soluble vitamins (RAE, RE, retinol, carotenoids, E, tocopherols, D, K total, K1 and K2). Results: Vitamin K content is new in 2013 and is now available for the food groups vegetables, fruit, legumes and dairy products. In the update special attention is paid to values for sodium and iodine. New analytical values for sodium became available for bread measured by the Dutch Bread association NBC (2012), cheese measured by the Dutch Dairy association NZO (between 2010 and 2012) and a broad range of other foods measured by the Dutch Food Safety Authority (2012). For milk new analytical values are included on macronutrients, fatty acids and minerals obtained through an extensive sampling protocol from Wageningen University (2007-2012). Special attention is also given to update the composition of gluten free food items and of margarine, low fat margarine and cooking fat. Additionally a large number of manufacturers provided new data on the composition of their foods, through the collaboration with the Dutch Nutrition Centre. Averaged foods are recalculated based on intake data from the most recent Dutch National Food Consumption survey 2007-2010. Access to NEVO Data: This publication links to the searchable NEVO online website as well as to the full report with background information on the procedures of data collection and compilation. The report includes details to identify the components in NEVO online and provides links to tables on the NEVO website (e.g. NEVO food group classification, recipes in NEVO, reference list). The complete report can be downloaded for free from http://www.rivm.nl/en/Documents_and_publications/Scientific/Tables_graphs/NEVO/NEVO _online_2013_background_information Full report is also available as ‘Supplementary File’. Additional Information: NEVO website: http://www.rivm.nl/en/Topics/D/Dutch_Food_Composition_Database/Introduction NEVO online searchable website: http://nevo-online.rivm.nl/ Downloading NEVO dataset: http://www.rivm.nl/en/Topics/D/Dutch_Food_Composition_Database/Access_NEVO_data/ Request_dataset

Registration of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao / Registro de enfermedades, lesiones y síntomas relacionados con el trabajo en Aruba, Bonaire y Curazao

OBJECTIVE: To estimate the incidence of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao and to identify some next steps in the prevention process. METHODS: All of the three countries' 18 occupational health specialists were asked to participate; 100 percent agreed to report all work-related diseases, injuries, and complaints in 2004-2008. A standard online notification form was used to register cases in a database maintained by the Netherlands Center for Occupational Diseases (NCOD). The public health service of Curaçao analyzed the data and presented the results to the participating physicians during educational and feedback meetings. RESULTS: During the study period, 1 519 cases were reported: 720 (47.0 percent) work-related diseases; 515 (34.0 percent) injuries; and 284 (19.0 percent) complaints. The mean patient age was 42.4 years (range 16-70 years); 924 (60.8 percent) were males and 571 (37.6 percent), females. Most frequently reported were musculoskeletal diseases, injuries, and complaints; mental health disorders; and skin injuries. Analysis showed incidence rates of work-related diseases, injuries, and complaints in Aruba to be 157 new cases per 100 000 employee years; in Bonaire, 53/100 000; and in Curaçao, 437/100 000. CONCLUSIONS: These results suggest that labor protection laws need improvement and that preventive action should be fostered. Further study is needed on working conditions, preventive policy, and the quality of occupational health and safety practices in Aruba, Bonaire, and Curaçao. Funding is imperative for collecting and publishing accurate data, which will keep this problem on the social-political agenda.

OBJETIVO: Calcular la incidencia de enfermedades, lesiones y síntomas relacionados con el trabajo en Aruba, Bonaire y Curazao e identificar los pasos siguientes en el proceso de prevención. MÉTODOS: Se invitó a participar a los 18 especialistas en salud ocupacional de los tres países; todos aceptaron notificar todas las enfermedades, lesiones y síntomas relacionados con el trabajo entre el 2004 y el 2008. Se usó un formulario estándar de notificación en línea para registrar los casos en una base de datos mantenida por el Centro para las Enfermedades Ocupacionales de los Países Bajos. El servicio de salud pública de Curazao analizó los datos y presentó los resultados a los médicos participantes durante las reuniones educativas y de retroalimentación. RESULTADOS: Durante el período del estudio se notificaron 1 519 casos relacionados con el trabajo: 720 (47,0 por ciento) enfermedades, 515 (34,0 por ciento) lesiones y 284 (19,0 por ciento) síntomas. La edad promedio de los pacientes fue 42,4 años (recorrido, 16-70 años); 924 (60,8 por ciento) eran varones y 571 (37,6 por ciento), mujeres. Se notificaron con mayor frecuencia las enfermedades, lesiones y síntomas musculoesqueléticos; los trastornos mentales; y las lesiones cutáneas. El análisis mostró tasas de incidencia de enfermedades, lesiones y síntomas relacionados con el trabajo de 157 nuevos casos por 100 000 empleados por año en Aruba, 53/100 000 en Bonaire y 437/100 000 en Curazao. CONCLUSIONES: Estos resultados indican que las leyes de protección laboral deben mejorarse y que deben promoverse las medidas preventivas. Es necesario llevar a cabo otros estudios sobre las condiciones de trabajo, los planes de prevención y la calidad de la salud ocupacional y las prácticas de seguridad en Aruba, Bonaire y Curazao. Se requiere financiamiento para recopilar y publicar datos exactos, a fin de mantener este problema en la agenda política y social.

Medical Education in the Netherlands / 医学教育

1)In the Netherlands, only high school graduates are accepted to medical schools.2) Several medical schools divide their courses into a bachelor's course and a master's course, according to the Bologna process.

Report on the 2nd “Hwa To” International Symposium / 全日本鍼灸学会雑誌

The 2nd Hwa To International Symposium (Integration of Eastern & Western Medicine) was held in Amsterdam on the 23rd & 24th of September 2006. “Hwa To” is a name of a famous ancient Chinese doctor, and the sponsor of this symposium is “Hwa To International University of T.C.M.” in Amsterdam. About 200 members participated from 19 countries, and as Japanese speakers Mr. Seino and Watanabe were invited. As the drawing up of the abstract book was not in time for the opening of the symposium, the contents of presentations were not clear except the name of speakers and their themes. Most of the presentations were lecture, and almost all of the lectures were expressed in English, and there were no loss of time by translation from Chinese to English which is usual in the assemblies of WFAS.<br>The atmosphere of the symposium or the titles of the card of Prof. Rangkuti suggested me that the European society of acupuncture has a tendency to keep aloof from WFAS.

What Happened in Our Medical Care System on Meiji Restoration / 日本東洋医学雑誌

At very beginning of Meiji Restoration when it was still under intensive anti-foreigner moves, the new government invited a medical staff of the English legation to the government military hospital in Kyoto as a medical adviser, and they admitted to accept the Western medicine as an official in the imperial palace, and further, employed a doctor trained in Netherlands Medicine “Ranpou-i” as a medical stuff in the palace for the first time. At the end of the first year of the Restoration, they opened a new medial school and declared that every medical doctor should take a national examination before they open their offices. Their attitude for the Western Medicine was so active to accept it and was a quite contrast to those of old Tokugawa government. The legation doctor was also accepted as the director of hospital and teacher of the medical school, and it was thought that the medicine in Japan will be under the influence of England instead of the Netherlands in future. Two young Ranpou-i who were tarined in both of Nagasaki and Sakura, and nominated as the attendants for the medical school strongly propoused based on their experience in medical tarining that the teacher of future medicine in Japan should be German because of their highest medical quality in the world. After their heavy disputes with the Government stuffs who were supporters for English Medicine, it was finally accepted to invite two German medical doctors as the teachers of the medical school. The German doctors moved so actively to renovate the Japanese medical education, eliminating Japanese educational tradition completely. Japanese medical students were educated and tarined by German teachers with German language from the levels of a fundamental science to clinical medicines. It was so drastic. But it was needed to establish the medical system in Japan for the first time.

Garantía de la calidad de la atención a la salud en los Países Bajos / Quality assurance in health care in the Netherlands

En este trabajo se describen los principales rasgos estructurales del sistema de salud de los Países Bajos, con un esbozo de la historia que lo ha ido conformando en los últimos años. Además se discuten, también con una perspectiva histórica, los lineamientos generales de la garantía de calidad de los servicios de salud en ese país

In this paper the main structural features of the dutch health system are described, together with a historical survey of its development in recent years. The basic elements of quality assurance in the country are also discussed.