[No effect of aircraft crash near South Limburg (the Netherlands) on self-perceived health, but an increase in perceived environmental nuisance by the inhabitants]. / Geen invloed van een vliegtuigongeluk nabij Zuid-Limburg op de ervaren gezondheid van omwonenden, wel toename van de ervaren milieuhinder.

OBJECTIVE: To investigate the influence of an aircraft crash near the South of Limburg, the Netherlands, on the perceived physical and psychological health and annoyance of local residents. DESIGN: Controlled, blinded, follow-up questionnaire survey. METHOD: Three months before an aircraft crash occurred, randomly selected local residents and control subjects who lived approximately 20 km from the crash site were asked to complete a health questionnaire. The study was repeated one year after the crash. The aim of the survey was not mentioned in the questionnaire. The questionnaire asked about demographic features, physical health, psychological health and environmental nuisance. In the first survey, 544/926 (59%) questionnaires were successfully returned, and after the disaster this figure was 677/900 (75%). Linear regression modelling was used to check whether or not any differences in outcome were due to confounding demographic variables. RESULTS: There was no significant difference in the perceived physical and psychological health of local residents before and after the aircraft crash. A year after the crash, the nuisance level of aircraft noise reported by local residents had markedly increased. Aircraft noise was the major cause of disturbance. More than 1 in 3 residents perceived daily aircraft noise as a nuisance compared with 1 in 6 before the crash. The scores of local inhabitants for annoyance due to aircraft odour and dust doubled after the crash. Compared with control subjects, local inhabitants scored more than 20 times higher for annoyance due to aircraft odour and 40 times higher for annoyance due to dust. The reported nuisance caused by road traffic noise, odour and dust also increased, although to a lesser extent. CONCLUSION: Health was not influenced by the aircraft crash. A year after the crash, there was a strong drop in tolerance of aircraft nuisance. There was also a reduction in the tolerance of comparable nuisance due, for example, to road traffic, although this change was less marked.

Changing relations between hospitals and primary health care: new challenges for hospital management.

Hospitals in the Netherlands are now operating in a rapidly changing environment. Most changes directly result from government's policy to achieve effective cost containment in health care. Some of them basically affect the existence and functioning of hospitals. These changing environmental conditions inspire hospitals to undertake innovative activities to protect or even strengthen their position. This will be illustrated below by a case in which a small acute hospital attempted to establish a close relationship with primary health care in order to protect its position. Our focus will be upon this innovative initiative and upon some management problems that must then be resolved.