Summary
Background In the Netherlands a nationwide study has shown that, in 38% of deaths, there have been medical decisions concerning the end of life (MDEL); 2·1% of all deaths were brought about ...by euthanasia or physician-assisted suicide (PAS). We investigated the incidence of MDEL in homosexual men with AIDS, suspecting that it might be higher, and studied the effect of euthanasia/PAS on survival time.
Methods The patients were 131 male homosexual participants in a cohort study in Amsterdam, diagnosed between 1985 and 1992 as having AIDS; all had died before Jan 1, 1995. Clinical and laboratory data and information on mode of death were obtained from their physicians and by review of hospital records. Those who died by euthanasia/PAS or in whom there had been other MDEL were then compared with those who died naturally.
Findings 29 men (22%) had died by euthanasia/PAS and in 17 (13%) another MDEL had been made; thus, more than one-third of these men had made medical decisions concerning the end of life. The greatest difference between the groups was in age at time of diagnosis—72% aged 40 or more in the euthanasia/PAS group compared with 38% in the natural death group. The likelihood (relative risk) of euthanasia/PAS increased with duration of survival after AIDS diagnosis. Comparison of the groups in terms of three laboratory markers (CD4+ and CD8+ cells and phytohaemagglutinin responses) in the two years before death, and estimates of these markers at the time of death, did not indicate any substantial shortening of life by euthanasia/PAS; in the judgment of the physicians, most of these patients would have died naturally within one month.
Interpretation A possible reason for the high incidence of MDEL in this cohort was a good knowledge of the characteristics of AIDS acquired through long-term awareness of HIV infection. The higher rate of euthanasia in those with long survival from AIDS diagnosis could reflect either additional suffering or the greater opportunity to discuss this option with friends and physicians. Our findings indicate that euthanasia and other MDEL did little to shorten life; rather, they were an extreme form of palliation, applied in the terminal phase of a lethal disease.
The cockroach allergen (Bla g 1) content was determined in the floor dust of 46 homes with recent cockroach extermination in Amsterdam, The Netherlands. IgE antibodies to Blattella germanica, ...house-dust mite, cat dander, dog dander, and a mixture of molds were determined in venous blood samples of 46 children (4-12 years) and one of their biologic parents (24-54 years). Specific IgE to cockroach was also determined in a sample of the general population studied in a previous case-control study, one group (n=20) with and three groups (n=76) without history of cockroach infestation of the home. Cockroach allergen was detected in floor dust from 44% of the homes, with levels up to 3899 ng Bla g 1/g. Seven of the 46 adults and only one of the 46 children studied had positive RAST to cockroach. Geometric mean cockroach allergen concentrations in living room and master bedroom of sensitized adults were similar to those of nonsensitized adults. In the groups of children without a history of cockroach infestation of the home, positive RAST against cockroach was observed in 16% of the children with respiratory symptoms, in 4% of the children without respiratory symptoms, and in 48% of the children with two or more positive RAST to other allergens. Of the 18 children with positive RAST against cockroach, only one had a history of cockroach infestation of the home and 16 (89%) had also positive RAST against house-dust mite.
To study the impact of AIDS on premature mortality in the city of Amsterdam (1982-1992).
We combined aggregated data from the Netherlands Central Bureau for Statistics with data from the municipal ...death and population registry and data from the Amsterdam AIDS surveillance system to calculate age standardized mortality rates for men aged 15-64 years and 25-54 years and working years of potential life lost before 65 years (WYPLL).
AIDS was the leading cause of death for men aged 25-54 years in Amsterdam from 1990 onwards, and the third leading cause of death for men aged 15-64 years in 1991. In this larger age group AIDS will probably become the leading cause of death in the coming years. In 1991, AIDS was already the leading cause of WYPLL before 65 years for men in the 15-64 age group. Without AIDS, there would have been a decrease in premature WYPLL from 1982 onwards; however, because of AIDS the number of WYPLL is increasing again.
AIDS has had a significant impact on the pattern of premature mortality in Amsterdam in the period 1982-1992. Its impact will probably increase over the next few years.
Cockroach allergen in house dust Wijnen, J. H.; Verhoeff, A. P.; Mulder‐Folkerts, D. K. F. ...
Allergy (Copenhagen),
April 1997, Letnik:
52, Številka:
4
Journal Article, Conference Proceeding
Recenzirano
The cockroach allergen (Bla g 1) content was determined in the floor dust of 46 homes with recent cockroach extermination in Amsterdam, The Netherlands. IgE antibodies to Blattella germanica, ...house‐dust mite, cat dander, dog dander, and a mixture of molds were determined in venous blood samples of 46 children (4‐12 years) and one of their biologic parents (24‐54 years). Specific IgE to cockroach was also determined in a sample of the general population studied in a previous case‐control study, one group (n=20) with and three groups (n=76) without history of cockroach infestation of the home. Cockroach allergen was detected in floor dust from 44% of the homes, with levels up to 3899 ng Bla g 1/g. Seven of the 46 adults and only one of the 46 children studied had positive RAST to cockroach. Geometric mean cockroach allergen concentrations in living room and master bedroom of sensitized adults were similar to those of nonsensitized adults. In the groups of children without a history of cockroach infestation of the home, positive RAST against cockroach was observed in 16% of the children with respiratory symptoms, in 4% of the children without respiratory symptoms, and in 48% of the children with two or more positive RAST to other allergens. Of the 18 children with positive RAST against cockroach, only one had a history of cockroach infestation of the home and 16 (89%) had also positive RAST against house‐dust mite.
