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ObjectiveConcentration of care and collaborations between hospitals increasingly reorganise oncological care into Comprehensive Cancer Networks (CCNs), aiming to improve care outcomes and reduce costs. This study aims to evaluate the effect of four CCNs on healthcare cost and outcomes for patients with colon or pancreatic cancer.DesignWe performed a retrospective cohort study based on claims data in the Netherlands. Data included patient characteristics, health insurance claims and healthcare activities. All costs were indexed to Euro 2023. We performed propensity score matching per CCN and applied regression models with a difference-in-difference design, adjusting for non-linear trends before the start of a CCN.SettingThe study was conducted within the Dutch healthcare system, analysing claims data representative of hospital-based cancer care.ParticipantsA total of 92 309 patients with colon cancer and 25 630 patients with pancreatic cancer were included. Patients were identified through health insurance claims between January 2013 and June 2021.InterventionImplementation of four CCNs, which included structured collaboration between healthcare organisations. Follow-up duration was 2 years post-diagnosis.Outcome measuresPrimary outcomes included 2-year oncological healthcare costs and 2-year mortality rate. Secondary outcomes involved care process indicators: referral rates and double diagnostics (an identical diagnostic activity performed within 4 weeks after referral to a secondary hospital).ResultsFor colon cancer, one CCN showed a significant decrease in 2-year oncological costs (−€1899). One CCN showed a significant decrease in referrals (−3.6%) and one a significant increase (+4.4%). No significant effect on 2-year mortality and double diagnostic activities was found. For pancreatic cancer, one CCN showed a significant decrease in 2-year oncological costs (−€3747) and one CCN showed a significant increase in double diagnostic activities (+8.6%). No significant effect on referrals and 2-year mortality was found.ConclusionCCNs do not consistently reduce costs or affect referral patterns or redundant diagnostics. No impact on mortality was found. Additional insights into determinants of CCN success are required before broad implementation is warranted.

This paper deals with the question: To what extent do individual religious characteristics, in addition to collective religious characteristics, contribute to the explanation of formal and informal volunteering in the Netherlands at the beginning of the 21st century? To answer this research question, we used the SOCON 2005-2006 dataset. Our main finding concerns informal volunteering: we found that spirituality increases the likelihood of informal volunteering, implying that openness to other people's needs increases the likelihood of the actual provision of help. There are no other aspects of religiosity that are related to informal volunteering. With regard to formal volunteering we found that, in line with previous research, religious attendance is related positively to formal volunteering, religious as well as secular volunteering, which can be regarded as support for the proposition that religious involvement is important for norm conformity. Further, having a more religious worldview decreases the likelihood of formal volunteering which might show that those with a strong religious worldview are more concerned with the 'otherworldly' and less so with what they do in this world. We found no influence of individual religious characteristics on formal volunteering. These results confirm the idea that integration into a religious community plays quite a large role in explaining formal volunteering. Informal volunteering, however, seems to be independent of social networks: it rather depends on individual motivation. Cet article traite de la question : Dans quelle mesure les caractéristiques religieuses individuelles, en plus des caractéristiques religieuses collectives, contribuent-elles à éclairer le bénévolat formel et informel aux Pays-Bas au début du 21 ème siècle? Pour traiter ce sujet de recherche, nous avons utilisé les données issues de l'étude SOCON 2005-2006. Notre conclusion principale concerne le bénévolat informel : nous avons déterminé qu'être porteur d'une spiritualité augmente la propension au bénévolat informel, ce qui implique que l'ouverture aux besoins d'autrui augmente la probabilité de fournir une aide active. Aucun autre aspect de la religiosité n'est lié au bénévolat informel. En ce qui concerne le bénévolat formel, conformément aux résultats des autres recherches, nous avons conclu que le fait de pratiquer une religion est lié de manière positive au bénévolat formel ainsi qu'au bénévolat religieux et laïque, ce qui peut être considéré comme une contribution à la proposition selon laquelle l'engagement religieux est un élément important de la conformité à la norme. Par ailleurs, plus le monde se trouve perçu selon une approche religieuse, moins grandes sont les chances d'être engagé dans une activité de bénévolat formel, ce qui pourrait indiquer que les personnes ayant une vision très religieuse du monde se sentent plus concernées par « l'au-delà » que par leurs actions dans ce monde. Nous n'avons décelé aucune influence des caractéristiques religieuses individuelles sur le bénévolat formel. Ces résultats confirment l'idée que l'appartenance à une communauté religieuse joue un rôle assez important dans l'explication du bénévolat formel. Le bénévolat informel semble quant à lui indépendant des réseaux sociaux : il dépend plutôt des motivations individuelles. Dieser Beitrag beschäftigt sich mit folgender Frage: In welchem Maße tragen individuelle religiöse Merkmale, zusätzlich zu den kollektiven religiösen Merkmalen, zur Erklärung formaler und informaler ehrenamtlicher Tätigkeiten in den Niederlanden zu Beginn des 21. Jahrhunderts bei? Zur Beantwortung dieser Forschungsfrage stützten wir uns auf den Datenbestand aus der von 2005 bis 2006 durchgeführten SOCON-Befragung. Unsere wichtigste Erkenntnis betrifft informale ehrenamtliche Tätigkeiten: Wir stellten fest, dass Spiritualität die Wahrscheinlichkeit informaler ehrenamtlicher Tätigkeiten erhöht, was darauf schließen lässt, dass die Offenheit gegenüber den Bedürfnissen anderer die Wahrscheinlichkeit zur tatsächlichen Hilfeleistung erhöht. Es gibt keine anderen Aspekte der Religiosität, die mit informalen ehrenamtlichen Tätigkeiten in Verbindung stehen. Hinsichtlich formaler ehrenamtlicher Tätigkeiten stellten wir fest, dass in Übereinstimmung mit früheren Studien die religiöse Teilnahme im positiven Zusammenhang mit formalen ehrenamtlichen Tätigkeiten sowohl im religiösen als auch im nicht religiösen Bereich in Verbindung steht, wodurch die Behauptung unterstützt werden kann, dass eine religiöse Beteiligung für die Normenkonformität wichtig ist. Weiterhin verringert eine religiösere Weltanschauung die Wahrscheinlichkeit zur Ausführung formaler ehrenamtlicher Tätigkeiten, was vielleicht zeigt, dass Personen mit einer stark religiösen Weltanschauung sich mehr mit dem „Jenseits” befassen und weniger mit dem, was sie auf dieser Welt tun. Wir konnten keinen Einfluss individueller religiöser Merkmale auf formale ehrenamtliche Tätigkeiten feststellen. Diese Ergebnisse bestätigen die Vorstellung, dass die Integration in eine religiöse Gemeinschaft eine äußerst große Rolle spielt bei der Erklärung formaler ehrenamtlicher Tätigkeiten. Informale ehrenamtliche Tätigkeiten dagegen scheinen von sozialen Netzwerken unabhängig zu sein; sie hängen vielmehr von der individuellen Motivation ab. En este trabajo se aborda la siguiente pregunta: ¿hasta qué punto las características religiosas individuates, además de las colectivas, contribuyen a explicar el voluntariado formal e informai en los Países Bajos a princípios del sigio xxi? Para responder a esta pregunta de investigación, hemos recurrido a la base de datos SOCON 2005-2006. Nuestro principal descubrimiento tiene que ver con el voluntariado informal: hemos descubierto que la espiritualidad incrementa la predisposición a convertirse en voluntario informal, lo que supone que una mentalidad abierta a las necesidades ajenas incrementa la posibilidad de prestar ayuda realmente. No hay otros aspectos de la religiosidad relacionados con el voluntariado informal. En relación con el voluntariado formal, hemos descubierto que, en consonancia con los estudios anteriores, la asistencia religiosa está positivamente relacionada con el voluntariado formal, tanto religioso como secular, por lo que podríamos considerar que se refuerza la propuesta de que la implicación religiosa es importante para la conformidad con las normas. Asimismo, al tener un punto de vista más religioso se reduce la probabilidad del voluntariado formal, lo que podría demostrar que las personas con una visión religiosa fuerte están más preocupadas por el otro mundo que por éste. No hemos encontrado influencia de las características religiosas individuales en el voluntariado formal. Estos resultados confirman la idea de que la integración en una comunidad religiosa desempeña un importante papel a Ia hora de explicar el voluntariado formal. No obstante, el voluntariado informal parece no depender de las redes sociales, sino más bien de la motivación individual.

Since intensive care unit (ICU) admission and chemotherapy use near death impair the quality of life, we studied the prevalence of both and their correlation with hospital volume in incurable gastroesophageal cancer patients as both impair the quality of life. We analyzed all Dutch patients with incurable gastroesophageal cancer who died in 2017–2018. National insurance claims data were used to determine the prevalence of ICU admission and chemotherapy use (stratified on previous chemotherapy treatment) at three and one month(s) before death. We calculated correlations between hospital volume (i.e., the number of included patients per hospital) and both outcomes. We included 3748 patients (mean age: 71.4 years; 71.4% male). The prevalence of ICU admission and chemotherapy use were, respectively, 5.6% and 21.2% at three months and 4.2% and 8.0% at one month before death. Chemotherapy use at three and one months before death was, respectively, 4.3 times (48.0% vs. 11.2%) and 3.7 times higher (15.7% vs. 4.3%), comparing patients with previous chemotherapy treatment to those without. Hospital volume was negatively correlated with chemotherapy use in the final month (rweighted = −0.23, p = 0.04). ICU admission and chemotherapy use were relatively infrequent. Oncologists in high-volume hospitals may be better equipped in selecting patients most likely to benefit from chemotherapy.

Tropical forests grab carbon Tropical forests store and process large amounts of carbon, affecting the amount of CO 2 in the atmosphere, and hence the rate and magnitude of climate change. The extent of the contribution of tropical forests in this role is uncertain, largely because of a lack of monitoring. An international collaboration has now collected and analysed data from a ten-country network of 79 long-term monitoring plots across the largest tropical continent - Africa. Their findings reveal that above-ground carbon storage in live trees increased by 0.63 tonnes of carbon per hectare per year between 1968 and 2007. Extrapolation to unmeasured forest components and scaling to the continent implies a total increase in carbon storage in African tropical forest trees of 340 million tonnes a year. These results provide evidence that increasing carbon storage in old-growth forests is a pan-tropical phenomenon. This study reports data from a network of long-term monitoring plots across African tropical forests, which finds that above-ground carbon storage in live trees increased by 0.63 Mg C ha −1 yr −1 between 1968 and 2007. The data is extrapolated to unmeasured forest components, and by scaling to the continent, a total increase in carbon storage in African tropical forest trees of 0.34 Pg C yr −1 is estimated. These results provide evidence that increasing carbon storage in old-growth forests is a pan-tropical phenomenon. The response of terrestrial vegetation to a globally changing environment is central to predictions of future levels of atmospheric carbon dioxide 1 , 2 . The role of tropical forests is critical because they are carbon-dense and highly productive 3 , 4 . Inventory plots across Amazonia show that old-growth forests have increased in carbon storage over recent decades 5 , 6 , 7 , but the response of one-third of the world’s tropical forests in Africa 8 is largely unknown owing to an absence of spatially extensive observation networks 9 , 10 . Here we report data from a ten-country network of long-term monitoring plots in African tropical forests. We find that across 79 plots (163 ha) above-ground carbon storage in live trees increased by 0.63 Mg C ha -1  yr -1 between 1968 and 2007 (95% confidence interval (CI), 0.22–0.94; mean interval, 1987–96). Extrapolation to unmeasured forest components (live roots, small trees, necromass) and scaling to the continent implies a total increase in carbon storage in African tropical forest trees of 0.34 Pg C yr -1 (CI, 0.15–0.43). These reported changes in carbon storage are similar to those reported for Amazonian forests per unit area 6 , 7 , providing evidence that increasing carbon storage in old-growth forests is a pan-tropical phenomenon. Indeed, combining all standardized inventory data from this study and from tropical America and Asia 5 , 6 , 11 together yields a comparable figure of 0.49 Mg C ha -1  yr -1 ( n = 156; 562 ha; CI, 0.29–0.66; mean interval, 1987–97). This indicates a carbon sink of 1.3 Pg C yr -1 (CI, 0.8–1.6) across all tropical forests during recent decades. Taxon-specific analyses of African inventory and other data 12 suggest that widespread changes in resource availability, such as increasing atmospheric carbon dioxide concentrations, may be the cause of the increase in carbon stocks 13 , as some theory 14 and models 2 , 10 , 15 predict.

Background The Dutch ACS working group endorses a delayed invasive approach for non-ST segment elevation myocardial infarction (NSTEMI) patients as safe and acceptable. We analysed the timing of invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) for all patients admitted with NSTEMI. Methods For this retrospective observational cohort study initiated by the Netherlands Heart Registration, we extracted Dutch medical claims and diagnosis codes for all NSTEMI patients who underwent PCI. Primary outcome was the time from hospital admission to ICA and PCI in patients admitted to PCI and non-PCI centres. Secondary analyses included the time from ICA to PCI and variation among individual PCI centres. Results A total of 36,573 NSTEMI patients (median age 68 years, 30% female) were included in the analysis. 24,857 patients (68%) were admitted to a hospital with PCI facilities ( n  = 30) and 11,716 patients (32%) to a hospital without PCI on site ( n  = 42). ICA was performed < 3 days (72 h) in 33,476 patients (92%). For patients admitted in PCI centres ICA was performed < 3 days in 94% ( n  = 23,328), median 0 days (IQR 0–1) vs 87% ( n  = 10,148), median 1 day (IQR 1–2) in non-PCI centres. The longest delay (median 3 days; IQR 2–5) between ICA and PCI occurred in patients first admitted to non-PCI centres and transferred after local ICA. Conclusions ICA within three days is achieved in a very high percentage of patients in both PCI and non-PCI centres. A clearly larger percentage receives PCI within three days when directly admitted to a PCI centre.

Background Lipid-lowering medication reduces the risk of future cardiovascular events and mortality, yet adherence is often disappointing. This study evaluates adherence rates of lipid-lowering medication and its subtypes during the first year following acute and elective percutaneous coronary intervention (PCI) in the Netherlands. Methods This retrospective cohort study utilized data from a nationwide all-payer claims database managed by Vektis, containing all medical care claims reimbursed by Dutch national insurance companies. We included 97,176 patients who underwent PCI in 2018–2020. Adherence was defined as a medication possession rate ≥ 80%. Results Adherence rates 0–3 months post-elective PCI ranged from 71–73% among the years and remained stable over the year following PCI. For acute PCI, adherence rates 0–3 months post-acute PCI were initially higher (79–81%) but declined to 74–76% during the year following PCI. During the year following PCI, adherence rates for ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors increased slightly to about 13%, respectively 2%, while statin adherence decreased. For statin subtypes, adherence rates for rosuvastatin increased at the expense of simvastatin, with adherence for atorvastatin and other statins remaining relatively stable. Lower adherence rates were observed among females and patients ≥ 80 years compared to males and younger patients. Conclusion This study found lipid-lowering medication adherence 1 year post-elective PCI ranged from 71–73% and post-acute PCI from 74–76%. Lower adherence rates were observed in women and elderly patients. Adherence rates of ezetimibe and PCSK9 inhibitors increased throughout the year following PCI, while statin use decreased.

Quantifying carbon dynamics in forests is critical for understanding their role in long-term climate regulation 1 – 4 . Yet little is known about tree longevity in tropical forests 3 , 5 – 8 , a factor that is vital for estimating carbon persistence 3 , 4 . Here we calculate mean carbon age (the period that carbon is fixed in trees 7 ) in different strata of African tropical forests using (1) growth-ring records with a unique timestamp accurately demarcating 66 years of growth in one site and (2) measurements of diameter increments from the African Tropical Rainforest Observation Network (23 sites). We find that in spite of their much smaller size, in understory trees mean carbon age (74 years) is greater than in sub-canopy (54 years) and canopy (57 years) trees and similar to carbon age in emergent trees (66 years). The remarkable carbon longevity in the understory results from slow and aperiodic growth as an adaptation to limited resource availability 9 – 11 . Our analysis also reveals that while the understory represents a small share (11%) of the carbon stock 12 , 13 , it contributes disproportionally to the forest carbon sink (20%). We conclude that accounting for the diversity of carbon age and carbon sequestration among different forest strata is critical for effective conservation management 14 – 16 and for accurate modelling of carbon cycling 4 . Capacity for carbon capture and storage in forests may not be monolithic but instead a function of complex dynamics of forest strata and age. The smaller trees that make up the understory in African tropical forests store their carbon longer as compared to sub-canopy and canopy trees and they represent a disproportionately large share of the carbon sink, in spite of their small size.

The use of healthcare insurance claims data for urinary incontinence (UI) pads has the potential to serve as an objective measure for assessing post-radical prostatectomy UI rates, but its validity for this purpose has not been established. The aim of this study is to correlate claims data with Patient Reported Outcome Measures (PROMs) for UI pad use. Patients who underwent RP in the Netherlands between September 2019 and February 2020 were included. Incontinence was defined as the daily use of ≥1 pad(s). Claims data for UI pads at 12–15 months after RP were extracted from a nationwide healthcare insurance database in the Netherlands. Participating hospitals provided PROMS data. In total, 1624 patients underwent RP. Corresponding data of 845 patients was provided by nine participating hospitals, of which 416 patients were matched with complete PROMs data. Claims data and PROMs showed 31% and 45% post-RP UI (≥1 pads). UI according to claims data compared with PROMs had a sensitivity of 62%, specificity of 96%, PPV of 92%, NPV of 75% and accuracy of 81%. The agreement between both methods was moderate (κ = 0.60). Claims data for pads moderately align with PROMs in assessing post-prostatectomy urinary incontinence and could be considered as a conservative quality indicator.

The relation between religiosity and donations to charity has frequently been subject of research. We analyzed effects of dimensions of individual religiosity (Glock and Stark 1966) on people's intention to donate to the poorest countries. We tested for cross-national effect differences in representative samples of seven European countries. Results turned out to be relatively robust across countries. We found that church attendance, dogmatic conviction and a consequential religious attitude affect intentional donations positively. The religiosity of one's network does have an additional effect. Partner's church attendance is positively related to willingness to donate. However, people with mainly friends with the same religious opinions are less willing to donate.

Aim: Our aim was to evaluate the extent to which we can predict and map tree alpha diversity across broad spatial scales either by using climate and remote sensing data or by exploiting spatial autocorrelation patterns. Location: Tropical rain forest, West Africa and Atlantic Central Africa. Methods: Alpha diversity estimates were compiled for trees with diameter at breast height ≥ 10 cm in 573 inventory plots. Linear regression (ordinary least squares, OLS) and random forest (RF) statistical techniques were used to project alpha diversity estimates at unsampled locations using climate data and remote sensing data [Moderate Resolution Imaging Spectroradiometer (MODIS), normalized difference vegetation index (NDVI), Quick Scatterometer (QSCAT), tree cover, elevation]. The prediction reliabilities of OLS and RF models were evaluated using a novel approach and compared to that of a kriging model based on geographic location alone. Results: The predictive power of the kriging model was comparable to that of OLS and RF models based on climatic and remote sensing data. The three models provided congruent predictions of alpha diversity in well-sampled areas but not in poorly inventoried locations. The reliability of the predictions of all three models declined markedly with distance from points with inventory data, becoming very low at distances > 50 km. According to inventory data, Atlantic Central African forests display a higher mean alpha diversity than do West African forests. Main conclusions: The lower tree alpha diversity in West Africa than in Atlantic Central Africa may reflect a richer regional species pool in the latter. Our results emphasize and illustrate the need to test model predictions in a spatially explicit manner. Good OLS or RF model predictions from inventory data at short distance largely result from the strong spatial autocorrelation displayed by both the alpha diversity and the predictive variables rather than necessarily from causal relationships. Our results suggest that alpha diversity is driven by history rather than by the contemporary environment. Given the low predictive power of models, we call for a major effort to broaden the geographical extent and intensity of forest assessments to expand our knowledge of African rain forest diversity.