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Objective-To study the trend in hospital admission rates for heart failure in the Netherlands from 1980 to 1993. Design-All hospital admissions in the Netherlands with a principal discharge diagnosis of heart failure were analysed. In addition, individual records of heart failure patients from a subset of 7 hospitals were analysed to estimate the frequency and timing of readmissions. Results-The total number of discharges for men increased from 7377 in 1980 to 13 022 in 1993, and for women from 7064 to 12 944. From 1980 through 1993 age adjusted discharge rates rose 48% for men and 40% for women. Age adjusted inhospital mortality for heart failure decreased from 19% in 1980 to 15% in 1993. For all age groups in-hospital mortality for men was higher than for women. The mean length ofhospital admissions in 1993 was 14-0 days for men and 16-4 days for women. A review of individual patient records from a 6-3% sample of all hospital admissions in the Netherlands indicated that within a 2 year period 18% of the heart failure patients were admitted more than once and 5% more than twice. Conclusions-For both men and women a pronounced increase in age adjusted discharge rates for heart failure was observed in the Netherlands from 1980 to 1993. Readmissions were a prominent feature among heart failure patients. Higher survival rates after acute myocardial infarction and the longer survival of patients with heart disease, including heart failure may have contributed to the observed increase. The importance of advances in diagnostic tools and of possible changes in admission policy remain uncertain.

SummaryWe studied the repeated effect of sterilisation on light intensity in laryngoscopes from Penlon, Riester, Heine (two different blades), Medicon and Upsher. Light intensity was measured by a light meter using two methods. Measurements were performed before the decontamination procedure was carried out and subsequently after each series of 25 procedures until a total of 200 cycles was reached. Using method 1 (and 2), the reduction in light intensity after 200 cycles was 100% (100%; no light emitted), 37% (13%), 75% (69%), 79% (60%), 37% (14%) and 63% (55%) for each blade, respectively. Keywords Equipment; laryngoscopes. Infection control; sterilisation. disinfection. Larynx; laryngoscopy. To prevent infection, decontamination of laryngoscopes is of vital importance, especially in the immunocompromised patient. Although decontamination should start with rigorous mechanical cleaning [1], machine washing being the most effective method, controversy exists as to whether this should be followed by highlevel disinfection or sterilisation [1±3]. Recently, this discussion became particularly relevant when Control of Substances Hazardous to Health (COSHH) regulations applicable throughout the EC made many disinfection agents (e.g. glutaraldehyde solutions) no longer easily accessible. In this respect it is disturbing that alcohol, a frequently used alternative, is not considered to be a high-level disinfectant [1]. There is a high incidence of noncompliance with current guidelines [4,5] and the result of any decontamination protocol relies on consistent adherence [3,6]. These problems can be overcome with the use of sterilisation.However, one of the potential disadvantages of steam sterilisation at 134 8C is that it might be detrimental to ®brelight blades. We are unaware of data describing the effect of steam sterilisation on the ®brelight laryngoscope blades currently on the market. We therefore undertook this study to evaluate the effect of automated machine washing and subsequent steam sterilisation at 134 8C on various ®brelight laryngoscope blades and handles, focusing on the effect on light intensity provided by the blades. Methods

We used a population based study in the Netherlands of 330 Hindustani Surinamese, 586 African Surinamese, and 486 ethnic Dutch (Dutch) to describe the prevalence of the metabolic syndrome (MS) and the association with differences in cardiovascular disease in and between ethnic groups. Fasting blood samples, blood pressure, and anthropometric measurements were obtained. MS was defined according to the criteria of the International Diabetes Federation (IDF) and the criteria of the National Cholesterol Education Program (NCEP). Cardiovascular disease was assessed by the Rose questionnaire and included questions on previous diagnoses of angina pectoris/myocardial infarction, cerebrovascular accident, intermittent claudication. The prevalence of MS (IDF and NCEP) was highest in Hindustani Surinamese men, followed by Dutch and African Surinamese men: 51.0%, 19.4%, and 31.2% (IDF), respectively. Among women, both the Hindustani and African Surinamese participants had a higher prevalence of MS (IDF and NCEP) than the Dutch. The association between the components, MS and cardiovascular disease differed between ethnic groups, in particular among men; OR for MS (NCEP) = 1.0 (0.4-2.7) among Hindustani Surinamese, OR = 4.9 (1.3-18.3) among African Surinamese, and OR = 2.8 (1.1-7.1) among Dutch. However, the differences in MS could not account for the ethnic differences in cardiovascular disease, regardless of the criteria used. The results suggest that, before the criteria can be used to guide practice, they may need to be changed and refined to take into account the differences between ethnic groups as well as the variations by gender.