Seasonality of birth in patients with childhood diabetes in The Netherlands.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
R A Hirasing
Publications and source records attributed to R A Hirasing.
Surveillance of acute flaccid paralysis in The Netherlands, 1992-94.
Detection and investigation of all cases of acute flaccid paralysis (AFP) in children below 15 years of age are among the criteria for poliomyelitis-free certification. In the absence of poliomyelitis the incidence of AFP is around 1 per 100,000 children aged < 15 years. In the Netherlands, surveillance of AFP began in October 1992 under the supervision of the Dutch Paediatric Surveillance System (NSCK). Over 90% of clinically active paediatricians participated in the monthly reporting of new cases of AFP. From October 1992 to December 1994 (27 months), 52 cases of AFP were reported. The incidence was 0.7 per 100,000 over the period, and reported cases were evenly distributed throughout the country. The main cause of AFP was Guillain-Barré syndrome. The average time between onset of symptoms and visiting a doctor was less than 3 days. The median reporting delay was 29 days, although the system was not intended as surveillance for action. Virological examination of faeces was carried out for only 40.4% of AFP patients. The start of the NSCK surveillance system coincided with the 1992-93 outbreak of poliomyelitis in the Netherlands, but only 7 of the 18 children with paralytic poliomyelitis were reported through the AFP surveillance system. For certification purposes, the present AFP surveillance system in the Netherlands needs to be improved with respect to coverage by including neurologists, rapidity of reporting, and completeness of laboratory investigations.
Adolescent↗
The use of oral contraceptives by adolescents for contraception, menstrual cycle problems or acne.
BACKGROUND: Oral contraceptives are prescribed as contraception but also as therapy for menstrual cycle disturbances and acne. We studied the prevalence of oral contraceptive (OC) use and the indications to start OC use among adolescents. METHODS: A cohort consisting of ninth grade secondary school girls (mean age 15.3+/-0.6 (s.d.) years) answered a questionnaire on their menstrual cycle. OC users were asked about duration and reasons for OC-use and the name of the preparation they used. The influence of calendar age, gynecological age and level of education on the prevalence of OC was studied by multiple logistic regression analysis. RESULTS: The response on the questionnaire was 92%. Of 2248 responders 248 (11%) used oral contraceptives: 74% used low dose 'sub 50' preparations, 3% pills with 50 microg estrogen, 3% tri-phase preparations and 17% pills with antiandrogens. Of girls aged 14, 15 and 16 years 4%, 12% and 28% respectively, used OC. Of the 15-year-olds 31% mentioned contraception as most important reason for OC use, 18% menstrual cycle irregularity, 26% dysmenorrhea, 10% acne and 5% other reasons. Calendar age, gynecological age and level of education were independent variables for OC use in general and for OC use for contraception or dysmenorrhea, but less so for OC use for menstrual cycle irregularity or acne. CONCLUSIONS: During adolescence low dose OC's were frequently used. In The Netherlands OC use among girls aged 15 and 16 years doubled in comparison with 1982. One third of the adolescent OC-users mentioned contraception as most important reason to start OC. Gynecological age (a determinant of biological maturation), calendar age (a determinant of biological maturation and lifestyle in peer groups), and level of education (a determinant of lifestyle in peer groups) were associated with OC use.
Acne Vulgaris↗
[Current developments in preventive health care].
On the occasion of the publication of the second revised edition of the Preventiegids (Prevention guide), some recent developments in preventive health care can be analysed and priorities for the near future can be formulated. Some controversies have been resolved (e.g. periconceptional use of folic acid, influenza vaccination of all elderly), a number of others still exist (e.g. postmenopausal oestrogen substitution, screening for hypertension and hypercholesterolaemia). Further health benefit can be obtained by preventive activities, albeit to a limited extent. The focus should be on correct implementation (standardisation) of existing prevention programmes plus evaluation, with improvements where possible. There will also be opportunities for new prevention programmes (e.g. use of the triple test in screening for Down syndrome). It will be possible to discontinue existing inefficient programmes (e.g. routine pregnancy ultrasonography, routine administration of iron to pregnant women.
Adolescent↗
Confirmation of high incidence of type 1 (insulin-dependent) diabetes mellitus in Moroccan children in The Netherlands.
The incidence of Type 1 (insulin-dependent) diabetes mellitus among Moroccan children aged (0-19 years) in The Netherlands was determined. Point of reference was the data derived from the second nationwide incidence study on Type 1 diabetes among children under 20 years of age. In that study the incidence among Dutch children was 13.2 100000(-1) year(-1). To scrutinize the data and to obtain more information a questionnaire was sent in 1993 to all specialists who had reported that they had diagnosed a patient with Type 1 diabetes during the years 1988-1990 whose parents originated from Morocco, Turkey or other foreign countries. The questionnaire requested information on origin and migration of child and parents. The response to the questionnaire was 86% for the Moroccan children, 75% for the Turkish children and 100% for the children from other countries. In only one case a wrong country had been recorded. None of the patients had been in The Netherlands for less than 6 months before the diagnosis. The incidence for Moroccan children was 20.0 (95% CI 14.6-26.9) and for Turkish children 4.5 (95% CI 2.2-8.0) 100,000(-1) year(-1). It is concluded that the incidence of Type 1 diabetes in Moroccan children (0-19 years) is 1.5 times higher than in Dutch children and 4.5 times higher than in Turkish children.
Adolescent↗
Food intolerance (food hypersensitivity) and chronic complaints in children: the parents' perception.
UNLABELLED: The aim of the study was to assess the prevalence of food intolerance (FI) in Dutch 5- and 6-year-old children and its association with chronic ailments with a survey among parents by questionnaire. Based on parents' perception the prevalence of "probable" FI was 3.8%. FI was associated with asthma, wheezing, eczema, hay fever, chronic rhinitis, hives, chronic diarrhoea and hyperactive behaviour. The Dutch research results are commensurate with the findings of a study carried out in the U.K. Parents frequently associate FI with eczema, hives, chronic diarrhoea and hyperactivity. The association with FI remains for asthma, wheezing, chronic rhinitis, hay fever, chronic diarrhoea and hyperactive behaviour even after adjustment for this information bias. CONCLUSION: Many parents are not aware that chronic ailments in their child may be caused by FI. The associations of FI and chronic complaints are strong enough to justify the discussion with parents during the client contacts by school physicians, in order to assess the advantages of consulting a paediatrician or allergologist.
Adult↗
Bedwetting and behavioural and/or emotional problems.
OBJECTIVE: To assess the link between enuresis nocturna and the severity of behavioural and/or emotional problems in Dutch children and the course of these problems. SETTING: West-Mine Region in the Netherlands. SUBJECTS AND METHODS: Prospective cohort study involving 66 of the 80 bedwetting children from all 1652 children born in 1983 in this region. After 1 y, contact was still possible with 64 of the enuretics. We used the Dutch version of the Child Behaviour Checklist (CBCL) and a questionnaire about bedwetting. RESULTS: The mean T-score for Total Problems (CBCL score) in 1992 (M1; mean age 8.6) was 52.1, and 1 y later was 49.2 (M2). There was no significant difference in the CBCL scores for M1, M2 and a matching group from the Dutch CBCL norm population, either in the group who remained wet or in the group who became dry. There were no differences between the sexes. There was no link between the severity of behavioural and emotional problems and the frequency of bedwetting. However, more children with bedwetting than expected were in the clinical range. CONCLUSION: There was no difference in behavioural and/or emotional problems between the first and the second measurement and the matching group from the CBCL norm group. There were no differences in behavioural and/or emotional problems between primary and secondary bedwetters, nor were there any consequences related to the frequency of bedwetting.
Affective Symptoms↗
Twenty years of childhood coeliac disease in The Netherlands: a rapidly increasing incidence?
BACKGROUND: The incidence of coeliac disease varies internationally. AIMS: To assess the incidence of childhood coeliac disease in The Netherlands and to study the clinical features and the presence of associated disorders. SUBJECTS: Identified cases of childhood coeliac disease in The Netherlands in 1993-4 by means of the Dutch Paediatric Surveillance Unit. METHODS: Inclusion criteria were born in The Netherlands, diagnosed with at least one biopsy of the small bowel in 1993-4 and age at diagnosis 0-14 years. The data were cross checked by the Dutch Network and National Database of Pathology and compared with data from a previous study on childhood coeliac disease, 1975-90. RESULTS: A total of 193 coeliac patients were identified by means of the Surveillance Unit, another 20 through the National Database of Pathology. The mean crude incidence rate of diagnosed childhood coeliac disease was 0.54/1000 live births, which is in the range of rates found in other western European countries and significantly higher than the mean crude incidence rate of 0.18/1000 live births found in The Netherlands in 1975-90. The clinical presentation was classic: chronic diarrhoea, abdominal distension, and growth failure. Associated disorders were present in 11.7% of the cases. CONCLUSIONS: The incidence of diagnosed childhood coeliac disease in The Netherlands seems to have increased significantly during the past few years. In a period of 20 years no significant changes could be found in the clinical picture at preentation of coeliac disease in Dutch children.
Adolescent↗
Enuresis nocturna in adults.
To assess the prevalence and characteristics of enuresis nocturna in adults, the treatment they received and the perceived impact, a random sample of 13081 non-institutionalized adults (18-64 years old) were asked to participate in the study in January-March 1996. The response rate was 87%. A personal computer questionnaire included 23 questions on frequency of bedwetting, daytime wetting, treatment and perceived impact. Any respondent reporting bedwetting at least once during the previous 4 weeks was considered to have enuresis nocturna. The overall prevalence of enuresis nocturna was 0.5%. Differences between age groups and sexes were not significant. Fifty percent of men and 19% of women reporting enuresis nocturna had primary enuresis nocturna, of those with enuresis nocturna, 12% of men and 29% of women had always daytime incontinence. Fifty percent of the men and 35% of the women had never consulted a care provider for their bedwetting and 38% of the men and 26% of the women had done nothing to become dry. Only 30% believed that bedwetting was treatable. Bedwetting was associated with several psychosocial problems. Enuresis nocturna in adults is common and may lead to embarrassment and discomfort. It may affect careers, social life and personal relationships. Adults should be more aware that bedwetting is a treatable problem. More information should be given on this issue.
Adolescent↗
[Prevalence, clinical aspects and prognosis of neural tube defects in The Netherlands].
OBJECTIVE: To determine the live birth prevalence of neural tube defects (NTD) in the Netherlands and describe the clinical picture. DESIGN: Descriptive. SETTING: TNO Prevention and Health, Leiden, the Netherlands. METHOD: Data collected through active surveillance of NTD on a monthly basis by paediatricians throughout the country. RESULTS: From October 1993 to September 1995, 203 infants with NTD were registered. Six were diagnosed with anencephaly, 10 with encephalocele and 157 with spina bifida. On 30 children no further information was available. Seventy-nine per cent of children with spina bifida had a myelomeningocele and 11% had a meningocele. Hydrocephalus was found in 75% of all registered infants and in 81% of infants with myelomeningocele. In 18% of the latter group a kyphosis was diagnosed. In 45% of 131 children prognosis of ambulation fair: they were expected to learn to walk. In 32% prognosis for motor disorder was very poor, and unsupported sitting was considered to be unlikely. At the time of registration, when most children were less than a month old, 55 (27%) had died; in infants with a myelomeningocele this was 35%. In many children treatment had not been started, probably because the prognosis was poor. Some had not been referred to a multidisciplinary team and only one of them received a hydrocephalus valve. CONCLUSION: The prevalence of spina bifida in the Netherlands is at least 100 live-born children per year among 195,000 total births. Mortality in the first month is high and for many surviving infants a severe handicap can be expected. Preventive strategies (such as folic acid supplementation) are urgently needed.
Activities of Daily Living↗
[Acquired non-scrotal testis in boys: an underrated phenomenon].
OBJECTIVE: To differentiate undescended testis into a congenital and an acquired form using earlier information on testis position. DESIGN: Descriptive. SETTING: Paediatric outpatients' clinic, Medical Centre Alkmaar, the Netherlands. METHOD: In a 3-year period (1991-1994), 77 boys were referred to the paediatric outpatients' clinic for non-descended testis. The testis positions in their earlier years were documented. The undescended testis was defined according to these data as a congenital or an acquired condition. RESULTS: In 23 boys (age: 2.2-12.7; mean: 7.6 years) the testis turned out to be retractile. In 25 boys (0.1-14.3 years; mean: 3.1) the diagnosis was congenital undescended testis; 21 of these underwent orchidopexy. In 29 boys (1.9-14.3 years: mean: 9.9) the non-descent was an acquired condition. Ten of these boys were treated with orchidopexy as initial therapy. In eleven hormonal therapy was given (human chorionic gonadotrophin administered by intramuscular injection) resulting in a fully descended position of the testis in 8 boys. CONCLUSION: The phenomenon of acquired non-descended testis is frequent. Incidence and aetiology are insufficiently known. There is no general agreement whether the condition should be treated and which treatment should be favoured. Very likely, the relatively high incidence of orchidopexy operations in the Netherlands is mainly due to operative treatment of the acquired undescended testis.
Child↗
[Prevalence of hemorrhages due to vitamin K deficiency in The Netherlands, 1992-1994].
OBJECTIVE: To determine the prevalence of vitamin K deficiency bleeding in the Netherlands, in order to evaluate the efficacy of recommendations on vitamin K prophylaxis. DESIGN: Descriptive. SETTING: University Hospital Nijmegen, the Netherlands. METHODS: Active surveillance of vitamin K deficiency bleeding (VKDB) by the Dutch Paediatric Surveillance Unit from October 1, 1992 to December 31, 1994. RESULTS: Of the 19 reported cases 5 could be validated as late vitamin K deficiency bleeding: 2 idiopathic cases, and 3 secondary cases due to liver disorders. One case had intracranial bleeding and died. None of the cases had received exactly the recommended prophylaxis. The incidence of late VKDB was calculated to be 1.1/100,000 live births. Before vitamin K prophylaxis was recommended the incidence was estimated to be 7/100,000. CONCLUSION: The present Dutch recommendations for prevention of vitamin K deficiency bleeding-1 mg vitamin K at birth and thereafter for breastfed infants daily 25 micrograms from 2 to 13 weeks-appear effective.
Cerebral Hemorrhage↗
[Increase in number of admissions and increased mortality due to malnutrition in children in Paramaribo].
OBJECTIVE: To determine the extent and severity of malnutrition in children in the last 10 years in 's Lands Hospitaal. SETTING: Paramaribo, Surinam. DESIGN: Retrospective descriptive study. METHOD: Data were collected from the medical files of children admitted because of malnutrition, by completing a standard questionnaire. RESULTS: The number of children hospitalized because of malnutrition increased markedly from fewer than 20 per year in the period 1985-1990 to 142 in 1994. The increase involved both sexes, all age groups and all ethnic groups. The number of children who died from malnutrition increased from a maximum of two per year before 1993 to 18 in 1994. CONCLUSION: The increase of admissions because of malnutrition and the increase of the corresponding mortality are the consequences of the deteriorated socioeconomic situation in Surinam.
Adolescent↗
Dry bed training by parents: results of a group instruction program.
PURPOSE: We assessed results of intensive dry bed training for groups of parents outside the hospital setting. MATERIALS AND METHODS: During 5 consecutive meetings 2 appointed coaches were responsible for providing 5 to 10 parents with detailed instructions outlining the dry bed training program for their child. The 91 participating children (mean age 9.3 years) were selected from various primary schools by school physicians from the youth health care sections of 2 community health services in The Netherlands from April 1991 to May 1994. RESULTS: All 91 parents completed the initial questionnaire and 86 (95%) completed the second questionnaire 6 months after dry bed training. Before starting the dry bed training program the children were wetting the bed an average of 5.4 times weekly. A total of 69 children (80%) successfully achieved the continence criterion of 14 consecutive dry nights. Mean time plus or minus standard deviation needed to achieve dryness was 6.9 +/- 3.7 weeks, including the continence criterion. Girls responded significantly faster than boys to dry bed training (5.1 versus 7.4 weeks, t[67] = 2.16, p < 0.05). A total of 16 children (23%) had relapse of whom 7 regained dryness 6 months after training. There were no statistical differences between the successful and unsuccessful groups for the variables of patient age, sex, bed-wetting frequency, secondary enuresis, family history and therapies followed. However, there was a difference in the use of drugs and number of specialist visits before dry bed training. The majority of parents (84%) was satisfied with the program but the opinions of the children were divided. CONCLUSIONS: Group dry bed training has proved to be effective therapy. It may rapidly result in improvement through intensive training in a relatively short period. Group dry bed training is a suitable method to control nocturnal enuresis in children 6 years old or older.
Adolescent↗
Going Dutch in nocturnal enuresis.
Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry-bed training in a group setting may follow; over 13 years of age, clinical dry-bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.
Adolescent↗
Is the incidence of diabetes increasing in all age-groups in The Netherlands? Results of the second study in the Dutch Sentinel Practice Network.
OBJECTIVE: To assess possible changes in the incidence of diabetes in all age-groups in The Netherlands during a 10-year period (1980-1983/1990-1992). RESEARCH DESIGN AND METHODS: Since 1970, a network of sentinel stations (the Dutch Sentinel Practice Network) consisting of approximately 1% of the Dutch population has been in operation to gain insight into the morbidity patterns of the Dutch population as recorded by general practitioners. One of the items recorded from 1990 to 1992 was the incidence of diabetes. The first study with a similar design that registered the incidence of diabetes was conducted from 1980 to 1983. RESULTS: The overall incidence of diabetes increased significantly by 12.1% in the period between the two studies. This overall increase can largely be attributed to a statistically significant increase in the age-group 45-64 years (30.5%). Although not statistically significant, the 36% increase of diabetes in the age-group 0-19 years is in accordance with the increase of type I diabetes based on the first and second nationwide retrospective studies covering the total Dutch population. CONCLUSIONS: There is a marked increase in the incidence of diabetes in the age-group 45-64 years. This selective increase is probably not due to a real rise caused by changes in exposure to risk factors but to an earlier recognition of symptoms and signs of diabetes followed by blood glucose measurements and/or to more intensive case finding in general practice.
Adolescent↗
Trends in hospital admissions among children aged 0-19 years with type I diabetes in The Netherlands.
OBJECTIVE: To determine the number and duration of hospital admissions due to diabetes in children aged 0-19 years between 1980-1991. RESEARCH DESIGN AND METHODS: Secondary analysis of data collected by the SIG Health Care Information was based on the 9th revision of the International Classification of Diseases. The subjects were all children in The Netherlands, aged 0-19 years. The main outcome measures were number and duration of hospital admissions due to type I diabetes (ICD 9 code 250.0-250.9). RESULTS: The hospital admission rate due to diabetes decreased > 30%. This decrease was statistically significant in all age subgroups. The total number of days in hospital due to diabetes decreased dramatically: from 24,961 in 1980 to 11,305 in 1991. The average duration of hospital stay length due to diabetes decreased as well from 14.5 days in 1980 to 11.9 days in 1991. CONCLUSIONS: The hospital admission rate and the length of hospital stay for diabetes in children aged 0-19 years have decreased, in spite of an increasing incidence. The hospital admission rate may decrease still further if more children with newly diagnosed diabetes can be adequately managed by team management at home in the initial phase.
Adolescent↗
[Insufficient participation in prevention programs for infants by Turkish, Moroccan, Chinese and Vietnamese parents in large cities].
OBJECTIVE: To establish the participation in a number of effective prevention programmes for infants of Turkish, Maroccan, Chinese and Vietnamese inhabitants of the four major cities in the Netherlands. DESIGN: Enquiry. SETTING: Health centres in Amsterdam, Rotterdam, The Hague and Utrecht. METHOD: Health centre staff members in 1994 asked 194 Turkish and 158 Maroccan parents to participate in the study: the responses were 142 (73%) and 104 (66%), respectively. With the aid of Chinese and Vietnamese female interpreters, 44 parents of Chinese and 75 of Vietnamese infants were persuaded to participate. Previously instructed interviewers presented the parents of all children with a number of structured questions in their own languages regarding use of vitamins (A)D and K and about vaccination against diphtheria, pertussis, tetanus and poliomyelitis (DKTP) and with BCG vaccine. RESULTS: Bottle feeding alone was given to 18% of the Turkish, 43% of the Maroccan, 71% of the Chinese and 51% of the Vietnamese children. 82% Of the children were given vitamin A(D), the Maroccan children the most and the Vietnamese children the least often. Of the breast-fed children, 65% were given vitamin K, the Turkish children the most often. The DKTP vaccination degrees (1st, 2nd and 3rd vaccination) of the Turkish, Vietnamese and Chinese children was in accordance with those of Dutch children, but of the Maroccan children, one in five had not been vaccinated according to the parents. The BCG vaccination degrees were too low among the Turkish (55%) and the Maroccan (42%) children. Of the mothers, 27% reported having been vaccinated against rubella; 2% had vaccination certificates. CONCLUSION: Participation of the four groups of allochtonous children in the effective prevention programmes investigated was insufficient. At contacts of health workers with these groups, participation in prevention programmes should always be established. Support by means of educative material to be developed specifically should be made a subject of research.
Adult↗