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PubMed2000

An operating surveillance system of surgical-site infections in The Netherlands: results of the PREZIES national surveillance network. Preventie van Ziekenhuisinfecties door Surveillance.

OBJECTIVES: To describe the results of the first year of the Dutch national surveillance of surgical-site infections (SSIs) and risk factors, which aims to implement a standardized surveillance system in a network of Dutch hospitals, to collect comparable data on SSIs to serve as a reference, and to provide a basic infrastructure for further intervention research. DESIGN: Prospective multicenter cohort study. SETTING: Acute-care hospitals in The Netherlands from June 1996 to May 1997. RESULTS: 38 hospitals participated, with a slight over-representation of larger hospitals. Following a total of 18,063 operations, 562 SSIs occurred, of which 198 were deep. Multivariate analysis of pooled procedures shows that age, preoperative length of stay, wound contamination class, anesthesia score, and duration of surgery were independent risk factors for SSI. When analyzed by procedure, the relative importance of these risk factors changed. Bacteriological documentation was available for 56% of the SSIs; 35% of all isolates were Staphylococcus aureus. Multiple regression analysis computed the mean extra postoperative length of stay associated with SSI to be 8.2 days. CONCLUSION: The first year of national surveillance has shown that it is feasible to collect comparable data on SSI, which are already used for education, policy, and decision making in the network of participating hospitals. This gives room to effectuate the next aim, namely to use the network as an infrastructure for intervention research. Multivariate analysis shows that feedback on a procedure-specific level is important.

Adult↗
PubMed2001

Surveillance of hospital-acquired infection in England, Germany, and The Netherlands: will international comparison of rates be possible?

Three national surveillance systems for nosocomial infection have been developed independently and implemented successfully in England, Germany, and The Netherlands. All three are based on the American National Nosocomial Infections Surveillance System and have adopted a surveillance strategy that is targeted at specific infections or groups of patients for limited time periods. Case-finding methods, the minimum data set, and analysis of data are similar and could be standardized easily. Resolution of the differences in the definitions of infection, the study population, and follow-up should make possible the international comparison of infection rates. Such comparisons may identify differences in healthcare practices between countries and suggest areas for improvement.

Cross Infection↗
PubMed1997

Genetic analysis of wild-type poliovirus importation into The Netherlands (1979-1995).

Wild polioviruses were isolated a number of times in The Netherlands outside the epidemic periods (1978 and 1992-1993) from patients infected abroad, from subclinically infected persons, and from river water. Sequence comparisons revealed discrete sources of importation: the Mediterranean, India, and Indonesia. The observed wide genetic variation is indicative of repeated importation and not of indigenous circulation. Isolates identical or closely related to the epidemic type 1 strain of 1978 were found in clinical and environmental specimens until 1983, probably due to repeated importation from Turkey. Viruses related to the 1992-1993 epidemic type 3 virus had already been isolated six times before the epidemic. Of particular importance are two documented isolations of prototype wild poliovirus indistinguishable from that used to produce the inactivated vaccine. These data underscore the continued risk to the unvaccinated religious population of exposure to wild poliovirus.

Adoption↗
PubMed1999

Assessment of complement deficiency in patients with meningococcal disease in The Netherlands.

The frequency of complement deficiency in 176 of 7,732 patients with meningococcal disease in the Netherlands from 1959 through 1992 was assessed. Complement deficiency was found in six patients (3%): 3 (7%) of the patients with Neisseria meningitidis serogroup C disease, 1 (2%) of the patients with N. meningitidis serogroup A disease, and 2 (33%) of the patients with infections due to uncommon serogroups and nongroupable strains of N. meningitidis. Of 91 additional patients with meningococcal infections due to uncommon serogroups, 33% also had complement deficiency. Thirty-four of the 36 complement-deficient patients with meningococcal disease who were from 33 families were 5 years of age or older. Twenty-six additional complement-deficient relatives were found. Screening individuals with meningococcal disease due to uncommon serogroups who were 5 years of age or older identified 30 of the 33 complement-deficient families. Only 27% of the complement-deficient relatives had had meningococcal disease. This risk was lower for relatives with properdin deficiency (18%) than for those deficient in the late component of complement (38%). Therefore, pedigree studies are warranted for identifying those complement-deficient persons who require vaccination for meningococcal disease.

Adolescent↗
PubMed2003

"The City of Din": decibels, noise, and neighbors in The Netherlands, 1910-1980.

Science and technology have played a crucial role in regulating problems resulting from urban overcrowding. In the twentieth century, the decibel became a major factor in controlling, for instance, urban traffic noise in the Netherlands. "The city of din" led to the creation of the portable noise meter to measure decibels, but the urban context also set limits on its utility in noise conflicts between neighbors. Regarding neighborly noise, the trust in numbers failed to be productive. Legislation,based on objective noise levels, aimed at regulating disturbance from neighbors was not realized in any comprehensive manner, due to changing class relations and the increasing recognition of both the subjectivity of noise and the right to make noise in the privacy of one's own home.

History, 20th Century↗
PubMed2002

'Reasonable' regulation of low doses in The Netherlands?

As long as it is not clear exactly what the risks of low doses are, exposures should be regulated to be 'as low as reasonably achievable' (ALARA). In radiation protection, for normal situations, this means that a projected dose reduction can only be obligatory when the efforts needed to achieve the reduction are 'reasonable' in comparison with it, economical and social aspects being taken into account. In the recent Dutch regulations, 'reasonable' values have been established for the relevant parameters used in the ALARA concept and the paper discusses the values required to calculate the doses for the critical group due to a source. In some cases, the effort expended in making the ALARA dose assessments might not be reasonable in comparison with the dose reduction to be expected. The system which has been developed in the Netherlands to avoid these 'unreasonable' dose calculations, measurements and assessments is explained.

Humans↗
PubMed2001

Molecular characteristics of penicillin-binding protein genes of penicillin-nonsusceptible Streptococcus pneumoniae isolated in the Netherlands.

Recently, a nation-wide molecular epidemiologic survey of penicillin-nonsusceptible Streptococcus pneumoniae has been performed in the Netherlands. In the current study, we analyzed the genes pbp1a, pbp2b, and pbp2x from these clinical isolates at the molecular level, and identified the genetic composition of the penicillin-binding domains. The pneumococcal strains were selected on the basis of differences in restriction fragment length polymorphism (RFLP) patterns of the genes pbp1a, pbp2b, and pbp2x, and represented 8, 7, and 10 distinct patterns, respectively. The genetic heterogeneity observed by sequence analysis of the pbp gene parts was comparable with the heterogeneity of the entire pbp genes as deduced from RFLP analysis. Furthermore, the mutations in the pbp sequences of the Dutch isolates invariably matched with the mutations described in pbp sequences of penicillin-nonsusceptible pneumococci isolated in other countries. Finally, novel mosaic structures were identified indicating horizontal exchange of pbp gene parts among penicillin-nonsusceptible pneumococci.

Aminoacyltransferases↗
PubMedDate not supplied

IgG antibodies to HTLV-III associated antigens in patients with AIDS and at risk for AIDS in The Netherlands.

Thirty-nine homosexual males, 11 of whom suffered from AIDS and 13 from Lymphadenopathy Syndrome (LAS), 18 healthy hemophiliacs and 12 healthy blood donors, not belonging to any AIDS risk group, were tested for IgG antibodies to Human T-lymphotropic retrovirus type III (HTLV-III) by indirect immunofluorescence. All tested people were from the area of Amsterdam or from elsewhere in The Netherlands. Five of 11 AIDS patients, 8 of 13 LAS patients and 5 of 15 healthy homosexuals had antibodies to HTLV-III. Five of 18 healthy hemophiliacs were seropositive for HTLV-III. None of the 12 blood donors was seropositive for HTLV-III.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Monitoring standards for molecular genetic testing in the United Kingdom, the Netherlands, and Ireland.

Molecular genetic techniques have entered many areas of clinical practice. Public expectations from this technology are understandably high. To maintain confidence in this technology, laboratories must implement the highest standards of quality assurance (QA). External quality assessment (EQA) is recognized as an essential component of QA. The United Kingdom National External Quality Assessment Service (UKNEQAS) for Molecular Genetics, first set up in 1991, is currently the longest provider of EQA to molecular genetic testing laboratories in the UK, The Netherlands, and Ireland. Errors in the scheme are sporadic events. However, evidence from this and other EQA schemes suggests that a residual error rate persists, which should be taken into account in clinical practice. This EQA scheme has evolved from the respective scientific bodies of the constituent countries and retains a strong emphasis on collective peer review. It is essential that the steps taken to ensure quality in this rapidly expanding field are clear and transparent to participants and public alike. We describe the procedures developed and the governance imposed to monitor and improve analytical and reporting standards in participant laboratories and we compare our experiences with those of equivalent EQA services in the United States.

Cytogenetic Analysis↗
PubMed1987

Serum selenium, vitamin antioxidants, and cardiovascular mortality: a 9-year follow-up study in the Netherlands.

The association between low serum selenium, vitamin A, and vitamin E levels and mortality from cardiovascular disease (CVD) was investigated in a case-control study nested in a 9-yr prospective study in the Netherlands. For 10,532 persons aged greater than or equal to 5 yr who participated in a 1975-1978 medical survey, serum was stored at -20 degrees C. For the 84 of 106 subjects aged 37-87 yr who died of CVD after the baseline exam, 168 cohort members alive at the end of 1983 and matched for age and gender were selected as controls. No significant associations between serum selenium. vitamin A, vitamin E, and CVD mortality were observed before and after multivariate analyses. The adjusted risk of death from CVD for subjects in the lowest selenium quintile (less than 105.0 micrograms/L) was 1.6 (95% CI, 0.8-3.2). For coronary and stroke death risk, estimates were 1.1 (95% CI, 0.5-2.6) and 3.2 (95% CI, 0.8-12.1). Our findings do not show a clear CVD risk from low selenium and vitamin levels. Although some of the risk estimates were strong, larger studies are required for definitive conclusions.

Adult↗
PubMed1994

Macrobiotic nutrition and child health: results of a population-based, mixed-longitudinal cohort study in The Netherlands.

A population-based study on the nutritional status of children consuming macrobiotic diets was carried out in The Netherlands. Participants followed a macrobiotic diet based mainly on whole-grain cereals, pulses, and vegetables. Studies in children aged 0-10 y suggested that growth was retarded mainly between 6 and 18 mo. This was confirmed in a subsequent mixed-longitudinal study (including data on diet, anthropometry, blood chemistry, and pediatric examination) in 4-18 mo-old macrobiotic infants and a matched omnivorous control group. Ubiquitous deficiencies of energy, protein, vitamin B-12, vitamin D, calcium, and riboflavin were detected in macrobiotic infants, leading to retarded growth, fat and muscle wasting, and slower psychomotor development. Breast milk from macrobiotic mothers contained less vitamin B-12, calcium, and magnesium. Supplementation of the macrobiotic diet with fat (minimum 20-25 g/d), fatty fish (minimum 100-150 g/wk), and dairy products (minimum 150-250 g/d) is recommended.

Calcium↗
PubMed2002

Intake of conjugated linoleic acid, fat, and other fatty acids in relation to postmenopausal breast cancer: the Netherlands Cohort Study on Diet and Cancer.

BACKGROUND: Conjugated linoleic acid (CLA), which is present in milk products and meat from ruminants, appears to have anticarcinogenic activity against breast cancer in animal and in vitro experiments. To date, few epidemiologic data are available in humans. OBJECTIVE: This study evaluated the relation between intakes of CLA and other fatty acids and breast cancer incidence in the Netherlands Cohort Study. DESIGN: Intake data derived from a validated 150-item food-frequency questionnaire were linked to an existing database with analytic data on specific fatty acids in European foods (the TRANSFAIR study). With 6.3 y of follow-up and 941 incident cases of breast cancer, multivariate rate ratios and 95% CIs were calculated for energy-adjusted intakes of fatty acids and CLA-containing food groups (eg, butter, cheese, milk, other milk products, and meat). RESULTS: CLA intake showed a weak, positive relation with breast cancer incidence (rate ratio for highest compared with lowest quintile: 1.24, 95% CI: 0.91, 1.69; P for trend = 0.02). Statistically significant positive associations were found with total trans fatty acids and (borderline) with saturated fatty acids. Significant inverse associations were found with monounsaturated and cis unsaturated fatty acids, whereas total fat and energy intake of CLA-containing food groups were not related to breast cancer incidence. CONCLUSION: The suggested anticarcinogenic property of CLA in animal and tissue culture models could not be confirmed in this epidemiologic study in humans.

Aged↗
PubMed1988

Therapeutic control of oral anticoagulant treatment in The Netherlands.

Therapeutic control achieved by an anticoagulant clinic may be assessed by calculation of the proportion of time spent by the patients within the prothrombin time target range aimed for by the clinic. Three calculation methods for such assessment have been described by other investigators. The three methods were compared with the use of the database of one anticoagulant clinic (Leiden Thrombosis Centre). Discrepant levels of control were obtained by these methods because of incorrect assumptions in two of them. The most accurate method is the "cross-section-of-the-files" approach, in which the last-recorded prothrombin time per patient is used. The authors believe it should be implemented in each anticoagulant clinic. With the use of this method, the level of therapeutic control achieved by the Leiden Thrombosis Centre for its patients on long-term treatment amounted to 80%. The same method was applied by 37 other thrombosis centers in the Netherlands using a single target range of 2.8-4.8 International Normalized Ratio for their patients. Thirty-one centers achieved a level of control of at least 70% in their long-term patients. Underanticoagulation was observed more frequently than overanticoagulation.

Administration, Oral↗
PubMed2000

Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: The Netherlands Cohort Study on Diet and Cancer.

The relation between vegetable and fruit consumption and colorectal cancer risk was comprehensively assessed in the Netherlands Cohort Study on Diet and Cancer using a validated 150-item food frequency questionnaire. After 6.3 years of follow-up (1986-1992), over 1,000 incident cases of colorectal cancer were registered. Using case-cohort analysis, the authors calculated rate ratios and 95% confidence intervals adjusted for age, alcohol intake, and family history of colorectal cancer. For colon cancer, no statistically significant associations with total vegetable intake or total fruit intake were found. However, among women, an inverse association was observed with vegetables and fruits combined (for the highest quintile vs. the lowest, the rate ratio was 0.66 (95% confidence interval: 0.44, 1.01)). Brassica vegetables and cooked leafy vegetables showed inverse associations for both men and women. Among women and, to a lesser extent, among men, inverse associations were stronger for distal colonic tumors than for proximal colonic tumors. For rectal cancer, no statistically significant associations were found for vegetable consumption or fruit consumption or for specific groups of vegetables and fruits; only Brassica vegetables showed a positive association in women. As in other cohort studies, the observed inverse relation between vegetable and fruit consumption and occurrence of colorectal cancer was less strong than relations reported in case-control studies.

Age Distribution↗
PubMed2001

Alcohol consumption and bladder cancer risk: results from The Netherlands Cohort Study.

Although several epidemiologic studies have been conducted on alcohol consumption and bladder cancer risk, the risk according to quantity and type of alcohol consumed is not clear. The authors investigated these associations in a large prospective cohort study on diet and cancer among 120,852 subjects in the Netherlands aged 55-69 years at baseline (1986). Subjects completed a questionnaire on risk factors for cancer, including alcohol consumption. Follow-up for incident cancer was established by record linkage to cancer registries. The case-cohort analysis was restricted to a follow-up period of 6.3 years and was based on 594 cases with bladder cancer and 3,170 subcohort members. The authors corrected for age and smoking in multivariable analyses. The incidence rate ratios for men who consumed <5, 5-<15, 15-<30, and > or =30 grams of alcohol per day were 1.49, 1.52, 1.16, and 1.63 compared with nondrinkers, respectively (p for trend = 0.13). Alcohol consumed from beer, wine, and liquor was associated with moderately elevated risks, although most were not statistically significant. The incidence rate ratios for women varied around unity. The results of this study do not suggest an important association between alcohol consumption and bladder cancer risk.

Aged↗
PubMed2001

Immunity to poliomyelitis in The Netherlands.

Despite a vaccination coverage rate of 97%, several poliomyelitis outbreaks occurred in the Netherlands during the last three decades, all among sociogeographically clustered, unvaccinated persons. Therefore, to eradicate polio, insight into poliomyelitis immunity is particularly useful. In 1995-1996, the authors conducted a population-based study and determined neutralizing antibodies against poliovirus types 1, 2, and 3 in 9,274 sera from the general population and from religious groups rejecting vaccination. In the general population, the antibody prevalence (>/=1:8) was 96.6% (95% confidence interval (CI): 95.9, 97.2), 93.4% (95% CI: 92.3, 94.5), and 89.7% (95% CI: 88.3, 91.0) for poliovirus types 1, 2, and 3, respectively. Antibodies persisted for long periods in persons with natural immunity as well as in persons whose immunity was induced by inactivated polio vaccine. In Orthodox Reformed persons, the antibody prevalence of poliovirus types 1, 2, and 3 was 65.0% (95% CI: 57.2, 72.9), 59.0% (95% CI: 40.1, 77.9), and 68.7% (95% CI: 65.2, 72.2), respectively. The recent outbreaks clearly affected the seroprevalence profiles of Orthodox Reformed groups but not the general population. At present, there is an insufficient social and political basis for mandatory vaccination; therefore, global eradication of poliovirus seems to be the only way to protect these Orthodox Reformed persons against future poliomyelitis outbreaks.

Adolescent↗
PubMed2005

Seasonal variations in mental disorders in the general population of a country with a maritime climate: findings from the Netherlands mental health survey and incidence study.

Seasonal variations in the prevalence of mental disorders in general population surveys have rarely been noted. Using a representative sample of the Dutch population, the authors studied the seasonality of 1-month mental disorders and gender-by-season and age-by-season interactions. Data were obtained from the Netherlands Mental Health Survey and Incidence Study, a psychiatric epidemiologic study in which 7,076 adults aged 18-64 years were interviewed (1996) using the Composite International Diagnostic Interview. Seasonal statistical differences were not found for the category "any diagnosis", although prevalence was higher in winter (18.1%) and lower in summer (16.0%). Seasonal variations were also not found for the main categories "mood disorders", "anxiety disorders", "substance-use disorders", "eating disorders", and "schizophrenia". Some differences were found for individual disorders, mostly anxiety. Panic disorder was more frequently reported in winter than in summer, generalized anxiety disorder more frequently in winter than in other seasons, and obsessive-compulsive disorder more frequently in autumn than in summer. Only a few gender and age differences in seasonal variation were found. The authors conclude that there are only limited seasonal variations in mental disorders in general population studies, at least in countries with a mild maritime climate. For reliable estimation of the prevalence of some disorders, these findings have implications for the design of large-scale population studies.

Adolescent↗
PubMed2005

The effect of data collection mode and ethnicity of interviewer on response rates and self-reported alcohol use among Turks and Moroccans in the Netherlands: an experimental study.

AIMS: To test the effects of data collection mode and ethnicity of interviewers on response rates and self-reported alcohol use among second-generation Turks and Moroccans in Rotterdam, The Netherlands. METHODS: Two hundred and sixty-nine Turks and 271 Moroccans were interviewed face-to-face, and 475 Turks and 482 Moroccans received a mailed questionnaire. Half of the Turks and Moroccans randomly allocated to the interview mode were ethnically matched to the interviewer; the remainder were allocated to a Dutch interviewer. RESULTS: Turks and Moroccans more often responded to a face-to-face interview than to a mailed questionnaire. No effect of ethnicity of interviewer on response rates was demonstrated. With respect to the effects on alcohol reports, Turks and Moroccans tended to report a higher alcohol use in the mailed survey than in the face-to-face interview. They reported significantly more often excessive drinking in the mail survey than in the face-to-face interviews. Ethnicity of the interviewer resulted in Turks and Moroccans reporting a higher prevalence of alcohol use during the previous 6 months when interviewed by a Dutch interviewer compared with an ethnically matched interviewer. CONCLUSIONS: Among second-generation Turks and Moroccans, mail surveys seem most suitable to measure mean and excessive alcohol use. However, interviews held by Dutch interviewers seem to be the most appropriate method to study the prevalence of alcohol use during the previous 6 months.

Adolescent↗

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