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PubMed2005

Cost-effectiveness of measures to prevent classical swine fever introduction into The Netherlands.

Recent history has demonstrated that classical swine fever (CSF) epidemics can incur high economic losses, especially for exporting countries that have densely populated pig areas and apply a strategy of non-vaccination, such as The Netherlands. Introduction of CSF virus (CSFV) remains a continuing threat to the pig production sector in The Netherlands. Reducing the annual probability of CSFV introduction (P(CSFV)) by preventive measures is therefore of utmost importance. The choice of preventive measures depends not only on the achieved reduction of the annual P(CSFV), but also on the expenditures required for implementing these measures. The objective of this study was to explore the cost-effectiveness of tactical measures aimed at the prevention of CSFV introduction into The Netherlands. For this purpose for each measure (i) model calculations were performed with a scenario tree model for CSFV introduction and (ii) its annual cost was estimated. The cost-effectiveness was then determined as the reduction of the annual P(CSFV) achieved by each preventive measure (DeltaP) divided by the annual cost of implementing that measure (DeltaC). The measures analysed reduce the P(CSFV) caused by import or export of pigs. Results showed that separation of national and international transport of pigs is the most cost-effective measure, especially when risk aversion is assumed. Although testing piglets and breeding pigs by a quick and reliable PCR also had a high cost-effectiveness ratio, this measure is not attractive due to the high cost per pig imported. Besides, implementing such a measure is not allowed under current EU law, as it is trade restrictive.

Animals↗
PubMed2006

Validity of the single-item question on self-rated health status in first generation Turkish and Moroccans versus native Dutch in the Netherlands.

BACKGROUND: The single-item question on self-rated health has been used in many studies as a global measure of general health. It is unclear whether ethnic minority groups in the Netherlands attach the same meaning to the single-item question as the native Dutch people do. OBJECTIVE: To assess the validity of using the single-item question on self-rated health in comparing health status in native Dutch with first generation Turkish and Moroccan ethnic groups in the Netherlands. METHODS: The associations between self-reported chronic illnesses and self-rated health were used to examine convergent validity, and self-rated health and health care use for predictive validity using logistic regression analysis. RESULTS: In general, chronic illnesses were associated with fair health and poor health ratings in all the ethnic groups but there were important differences in associations between the groups. There were significant interactions between ethnicity and chronic illnesses on fair health, and poor health, independent of socio-demographical factors. There was also significant interaction between ethnicity and self-rated health on health care uses. These findings indicate that the meaning(s) attached to the single-item question differ between these ethnic groups. CONCLUSION: The study findings suggest that the use of the single-item question on self-rated health to compare native Dutch with the first generation Turkish and Moroccan ethnic groups is not valid. These findings imply that researchers need to be cautious about the interpretation of self-rated health ratings when comparing different ethnic groups. A qualitative research is needed to find out more about how these single-item ratings are being interpreted by Turkish and Moroccan elderly in the Netherlands.

Aged↗
PubMed2004

Does a population survey provide reliable influenza vaccine uptake rates among high-risk groups? A case-study of The Netherlands.

All European countries have recommendations for influenza vaccination among the elderly and chronically ill. However, only a few countries are able to provide data on influenza uptake among these groups. The aim of our study is to investigate whether a population survey is an effective method of obtaining vaccination uptake rates in the different risk groups and to find out what reasons people give as to why they have accepted or refused influenza vaccination and whether this varies among the risk groups. A mail questionnaire was sent out to households in The Netherlands, the response rate was 73%. This resulted in data for 4037 individuals on influenza and influenza vaccination during the 2001-2002 influenza season. The uptake rates and size of different risk groups from the panel survey were comparable with other national representative sources (from the National Information Network of GPs (LINH) and Statistics Netherlands (CBS)). The main reason cited for undergoing vaccination was the existence of a chronic condition. The main reasons for refraining from vaccination were having enough resistance to flu and ignorance about the recommendations. In The Netherlands, the GP is the main administrator of influenza vaccines. We believe that population surveys may be useful for revealing influenza vaccination uptake rates for the groups at risk. When combined with questions about reasons for undergoing vaccination, the results may provide useful policy information and can be used to direct vaccination campaigns at under-vaccinated risk groups or to target the information campaign more effectively.

Adolescent↗
PubMed2006

The epidemiology of varicella and herpes zoster in The Netherlands: implications for varicella zoster virus vaccination.

We studied the epidemiology of varicella (chickenpox) and herpes zoster (shingles) in The Netherlands to assess the desirability to implement routine varicella zoster virus vaccination in The Netherlands. Data on seroprevalence of varicella zoster virus in the general population (1995-1996), consultations of general practitioners for varicella (2000-2002) and herpes zoster (1998-2001) and hospital admissions due to varicella (1994-2001) and herpes zoster (1994-2001) in The Netherlands were analysed. The seropositivity increased sharply with age from 18.4% for both 0- and 1-year-olds, to 48.9%, 59.0%, 75.7% and 93.0% for 2-, 3-, 4- and 5-year-olds, respectively, and varied between 97.5% and 100% for older age groups. The average annual incidence of GP-consultations amounted to 253.5 and 325.0 per 100,000 for varicella and herpes zoster, respectively. The incidence of hospital admission due to varicella and herpes zoster was 1.3 (2.3 including side diagnosis) and 2.7 (5.8) per 100,000, respectively. Whilst for varicella, the incidence of GP-consultations and hospital admissions were highest in childhood, for herpes zoster, these were highest in elderly. Insight into epidemiology of varicella zoster is needed for the assessment of the desirability of introduction of routine varicella zoster vaccination.

Adolescent↗
PubMed2006

Supranational comparison of Neospora caninum seroprevalences in cattle in Germany, The Netherlands, Spain and Sweden.

Herd, within-herd and animal prevalences for Neospora caninum in beef and dairy cattle were compared between four countries. In randomly selected herds from regions of Germany, The Netherlands, Spain and Sweden that were representative for the cattle production of these countries, all animals > or = 2 years were examined serologically by enzyme-linked immunosorbent assays (ELISAs) with high test specificity (> 98.0%). In a previous study, the ELISAs had been validated against each other. Single reacting animals within a herd were confirmed by immunobloting. At the time of sampling, animal (age, breed, herdtype, sex, lactation stage) and herd data (region) were collected. Considerable differences in N. caninum herd, within-herd, and overall animal prevalence estimations were observed between countries, regions, herdtype, age categories and breeds. Herd prevalences, based on confirmation of single reactors, for dairy herds were estimated to be 16% (95%CI: 10-24%) in Sweden, 49% (95%CI: 39-59%) in Germany, 63% (95%CI: 57-69%) in Spain and 76% (95%CI: 67-84%) in The Netherlands and for beef herds 41% (95%CI: 31-50%) in Germany, 46% (95%CI: 41-51%) in Spain and 61% (95%CI: 50-72%) in The Netherlands. No beef herds were examined in Sweden. The lowest animal true prevalence was estimated in dairy cattle in Sweden (0.5% (95%CI: 0.1-0.8%)) while the highest animal true prevalence was estimated for dairy cattle in Spain (16.2% (95%CI: 14.9-17.5%)). Within-herd prevalences varied greatly, with very few farms in Sweden having more than 10% seropositive animals while in Spain more than 10% of the herds had within-herd prevalences between 50 and 100%. Seropositivity was significantly associated with herdtype (beef versus dairy), age, breed and region within countries. The results of this supranational comparative study showed that the importance of N. caninum infection varied greatly within in Europe. Estimates of prevalence can be used to calculate the economic impact of N. caninum infection as well as to evaluate the effect of prevention and control strategies over time.

Age Factors↗
PubMed2001

Accreditation of medical laboratories in The Netherlands.

Among the medical laboratory professionals, a growing interest exists in the systematic application of quality assurance to their own practice, and consequently in The Netherlands, there is an increasing request for an official accreditation of the quality management system and the competence of the professionals through Coordinatie Commissie voor Kwaliteitsbewaking in Laboratoria in de gezondheidszorg (CCKLtest), the Dutch Accreditation Board for Medical Laboratories. This article gives an overview of the current situation in The Netherlands; regarding the standards, the rules for accreditation, the training and selection assessors and what meanwhile is achieved. Since 1994, 60 clinical laboratories have been recognized by CCKLtest and another 40 laboratories have requested accreditation and are waiting for the inspection in 2001. Thus, 25% of all clinical laboratories in The Netherlands will be inspected within the current year.

Accreditation↗
PubMed2002

Low use of medication in home deliveries in the Netherlands.

OBJECTIVES: In view of the growing concern for de-medicalizing childbirth, the aim of this study is to give detailed figures on the use of medication during home deliveries in the Netherlands. METHODS: A prospective study of medication use by 68 community midwives during 716 home births in the Netherlands. RESULTS: Medication was used in 58.4% of the home deliveries, with an average of 1.4 drugs per delivery. The drugs used were mostly oxytocin (in 35.6% of all deliveries) and local anesthetics (in 32.9%). When medication was used, it was administered before cutting the umbilical cord in 16.7% of the cases. Prophylactic or routine administration of local anesthesia, postpartum hemorrhages, and retained placenta were the most frequent indications for using medication. CONCLUSIONS: The use of medication during home deliveries in the Netherlands is low and newborns are minimally exposed to medication. This illustrates the Dutch birth culture, which tends to minimize the medical aspect of childbirth.

Adult↗
PubMed2003

Regional differences in healthy life expectancy in The Netherlands.

BACKGROUND: Healthy life expectancy has mainly been studied at the level of healthcare systems rather than at regional level within healthcare systems. In this article, healthy life expectancy at birth and at 65 years of age for men and women in the Netherlands has been described, and factors related to these regional variations have been explored. METHODS: Ecological study of 27 healthcare regions (hospital catchment areas). Life expectancy and healthy life expectancy were calculated using 1995 mortality data and pooled health interview survey data (1992-1997) from Statistics Netherlands. RESULTS: Healthy life expectancy shows a regional pattern, slightly different from that found in life expectancy and self-reported health. The regional distribution of male and female healthy life expectancy is different, especially at 65 years. Healthy life expectancy of women aged 65 years is independent of their total life expectancy. Social conditions and lifestyle differences between regions are negatively associated with healthy life expectancy in Dutch regions. Healthcare supply variables show no clear relationship. CONCLUSION: Although the Netherlands is a small, homogeneous country, substantial differences were found in healthy life expectancy.

Aged↗
PubMedDate not supplied

Prescribing of selective serotonin reuptake inhibitors, anxiolytics, and sedative-hypnotics by general practitioners in The Netherlands: a multivariate analysis.

A study of the prescribing of anxiolytics and sedative-hypnotics and the occurrence of anxiety or sleep disorders before and after the initiation of selective serotonin reuptake inhibitor (SSRI) therapy may provide insight into differences in individual SSRIs. The purpose of our study was to evaluate whether and in what way the likelihood of being prescribed an anxiolytic or sedative-hypnotic or receiving a diagnosis of an anxiety or sleep disorder differed in patients prescribed either fluoxetine or paroxetine by a general practitioner (GP) in the Netherlands, where these two agents are the most commonly prescribed SSRIs. Episodes of SSRI treatment were constructed from a recently available GP database in the Netherlands. Logistic regression analysis was used to determine whether, after controlling for other observable factors, the receipt of paroxetine or fluoxetine was a statistically significant determinant for receipt of an anxiolytic or sedative-hypnotic or a diagnosis of an anxiety or sleep disorder. We found that patients who were prescribed fluoxetine as their index drug were less likely to receive a concomitant sedative-hypnotic on their index date compared with patients receiving paroxetine. After controlling for other observable factors, such as use of anxiolytics and sedative-hypnotics before SSRI therapy or on the index date or the existence of comorbid anxiety or sleep disorders, patients starting fluoxetine therapy were no more likely than patients starting paroxetine therapy to receive an anxiolytic or sedative-hypnotic or a diagnosis of an anxiety or sleep disorder during the 60-day post period. The likelihood of a patient's being diagnosed with or receiving a prescription for an anxiety or sleep disorder does not appear to be a differentiating factor between the prescribing of fluoxetine or paroxetine by GPs in the Netherlands.

Aged↗
PubMed2001

Comparative studies on the concentration of rare earth elements and heavy metals in the atmospheric particulate matter in Beijing, China, and in Delft, The Netherlands.

Atmospheric particulate matter (APM) was collected at three sampling sites in Beijing, China, from February to June 1998. The concentrations of rare earth elements (REE) and cobalt (Co), zinc (Zn), copper (Cu), cadmium (Cd) and lead (Pb) in the APM were determined by inductively coupled plasma mass spectrometry (ICP-MS). The results obtained in Beijing, China, were compared to that obtained in Delft, the Netherlands, in 1997. The influence of coal combustion was considered. The results demonstrated that the content of APM, the concentrations of REE and Co, Zn, Cd, Pb in the APM in Beijing, China, were higher than that in Delft, the Netherlands. From the ratios of La to Ce, and La to Sm, which may be used as tracers for the origin of the REE, it is concluded that the origins of REE in China differ from those in the Netherlands.

Air Pollutants↗
PubMed2002

Quality control of brachytherapy equipment in the Netherlands and Belgium: current practice and minimum requirements.

BACKGROUND AND PURPOSE: Brachytherapy is applied in 39 radiotherapy institutions in The Netherlands and Belgium. Each institution has its own quality control (QC) programme to ensure safe and accurate dose delivery to the patient. The main goal of this work is to gain insight into the current practice of QC of brachytherapy in The Netherlands and Belgium and to reduce possible variations in test frequencies and tolerances by formulating a set of minimum QC-requirements. MATERIALS AND METHODS: An extensive questionnaire about QC of brachytherapy was distributed to and completed by the 39 radiotherapy institutions. A separate smaller questionnaire was sent to nine institutions performing intracoronary brachytherapy. The questions were related to safety systems, physical irradiation parameters and total time spent on QC. The results of the questionnaires were compared with recommendations given in international brachytherapy QC reports. RESULTS: The answers to the questionnaires showed large variations in test frequencies and test methods. Furthermore, large variations in time spent on QC exist, which is mainly due to differences in QC-philosophy and differences in the available resources. CONCLUSIONS: Based on the results of the questionnaires and the comparison with the international recommendations, a set of minimum requirements for QC of brachytherapy has been formulated. These guidelines will be implemented in the radiotherapy institutions in The Netherlands and Belgium.

Belgium↗
PubMed2003

Evaluations of health interventions in social insurance-based countries: Germany, the Netherlands, and Austria.

Health Technology Assessment (HTA) in social insurance-based, or so-called 'Bismarck' health care systems (Germany, Austria, and the Netherlands) has taken a different course than in either taxed-based (Sweden, Norway, United Kingdom, and Spain) or private health care systems (such as the United States). The culture of informed decisions supported by transparent and evidence-based evaluations of health interventions was hindered by the strong professional autonomy and sectoral interests in Germany and Austria for a long time. On the other hand, HTA has a long-standing tradition in the Netherlands. In all three countries sickness funds play an important role in implementing evaluations-as a policy tool-by linking reimbursement to explicit proof of effectiveness in both new and established interventions. This article focuses on the obstacles and opportunities for HTA in Germany, Austria and the Netherlands as countries with insurance-based health care systems.

Austria↗
PubMed2003

Should I stay or should I go? Waiting lists and cross-border care in the Netherlands.

The recent ruling of the European Court of Justice in the case Smits-Peerbooms explicitly mentions undue delay as a legitimisation for cross-border care within the EU. In the Netherlands, waiting times are well above the norm set by several health care parties as well as maximally acceptable waiting times elicited in patients. This might indicate that Dutch patients are often entitled to care in other Member States, in the sense that insurers cannot withhold reimbursement of cross-border care in the present situation. However, experiments clearly demonstrate that few Dutch patients are willing to travel abroad. Patients seem to prefer longer waiting in the Netherlands over shorter waiting by going abroad, even those living in border regions. In addition, mobility of patients within the Netherlands is very modest. Given this inertia in patient mobility, in the short run, cross-border care will probably remain an insignificant phenomenon in terms of quantities of patients travelling abroad and therefore the impact of the Smits-Peerbooms rulings is limited.

Delivery of Health Care↗
PubMed1999

Identification and priority setting for health technology assessment in The Netherlands: actors and activities.

This article describes the actual situation at the beginning of 1999 with regard to identification and priority setting for health technology assessment (HTA) on a national level in the Netherlands. For this purpose the literature on HTA published in 1980-1998, mainly national, was thoroughly reviewed. Many policy documents and other reports from the 'grey literature' of identification and priority setting for HTA in the Netherlands were also used. The results show that attempts to identify and set priorities for HTA is a new activity in the Netherlands. The three most important actors in the field are the Health Council, the Council for Health Research and the Health Insurance Council. Methodologies differ depending on the content and scope of each programme. In addition, the methods used are not always transparent and the activities are not co-ordinated. The lack of co-ordination is due to the fact that there is no single organisation that is authorized to identify and set priorities for HTA. Suggestions for improving co-ordination are proposed with the aim of developing a truly national effort in this field, which will enable a more balanced and efficient set of HTA activities.

Decision Making, Organizational↗
PubMed1999

Inter-agency services in England and The Netherlands. A comparative study of integrated care development and delivery.

In England and the Netherlands there is much comparable experience in developing and delivering integrated services, provided by different health care agencies to people with multiple care demands. The achievement of integrated care provision in such cases appears to be very difficult and laborious in both countries. This article may be considered a first step in exploring the reasons for this and in developing a framework that is not context specific, as a contribution to a more generally applicable analysis of obstacles to integration and the means for overcoming them. After analysing the English and Dutch health and social care systems and their development in recent decades, we conclude that basically there are clear system similarities which are hindering the integration of services, for instance the predominant complexity of the system with a lot of stakeholders having different roles, tasks, interests and power positions. We have identified common mechanisms that play a dominant role in both systems; not only the social, economic and political context, but also the local context, the legal context and funding streams. Other relevant factors are the procedural and structural arrangements at different system levels and the collaborative culture and tradition. The way these mechanisms work in practice, however, is different for England and the Netherlands, due to system differences. In the Netherlands for instance there is a clear emphasis on bargaining in the context of non-hierarchical structured networks, whilst in England hierarchies and the interplay between hierarchies, markets and networks play a more dominant role. In spite of the differences and problems in both countries we have found a similar recognition of interdependence and willingness to pursue integration of services for multi-problem patients.

Delivery of Health Care, Integrated↗
PubMed2001

The role of cultural and economic determinants in mortality decline in the Netherlands, 1875/1879-1920/1924: a regional analysis.

The objective of this study was to determine the relative importance of cultural and economic factors in mortality decline in the Netherlands in the periods 1875/1879-1895/1899 and 1895/1899-1920/1924. Mortality data by region, age, sex and cause of death as well as population data were derived from Statistics Netherlands for the years 1875/1879, 1885/1889, 1895/1899, 1910/1914, 1920/1924. Regional mortality declines were estimated on the basis of Poisson regression models. In a multivariate analysis the estimated declines were associated with economic (wealth tax) and cultural variables (% Roman Catholics and secularisation) corrected for confounders (soiltype, urbanisation). In the period from 1875/1879-1895/1899, %Roman Catholics was significantly associated with all-cause mortality decline and with mortality decline from diseases other than infectious diseases. Mortality declined less rapidly in areas with a high percentage of Roman Catholics. Secularisation was significantly associated with infectious-disease mortality decline. In areas with a high percentage population without a religious affiliation, mortality declined more rapidly. In the period from 1895/1899 to 1920/1924, wealth tax was significantly associated with all-cause and infectious-disease mortality decline. Mortality declined more rapidly in wealthy areas. Intermediary factors in the relationship between cultural factors and mortality decline were fertility decline, but more importantly, the number of medical doctors per 100,000 inhabitants. No intermediary factors were found for the association between the economic variable and mortality decline. Cultural and economic factors both played an important role in mortality decline in The Netherlands, albeit in different periods of time. The analysis of intermediary factors suggests that the acceptance of new ideas on hygiene and disease processes was an important factor in the association between culture and mortality decline in the late 19th century.

Confounding Factors, Epidemiologic↗
PubMed2001

Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in The Netherlands and England, 1970-1999.

Medical audit has been introduced among hospital specialists in both the Netherlands and England. In the Netherlands following some local experiments, medical audit was promoted nationally as early as 1976 by the medical profession itself and became a mandatory activity under the Hospital Licensing Act of 1984. In England it was the government who promoted medical audit as a compulsory activity for medical specialists, in particular since 1989. In this article the development and introduction of medical audit in the two health care systems is described and its impact on the clinical autonomy of medical specialists gauged. It is concluded that in both countries external pressures seem to have been crucial in the 'compulsory' introduction of medical audit. Although there are differences in the organisation and culture of the medical profession in the two countries, in both countries medical audit turned out to be an instrument 'controlled' by the profession itself. The question whether medical audit is instrumental in preserving clinical autonomy has also been addressed. Our conclusion is that in its present form medical audit in the two countries has not been a threat to the clinical autonomy of the medical profession. At the same time it is clear that the study of one quality instrument is insufficient to draw conclusions about the development of clinical autonomy, let alone autonomy in general. Moreover, it remains to be seen how medical audit can survive alongside quality improvement mechanisms such as accreditation, certification, performance indicators and formal quality systems (ISO, EFQM) where hospital management executes more control. The history of medical audit in the Netherlands and England over the past 30 years does illustrate, however, the capability of the profession to maintain autonomy through re-negotiated mechanisms for self-control.

England↗
PubMed2000

Tuberculosis screening among immigrants in The Netherlands: what is its contribution to public health?

Understanding the epidemiology of tuberculosis in migrant communities and designing adequate and comprehensive control strategies is a major challenge facing public health authorities in many low-prevalence countries. In The Netherlands, screening immigrants from tuberculosis high prevalence countries has been conducted since 1966. In this paper, we review risk factors for tuberculosis in migrant populations, the public health importance of tuberculosis and the current screening policy in The Netherlands. TB treatment outcome in migrant populations and operational considerations that ought to be taken into account to optimize current screening practices are also reviewed. The article recommends the setting-up of an information system to evaluate the effectiveness of screening immigrants in The Netherlands, and adjustment of screening policies where needed.

Emigration and Immigration↗