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PubMed2000

Chiropractic through the eyes of physiotherapists, manual therapists, and osteopaths in The Netherlands.

OBJECTIVES: To identify current perceptions and levels of awareness of chiropractic among physiotherapists, osteopaths, and manual therapists in The Netherlands. In addition, to investigate how future communication and interprofessional collaboration between the four professions may be improved in the interests of patient care as perceived by these groups. DESIGN: Four hundred and ninety-four (494) questionnaires were distributed to 100 manual therapists, 299 physiotherapists, and 95 osteopaths across The Netherlands. Questionnaires were identical for each profession. RESULTS: An overall response rate of 48% was achieved. The majority of practitioners reported limited knowledge of chiropractic. However, chiropractic was generally perceived as a primary health care profession most suited to extramural care. Sixty-seven percent (67%) of the manual therapists regarded it as direct competition, while 45% of the osteopaths and 48% of physiotherapists considered chiropractic complementary to their professions. While the majority of osteopaths felt that statutory self-regulation should be granted to chiropractors in The Netherlands, this was not supported by the manual therapists and physiotherapists. Moreover, there was only minimal (4%-11%) support for the availability of chiropractic treatment as part of the Dutch National Health Service. Although most respondents had never had contact with a local chiropractor, all osteopaths and 50% of the manual therapists and physiotherapists considered chiropractors to be skilled practitioners. However, this was more likely to be so if they had had contact with a chiropractor in the past. Current levels of communication and cooperation were thought to be poor to nonexistent although the majority welcomed closer links, particularly in relation to the treatment of spinal complaints. CONCLUSION: Greater awareness appears to be associated with increased levels of interprofessional acceptance and respect. The professions may wish to pursue areas of broad agreement identified by their practitioners in the interests of professional development and optimal standards of care for individuals in need of musculoskeletal services.

Adult↗
PubMed2006

Physicians' opinions on palliative care and euthanasia in the Netherlands.

BACKGROUND: In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. OBJECTIVE: The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. DESIGN: Cross-sectional. SETTING/SUBJECTS: Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). MEASUREMENTS: Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. RESULTS: Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. CONCLUSION: The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.

Adult↗
PubMed2005

Attempt to detect evidence for tick-borne encephalitis virus in ticks and mammalian wildlife in The Netherlands.

To investigate if tick-borne encephalitis virus (TBEV) is present in mammalian wildlife species or ticks in The Netherlands, serum samples and ticks were tested for TBEV antibodies and TBEV RNA, respectively. Serum samples were collected from wild boar (666), deer (13), fox (399), and rodents (90), and were tested for TBEV antibodies, using ELISA, and SN test or HI test. Over a period of 4 years, a total of 906 ticks was collected from seven regions in The Netherlands. In four different regions, this was done on a monthly basis and during four consecutive summers. All ticks were tested for TBEV RNA by RT-PCR. TBEV antibody was detected by ELISA in two (0.5%) sera of foxes and 49 (7%) sera of wild boar, but not confirmed by HI or SNT. TBEV RNA was not detected in any of 906 ticks. It was concluded that there is no real evidence for a TBEV reservoir in ticks or wildlife in The Netherlands.

Animals↗
PubMed1996

The clinical spectrum of limb girdle muscular dystrophy. A survey in The Netherlands.

A cross-sectional study was performed in the Netherlands to define the clinical characteristics of the various subtypes within the broad and heterogeneous entity of limb girdle muscular dystrophy (LGMD). An attempt was made to include all known cases of LGMD in the Netherlands. Out of the reported 200 patients, 105 who fulfilled strictly defined criteria were included. Forty-nine patients, mostly suffering from dystrophinopathies and facioscapulohumeral muscular dystrophy, appeared to be misdiagnosed. Thirty-four cases were sporadic, 42 patients came from autosomal recessive and 29 from autosomal dominant families. The estimated prevalence of LGMD in the Netherlands was at least 8.1 x 10(-6). The clinical features of the autosomal recessive and sporadic cases were indistinguishable from those of the autosomal dominant patients, although calf hypertrophy was seen more frequently, and the course of the disease was more severe in autosomal recessive and sporadic cases. The pectoralis, iliopsoas and gluteal muscles, hip adductors and hamstrings were the most affected muscles. Distal muscle involvement occurred late in the course of the disease. Facial weakness was a rare phenomenon. The severity of the clinical picture was correlated with a deteriorating lung function. All autosomal dominantly inherited cases showed a mild course, although in two families life-expectancy was reduced because of concomitant cardiac involvement.

Adolescent↗
PubMed1993

Meningococcal disease in The Netherlands, 1958-1990: a steady increase in the incidence since 1982 partially caused by new serotypes and subtypes of Neisseria meningitidis.

In order to explain a threefold increase in the incidence of meningococcal disease in the Netherlands during the 1980s, we serotyped and subtyped Neisseria meningitidis isolates recovered between 1958 and 1990 from > 3,000 patients with systemic disease. No single strain could be held responsible for the increase. Apart from the newly introduced strain B:4:P1.4, which became the most prevalent phenotype in 1990 (21% of all isolates), the majority of the cases in 1990 were caused by many different strains that were already present in the Netherlands before 1980. For the period 1980-1990, a shift in the age distribution of patients with meningococcal disease from younger to older age categories was found, particularly with regard to cases due to meningococci of serogroup B; this shift is explained by the changing distribution of serotypes and subtypes within serogroup B. A polyvalent group B, class 1 outer-membrane-protein vaccine of a stable composition could theoretically have prevented approximately 80% of all group B meningococcal infections in the Netherlands during the past 30 years.

Adolescent↗
PubMed2006

Use of health care services by ethnic minorities in The Netherlands: do patterns differ?

BACKGROUND: This article examines the nature of ethnic differences in health care utilisation by assessing patterns of use in addition to single service utilisation. METHODS: Data were derived from the Second Dutch National Survey of General Practice. A nationally representative sample of 104 general practices participated in this survey. Data on health and health service utilisation were collected through face-to-face interviews. Based on a random sample per practice, a total of 12 699 Dutch-speaking people were interviewed, regardless of ethnic background. An additional study among a random sample of 1339 people from the four largest minority groups in The Netherlands was conducted. These four groups comprised people from Turkey, Surinam, Morocco, and The Netherlands Antilles. Multilevel analyses were performed to investigate ethnic differences in health care utilisation, adjusting for socio-economic status, health status, and level of urbanisation. RESULTS: Differences in utilisation patterns were particularly marked for people with a Moroccan, Turkish, or Antillean background. Compared to the other groups, Surinamese were more likely to have had contact with any professional health care service. No evidence was found that the gate keeping role of general practitioners in The Netherlands functions less effectively among the ethnic minority groups as compared to the indigenous population. CONCLUSION: The analysis of patterns of utilisation proved to supply useful information concerning the relationship between ethnicity and use of health care services in addition to figures concerning single service use only.

Adolescent↗
PubMed1994

Differences in mortality and coronary heart disease between Lithuania and The Netherlands: results from the WHO Kaunas-Rotterdam Intervention Study (KRIS).

BACKGROUND: A 9.5-year follow-up of the Kaunas-Rotterdam Intervention Study (KRIS) provided an opportunity to compare mortality patterns and rates in a population from Lithuania, one of the former republics of the Soviet Union, with a population from the Netherlands. These populations consisted of 2452 and 3365 males, respectively, aged 45-60 years. In 1972-1974, these males were extensively screened for cardiovascular risk factors, using uniform methods. METHODS AND RESULTS: During the follow-up, 303 males in Kaunas (Lithuania) and 350 males in Rotterdam (the Netherlands) died. Using Cox proportional hazards and logistic regression analysis, it was found that all-cause mortality rates during follow-up were 30% higher in Kaunas; this was mainly due to higher mortality rates from external causes (relative risk = 6.69), stomach cancer (RR = 2.78), stroke (RR = 2.30) and infectious diseases (RR = 12.43). The risk of fatal and non-fatal coronary heart disease (CHD) was, however, smaller in Kaunas (RR = 0.72). This lower risk closely corresponded with the Lithuanian risk profile which could be described by less smoking, lower cholesterol levels, and higher physical activity. As Lithuanians had a more advantageous cardiovascular risk profile, the higher Lithuanian all-cause mortality rates could not be explained by this risk profile. CONCLUSIONS: The results provide evidence for geographical differences in mortality and morbidity between Lithuania and the Netherlands. Population-specific health behaviours were shown to be involved in differences in the risk of CHD. The lower CHD rates in Eastern European communities in the 1970s, in this study confirmed for Lithuania, suggests that the apex of the CHD epidemic had not yet reached the Lithuanian population.

Blood Pressure↗
PubMed1994

Total and HDL-cholesterol in The Netherlands: 1987-1992. Levels and changes over time in relation to age, gender and educational level.

BACKGROUND: To gain insight into the prevalence of and trends in plasma cholesterol levels in the general population of the Netherlands, a monitoring project was carried out from 1987 to 1992. METHODS: Each year a random sample of men and women aged 20-59 years in three towns in the Netherlands was invited to participate in the study. The overall response rate was 50% for men and 57% for women and a total of almost 42,000 men and women participated. Total (TC) and high density lipoprotein cholesterol (HDL-C) was measured and the non-HDL-C/HDL-C ratio was computed. Data were age-standardized to the Dutch population distribution aged 20-59 years. RESULTS: The prevalence of hypercholesterolaemia (TC > or = 6.5 mmol/l) in men ranged from 5% in the youngest (20-29 years) to 29% in the oldest age group (50-59 years), and from 4% to 38% in women. Low HDL-C levels (< or = 0.9 mmol/l) in men ranged from 15% in the youngest to 26% in the oldest age group, and in women from 4% in the youngest to 7% in the oldest age group. The lipid profile of those with a higher educational level was more favourable than that of the less educated. From 1987 to 1992, in men, TC decreased by 0.12 mmol/l, HDL-C decreased by 0.07 mmol/l and the non-HDL-C/HDL-C ratio increased by 0.22. In women no statistically significant changes were observed. Changes over time did not differ according to age and educational level. CONCLUSION: The prevalence of hypercholesterolaemia is still high in the Netherlands. During the period 1987-1992 the lipid profile worsened in men and remained stable in women.

Adult↗
PubMed1997

The geographical distribution of tick bites and erythema migrans in general practice in The Netherlands.

BACKGROUND: Lyme disease is caused by Borrelia burgdorferi which is transmitted in Europe by the tick ixodes ricinus. Erythema migrans is a skin lesion which is pathognomonic of Lyme disease. A retrospective study was carried out to determine the geographical distribution of the occurrence of tick bites and erythema migrans in the Netherlands and to identify ecological risk factors. METHODS: In April 1995, all general practitioners (GPs) in the Netherlands were asked to complete a postal questionnaire on the number of tick bites and erythema migrans case-patients seen in 1994 and the size of the practice. Reminders were sent to non-responders. Information on ecological risk factors by local government area was obtained from a geographical information system. RESULTS: The response rate was 79.9%. In 1994, GPs reported seeing approximately 33,000 patients with tick bites and 6500 with erythema migrans. The incidence rate of erythema migrans was estimated at 4.3 per 10,000 population. Ecological risk factors for both tick bites and erythema migrans were the proportion of the area covered by woods, sandy soil, dry uncultivated land, the number of tourist-nights per inhabitant and sheep population density. The cattle population density was a risk factor for erythema migrans. CONCLUSIONS: Using simple methods, a crude estimate of the incidence rate of erythema migrans was obtained rapidly, and high risk areas were identified. Lyme disease appears to be an important problem in the Netherlands.

Animals↗
PubMed2001

Trends in total and high density lipoprotein cholesterol and their determinants in The Netherlands between 1993 and 1997.

BACKGROUND: The aim of this study is to describe trends in plasma total and high density lipoprotein (HDL) cholesterol in The Netherlands between 1993 and 1997 and to examine whether these trends in cholesterol could be explained by changes in body mass index, smoking, alcohol intake, use of cholesterol lowering medication, intake of saturated fat, trans fatty acids and dietary cholesterol. METHODS: Each year a random sample of men and women aged 20-59 years living in three towns in The Netherlands was invited to participate in the study. In total more than 21 000 people were examined. RESULTS: Between 1993 and 1997 plasma total cholesterol decreased significantly by 0.19 mmol/l in men and by 0.27 mmol/l in women. During this period HDL cholesterol remained stable in both men and women. Small decreases were observed in the intake of saturated fat, trans fatty acids and dietary cholesterol in both men and women. The use of cholesterol lowering medication and for women oral contraceptives and prescribed oestrogens increased significantly. After adjustment for these determinants in multivariate analyses the trend in total cholesterol remained highly significant. CONCLUSIONS: Between 1993 and 1997 the mean total cholesterol level decreased significantly while the mean HDL cholesterol remained stable in both men and women in The Netherlands. The observed trend in total cholesterol could only for a small part be explained by changes in the determinants studied.

Adult↗
PubMed2004

Ethnic inequalities in age- and cause-specific mortality in The Netherlands.

BACKGROUND: By describing ethnic differences in age- and cause-specific mortality in The Netherlands we aim to identify factors that determine whether ethnic minority groups have higher or lower mortality than the native population of the host country. METHODS: We used data for 1995-2000 from the municipal population registers and cause of death registry. All inhabitants of The Netherlands were included in the study. The mortality of people who themselves or whose parent(s) were born in Turkey, Morocco, Surinam, or the Dutch Antilles/Aruba was compared with that of the native Dutch population. Mortality differences were estimated by Poisson regression analyses and by directly standardized mortality rates. RESULTS: Compared with native Dutch men, mortality was higher among Turkish (relative risk [RR] = 1.21, 95% CI: 1.16, 1.26), Surinamese (RR = 1.24, 95% CI: 1.19, 1.29), and Antillean/Aruban (RR = 1.25, 95% CI: 1.15, 1.36) males, and lower among Moroccan males (RR = 0.85, 95% CI: 0.81, 0.90). Among females, inequalities in mortality were small. In general, mortality differences were influenced by socio-economic and marital status. Most minority groups had a high mortality at young ages and low mortality at older ages, a high mortality from ill-defined conditions (which is related to mortality abroad) and external causes, and a low mortality from neoplasms. Cardiovascular disease mortality was low among Moroccan males (RR = 0.51, 95% CI: 0.44, 0.59) and high among Surinamese males (RR = 1.13, 95% CI: 1.05, 1.21) and females (RR = 1.14, 95% CI: 1.06, 1.23). Homicide mortality was elevated in all groups. CONCLUSION: Socio-economic factors and marital status were important determinants of ethnic inequalities in mortality in The Netherlands. Mortality from cardiovascular diseases, homicide, and mortality abroad were of particular importance for shifting the balance from high towards low all-cause mortality.

Adolescent↗
PubMed2002

Antibiotic guidelines and antibiotic use in adult bacterial meningitis in The Netherlands.

In The Netherlands, national guidelines for the treatment of adult patients with bacterial meningitis were introduced in October 1997. In 1998 we began a prospective, nationwide study to evaluate the compliance with these consensus-based guidelines. In addition, we evaluated whether the recommended initial treatment provides adequate microbiological coverage. From October 1998 to January 2000, 365 adults with bacterial meningitis were identified using information from The Netherlands Reference Laboratory for Bacterial Meningitis; 263 patients were classified into four categories depending on patient's age and underlying health status. In the first category, patients 16-60 years without risk factors, Neisseria meningitidis was the most common pathogen (53%); 62 of 127 patients (49%) received treatment in compliance with the guidelines. In the second and third categories, patients >60 years without risk factors and those with risk factors independently of age, Streptococcus pneumoniae caused 61% and 58% of cases, respectively. Compliance in these categories was about 17%. Overall, 33% of patients received treatment in compliance with the guidelines. The microbiological coverage of patients treated in compliance and not in compliance with the guidelines was 98% and 93%, respectively. In conclusion, 1 year after national consensus-based guidelines for the initial treatment of adult patient with bacterial meningitis were introduced in The Netherlands, only one-third of Dutch physicians were adhering to the guidelines. The microbiological coverage for the patients who were treated in compliance with the guidelines was almost complete (98%).

Adolescent↗
PubMed1995

Costs of schizophrenia in The Netherlands.

This study tries to identify and estimate the health care costs of schizophrenia in The Netherlands and to determine in a broader sense the total costs of schizophrenia for society in terms of productivity loss caused by absence from work and early retirement. The study can be described as a "cost-of-illness" study based on prevalence data. It shows that in The Netherlands about 2 percent of the total health care budget is spent on the treatment of schizophrenia patients. This figure is rather high, since the prevalence rate of schizophrenia in The Netherlands is only 0.6 percent. The indirect costs--production lost because of absence from work, disability, and early death--were very low, but these costs are underestimated because schizophrenia patients are unlikely to become active participants in the labor force. It is also difficult to identify people who have died of schizophrenia in national data because schizophrenia in itself is not lethal, but individuals with schizophrenia may die because of suicide or violent death.

Absenteeism↗
PubMed1999

Christianization of the soul: religious traditions in the care of people with learning disabilities in the Netherlands in the nineteenth century.

Educational and therapeutic optimism with respect to those with learning disabilities led to new developments in some countries around the mid-nineteenth century. In the Netherlands there was little specialist care and few special initiatives were taken before the end of the century. The dominant expert opinion was that these people required the standard care offered by the asylum. Two mid-nineteenth-century initiatives, however, are worth analysing, since they signal the cautious start of special institutional education in the Netherlands: the Idiotenschool (School for Idiots) in The Hague and the class for idiots at the Meerenberg Asylum. However, the most important alternative to care in the asylum was offered by institutions with explicitly religious motives, which evolved from Catholic charity and Protestant philanthropy for many different types of socially weak and dependent groups. This article will examine the nineteenth-century religious roots of the care of people with learning disabilities in the Netherlands; it will also show how older educational ideas began to reappear in this context by the end of the century.

History, 19th Century↗
PubMed2000

Total but not high-density lipoprotein cholesterol is consistently associated with coronary heart disease mortality in elderly men in Finland, Italy, and The Netherlands.

We studied the relation between serum total and high-density lipoprotein (HDL) cholesterol and 10-year coronary heart disease mortality in elderly men in different European countries. The Finland, Italy and the Netherlands Elderly (FINE) Study is a prospective follow-up study in 2,132 elderly men ages 65-84 years in Finland, the Netherlands, and Italy. We estimated relative risks using Cox proportional hazard analysis with time-dependent covariates. Total cholesterol was positively related to coronary heart disease mortality in all three countries. The combined relative risk for the total population of the FINE Study was 1.17 (95% confidence interval = 1.06-1.29) for each 1.00 mmol/liter increase in total cholesterol. HDL cholesterol was inversely related to coronary heart disease mortality in Finland, but not in the Netherlands and Italy. In Italy we noted an interaction among HDL cholesterol, body mass index, and alcohol intake, with an inverse association for HDL cholesterol in lean men who drank <40 gm of alcohol daily and a positive association for HDL cholesterol among overweight men who drank > or =40 gm of alcohol per day. Serum total cholesterol remains an important predictor of coronary heart disease mortality in elderly men in different European countries. The effect of HDL cholesterol differed among the three countries.

Aged↗
PubMed2001

The impact of immigration on env HIV-1 subtype distribution among heterosexuals in the Netherlands: influx of subtype B and non-B strains.

OBJECTIVE: To examine the epidemiological factors influencing the distribution and spread of HIV-1 subtypes among heterosexuals in the Netherlands. METHOD: A nationwide serosurveillance in 21 HIV/AIDS centres from 1997 to 1999 involved 200 individuals for whom the mode of HIV transmission was heterosexual contact or unknown. HIV-1 subtypes were determined by phylogenetic analysis of env V3 sequences and correlated with sociodemographic characteristics of the subjects and their sexual partners. RESULTS: HIV-1 subtype B infection occurred in 121 subjects (60%). Non-B subtypes were identified in 31 (A), 24 (C), 10 (D), six (E), four (F) and three (G) individuals; one had an unclassified subtype. The proportion of subtype B was about 60% in four of the six regions of the Netherlands, but in the Northwest and Southwest regions these proportions were 76% and 46%, respectively. The Surinamese and Antilleans, large immigrant groups, were all infected with subtype B, as were almost all individuals with an unknown source. The proportions of non-B viruses did not change significantly over time in Amsterdam, where subtyping was available from 1988 onward, but a shift in the various subtype B strains was observed, suggesting introductions of new subtype B strains in Amsterdam. CONCLUSION: To date, HIV-1 non-B subtypes in the Netherlands are still found predominantly among heterosexuals with an epidemiological link with sub-Saharan Africa. Despite continuing introductions of non-B subtypes, the B/non-B distribution has been stable over time, most likely as a result of introductions of subtype B strains from Caribbean and South American countries.

Female↗
PubMed1998

Geographical distribution of radiation risks in The Netherlands.

Risk assessment of exposure to sources of radiation is an important tool for national governments in regulating radionuclide emissions and thus reducing radiation doses for the general public. For this reason radiation doses from sources throughout The Netherlands have been analyzed. For sources with well-defined locations and doses that were thought to vary significantly throughout The Netherlands, radiation dose maps were produced. Average dose values were calculated or derived from the literature for doses considered to be evenly distributed throughout the country or for which no information on the geographical distribution of dose was available. Emission, dispersion, and individual dose were modeled for each source using various pathways and exposure routes. Indoor radon and gamma radiation from building materials generate the highest dose values. The highest human induced radiation doses for industries of which the doses showed to be geographically distributed are found in the cement industry, elemental phosphorus production, phosphoric acid production, and iron and steel production. Radiation dose from some of these sources has a very local peak and decreases rapidly with distance. The elemental phosphorus production causes relatively high radiation doses throughout a large part of The Netherlands. Cumulation of doses from various sources occurs, but these are often masked by doses from a few large industries.

Eating↗
PubMed2002

Seroprevalences of herpes simplex virus type 1 and type 2 among pregnant women in the Netherlands.

BACKGROUND: In the Netherlands 73% of cases of neonatal herpes are caused by herpes simplex virus type 1 (HSV-1), whereas in the United States a majority are caused by HSV type 2 (HSV-2). GOAL To understand this difference we undertook a seroepidemiological study on the prevalence of HSV-1 and HSV-2 among pregnant women. STUDY DESIGN: Type-specific antibodies to HSV-1 and HSV-2 were detected by enzyme-linked immunosorbent assay (ELISA) in serum samples from 1,507 pregnant women in Amsterdam, Rotterdam, and Nijmegen. RESULTS: The prevalence of HSV-1 was 61% in Nijmegen, 73% in Amsterdam, and 75% in Rotterdam. The prevalence of HSV-2 was 11% in Nijmegen, 35% in Amsterdam, and 27% in Rotterdam. CONCLUSION: The seroprevalence of HSV-1 and HSV-2 antibodies among pregnant women in the Netherlands shows significant geographical differences, which were attributed to ethnical variation. However, the epidemiologic differences did not correlate with the incidence of neonatal herpes in the Netherlands.

Adolescent↗