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PubMed2006

Shiga toxin-producing Escherichia coli (STEC) O157 outbreak, The Netherlands, September-October 2005.

In September 2005, the first national food-related outbreak of Shiga toxin (Stx)-producing Escherichia coli (STEC) O157 was investigated in the Netherlands. A total of 21 laboratory-confirmed cases (including one secondary case), and another 11 probable cases (two primary and nine secondary cases) were reported in patients who became ill between 11 September and 10 October 2005. Preliminary investigation suggested consumption of a raw beef product, steak tartare (in the Netherlands also known as "filet americain"), and contact with other symptomatic persons as possible risk factors. A subsequent case-control study supported the hypothesis that steak tartare was the source of the outbreak (matched odds ratio (OR) 272, 95% confidence interval (CI) 3-23,211). Consumption of ready-to-eat vegetables was also associated with STEC O157 infection (matched OR 24, 95% CI 1.1-528), but was considered a less likely source, as only 40% of the cases were exposed. Samples of steak tartare collected from one chain of supermarkets where it is likely that most patients (67%) bought steak tartare, all tested negative for STEC O157. However, sampling was done three days after the date of symptom onset of the last reported case. Since 88% of the cases became ill within a two week period, point source contamination may explain these negative results. It is concluded that steak tartare was the most likely cause of the first national food-related outbreak of STEC O157 in the Netherlands.

Disease Outbreaks↗
PubMed2006

['Multifactorial disorders in the genomics era'; notes on a recent report from The Royal Netherlands Academy of Arts and Sciences].

The Royal Netherlands Academy of Arts and Sciences (KNAW) has issued a report entitled 'Multifactorial diseases in the genomics era'. It makes two major recommendations. The ministers of Science, Health and Economic Affairs are advised to (a) to take steps to ensure the development, evaluation and implementation of advanced high-throughput technologies in order to improve the international position of the Netherlands, and (b) to actively promote the setting up of one or more general biobanks in the Netherlands that should contain biological samples and data from parts of the population and that are not restricted to a single disorder. The report fails to address some important aspects of biobanks, such as the registration of the ethnicity of patients and controls. In addition monogenetic subvariants in multifactorial disease are not mentioned.

Biomedical Research↗
PubMed1991

[The history of pain control in dentistry in The Netherlands].

Pain control in The Netherlands used to be in the hands of surgeons. Dentists were not allowed to use any drugs which could have a general effect. In the Anglo-Saxon countries dentists and anaesthesiologists working together since 1846 have achieved a high standard of pain control. Anaesthesiology has been recognised in The Netherlands only since 1948. The advantages of a sequence of possibilities for pain control have since become available for dentistry in The Netherlands.

Anesthesia, Dental↗
PubMedDate not supplied

[Secondary effects of drugs. The 1979 Halcion experience in the Netherlands, a false alarm?].

In the course of 1979 the Netherlands Centre for Monitoring of Adverse Reactions to Drugs (NARD) received a remarkably large number of reports on patients with unusual and complex psychic disturbances, attributed to the use of the then recently marketed hypnotic triazolam. The interpretation of the data was difficult, however, and several questions could at that time not be properly answered. In the past 10 years a specific benzodiazepine withdrawal syndrome has been identified, showing many similarities with the disturbances as reported in association with triazolam. In addition similar adverse experiences with triazolam have been reported in many other countries. Tablets containing 1 mg and 0.5 mg triazolam, as were widely used in the Netherlands, have in the mean time been globally removed from the market. It is concluded that the triazolam syndrome may be explained as a combination of strong benzodiazepine effects and withdrawal phenomena. The ultra short half-life of triazolam and the high doses used may have contributed to the problems as observed in the Netherlands. The signal perceived by the NARD appears to have been a valuable warning, rightly casting doubt on the safety of triazolam and the original dosage recommendations.

Dose-Response Relationship, Drug↗
PubMed1989

Twenty-four-hour ambulatory oesophageal pH monitoring: experience in The Netherlands.

Twenty-four-hour ambulatory oesophageal pH monitoring has become a major diagnostic method for the evaluation of gastro-oesophageal reflux disease. Essential requirements for registration and reproduction of the pH are reliable pH electrodes, well-performed calibration and optimal reproduction and analysis of the signal. The most commonly used pH probes in The Netherlands are not-combined monocrystalline antimony electrodes (Synectics Ltd, Sweden) and combined glass electrodes (Ingold and Radiometer). For diagnostic intra-oesophageal pH measurements both types are suitable; for research purposes, especially intragastric, glass electrodes are preferable. In The Netherlands several types of solid-state recorders are commercially available: all fulfill the conditions necessary to produce reliable registrations. In the present study, available measuring systems in The Netherlands and current practices associated with ambulatory pH monitoring were evaluated. Inquiry among the Dutch pH registration centres showed that more than half were using Synectics electrodes and equipment. Positioning of the pH probe was based on manometry (25%), fluoroscopy (22%) or endoscopy (20%). In the initial phase there were many problems, especially related to ignorance of the complicated registration procedure. For ambulatory pH measurements we recommend a simple datalogger with a sufficient memory capacity and direct interface with a PC, a combined glass electrode positioned 5 cm above the manometrically determined lower oesophageal sphincter. For clinical interpretation of the results the percentage of time with pH below 4 is probably the most reliable parameter for the detection of pathological gastrooesophageal reflux.

Calibration↗
PubMed1986

[The copper status of cattle in the Netherlands].

During two periods of investigation, at an interval of five years, samples of 333 livers of cows of known origin were collected in the Netherlands. The concentrations of copper were analysed approximately in 0.5 g of dry matter by acid incineration and atomic absorption spectrophotometry. The results showed that there were areas characterised by a rather large number of low concentrations (Leyden, Isle of Texel, southern Limburg) and areas characterised by very high concentrations (Veluwe and Peel areas), the latter probably resulting from the use of pig manure on a large scale. In the present paper the significance of threshold values of the concentrations of copper in the liver are discussed; these were 25 and 400 mg/kg of dry matter, normal copper levels and a normal structure and function of the liver being maintained. On the basis of these threshold values the two investigations revealed too low concentrations of copper in the livers in thirty (17 per cent) of the cases and too high concentrations in eight (17 per cent) of the cases. Sampling livers from slaughterhouses naturally does not produce a representative picture of the entire population of dairy cattle in the Netherlands. None the less the results show that the copper status of cows in the Netherlands not infrequently leaves much to be desired.

Animal Feed↗
PubMed1986

Regional perinatal mortality and regional hospitalization at delivery in The Netherlands.

In The Netherlands 34-35% of all deliveries still take place at home, but with considerable regional differences. A study was made of the relation between the perinatal mortality rate and the percentage of hospital deliveries in the 11 provinces of The Netherlands, in municipalities divided into groups according to the number of inhabitants, and in the 17 cities with more than 100,000 inhabitants. No relation could be demonstrated between the regional percentage of hospital deliveries and the regional perinatal mortality rate. The proportion of hospital delivery appears not to be a major factor determining the regional perinatal mortality rate in the current system of obstetric care in The Netherlands.

Delivery, Obstetric↗
PubMed1971

An eleven-year study of drug resistance in Salmonella in the Netherlands.

From 1959 to 1969 a total of 123 070 strains of salmonellae, representing nearly all the strains that have been isolated from animals and man, were collected in the Netherlands and tested for antibiotic resistance.In the course of the study, only a few strains of S. typhi and S. paratyphi B were found to be resistant to chloramphenicol, ampicillin, or tetracycline.From 1959 to 1966 there was a sharp increase in the prevalence of tetracycline resistance in both the human and the animal strains of S. typhimurium and S. panama; subsequently, however, the prevalence declined. During 1966-70 approximately one-third of the tetracycline-resistant human and animal strains of S. typhimurium were also resistant to ampicillin. This type of multiple resistance was only occasionally encountered in the other serotypes. In contrast to resistance to tetracycline and ampicillin, the incidence of S. typhimurium resistant to chloramphenicol remained low during the whole period of observation. In all other serotypes drug resistance remained at a low level.It is shown in this study that the greatly increased use of broad-spectrum antibiotics for medical and veterinary purposes and for animal feeding over the last decade in the Netherlands has not led to the development of serious drug resistance from the medical point of view. An important factor involved in the low incidence of resistance to chloramphenicol may be that R-factors in salmonellae usually lose this resistance determinant rapidly.In the Netherlands the annual mortality figures for all forms of salmonellosis decreased from 0.84 (per 100 000 inhabitants) in 1961 to 0.25 in 1969.

Ampicillin↗
PubMed1995

[20-year national screening for phenylketonuria in The Netherlands. National Guidance Commission PKU].

OBJECTIVE: Evaluation of the Dutch national screening programme for phenylketonuria (PKU). DESIGN: Descriptive. SETTING: Nationwide. METHODS: Data on the screening were obtained from the laboratories, from the registration offices of vaccination and screening results and from the paediatricians to whom infants with positive screening values were referred, during the period from September 1st, 1974 to December 31st, 1993. RESULTS: During the study period 3,481,738 infants were screened in the Netherlands (99.4% of all live births). The sensitivity of the programme was 98%, the specificity 99.99% and the positive predictive value 50%. The prevalence of PKU varied considerably between regions, e.g. from 1:33,600 in Zuid-Holland to 1:8,250 in Limburg (average in the Netherlands 1:18,000). The percentage of patients treated before the age of 22 days was 84% in the period from 1974 to 1988 and 95% in the period from 1989 to 1993 (p = 0.04). Birth weight in patients with PKU was 141 g (95% confidence interval: 66-216) less than the expected birth weight in the Netherlands. Furthermore, a slight growth retardation occurred in the first three years of life in early treated patients. The percentage of patients following special education was twice as high as in the general population (p < 0.001). CONCLUSION: The screening procedure for PKU is functioning at a high level. Despite early treatment development of patients with PKU is slightly below normal.

Child↗
PubMed1995

[Clinical studies of adjuvant systemic chemotherapy in breast cancer in The Netherlands assumes a greater number of patients than is available].

OBJECTIVE: To determine whether the number of breast cancer patients in the Netherlands is sufficient for the current clinical investigations of adjuvant systemic chemotherapy. DESIGN: Descriptive. SETTING: Nationwide. METHOD: The number of current investigations of adjuvant therapy for breast cancer was obtained from the chairmen of the Comprehensive Cancer Centres and from the Protocol Review Committee of the Dutch Cancer Society (Koningin Wilhelmina Fonds). There were eight studies in progress. RESULTS: The current investigations of adjuvant therapy for breast cancer need 3612 patients (903 per year with a study duration of 4 years). The total number of relevant breast cancer patients per year in the Netherlands is 4993. Taking into account the necessary subgroups with respect to age and positive/negative axillary lymph nodes, and possible reluctance of patients and doctors to cooperate, it is not surprising that a number of studies are delayed. CONCLUSION: The number of breast cancer patients needed for clinical trials of adjuvant systemic chemotherapy in the Netherlands is a limiting factor for the progress of these studies.

Adult↗
PubMed1994

Cord blood levels of potentially neurotoxic pollutants (polychlorinated biphenyls, lead and cadmium) in the areas of Prague (Czech Republic) and Katowice (Poland). Comparison with reference values in The Netherlands. The Czech/Polish/Dutch/German Research Team.

In a preliminary study the levels of four non-planar polychlorinated biphenyls congeners (118, 138, 153 and 180), and of the toxic metals lead and cadmium, and their antagonist selenium and zinc were measured in cord blood from apparently healthy neonates from the region of Prague and Upper Silezia (Katowice). These "background" levels were compared with similar values from neonates in the Netherlands. It was found that the levels of three PCB congeners (138, 153 and 180) were significantly higher in the Prague samples than in the Netherlands; but in the Katowice group they were significantly lower. In Upper Silezia (Katowice) the values of the metals lead and cadmium, and in Prague those of cadmium and selenium were significantly higher than in the Netherlands. The importance of these findings is discussed. It is argued that neurotoxic effects of perinatal exposure can be expected to be more prominent in Central Europe than in Western European countries. A more thorough study is indicated and will be undertaken by a joint Czech/Polish/Dutch/German research group.

Cadmium↗
PubMedDate not supplied

Chiropractic in The Netherlands: a survey of Dutch chiropractors.

BACKGROUND: In the Netherlands, there is increasing public and political interest in chiropractic treatment. There is, however, very little descriptive information available in the Netherlands on the chiropractic profession. Therefore, a survey was conducted among all Dutch chiropractors. METHODS: A questionnaire was sent to all members of the Netherlands' Chiropractors Association (n = 59). It contained questions on (postgraduate) education, practice management, diagnostics (including radiology use), treatment, interprofessional cooperation and referral. RESULTS: The response was 88%. Chiropractic is growing rapidly: the number of chiropractors has doubled in five years. Chiropractors primarily treat back and neck pain, with an average of 8 treatments. Conventional orthopedic and neurological examination along with motion palpation are the cornerstones of physical examination. The respondents stressed the importance of direct access to radiography and specialized (hospital) diagnostics. Fifty-eight percent of the chiropractors have their own X-ray equipment. The most frequent reason for taking new X-rays was the absence of cooperation with radiology departments. Self-referral is the largest source of patients. The referral rate to other health care professionals is low. CONCLUSIONS: The number of chiropractors is growing rapidly. They have an exceptional position in the Dutch health care system. Access to X-ray and more specialized diagnostics are presently the most important political issues.

Chiropractic↗
PubMed1994

[Drug addicts in the Netherlands].

Dutch Government admit that tolerate attitude toward lower-risk drug abuse could reduce criminality and protect drug addict's health. Some Dutch psychiatrists disagree and try to struggle against this so called "normalization" politic. Morphine legal consumption, per million inhabitants is higher in Netherlands than in France, showing a certain latitudinarianism of health profession. During last years, illicit traffic data indicate an extensive increase, but drug addicts statistics are no more trustworthy than in France. International Narcotics Control Board (UNO) disapprove of the non application of 1961 Narcotics Convention in Netherlands. Recently dutch authorities suggest french government to develop bilateral cooperation in drug prevention. In fact, Netherlands liberate cannabis consumption which brings, as in other countries an increasing of drug addiction Nevertheless, this liberalization is still recommended by there who ignore the international last century experiences. In a word, acting toward supply and not only towards demand is necessary for a correct prevention as WHO and UNO recommend it.

Humans↗
PubMed1994

Cost containment: Europe. The Netherlands.

In The Netherlands, 8.3% of the gross national product is allocated to health care. Medical care provided in ICUs consumes approximately 8% of hospital budgets, or approximately 2.5% of the total healthcare budget. The high cost of intensive care medicine in The Netherlands has become a matter of concern during the last decade. A national intensive care study was conducted from 1989 through 1990 to evaluate the effectiveness and organization of ICUs in the country. This study has shown that there is an association between the operational characteristics of ICUs and the hospital in which these units operate. In approximately 50% of ICUs studied, a marked mismatch existed between the provision and the use of resources. Surgical activities in the hospital were the major observed cause for this mismatch, mainly because ICUs were often used instead of the recovery room, which operated only about 8 to 10 hrs/day during working days. In addition to an absence of clearly written policies for the use of the facilities, a lack of sound ICU business organization and management was also documented and may have contributed to the observed misuse of resources and the dissatisfaction and burnout of hospital personnel. In order to improve the use of resources and to establish a controllable program of cost containment in ICUs in The Netherlands, the recommendations made to Dutch authorities were aggregated under two headings: a) the adoption of a quantifiable method for defining levels of ICU care; and b) the enforcement of the professional organization and management of ICUs.

Cost Control↗
PubMed1996

Invasive cutaneous melanoma in The Netherlands, 1989-1990.

The Breslow or tumour thickness is the most important prognostic factor for survival from cutaneous melanoma. We studied the occurrence of melanoma in relation to tumour thickness and subsite in The Netherlands. Data on all newly diagnosed invasive cutaneous melanomas in the Netherlands Cancer Registry in 1989 and 1990 were used to estimate age and sex-specific incidence rates according to site and depth of tumour invasion. The incidence among women (9.5 per 100,000 person-years) was relatively high compared with other European countries. The predominant site was the trunk among men and the leg among women. After age 70, one-third of the melanomas were observed in the head and neck region. According to data from PALGA, the national computerized archive of Dutch pathology laboratories, 37% of the men and 29% of the women had a melanoma > 1.5 mm thick. Among persons younger than age 60, 26% had a melanoma > 1.5 mm thick, compared with 44% among those 60 years and over. In both registries the absolute and relative risks for a thicker melanoma increased with age, particularly for men. In The Netherlands, preventive measures for population groups with thicker melanomas should be targeted towards men and elderly persons.

Adolescent↗
PubMedDate not supplied

Five years of laparoscopic cholecystectomy in The Netherlands.

Since its introduction in spring 1990, laparoscopic cholecystectomy has become the treatment of choice for uncomplicated gallstone disease in The Netherlands. Several nation-wide surveys conducted by the authors show a rapid diffusion of this operation. 70-75% of all cholecystectomies are performed laparoscopically in almost all Dutch hospitals. The incidence of common bile duct lesions was relatively high at the beginning (1% in 1991) but declined to 0.68% at the end of 1992. It is assumed that the incidence of these lesions will decrease further to a percentage comparable to that after conventional cholecystectomies of 0.5%. The wound related complications of 1.65% is rather low. Despite the reduction in operative morbidity and early resumption of full activity resumption laparoscopic cholecystectomy has met financial restraints, because of the budget system in The Netherlands. There are no incentives for surgeons, hospital management and health insurance companies to stimulate laparoscopic cholecystectomy. The social-economic benefit of the operation is difficult to quantify in the current health care system in The Netherlands.

Activities of Daily Living↗
PubMed1996

[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↗
PubMed1996

[Drug resistance in Mycobacterium tuberculosis in The Netherlands].

OBJECTIVE: To determine magnitude, trend and specific features of the resistance problem. DESIGN: Descriptive. SETTING: Royal Netherlands Tuberculosis Association, The Hague, the Netherlands. METHODS: The data of the National Institute of Public Health and Environmental Protection concerning the prevalence of drug-resistant tuberculosis during the period 1990-1994 were analysed. Also, features of patients with and without drug resistance were compared (Dutch National Tuberculosis Register: cohort 1993). RESULTS: Isoniazid and streptomycin resistance were each observed in approximately 6% of susceptibility tests, showing no clear trend over the study period. Rifampicin resistance increased from 0% to 1.5% in 1994. In the 1993 patient cohort, 809 cases were analysed, showing resistant organisms in 103 (13%). The resistance group included 84 (82%) foreigners versus 387 (55%) among the 'sensitives' (p < 0.001). The percentages of (known) HIV infections were equal in both groups (5-6%). The percentage of isoniazid-resistance varied from 1.8% in Dutch patients to 7.8% in foreign patients. Recent immigrants and refugees waiting for official status were important risk groups for resistance (p < 0.005). Foreign tuberculosis patients defaulted more often from treatment than Dutch patients (p < 0.001). CONCLUSION: Drug-resistant tuberculosis in the Netherlands is mainly due to import of resistant strains. Transmission and further development of resistance within the country must be prevented.

Antibiotics, Antitubercular↗