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PubMedDate not supplied

The metamorphosis of health planning in the Netherlands and the USA.

The United States and the Netherlands are the focus for this comparative analysis of the evolutionary interaction between health planning and the political system, seen in the context of change in social and economic ideologies. While health planning in the USA started in 1946, it was the comprehensive health planning program in 1966 that created the form to be followed by Health Systems Agency effort in 1974: local, voluntary planning, coordinated by state agencies, supported by federal funding. Health planning in the Netherlands has moved through four distinct periods: a hospital construction period starting during the post-war recovery; a hospital regionalization period, from 1971 through the late 1970s; a transition period from the late 1970s to 1982, during which several planning approaches were considered; and, the current comprehensive health and social services planning period. Today, federal support for health planning in the US has been eliminated as part of the current de-regulatory, competitive health care strategy. Health planning in the US is now an institutional activity, with less focus on community needs. Advocated changes in the Dutch planning approach incorporate ideas similar to past approaches in the US; but, a failed approach in one nation may work in another, if the underlying cultural and organizational characteristics are sufficiently different.

Delivery of Health Care↗
PubMed2005

The incidence of congenital cytomegalovirus infections in The Netherlands.

Cytomegalovirus (CMV) is one of the most common causes of congenital infection without an effective treatment or an effective vaccine available to date. The emphasis has to be on preventive strategies, which rely on the epidemiological situation. The incidence of congenital CMV infections, however, is not known for The Netherlands. Therefore, a prospective virological study was carried out in a population of 7,524 pregnant women and 7,793 newborns. CMV-specific IgG antibodies were determined in cord blood by ELISA. When CMV antibodies were present, a CMV specific PCR was performed on the throat swab. A positive PCR was confirmed by urine culture. In addition, the seroepidemiology for CMV was investigated in the metropolitan region (Amsterdam and Rotterdam) which has a different ethnic composition. Congenital CMV infection was found in 7 infants (0.9 per 1,000). None had symptoms at birth or during 24 month follow-up. Carriage or CMV was 41%, with a variation between 35% and 100% depending on ethnicity. The ethnic composition in the south-eastern region was different from that in large cities, but similar to that in the rest of the country. The incidence of congenital CMV infections in The Netherlands is the lowest described to date, which does not justify special preventive policies.

Antibodies, Viral↗
PubMed2006

A comparison of pressure ulcer prevalence rates in nursing homes in the Netherlands and Germany, adjusted for population characteristics.

Annual pressure ulcer surveys in the Netherlands and Germany have shown remarkable differences in prevalence rates. We explored the differences between the two populations, and the degree to which these differences were associated with differences in prevalence. To this end, data from 48 Dutch and 45 German facilities (n = 9772) from 2003 were analyzed. The prevalence of pressure ulcers (excluding grade 1) was 12.5% in the Netherlands and 4.3% in Germany. After adjusting for age, sex, and other risk factors, the probability of developing a pressure ulcer of stage 2 or higher in Dutch nursing homes was three times greater than in German homes.

Activities of Daily Living↗
PubMed2006

Carrier diagnostics and prevention of hemoglobinopathies in early pregnancy in The Netherlands: a pilot study.

BACKGROUND: We have offered, for the first time in The Netherlands, carrier diagnostics for hemoglobinopathies (HbP) to early pregnant women. The aim of this study was to establish whether carrier analysis would be welcome by the public and feasible at the outpatient level. METHOD: One hundred and thirty-nine randomly selected women were informed and offered basic carrier diagnostics at the first pregnancy control. RESULTS: Carrier diagnostics was accepted by 136 women (97.8%). The population consisted of 31% of recent immigrants and 69% of native Dutch. One carrier of HbS and one of beta-thalassemia were found, both among the group of the recent immigrants. In both cases, partners were tested excluding a couple at risk. In addition, five carriers of alpha(+)-thalassemia were diagnosed at the molecular level, one of them in the native Dutch population. Basic carrier analysis was done both at the Hospital Laboratory and at the Reference Laboratory. No discrepancies were found. CONCLUSIONS: This pilot study shows that (1) as predicted the prevalence of risk-related HbP and of alpha(+)-thalassemia is high in the immigrant population. (2) The compliance with carrier analysis in both native Dutch and immigrants is virtually total and (3) carrier diagnosis in early pregnancy and partner analysis in Hospital Laboratories is possible and is an effective tool for primary prevention of HbP in The Netherlands.

Adult↗
PubMed2007

Developments of the incidence of osteoporosis in The Netherlands: a PHARMO study.

PURPOSE: To assess recent and to predict future time trends in the incidence of osteoporosis using routine databases in The Netherlands in the period 1993-2015 and to compare estimations based on hip fractures versus a proxy based on pharmacy and hospitalisation data. METHODS: The incidence of hip fractures was estimated over the period 1986-2002 using information from the Dutch Medical Registry, covering more than 99% of all Dutch hospitalisations. Additionally, a proxy (hospitalisation for osteoporosis or osteoporotic fractures, treatment with glucocorticosteroids or treatment with anti-osteoporosis drugs) was constructed in order to identify osteoporotic patients in the PHARMO database. Age and gender specific incidences of hip fractures and osteoporosis were calculated and extrapolated to The Netherlands. Results of both studies were extrapolated till 2015 using a power function. RESULTS: The incidence of hip fractures decreased slightly (270 per 100,000 in 1993, 260 per 100,000 in 2002). The incidence of osteoporosis using the constructed proxy decreased from 870 per 100,000 in 1993 to 700 per 100,000 in 2002. The incidence of hip fractures and osteoporosis remained fairly constant when modelled till 2015. Both studies showed the same time trends. CONCLUSION: Both the estimations based on the hospitalisations for hip fracture and on our proxy for osteoporosis showed that the increase in the incidence of osteoporosis as observed in the 1990s is levelling off. Due to ageing of the population the absolute number of hip fractures will however increase. Our definition of osteoporosis resulted in a higher estimation of the incidence of osteoporosis and may be used in future studies to follow developments in osteoporosis prevalence and incidence.

Adult↗
PubMed2003

Audit of prenatal and postnatal diagnosis of isolated open spina bifida in three university hospitals in The Netherlands.

OBJECTIVE: To audit the current Dutch policy of prenatal detection of isolated open spina bifida based on offering detailed ultrasound examination only on indication. METHODS: A retrospective analysis of prenatally diagnosed isolated spina bifida cases and of newborns diagnosed with this condition was carried out in three university hospitals. The data were collected from databases and clinical records of the departments of prenatal diagnosis, obstetrics, neonatology, child neurology and neurosurgery of the three centers. RESULTS: Between January 1996 and December 1999, 88 cases of isolated open spina bifida were diagnosed prenatally by ultrasound investigation. Thirty-eight cases (43%) were diagnosed before the 24th week of gestation. Of these, 35 (92%) ended in termination of the pregnancy at the parents' request. Of the remaining 50 cases (57%) diagnosed after the 24th week of gestation, eight (16%) pregnancies were terminated beyond the legal limit for termination due to the severity of the condition. Of the 88 cases of isolated spina bifida, 25 infants (28%) were still alive at the age of 4 years. In the same audit period 112 newborn infants with isolated open spina bifida were admitted to the neonatology, child neurology, or neurosurgery ward of the three centers. Of these cases, 47 (42%) had been diagnosed prenatally and 65 (58%) were an unexpected finding at birth. In 24 infants (21%) surgical treatment was withheld because of the severity of the condition and predicted poor outcome, whereas the remaining 88 infants (79%) underwent surgical repair. CONCLUSION: The current practice in The Netherlands of offering ultrasound screening to high-risk patients only leads to the early detection of a minority of cases of spina bifida. Most cases are diagnosed either after the 24th week of gestation or they remain undiagnosed until after birth. When spina bifida is diagnosed before the 24th week of gestation the vast majority of parents opt for termination. In order to reduce the birth prevalence of spina bifida in The Netherlands the introduction of a policy of routine ultrasound screening should be considered.

Child, Preschool↗
PubMed1995

Possible side effects of airborne pesticides on fungi and vascular plants in The Netherlands.

A survey of the potential side effects of volatilized pesticides on fungi and vascular plants in The Netherlands has been made for two herbicides (atrazine and MCPA), a fungicide (captan) and a soil fumigant (metham sodium). By applying existing models, a prediction is presented of post-treatment dispersal and deposition due to volatilization, both at short and long ranges, and of the potential side effects on fungi and vascular plants. The general conclusion is that side effects (stunting and growth anomalies) are to be expected outside the target area, especially close (< 500 m) to treated plots with atrazine and metham sodium. In view of agricultural acreage in The Netherlands, these short-range effects may impinge on a relatively large scale. There may also be an impact at greater distances from treated plots, especially in the case of compounds that are slow to degrade such as MITC (methyl isothiocyanate), the active toxic moiety generated in soil from metham sodium.

2-Methyl-4-chlorophenoxyacetic Acid↗
PubMed1993

International comparison of odor threshold values of several odorants in Japan and in The Netherlands.

The purpose of this paper is to compare the published odor threshold values of six odorants. In Japan, all of the odor threshold values used in the Offensive Odor Control Law (enacted in 1972) were determined in an odor-free room (4 m3) by a trained panel (20 men, ages 30-45 years who were perfumers) who sniffed the odors directly and made absolute judgments of odor quality and intensity. In The Netherlands, sensorial odor concentration measurements were made with an olfactometer in a mobile sniffing car with eight panelists, four men and four women, ages 18-40 years. Such presentations are repeated with different dilution ratios. Comparison of the threshold data for the six different compounds given as the barely perceptible concentration level revealed striking similarities for hydrogen sulfide (in Japan 0.0005 ppm/in The Netherlands 0.0003 ppm), phenol (0.012/0.010), styrene (0.033/0.016), toluene (0.92/0.99), and tetrachloroethylene (1.8/1.2) but not for m-xylene (0.012/0.12). Such a similarity was not found with any other literature sources.

Adolescent↗
PubMedDate not supplied

Detecting the medically compromised patient in dentistry by means of the medical risk-related history. A survey of 29,424 dental patients in The Netherlands.

BACKGROUND: This study focuses on the detection of medically compromised dental patients in the Netherlands by means of a validated patient-administered medical risk-related history (MRRH). Due to social changes and scientific innovations in the past decade, more medically compromised patients will be needing special dental treatment. METHODS: The medical problems of 29,424 dental patients (age 18 years and over) from 50 dental practices in the Netherlands were registered by means of the MRRH. The patients were classified according to the ASA risk-score system, which was modified for dental treatment. An inventory of the number and nature of medical problems and the modified ASA risk score was drawn up in relation to dental treatment and age. RESULTS: The average age of the patients was 37.1 +/- 13.5 years. According to the current guidelines, dental treatment must be modified if the patient has an ASA score of III or IV. A relatively high percentage of patients ages 65-74 (23.9%) and 75 or over (34.9%) did have an ASA score of III or IV. Furthermore, the medical problems were classified into 10 categories, and the relationship to age was examined. The conditions that increased with age were hypertension and cardiovascular, neurological, endocrinological, infectious, and blood diseases. CONCLUSIONS: For the dental practice, these results mean that the MRRH can play an important role in adapting dental treatment to the specific needs of patients. This is especially important in the case of elderly patients.

Adolescent↗
PubMed1999

Primordial prevention of cardiovascular disease risk in The Netherlands.

Developments about cardiovascular disease (CVD) risk factors in The Netherlands since the 1970s are described in relation to health policy. The prevalence of hypercholesterolemia, hypertension, and obesity changed little in the 1970s and 1980s. In recent years, however, the prevalence of hypercholesterolemia tended to decrease and that of obesity to increase. The prevalence of hypertension remained stable but the percentage of treated hypertensives declined since 1987. Between 1958 and 1993 the percentage of male smokers decreased from 90% to about 40%. In women the percentage of smokers decreased from about 40% in 1975 to about 30% in 1993. Between 1987 and 1992 the intake of saturated fat decreased from 16.5 to 14.1% of energy. But during that period the intake of vegetables also decreased from 144 to 128 g/day and that of fruits from 125 to 114 g/day. Recent surveys show that up to age 65, approximately 25% of the Dutch population is physically inactive. This percentage increases sharply after age 65. Health policy for primordial prevention of CVD in The Netherlands is aimed at reduction of smoking prevalence, improvement of dietary habits, and promotion of physical activity.

Cardiovascular Diseases↗
PubMed2000

Independent introduction of transmissible F/D recombinant HIV-1 from Africa into Belgium and The Netherlands.

Most HIV-1 subtype F viruses described so far have been isolated from individuals originating in South America, Romania, or Central Africa. Previous studies have shown that subtype F viruses from these three areas can be distinguished by phylogenetic tree analysis of various parts of the HIV genome. Subtype F strains circulating in Central Africa and classified as subgroup F2 and F3 have relatively large nucleotide distances from strains of subgroup F1, which includes some African strains, along with strains from Romania and South America. Subtype F strains have now appeared in Europe. In this study, we analyzed the complete gag gene and a large fragment of the pol gene of seven strains of African origin that represent the three F subgroups. At least five of the seven strains appear to be intersubtype recombinants. Of four strains circulating in Belgium and the Netherlands, three were F/D mosaics and the fourth harboured a G(gag)/GH(pol)/F3(env) recombinant structure. Two of the three F/D mosaics showed identical breakpoints and were independently introduced in Belgium and the Netherlands. At least two of the mosaics were further transmitted. The remaining three strains of the seven we studied were isolated from individuals in Cameroon. Two included large or smaller F1 fragments in gag and pol. The third strain was subtype D along the entire gag and pol fragment. A parental African subtype F that showed no evidence for recombination was not found.

Africa↗
PubMed1993

Chemical threat to birds and mammals in The Netherlands.

This article reviews the impact of xenobiotic substances on wild birds and mammals in The Netherlands, as recorded in the field over the past 25 yr. First, a brief survey is given of population trends during this period, using a few illustrative examples to indicate the role played by "environmental policy themes" other than diffusion. The present review of the policy theme diffusion is not intended to be exhaustive, but to provide a broad summary of the nature of the problems involved. Based on this review, conclusions are drawn about the ecological compatibility of various groups of xenobiotics with respect to birds and mammals. Because policy-makers are interested in the relative significance of both the various groups of substances and the various environmental themes for the decline of bird and mammal populations in The Netherlands, a provisional estimate of these contributions is also presented. The main conclusion is that, in the context of the policy theme diffusion, PCBs and pesticides have the greatest impact on birds and mammals. PCBs have an impact up to the species level, whereas the main impact of pesticides today is probably ecological, that is, foraging and habitat changes. It is also concluded that the share of the theme diffusion in the sum total of negative environmental influences is approximately one-quarter.

Animals↗
PubMed1992

Canadian Mennonites and individuals residing in the Friesland region of The Netherlands share the same molecular basis of 17 alpha-hydroxylase deficiency.

A common mutation within the CYP17 gene that causes 17 alpha-hydroxylase deficiency, a form of congenital adrenal hyperplasia, has been found by direct sequencing of polymerase chain reaction (PCR) fragments of genomic DNA from six families residing in the Friesland region of the Netherlands. The mutation is a 4-base duplication within exon 8 of the CYP17 gene, which alters the reading frame encoding the C-terminal 26 amino acids of cytochrome P45017 alpha. This mutation has previously been found in two Canadian patients who are members of ostensibly unrelated Mennonite families. The Mennonite Churches derive their name from Menno Simons, an early leader of the sect in Friesland. Presumably this 4-base duplication appeared within the Friesian population prior to emigration of the Mennonites from the Netherlands.

Adrenal Hyperplasia, Congenital↗
PubMedDate not supplied

Changing patterns in graduate surgical education in The Netherlands.

An overview is presented of the organization, outline, and contents of graduate surgical training programs in The Netherlands. Adaptations of these programs to changes in demands in surgical practice and health care delivery systems are discussed. Special emphasis is given to the relation of surgery and the surgical specialties, additional training, theoretic training, and manpower planning. The principal questions regarding the optimal way to respond to changing concepts in the field of surgery are presented and discussed in the context of the situation in The Netherlands, but they seem to be similar in the surgical communities of many countries.

Delivery of Health Care↗
PubMed1992

The incidence of male childhood type 1 (insulin-dependent) diabetes mellitus is rising rapidly in The Netherlands.

This study evaluates the cumulative incidence of Type 1 (insulin-dependent) diabetes mellitus in male army conscripts 0-18 (inclusive) years of age in the Netherlands (birth cohorts) over 10 years. Data from 2136 cases were retrieved from files of the conscript registry of the Royal Dutch Army. Ascertainment was sought by the capture-recapture method, achieving an average ascertainment rate of 89.7%. Poisson regression modelling was used to determine the change in incidence over time. A significant non-linear increase in the incidence of insulin-dependency in the birth cohorts of 1960-1970 was found. The cumulative incidences of the early birth cohorts 1.85/1000 (1960), 1.76/1000 (1961), 1.11/1000 (1962) were considerably lower than of the later birth cohorts 1.96/1000 (1968), 2.11/1000 (1969), 2.12/1000 (1970). Overall the risk of Type 1 diabetes increased on the average 4.4% with each annual birth cohort. Only for the 1962 birth cohort was a significant dip in the incidence observed. The results indicate a rapidly increasing incidence of diabetes in males in the Netherlands consistent with the concurrent rapid rise in Northern Europe, found in both sexes.

Adolescent↗
PubMed1992

Muskrats as carriers of pathogenic leptospires in The Netherlands.

Leptospires were isolated from 24 of 327 (7%) muskrats (Ondatra zibethicus) caught in The Netherlands. All isolates were identified as Leptospira interrogans. One isolate was typed as serovar copenhageni in the Icterohaemorrhagiae serogroup, one as serovar lora in the Australis serogroup. Twenty-one isolates showed a close relationship with serovars grippotyphosa, valbuzzi, muelleri and ratnapura from the Grippotyphosa serogroup. One isolate was lost. Sera from 196 muskrats were examined by the microscopic agglutination test. Forty-five (23%) sera reacted positively (titers greater than or equal to 1:160), 42 (21%) of these 45 sera to Grippotyphosa and 3 (2%) to Sejroe serogroup antigens. This is the first report of serological and cultural evidence of leptospira infection in muskrats in The Netherlands.

Animals↗
PubMed1994

Does it matter where I live in Western Europe? An analysis of regional mortality differentials in Belgium, Germany and the Netherlands.

"Regional differentials in life expectancy at birth during the 1980s in Belgium, The Netherlands and some parts of the former Federal Republic of Germany are presented and commented upon. Life expectancy at birth during the 1980s was highest in the Netherlands, and lowest in some parts of southern Belgium. Substantial differentials existed in 1980, particularly because of differential mortality due to diseases of the circulatory system, lung cancer, breast cancer, motor vehicle accidents and suicide. These differentials persisted throughout the 1980s, but gradually converged. Gains in life expectancy were mainly due to declining cardiovascular and cerebrovascular mortality. Sharp and persistent differentials between border regions in the study area point to societal and cultural forces bringing about dividing lines between relatively homogeneous mortality profiles." (SUMMARY IN FRE)

Belgium↗
PubMed1990

Patients refused admission to psychiatric hospitals in The Netherlands.

In The Netherlands unforeseen and unwanted effects of the "de jure" policy of the government are outpatient waiting lists and refusal of applications for admission to mental hospitals. A register of applications of six mental hospitals in the northern part of The Netherlands reveals that there are significant differences between admitted and refused patients with regard to juridical status, urgency, catchment area, referral source, age and type of problems.

Adult↗