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PubMed1999

Classical swine fever in The Netherlands 1997-1998: a description of organisation and measures to eradicate the disease.

The central and regional organisation of the campaign to eradicate the CSF epidemic in The Netherlands in 1997/1998 is described. The main instruments used in the campaign were based on stamping-out and movement restrictions specified by the European Union. Additional instruments were used for the first time, namely, pre-emptive culling of contact and neighbouring farms, compartmentalisation of transport, monthly serological screening in established surveillance areas and supervised repopulation of all farms in the former surveillance zone. Two other measures, the killing of very young piglets and a breeding ban were introduced to reduce production in established surveillance zones. Several factors complicated the eradication campaign, for instance, the late detection of the first infection; artificial insemination as a source of infection; the organisation of pig farming in The Netherlands, with its highly concentrated production and dependence on the transport of stock from one unit to another; insufficient rendering capacity; decreasing sensitivity of clinical inspection; and extremely high costs.

Animal Husbandry↗

PubMed2001

Determination of the accuracy of implant reconstruction and dose delivery in brachytherapy in The Netherlands and Belgium.

PURPOSE: To gain insight into the accuracy of brachytherapy treatments, the accuracy of implant reconstruction and dose delivery was investigated in 33 radiotherapy institutions in The Netherlands and Belgium. MATERIALS AND METHODS: The accuracy of the implant reconstruction method was determined using a cubic phantom containing 25 spheres at well-known positions. Reconstruction measurements were obtained on 41 brachytherapy localizers, 33 of which were simulators. The reconstructed distances between the spheres were compared with the true distances. The accuracy of the dose delivery was determined for high dose rate (HDR), pulsed dose rate (PDR) and low dose rate (LDR) afterloading systems using a polymethyl methacrylate cylindrical phantom containing a NE 2571 ionization chamber in its centre. The institutions were asked to deliver a prescribed dose at the centre of the phantom. The measured dose was compared with the prescribed dose. RESULTS: The average reconstruction accuracy was -0.07 mm (+/-0.4 mm, 1 SD) for 41 localizers. The average deviation of the measured dose from the prescribed dose was +0.9% (+/-1.3%, 1 SD) for 21 HDR afterloading systems, +1.0% (+/-2.3%, 1 SD) for 12 PDR afterloaders, and +1.8% (+/-2.5%, 1 SD) for 15 LDR afterloaders. CONCLUSIONS: This comparison showed a good accuracy of brachytherapy implant reconstruction and dose delivery in The Netherlands and Belgium.

Belgium↗

PubMed2000

Control of aphid-borne Lily symptomless virus and Lily mottle virus in Lilium in the Netherlands.

An overview is presented on the management of viruses of Lilium crops in the Netherlands since the 1960s. This mainly concerns Lily symptomless virus (LSV) and Lily mottle virus (LMoV). Various factors which affect the efficiency of control are considered. The variable symptoms of LMoV in the many vegetatively propagated cultivars grown (c. 340) pose problems in the efficient roguing of diseased plants of some cultivars. Additionally the acceptable incidence of viruses such as LSV which are generally symptomless in field-grown plants may cause problems under the unfavourable light and growing conditions of year-round cut-flower production in greenhouses. The reduction in bulb yield and quality caused by viruses of lilies necessitates a further decrease in the already low virus levels still tolerated in lily bulb stocks. The routine detection of LSV and LMoV by ELISA has been developed extensively over the years. The impact of testing bulbs ('bulb test') during storage has been important in achieving an overall decrease in virus incidence in many stocks of lily cultivars, e.g. in Asiatic hybrids. The 'leaf test' used to assess many other cultivars, e.g. oriental hybrids, in which the bulb test for LMoV is not applicable, will be developed so as to eliminate at an early stage severely infected stocks that were initially intended for further propagation. The spread of the aphid-borne LSV and LMoV generally occurs very rapidly. The low virus incidence in the initially virus-tested stocks obtained by tissue culture procedures is effective in decreasing the access of vectors to virus-infected lilies. The viruses spread mainly in June and July, considerably less in May and least in August/September. Consequently the routine spraying of mixtures of mineral oil and pyrethroid insecticide is generally done weekly in May, June and July and fortnightly in August and September. There are differences in efficacy of the different brands of mineral oil. The rapid propagation of lilies, as done routinely by the scaling of bulbs and by tissue culture procedures, enables the rapid bulking of virus-tested and other stocks of high quality which have the health status required. The impact of the different factors in the management and control of viruses in Lilium crops in the Netherlands is discussed.

Animals↗

PubMed2001

Timing of adoption of laparoscopic cholecystectomy in Denmark and in The Netherlands: a comparative study.

Laparoscopic cholecystectomy (LC) has diffused rapidly in most industrialised countries. The aim of this study has been to analyse the impact of different hospital characteristics on the hospital adoption of LC in Denmark and The Netherlands. Data on the timing of the adoption of LC and hospital characteristics (hospital size, teaching status and location) were retrieved in both countries. Proportional hazard regression was used to analyse different multivariate models. A total of 59 Danish and 109 Dutch hospitals adopting LC were identified. The multivariate analyses showed that increased hospital size was associated with relatively early adoption of LC in Denmark. Neither this nor other hospital characteristics influenced the timing of adoption in The Netherlands. As in other countries studied, hospital size is identified as an important factor in hospital adoption, whereas teaching status and location play a more limited role. The study shows that a multivariate method, such as the proportional hazard regression, can be used to elucidate differences among countries of the impact of different factors on the adoption of medium-ticket technologies like LC. Such multinational comparisons provide valuable information for health policy and planning.

Cholecystectomy, Laparoscopic↗

PubMed2002

Free choice of sickness funds in regulated competition: evidence from Germany and The Netherlands.

Sickness funds became the focal point of health insurance reforms in the 1990s. Policy makers expected funds to become more consumer-oriented and more active in managing the provision of health care. This is especially true for two countries in the heart of Europe that, on first view, have many similar institutional characteristics. Both Germany and The Netherlands have introduced competition between sickness funds in the last decade. We present extensive quantitative, as well qualitative, data with regard to the behaviour of consumers after the introduction of free choice between sickness funds. National data was used with regard to contribution rates and member flows and survey data was used to investigate personal motives for actual change and perception of differences between sickness funds. In Germany, contribution rates between sickness funds differ significantly. Accordingly, these differences are the main reason for consumers to switch funds, which occurs on a considerable scale. However, survey data show that other reasons may be important too. In The Netherlands, premium differences are much lower. The same is true for the degree of change. Survey data show that consumers perceive very small differences between sickness funds and do not see much reason for change. Our findings support the claim that the degree of actual changing depends strongly on economic incentives, especially with regard to the extent of financial risk sickness funds have to bear and to the extent premiums or contribution rates can differ. However, the higher the financial risk of individual sickness funds actually is, the higher the incentives for risk selection.

Choice Behavior↗

PubMed2002

Priority setting for health technology assessment in The Netherlands: principles and practice.

The resources for health technology assessment fall short of that needed to evaluate all health technologies. Therefore, priorities have to be set. In The Netherlands, the Health Care Insurance Board tried to address this issue by developing a more explicit priority setting procedure for the Fund for Investigative Medicine, which is the most important health technology assessment programme in The Netherlands. The procedure provides one of the first examples of the application of theoretical principles for priority setting. The aim is to select those health technologies for assessment that are most relevant for policy-making. To determine the policy relevance of research proposals, different procedures for categorising, scoring, and weighting policy criteria were defined, and different classification strategies were explored. Our first experiences using the priority setting procedure are described by means of an example on low back pain. Subsequently, the procedure has been applied to research proposals submitted to the Fund for Investigative Medicine in 1998 to illustrate how decisions on the funding of health technology assessments can be guided. The results show a different rating of research proposals into one of three predefined categories of policy relevance, high, intermediate and low, implying that decisions about funding can heavily dependent on the selected procedure. Therefore, it seems to be important that the selected procedure reflects the viewpoint of the organisation wishing to set priorities. The different ratings of the research proposals using a more explicit procedure suggest that there may be scope for further development and application of the procedure.

Health Policy↗

PubMed1999

Towards a reinforced agency role of health insurers in Belgium and The Netherlands.

This article describes some recent developments in health insurance in Belgium and the Netherlands. Both countries are moving towards greater financial responsibility of health insurers by means of risk-adjusted capitation payment systems. Although for the unwary observer it would appear as if both countries were following similar paths towards a common model, the authors make clear that rather different underlying rationales are driving these trends. In the Netherlands, the grand design 'Dekker proposal' for regulated competition has been replaced by a more gradual implementation of reforms with more limited scope. The ultimate goal remains a system of managed competition, albeit only for part of the health care services. In Belgium, prospective risk-adjusted capitation payment has always been at the heart of the original system in principle since its inception, but non-enforcement led to retrospective and inequitable financing in practice. Although the rhetoric of managed competition has never been used explicitly in any Belgian official government policy document, it seems unlikely that putting the insurers at financial risk without simultaneously also reinforcing their agency role by providing instruments for care management-like, for example, selective contracting--is viable in the longer run without jeopardizing the solvency of the insurers. The authors conclude that although the logic of the managed competition model is appealing, the lack of conclusive empirical evidence of success elsewhere makes governments reluctant to surrender their traditional cost containment tools. But making insurers financially accountable without simultaneously providing them with tools to take on the accountability seems useless and illogical.

Belgium↗

PubMed1984

Epidemiological aspects of canine leptospirosis in the Netherlands.

The epidemiology of canine leptospirosis has been examined in a limited study in the Netherlands from 1969 through 1982. Leptospira interrogans serotype icterohaemorrhagiae and canicola were found to be the only serotypes causing clinical leptospirosis. However, positive agglutination titres to the serotypes grippotyphosa, bratislava, poi and ballum have also been detected. The incidence of infection caused by serotype icterohaemorrhagiae was highest during summer and autumn. Infections with serotype canicola were more evenly distributed over the year with only a slight increase during summer and autumn. Infections caused by serotype canicola were significantly more prevalent in male dogs, whereas infections with serotype icterohaemorrhagiae were found both in males and females in almost equal numbers. The incidence of infections with serotype icterohaemorrhagiae was highest in immature dogs. Infections with serotype canicola were detected in young as well as older animals. In contrast to the situation in the past, infections with serotype icterohaemorrhagiae are now more common than those caused by serotype canicola, which have become rare. The highest incidence of infection was found in the western part of the country. The majority of infections was demonstrated in guard-dogs and sporting-dogs. Dogs proved to be of minor importance as a source of human infection in the Netherlands.

Age Factors↗

PubMed2003

The 2373insG mutation in the MYBPC3 gene is a founder mutation, which accounts for nearly one-fourth of the HCM cases in the Netherlands.

AIMS: Hypertrophic cardiomyopathy (HCM) is caused by mutations in genes that encode sarcomeric proteins. In this study we investigated the involvement of the sarcomeric myosin binding protein C in the Dutch HCM population. METHODS AND RESULTS: We initially screened 22 Dutch index patients for mutations in the MYBPC3 gene, which revealed four different mutations in 14 patients. The 2373insG mutation was identified in 10 apparently unrelated patients. A subsequent screening for the 2373insG mutation in a group of another 237 unrelated HCM patients revealed 50 additional carriers of the same genetic defect. Genotyping with polymorphic repeat markers and intragenic SNPs of the 60 Dutch as well as two German and five North American 2373insG carriers indicated they all share the same haplotype. CONCLUSION: The 2373insG mutation accounts for almost one-fourth of all HCM cases in the Netherlands (60/259), which is predominantly present in the northwestern part of the country (22/66) and is a founder mutation probably originating from the Netherlands.

Cardiomyopathy, Hypertrophic, Familial↗

PubMed1998

Report from Working Group 3 (the Czech Republic, Denmark, Finland, Norway, The Netherlands, Slovakia, Sweden and the UK).

The Czech Republic, Denmark, Finland, Norway, the Netherlands, Slovakia, Sweden and the UK all have very low HBsAg carrier rates; in the Scandinavian countries, for instance, carrier rates are on the order of 0.05%. Most countries in this group are unconvinced that the carrier rates and the burden of disease caused by new hepatitis infections warrant the expense of universal childhood immunization. In Scandinavia and the UK hepatitis B prevention programmes are based on immunization of high-risk groups. In Scandinavia (excepting Denmark), the UK and the Netherlands, pregnant women are screened and newborns of carrier mothers vaccinated. Only the Czech Republic and Slovakia--both of which now employ high-risk group strategies of hepatitis B prevention--have expressed interest in implementing programmes of universal hepatitis B vaccination of infants and/or adolescents.

Czech Republic↗

PubMed2003

The effect of small peer group continuous quality improvement on the clinical practice of midwives in The Netherlands.

OBJECTIVE: To study the effects of small group continuous quality improvement (CQI) on the clinical practice of midwives in the Netherlands. DESIGN: Randomised pre-/post-test (balanced block). INTERVENTION: The CQI groups were assigned to either the set of peer review topics including 'perineal repair' and 'artificial rupture of the membranes (ARM)', or to the set of topics including 'airway aspiration' and 'measuring blood pressure'. The two research groups acted as each other's control group. SETTING: The Netherlands. PARTICIPANTS: Two hundred and fifty-five individual midwives practising in primary and secondary care who made up 28 peer groups. MEASUREMENT AND KEY FINDINGS: Questionnaires were used to collect data on clinical practice prior to the start of the intervention and one year later. Pre- and post-test data were received from 156 respondents. The intervention had a positive effect on adherence to the recommendations with respect to airway aspiration of the baby and measuring blood pressure. For ARM, no difference was found between pre- and post-test adherence to recommendations in the intervention group, while in the control group, the percentage of midwives that adhered to the recommendations decreased in the period between pre- and post-test. No significant effect was found for perineal repair. IMPLICATIONS FOR PRACTICE: Small group CQI had a positive effect on changing clinical practice when the learning of new skills (e.g. learning a new suturing technique) was not necessary. Additional interventions are needed when implementing guidelines that recommend the learning of new skills.

Adult↗

PubMed1998

Mortality decline in The Netherlands in the period 1850-1992: a turning point analysis.

The aim of this paper is to give a detailed and fairly objective description of rapid mortality decline in The Netherlands between 1850 and 1992 with respect to the start, end, and phases of the decline. Turning points were estimated for the standardized mortality trend, and for age and sex-specific trends between 1850-1992. The technique used was derived from spline functions. The turning points divided the trends into phases with different paces of decline. Standardized mortality started to decline rapidly in The Netherlands around 1880. Four phases in the period of decline could be distinguished: 1880-1917 (1.2% annually), 1917-1955 (1.6%), 1955-1970 (0.4%), 1970-1992 (1.1%). For nearly all age groups, the most rapid decline occurred in a period comparable to 1917-1955. Causes of death which might have shaped the standardized mortality trend are, among others, respiratory tuberculosis (1917), heart disease (except ischemic) (1955), and ischemic heart disease (1970). Causes of death that shaped the mortality trend are related to trends of determinants of mortality decline. The technique used in this paper can also be applied to other trends e.g. fertility decline.

Cause of Death↗

PubMed2000

Consultation with another physician on euthanasia and assisted suicide in the Netherlands.

Consultation with another physician is considered to be an important safeguard of the practice of euthanasia and physician-assisted suicide. The objective is to describe the frequency and characteristics of consultation in cases of euthanasia or physician-assisted suicide (EAS) in the Netherlands. Data from two cross-sectional descriptive nationwide surveys, carried out in 1995, were used. Questionnaires were mailed to physicians attending 6060 deaths, identified from death certificates, and a stratified sample of 405 physicians were interviewed. In 1990, a cross-sectional descriptive postal survey of a random sample of 1042 general practitioners took place. Consultation took place in 63% of cases of EAS in the Netherlands, in 99% of the cases reported to the public prosecutor and in approximately 37% of unreported cases. In almost half of the unreported cases the decision had been discussed less formally with at least one colleague. In 1990, 7% of general practitioners met all 8 criteria for good consultation; this increased to 64% in 1995. Of the respondents, 26% had at some time advised against performing euthanasia or assisted suicide when acting as a consultant. This study shows that approximately two thirds of all cases of EAS are safeguarded by consultation. Although in the majority of these cases the consultation is of good quality, there is certainly still room for improvement. The quality of consultation could be improved, for instance, by appointing independent and specifically trained consultants.

Euthanasia↗

PubMed2001

What happens to patients starting dialysis in the Netherlands?

BACKGROUND: despite improvements in dialysis technology, publications around 1990 showed increasing mortality rates in dialysis patients. The Dialysis Group of the Netherlands initiated the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) to investigate the association of patient and therapy characteristics with outcome. METHODS: 250 patients were included in this prospective multicentre study 3 months after the start of dialysis. We used Cox regression to predict mortality and technique failure and repeated measures analysis of variance to study the time course of continuous parameters. RESULTS: there were considerable differences in patient populations among dialysis centres. Patient survival was 76% at 2 years. Technique survival was higher in haemodialysis. Hospitalisation decreased from 25 days between 3 and 12 months to 19 days per patient year in the third year. Residual renal function decreased at a similar rate in both modalities, but blood pressure tended to increase in females receiving peritoneal dialysis. Outcome was predominantly dependent on patient characteristics. CONCLUSIONS: In the light of the increasing age of patients starting dialysis, increasing mortality can be expected. Furthermore, if outcome is to play a role in the quality assessment of dialysis centres, it is essential to know the characteristics of their patient populations.

Age Factors↗

PubMed2001

Experts' opinions on the profile of optimal care for patients with diabetes mellitus type 2 in the Netherlands.

BACKGROUND: The St. Vincent Declaration has resulted in discussions and initiatives on optimal diabetes care during recent years. Both are based on two sources of knowledge: evidence and experience. We wanted to reveal the experience based knowledge in the Netherlands to identify essential elements or prerequisites for high quality type 2 diabetes care. METHODS: A group of 56 experts on diabetes care were invited to fill in a questionnaire. This included a ranking of 18 elements on the organization of diabetes care and 9 on patient education. RESULTS: The response rate was 87.5%. With regard to the organization of care 'active patient participation', 'protocolized care' and 'patient education' were evaluated as the most important. The integration in daily diabetes care was seen as the most important aspect of patient education. Optimal diabetes patient education would include five sessions (range: 1-10) of 1 h (range: 0.25-3) with active follow-up. The most appropriate disciplines for patient education are the diabetes nurse (chosen by 93% of the experts) and the dietician (77%). CONCLUSIONS: Optimal care for diabetes mellitus type 2 consists of structured care with integrated patient education. The majority of the experts indicated that this is not optimally organized within the Netherlands.

Attitude of Health Personnel↗

PubMed2000

Perceived barriers to the implementation of diabetes guidelines in hospitals in The Netherlands.

OBJECTIVE: To determine the organisational and personal barriers to the implementation of diabetes guidelines in hospitals in The Netherlands and relate them to structural factors of diabetes care. METHOD: In a written survey internists specialised (or with a specific interest) in diabetes in all general hospitals in The Netherlands (n = 120) were asked to indicate the perceived organisational and personal barriers to adherence to the diabetes guidelines. In the same questionnaire their activities related to diabetes care and the working hours of the additional personnel involved were measured. RESULTS: There was at least one specialised diabetes nurse employed in all hospitals, although the extent of the appointment varied widely from 0.2 to 6.9 full-time equivalent (average 1.5). In most hospitals (90%) a diabetes care team had been established, while podiatrists were working in only 72% of the hospitals. Furthermore, 65-80% of the hospitals organised special consultation hours for diabetic patients, had a protocol for diabetes treatment, or patient held administration booklets. The most frequently mentioned barriers to the implementation of diabetes guidelines were high workload, no adequate financial compensation, and a shortage of necessary personnel. CONCLUSION: A number of preconditions for structured diabetes care, like the presence of a diabetes team and a specialised diabetes nurse, were in place. However, large differences between the hospitals in the organisation of diabetes care and the availability of staff, together with the related perceived barriers to the implementation of the guidelines showed that there are still many opportunities for improvements.

Attitude of Health Personnel↗

PubMed2002

Estrogenic effects in fish in The Netherlands: some preliminary results.

Recently, a large-scale field study in The Netherlands has focused on the effects of estrogenic contaminants on feral fish populations. The freshwater bream (Abramis brama) and the estuarine flounder (Platichthys flesus) were sampled at a large number of locations in the spring and autumn of 1999. Concentrations of the yolk protein vitellogenin (VTG) in blood plasma of male flounders were small at most sites. At two sites, however, moderately elevated concentrations were found in autumn. Both sites were situated in the same industrial harbour zone also receiving effluent from sewage treatment works. At many sites VTG levels in male bream were significantly greater than at the control site. The greatest concentrations were observed in individuals collected from a small stream, close to the discharge of a relatively large municipal waste water treatment plant. This was also the only site where considerable intersex occurred; 37% of male bream exhibited ovotestes. Ovotestis was not observed in any of the male flounder captured. The results from The Netherlands are briefly discussed and compared with the well-known case studies in the UK.

Animals↗

PubMed1998

Increased maternal mortality in The Netherlands from group A streptococcal infections.

OBJECTIVE: To assess genital tract sepsis-related maternal mortality in The Netherlands during 1983-1992. STUDY DESIGN: A nationwide Confidential Enquiry into the causes of maternal death. RESULTS: Genital tract sepsis-related maternal mortality during 1983-1987 was 0.11 per 100,000 live births (1/893,998) and 0.93 per 100,000 live births (9/968,990) during 1988-1992. The relative risk of dying due to sepsis in the second 5-year period as compared to the first period was 10.1 (1/72 versus 9/72 maternal deaths; 95% CI 1.3-82.3; P < 0.01). CONCLUSIONS: Also in The Netherlands an increase of death due to genital tract sepsis has been observed since the 1980s.

Female↗