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PubMed1998

Aspects of food and fluid intake during labour. Policies of midwives and obstetricians in The Netherlands.

OBJECTIVE: This study outlines the current policies on food and fluid intake during labour in The Netherlands and discusses the pro's and con's of food-restriction. STUDY DESIGN: 50 midwives and 30 obstetricians were asked about their actual policy on food and fluid-intake during labour. RESULTS: A restrictive policy during normal labour is followed by 20% of the midwives and 14% of the obstetricians. About 75% leaves the decision on food and fluid-intake to the women themselves. CONCLUSIONS: Despite the non-restrictive policy in The Netherlands, the mortality due to the Mendelson-syndrome is not higher than in countries where a restrictive policy is followed. During normal labour there are no conclusive reasons for food or fluid-restriction. From a metabolic point of view it is hypothesized that the intake of energy-rich substrates may have a positive influence on labour progression. Further study on the subject seems indicated.

Drinking↗
PubMed1998

Contribution of congenital malformations to perinatal mortality. A 10 years prospective regional study in The Netherlands.

OBJECTIVE: : To determine the precise contribution of congenital malformations to perinatal mortality in a region. DESIGN: Prospective, descriptive. SETTING: Region, Delft-Westland-Oostland (DWO) in the Netherlands. MATERIAL AND METHODS: The registration was based on data concerning all deliveries of women domiciled in the health region DWO of the Netherlands. The incidence and contribution of congenital malformations to perinatal death was evaluated by a team consisting of a gynaecologist. a paediatrician and a paediatric pathologist. Malformations were classified as lethal or nonlethal and recorded separately for stillbirth (from 28 weeks gestation) and liveborn infants with 7-day follow-up. RESULTS: In 10 years (1993-1992) 28983 children were born in the region DWO. The perinatal mortality was calculated as 247 cases (0.85%). The overall incidence of congenital malformations in the perinatal death-group was 33%. Lethal congenital malformations were found in 51% of the cases in the stillbirth-group and 70% of the cases in the neonatal death-group. Congenital malformations of the central nervous system are mostly lethal in the stillbirth-group (45%). Cardiovascular- and pulmonary-defects were more prominent in the neonatal period (27% and 33% respectively of the neonatal deaths). Uro-genital and minor malformations (miscellaneous) are more often seen in perinatal deaths without being a contributor to the cause of death. CONCLUSIONS: As most congenital malformations are multifactorial in origin, it is in the understanding and control of such conditions that efforts and resources should now be turned. Through a detailed postmortem fetal and placental examination and clinical-pathological correlations lethal congenital malformations were found in 51% in stillbirths (mainly central nervous system) and 70% in neonates (mainly cardiovascular and pulmonary defects).

Cardiovascular Abnormalities↗
PubMed2000

Regional trend variations in infant mortality due to perinatal conditions in the Netherlands.

CONDENSATION: In the Netherlands, regional variations in trends in infant mortality due to perinatal conditions (1984-1994) exist, which could not be explained by health care characteristics (i.e., place or supervision of delivery and the presence of specialised neonatal care). The only sociodemographic factor that showed a consistent correlation with mortality was the percentage of Roman Catholic inhabitants of a region. OBJECTIVE: To describe and explain regional variations in trends in infant mortality due to perinatal conditions. STUDY DESIGN: A mixed (geographical and temporal) ecological design has been used. Infant mortality due to perinatal conditions was defined as mortality in the first year of life caused by diseases of the newborn period (chapter XV of the ICD-9). Trends in sex-adjusted mortality for the period 1984-1994 as well as mortality levels at the start of this period were calculated using log linear regression. Linear regression was used to examine the association between mortality trends and starting levels on the one hand and both health care and sociodemographic factors on the other. RESULTS: Statistically significant variations in mortality trends were found between regions. The trends in the two Southern regions were found to deviate significantly from the national trend. No strong association was found between mortality and each of the health care factors (i.e. place and/or supervision of delivery and the presence of specialised neonatal care). The only sociodemographic factor that showed consistent results was the percentage of Roman Catholic inhabitants of a region: A higher percentage in 1985 was associated with a higher mortality in 1985 and a stronger mortality decline during the period 1984-1994. This association could not be explained by parity or the age of the mother. CONCLUSIONS: Regional differences in trends in infant mortality due to perinatal conditions in the Netherlands could not be explained by variations in health care factors. This is an important finding as the Dutch system of obstetric care, that includes a considerable number of home deliveries, has been subject to much debate. Further research that includes other causes of death and determinants is needed to unravel the causes of the trend variations.

Adult↗
PubMed2000

Risk analysis and safety policy developments in the Netherlands.

In the Netherlands, external safety policy has been developed and implemented since the early eighties on the basis of a risk-based approach involving quantitative criteria for the tolerability of risk. Good experiences have been gained with the risk policy that applies to some 4000 establishments in the Netherlands where hazardous substances are present. On the basis of these experiences, legislation is now being prepared to give the risk tolerability criteria a full legal basis. This is aimed, in particular, to balance between risk control measures at the source through the licensing system, and spatial planning instruments to protect, e.g. residential areas against major hazards. The revision of the Seveso directive (96/82/EC) leads to the implementation of an integrated form of safety reporting, evaluation and inspection. Practical tools were developed for this implementation, e.g. for facilitating the selection of establishments and for assessing risks from major hazard establishments to surface water. In the past few years, the application of risk-based safety policy has been extended to other fields than establishments, e.g. for transport of hazardous chemicals and external safety of airports.

Environmental Monitoring↗
PubMed2000

The 1997-1998 epidemic of classical swine fever in the Netherlands.

In 1997, the pig husbandry in the Netherlands was struck by a severe epidemic of classical swine fever (CSF). During this epidemic 429 CSF-infected herds were depopulated and approximately 1300 herds were slaughtered pre-emptively. In addition millions of pigs of herds not CSF-infected were killed for welfare reasons (over crowding or overweight). In this paper, we describe the course of the epidemic and the measures that were taken to control it. The first outbreak was detected on 4 February 1997 in the pig dense south-eastern part of the Netherlands. We estimate that CSF virus (CSFV) had already been present in the country by that time for 5-7 weeks and that the virus had been introduced into approximately 39 herds before the eradication campaign started. This campaign consisted of stamping-out infected herds, movement restrictions and efforts to diagnose infected herds as soon as possible. However, despite these measures the rate at which new outbreaks were detected continued to rise. The epidemic faded out only upon the implementation of additional measures such as rapid pre-emptive slaughter of herds in contact with or located near infected herds, increased hygienic measures, biweekly screening of all herds by veterinary practitioners, and reduction of the transportation movements for welfare reasons. The last infected herd was depopulated on 6 March 1998.

Animals↗
PubMed2000

Laboratory experience during the classical swine fever virus epizootic in the Netherlands in 1997-1998.

From February 1997 till May 1998 the national reference laboratory for classical swine fever (CSF) in the Netherlands was confronted with millions of samples taken from pigs during an outbreak of CSF in a pig dense region. In a limited period major logistic problems needed to be solved regarding the processing of samples and information at the laboratory facilities. In total over 2.3 million samples were examined by different CSF diagnostic methods. The majority (approximately 2.1 million) of these samples were blood samples which were tested for CSF serum antibody in a semi-automated ELISA. Approximately 166,000 samples were examined for the presence of CSF virus or viral antigen. Automated preparation and testing of blood samples for CSF serum antibody, the obligatory identification and registration system of pig holdings and the computerised laboratory management system made it possible to process the huge amount of samples and information presented in a limited period. The majority of the test results was sent to the veterinary authorities via e-mail or a computerised fax system. Of the 429 outbreaks 82% were detected via a direct immunofluorescence technique performed on cryostat sections of the tonsil. The sampling of clinically suspected pigs ('guided' sampling) for this diagnostic method provided rapid positive and negative results and thus played a paramount role during the eradication campaign. Serological surveys identified 13.5% of the infected pig holdings: such surveys proved very effective in the screening of holdings which were subjected to restrictions (protection or surveillance zones) for many months. Virus isolation performed on different types of samples detected 4. 5% of the infected pig holdings. In conclusion, analysis of data collected in the laboratory and epidemiological analysis should result in an improved eradication plan for the future control of outbreaks of CSF in the Netherlands supported by optimised CSF diagnostic methods.

Animals↗
PubMed2000

Prevalence and regional distribution of paratuberculosis in dairy herds in The Netherlands.

In the Netherlands a survey was conducted to estimate the prevalence of paratuberculosis in dairy herds. In total 15822 cows of at least 3 years of age, belonging to 378 herds were tested using an absorbed ELISA. Of these herds, 55% (n=207) had one or more serologically positive cows. Of the positive non-vaccinated herds, most had one (n=98) or two (n=49) positive cows. The percentage positive cows per herd was 2.5+/-3.2%.The true prevalences on cow and herd levels, based on a test sensitivity that ranged from 0.3 to 0.4 and a specificity that ranged from 0.985 and 0.995, were estimated at 2. 7-6.9% and 31-71%. Seven herds had been vaccinated against paratuberculosis and these herds had a significantly higher percentage of serologically positive cows (23%) than the non-vaccinated herds (2.5%). In conclusion, a small percentage of the dairy cows and a high percentage of the dairy herds in the Netherlands is serologically positive. The percentages true infected cows and herds are difficult to estimate precisely due to uncertainties in test sensitivity and specificity.

Animals↗
PubMed2002

Sero types, phage types and antibiotic susceptibilities of Salmonella strains isolated from horses in The Netherlands from 1993 to 2000.

We studied 232 Salmonella strains from horses with salmonellosis in The Netherlands, isolated in the period from 1993 to 2000 in order to provide insight in the dynamics of sero-, phage types (pt) and antibiotic susceptibilities over time. The strains were tested for susceptibility to seven antimicrobial agents using the agar diffusion method. In addition, the isolates were sero typed and Salmonella enterica subspecies enterica Typhimurium and Enteritidis strains were further phage typed. S. Typhimurium strains of phage type 506 and 401 (both classified as DT 104 in the English phage typing system) were additionally tested for their susceptibility to chloramphenicol (C), streptomycin (S) and sulfonamides (Su). Resistance was common against tetracycline and ampicillin. Most strains were susceptible to enrofloxacin (Enr) and ceftiofur (Cef). Resistance to tetracycline (T), kanamycin (K), ampicillin (A) and trimethoprim/sulfonamide (Sxt) combinations decreased from 1993 to 2000, whereas the resistance to gentamicin (G), ceftiofur and enrofloxacin was stable over time. S. Typhimurium was the predominant serovar and showed more (multiple) resistance compared to other Salmonella serovars. Sixteen different resistance patterns were found, with resistance to T alone and the combination of ACSSuT and AKSxtT being the most common. The multiresistant S. typhimurium phage type 506 (DT 104) was the most common phage type isolated from horses and most of these strains showed the pentadrug resistance pattern ACSSuT. The S. Typhimurium phage type 401 (DT 104) was also found frequently with an ASSuT resistance pattern. The most common S. Typhimurium phage types in horses corresponded with those found in humans, pigs and cattle in the same period in The Netherlands.

Animals↗
PubMed1999

Comparative sequence analysis of classical swine fever virus isolates from the epizootic in The Netherlands in 1997-1998.

Sixteen classical swine fever virus (CSFV) field isolates from outbreaks of classical swine fever from the period between February 1997 and March 1998 in the Netherlands were sequence analysed. Parts of the 5' noncoding region (5'NCR) and the E1/E2 gene were sequenced after RT-PCR. The obtained sequences were compared with isolates of recent outbreaks in Europe and those of former outbreaks in the Netherlands. Sequence alignment of the 5'NCR region (321 bp) revealed that the isolates of the Dutch outbreak of 1997-1998 were closely linked to an isolate of the CSF outbreak that started in Paderborn, Germany in 1996. A relatively large fragment of the E1/E2 gene of 850 bp, including the antigenic region of E2, which is one of the most variable regions of the CSFV genome, was sequenced to determine whether this region can be used for epidemiology within an epizootic. Epidemiological tracing of transmission of virus was followed, starting from the first isolate and a line of five generations of viruses was analysed. Besides this, new isolates which could not be epidemiologically linked to preceding ones were also characterised. Differences between the isolates of the Dutch outbreak were minor both for the linked as well as for the non-linked isolates, indicating that all isolates have a common origin. Furthermore, our data show for the first time the genetic stability of CSFV even in the highly variable antigenic region of the E2 gene during a major epidemic lasting more than 1 year.

Animals↗
PubMed2000

Cytotoxic, hepatoprotective and free radical scavenging effects of propolis from Brazil, Peru, the Netherlands and China.

Propolis is a resinous hive product collected by honeybees from various plant sources. The composition of the propolis depends upon the time, vegetation and the area of collection. Thus, quality evaluation of the propolis is important, before use in food and beverages. For this propose three different biological activities were carried out, i.e. 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity, cytotoxicity and hepatoprotective activity, of MeOH and water extracts of nine different propolis from Brazil, Peru, the Netherlands and China. The results showed that water extracts of six Brazilian and a Chinese propolis possessed stronger DPPH free radical scavenging activity than the corresponding MeOH extract, whereas in the case of Netherlands and Peruvian propolis MeOH extract exhibited stronger DPPH free radical scavenging activity. The MeOH extracts of all propolis possessed stronger cytotoxicity than the corresponding water extract towards murine colon 26-L5 carcinoma and human HT-1080 fibrosarcoma cells. The result of hepatoprotective activity of Brazilian propolis on D-galactosamine (D-GalN)/tumor necrosis factor-alpha (TNF-alpha)-induced cell death in primary cultured mouse hepatocytes were found in accordance with the grade set up by beekeepers in Brazil.

Animals↗
PubMed2002

Antiproliferative activity of the Netherlands propolis and its active principles in cancer cell lines.

The MeOH extract of the Netherlands propolis showed promising antiproliferative activity toward highly liver-metastatic murine colon 26-L5 carcinoma with an EC(50) value of 3.5 microg/ml. Further, antiproliferative activity-guided purification of the MeOH extract led us to isolate four flavonoids (1-4), seven cinnamic acid derivatives (5-11) and two new glycerol derivatives (12, 13), whose structures were elucidated on the basis of spectral analysis. The isolated compounds were tested for their antiproliferative activity against murine colon 26-L5, murine B16-BL6 melanoma, human HT-1080 fibrosarcoma and human lung A549 adenocarcinoma cell lines. The benzyl (9), phenethyl (10) and cinnamyl caffeates (11) possessed potent antiproliferative activities with EC(50) values of 0.288, 1.76 and 0.114 microM, respectively, toward colon 26-L5 carcinoma. These caffeates were considered to be active constituents of the Netherlands propolis in their antiproliferative activity. The antioxidative activity of these caffeates may play an important role in their antiproliferative activities.

Animals↗
PubMed2001

Driving under the influence of alcohol and/or drugs in the Netherlands 1995-1998 in view of the German and Belgian legislation.

This study presents the test results of blood and urine samples of impaired drivers in the Netherlands between January 1995 and December 1998. In this period, the blood alcohol concentrations of 11,458 samples have been determined and 1665 blood or urine samples have been analysed for drugs. The median alcohol concentration was between 1.7 and 1.8 mg/ml blood. In 80% of the 1665 analysed samples drugs were detected. At least 42% (702/1665) of the impaired drivers were poly-drug users, with cocaine present in the most frequent combinations. In the Netherlands, the procedure to prove driving under the influence is complex. This procedure can be made more efficient and more effective by embedding the analytical test results, needed to prosecute an impaired driver, in the law. In Belgium and Germany, such laws already are in force. If we would apply the qualifications of the new Belgian law on our analytical data, 67% of the impaired drivers included in this comparison could have been prosecuted without discussion in court.

Alcoholic Intoxication↗
PubMed2003

Forensic cases involving the use of GHB in The Netherlands.

In this study, forensic cases involving the use of Gamma Hydroxy Butyric acid (GHB) from the second half of 1999 through the second half of 2001 in The Netherlands (blood >5mg/l and urine >10mg/l) are described. GHB was analysed by GC-MS after lactone formation and using GHB-d6 as internal standard. The results are divided into three groups: cases of chemical submission, cases of driving under the influence and cases of unknown causes of death.GHB was found in six cases of possible chemical submission. In these cases, relatively low concentrations of GHB were found. The results show that in cases of chemical submission, urine should be analyzed, because GHB is present longer in urine than in blood. The police should collect the samples in containers that do not contain citrate as anticoagulant. Especially at low levels of GHB, the formation of GHB in these tubes hampers an interpretation of the results.GHB was found in 13 cases of driving under the influence. In contrast to the cases of chemical submission, high concentrations of GHB were found, corresponding with observations of extreme sleepiness or temporary loss of consciousness.GHB was found in 16 cases of unexplained death: the measured range of GHB concentrations in blood might correspond to effects such as drowsiness, but not to serious toxicity of GHB. In 4 of these 16 cases, the role of GHB could be excluded. In the remaining cases, the role of GHB remains unclear; more research into "background" concentrations of GHB in post-mortem material is required. The incidence of the use of GHB in The Netherlands cannot be derived from these toxicological data. As GHB is not routinely found during systematical toxicological analyses, these data may seriously underestimate the use of GHB. Therefore, information from the police to the forensic institute is essential.

Automobile Driving↗
PubMed2001

Psychosocial care in family cancer clinics in The Netherlands: a brief report.

The present survey was undertaken to obtain a better understanding of the organisation of standard psychosocial services at the family cancer clinics in The Netherlands. Colleagues at the nine family cancer clinics in The Netherlands completed a brief questionnaire. It was found that all clinics offered professional psychosocial support for asymptomatic women from hereditary breast-ovarian cancer (HBOC) families. On average, one half-time psychosocial worker (usually a social worker and/or a psychologist) was involved in the genetic counselling. All clinics have developed education material about HBOC independently. As a result of the survey, an effort is made to coordinate the development of education material. Furthermore, it is concluded that more attention should be paid to symptomatic mutation carriers and those individuals, who receive inconclusive genetic test results. These subgroups are usually excluded from the protocols for psychosocial care in genetic counselling.

Breast Neoplasms↗
PubMed1997

Changing attitudes towards breast-conserving treatment of early breast cancer in the south-eastern Netherlands: results of a survey among surgeons and a registry-based analysis of patterns of care.

To see whether personal preferences of surgeons can explain the trends in the use of breast-conserving therapy (BCT) of early breast cancer, questionnaires were sent to the surgeons of seven community hospitals in the south-eastern Netherlands in 1987 and 1995. The answers were set against the actual use of breast-conserving therapy in the hospitals in the period 1984-94, as monitored by the Eindhoven Cancer Registry. The proportion of surgeons who were willing to use BCT for tumours < or =3 cm increased from 43% in 1987 to 93% in 1995. In 1995, the majority of the surgeons considered multicentric tumour growth, diffuse microcalcifications on the mammogram and an extensive intraductal component around the tumour as contraindications for breast-conserving therapy. The proportion of patients with an operable, non-metastasized breast tumour of < or =5 cm in diameter undergoing breast-conservative surgery increased from 31% in 1984 to 60% in 1989 (P<0.01) and remained at that level in 1990 and 1991. Between 1991 and 1993, the proportion receiving breast-conservative surgery decreased significantly for patients younger than 50 years and a tumour 2.1-3.0cm in diameter, and also for those 50-69 years old with a tumour < or =2.0cm or 3.1-5.0cm across. The observed decrease in BCT in the south-eastern Netherlands in some subgroups seems to reflect the growing awareness of potential risk factors for local recurrence following BCT.

Adult↗
PubMed1987

Reverse smoking in the Netherlands.

A review of the literature on reverse smoking is presented, followed by a report of a case of reverse smoking in a 59-year-old woman, living in the Netherlands. This is the first report of a case of reverse smoking in the Netherlands so far. The clinical and histological findings are in accordance with those found in the literature. The patient refused to give up her habit. During the 4 years follow-up period, no clinical changes were noticed.

Female↗
PubMed1997

Asthma statistics in The Netherlands 1980-94.

Concern about the rising asthma mortality and morbidity in several countries in the 1980s, and the consequent development of international guidelines for diagnosis and management of asthma, gave reason to evaluate national mortality and hospital admission data from the Netherlands for asthma [International Classification of Diseases (ICD) 493] over the period 1980-94, as well as for chronic obstructive pulmonary disease (COPD) (ICD 490-2, 496) and acute bronchi(oli)tis (ICD 466), according to age (0-4, 5-34, 35-64 and > or = 65 years). Rates per million population per year were calculated and time trend analyses were performed. Hospital admissions for asthma showed a decrease in all age groups except in age group 0-4 years. In this age group, an increase was found which continued in the 1990s. Hospital admissions also increased for COPD and acute bronchi(oli)tis in the age group 0-4 years. These increases, however, had no impact on the respiratory mortality, which remained stable and even fell for acute bronchi(oli)tis. Asthma mortality showed a large decline in the 1990s in age group > or = 65 years in both sexes, and also fell, to a lesser extent, in age group 35-64 years. In both age groups, rising COPD trends were found in hospital admissions and mortality, except in males aged 35-64 years, in whom trends fell in the last decade. In age group 5-34 years, asthma mortality declined over the whole study period, whilst the other respiratory trends were stable. It is concluded that asthma statistics in the Netherlands indicate favourable development, except for the age group 0-4 years. In this age group, morbidity from asthma and from other reactive airway disorders is still of great concern.

Acute Disease↗
PubMed2001

The introduction of mammographical screening has had little effect on the trend in breast-conserving surgery: a population-based study in Southeast Netherlands.

In addition to reducing breast cancer mortality, breast cancer screening programmes are expected to increase the proportion of patients who can undergo breast-conserving surgery. Trends in the use of breast-conserving surgery (BCS) in Southeast Netherlands between 1990 and 1998 were studied in relation to the gradual introduction of mammographical screening for women 50-69 years of age between 1992 and 1996. The characteristics of the tumours detected by the screening programme or outside of the programme were compared, to see whether this might clarify the observed trends. In the period 1990-1998, 4788 patients were diagnosed with invasive, operable breast cancer, of whom 2341 were 50-69 years of age. Although the screening programme resulted in a larger proportion of patients with small tumours and more favourable tumour characteristics, no increase was observed in the use of BCS for patients 50-69 years of age in the period 1990-1998 (64% in 1990 and 1998). Patients with a screening-detected tumour, however, were more likely to undergo breast conservation compared with those presenting clinically (68% versus 54%; P<0.0001). In conclusion, no increase in the proportion of breast-conserving surgical procedures was observed in Southeast Netherlands among patients 50-69 years of age in the period 1990-1998, during the introduction of mass mammographical screening for this group. Screening, however, resulted in a larger proportion of patients with small tumours with more favourable characteristics, who are better candidates for breast conservation.

Adult↗