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PubMed2001

Environmental monitoring in the The Netherlands: past developments and future challenges.

During the past three decades environmental monitoring systems covering an immense variety of environmental problems emerged rapidly throughout the world. In The Netherlands the entire spectrum of monitoring systems is present. Their development is especially interesting because of the Dutch complex environmental landscape: a result of the combination of a natural setting with a high small-scale variation and an intense use of the available space by both industry and agriculture. This necessitates a well balanced environmental policy wherein monitoring of both environmental compartments and environmental policy itself plays an important role. In this article we focus on abiotic systems, whereby the development of monitoring will be related to that of environmental policy in general. Some general lines emerge: from quantity towards quality, from single pollutants towards environmentally harmful processes as a whole, and from a focus on human health and safety towards integrated environmental management. Because The Netherlands is a highly organized and highly educated society, reacting fast and flexible to new problems, this progression has happened quickly. However, still much remains to be desired and flexibility not necessarily guarantees optimal routes of development. Paramount is the development of sophisticated and robust monitoring systems that truly support integrated environmental management. This asks for clear objectives based on solid scientific insights.

Environment↗
PubMed2001

Antidepressant prescription for depression in general practice in The Netherlands.

OBJECTIVE: To evaluate diagnoses and the prescription of antidepressants drugs for depression, based on data from 1993 to 1998 related to consultations for depression in general practice in the Netherlands. METHOD: An exploratory analysis of data provided by IMS Health. Consecutive annual representative samples of 640 GPs regularly registered data on morbidity and (drug) treatment for specific medical problems in special booklets for a period of one week. The data refer to consultations for depression. The diagnoses were initially based on ICD-9 criteria and later ICD-10 criteria for depression. MAIN OUTCOME MEASURES: Number of diagnoses of depression and number of prescriptions for antidepressants. RESULTS: The number of first consultations for depression rose gradually, from 909 in 1993 (95% CI: 774 to 1043), to 1,482 (CI: 1292 to 1672) in 1998: an increase of 63%. For an individual GP, this represents an increase from 18 to 30 in first consultations for depression. The number of prescriptions for antidepressants also increased, mainly during repeat consultations: a 278% increase, from 3,708 in 1993 to 14,024 in 1998 (CIs: 3,504 to 3,912 and 13,252 to 14,796). Antidepressants were prescribed during the first consultation 564 times in 1993 compared with 1,080 times in 1998. The first contact with a GP for depression led to an antidepressant prescription in 62% of cases in 1993 and 73% in 1998. Although the guidelines issued by the Dutch College of General Practitioners in 1994 recommended tricyclic antidepressants (TCAs) for the treatment of depression, paroxetin, fluoxetin, and mirtazapin (SSRIs) accounted for 56% of the prescribed antidepressants. CONCLUSION: Between 1993 and 1998, GPs in the Netherlands prescribed increasingly more antidepressants, and they prescribed more SSRIs than TCAs. Furthermore, GPs diagnose depression more frequently and the number of repeat consultations has increased.

Antidepressive Agents↗
PubMed2001

Pesticides and nitrate in groundwater and rainwater in the Province of Limburg in The Netherlands.

The purpose of this study was to investigate the occurrence of high levels of pesticides in groundwater and rainwater in The Province of Limburg in The Netherlands. In groundwater samples in particular the presence of triazines--atrazine, simazine and propazine--was observed; besides these pesticides, dieldrin has also been observed. Atrazine and simazine were found to exceed the groundwater standard of 100 ng L(-1). In the rainwater samples, the presence of 13 of 23 different analyzed pesticides was observed. A number of pesticides were found in high concentrations; e.g. atrazine (>200 ng L(-1)). Two pesticides detected in rainwater (beta+gamma-HCH and atrazine) were found to exceed the groundwater standard. Seven pesticides in rainwater were found to exceed the target value and three pesticides the maximum tolerable risk value (DDT, heptachlor and heptachlorepoxide A), which are used as ecotoxicological standards in The Netherlands. Nitrate in 15 of 16 analyzed natural springs was found to exceed the guideline value for nitrate in drinking water of 50 mg L(-1), up to levels of about 200 mg L(-1). Nitrate concentrations in rainwater samples were observed up to 4.5 mg L(-1). A risk analysis of exposure to high pesticide levels in groundwater or rainwater has been performed using the model HESP. For atrazine levels due to deposition of rainwater in two different locations, exceedance of the T.D.I. level of 0.5 microg kg(-1) day(-1) based on WHO criteria was observed for children using both an urban and a rural scenario and use of groundwater as drinking water.

Environmental Monitoring↗
PubMed2001

Epidemiology and survival in patients with carcinoid disease in The Netherlands. An epidemiological study with 2391 patients.

BACKGROUND: Carcinoid tumours are rare malignant neuroendocrine tumours. In 1992 octreotide was introduced in the Netherlands as a palliative treatment for the carcinoid syndrome in metastatic carcinoid disease. The aims of this epidemiological study were to evaluate epidemiological data and the impact of octreotide on survival in metastatic carcinoid disease. PATIENTS AND METHODS: Between 1989 and 1996, 2391 patients with carcinoid disease were diagnosed in the Netherlands. Survival data from two Registries were available in 619 patients, diagnosed between 1980 and 1997. RESULTS: Between 1989 1996, incidence was 1.95/100,000. Under the age of 50 years a significant female predominance was observed. Under the age of 35 years, appendiceal carcinoid was the most frequently diagnosed primary site. Incidence of distant metastases at diagnosis for appendix and lung primary sites was 1.6% and 5.5%, compared to 40%, in the other primary sites. Multivariate analysis of 619 patients revealed that age, stage and appendix localisation predicted survival. In metastatic disease, however, only year of diagnosis after 1992 independently predicted survival (P = 0.012). CONCLUSIONS: The female predominance found under the age of 50 years suggests hormonal influence. Improved survival in metastatic carcinoid disease might relate to the use of octreotide.

Adolescent↗
PubMed1998

The Lancashire Quality of Life Profile: first experiences in The Netherlands.

In the Netherlands, as in many other European countries, there is a strong desire for a reliable, valid and feasible instrument to assess the quality of life of people with long-term mental illness. After careful evaluation, it was decided to translate and adapt the Lancashire Quality of Life Profile (LQOP) developed by Oliver and associates. This article presents the preliminary results of a pilot study using the LQOLP. Emphasis is given to describing the psychometric properties of the extended Dutch version and its clinical applicability. Results indicate that the psychometric properties of the translated LQOLP are encouraging and that the instrument can be used for people with mental illness who live in the Netherlands.

Adult↗
PubMed2003

The implementation of families first in The Netherlands: a one year follow-up.

This study examined whether the American family preservation program Families First was successfully implemented in The Netherlands. Data were collected on 250 children of 177 families who received Families First. At the start of treatment 78% of the children appeared to have serious behavioral problems, 67% of the parents experienced a high level of parental stress, and 63% of the children went through a substantial number of life events during the year preceding the treatment. On average the treatments had the intended duration (about 4 weeks), intensity (about 10 hours a week) and availability (during working hours as well as in evenings and in weekends), and family workers did adhere to important guidelines of treatment delivery. One year after treatment 76% of the children were still living at home. Moreover, children's behavioral problems, parental stress and the number of life events turned out to be significantly decreased. It was concluded that Families First had reached its intended target group, delivered the treatment as intended, and achieved its intended outcomes, suggesting a successful implementation in The Netherlands.

Adult↗
PubMed2003

Utilisation of malaria prophylaxis: the effect of changes in guidelines in The Netherlands, 1993-1998.

INTRODUCTION: The increase in international travelling from temperate zones to tropical countries and increasing drug resistance of Plasmodium falciparum has resulted in a growing number of travellers that are at risk for contracting malaria. The objective of this study was to obtain insight into dispensing patterns of malaria chemoprophylaxis and to determine whether health care providers have followed changes in guidelines. METHODS: Data on prescriptions of proguanil and mefloquine were obtained from the Dutch 'Foundation for Pharmaceutical Statistics' (SFK) covering the period 1 January 1993 up to 31 December 1998. From Statistics Netherlands (SN), we obtained the number of travellers to endemic areas during the years 1994-1998. RESULTS: There were 420,963 prescriptions for mefloquine and 464,904 for proguanil dispensed during the study period. The total number of prescriptions for malaria chemoprophylaxis increased during the period 1993-1997 from 98,325 (of which 14,427 (14.7%) for mefloquine and 83,898 (85.3%) for proguanil) to 168,452 (of which 90,232 (53.6%) for mefloquine and 78,220 (46.4%) for proguanil). The number of prescriptions per 1000 travellers decreased over the years for proguanil from 169 to 118 but remained stable for mefloquine at 126. The average duration for which mefloquine was prescribed remained stable, whereas the average duration for which proguanil was prescribed decreased over time. We observed differences in the prescription rate of prescriptions for mefloquine between geographical regions in the Netherlands. CONCLUSION: Changes in the guidelines of malaria prophylaxis with respect to type and duration were generally followed by health care providers. Nevertheless there are variations between the regions in the proportion of prescribed courses of mefloquine.

Antimalarials↗
PubMed2003

Consumer price sensitivity and social health insurer choice in Germany and The Netherlands.

In this paper, we examine the effects of the introduction of free choice and price competition in social health insurance in Germany and the Netherlands. Using panel data at the sickness fund level we estimate the price elasticity of sickness fund choice in both countries. We find that the price elasticity in Germany is high and rapidly increasing. Consistent with findings of other studies on health plan choice, the price elasticity is much lower for elderly than for non-elderly. In the Netherlands, by contrast, the price elasticity of fund choice is negligible. Only when people were forced to choose a sickness fund, they were quite sensitive to premium differences. Key factors in explaining the observed differences in switching behavior between both countries are the degree of financial risk for sickness funds, the features of the risk-adjustment mechanism and the role of employers.

Aged↗
PubMed2004

Alcohol and ovarian cancer risk: results from the Netherlands Cohort Study.

OBJECTIVE: To study alcohol consumption in relation to ovarian cancer risk in a prospective cohort study. METHODS: The Netherlands Cohort Study on diet and cancer was initiated in 1986. A self-administered questionnaire on dietary habits and other risk factors for cancer was completed by 62,573 postmenopausal women. Follow-up for cancer was established by annual record linkages with the Netherlands Cancer Registry. After 9.3 years of follow-up, 214 incident invasive epithelial ovarian cancer cases and 2211 subcohort members with complete data on alcohol intake were available for analysis. All incidence rate ratios (RRs) were corrected for age, use of oral contraceptives, parity, height, body mass index, energy intake and current cigarette smoking. RESULTS: The RRs of ovarian cancer for women who consumed up to 5, 15 and >15 g of alcohol per day were 1.13 (95% confidence interval, 95% CI = 0.79-1.63), 0.85 (95% CI = 0.53-1.37) and 0.92 (95% CI = 0.55-1.54), respectively, compared to non-drinkers. Alcohol consumption in the form of wine, beer or liquor was not associated with ovarian cancer risk. CONCLUSION: These data do not suggest a major association between alcohol intake and ovarian cancer risk in this population.

Aged↗
PubMedDate not supplied

Nitrate leaching by atmospheric N deposition to upper groundwater in the sandy regions of The Netherlands in 1990.

Anthropogenic increase in atmospheric nitrogen (N) deposition in nature areas results in nitrate leaching to groundwater, threatening its quality. Member states of the European Union are obliged to reduce groundwater nitrate concentrations and to monitor this reduction. The relationship between N deposition and groundwater nitrate concentrations is quantified using a field survey and geographical information. Nitrate concentrations of the uppermost metre of groundwater in nature areas in the sandy regions in 1990 were related to geographical data by means of regression analysis. In this way nitrate concentrations could be explained by potential ammonia deposition, soil type, vegetation and land use. We found that about 35% of 54 kg ha(-1) a(-1) atmospheric N deposition was leached to the upper groundwater as nitrate, resulting in a mean NO3 concentration of about 30 mg L(-1). The critical N load for exceeding the EC limit value (50 mg L(-1)) in the sandy regions of The Netherlands composed of natural vegetation will be about 80 kg ha(-1) a(-1). Leaching is less than expected for nature areas but comparable with leaching of N surpluses in pastures in The Netherlands. A reduction in nitrate leaching by 25% or more can currently be detected via a new field survey.

Environmental Monitoring↗
PubMed2004

Direct-to-consumer communication on prescription only medicines via the internet in the Netherlands, a pilot study. Opinion of the pharmaceutical industry, patient associations and support groups.

OBJECTIVE: Investigation of the current application of direct-to-consumer (DTC) communication on prescription only medicines via the Intemet in the Netherlands. METHOD: Questionnaires were sent by e-mail to 43 Dutch innovative pharmaceutical industries and 130 Patient Association and Support Groups (PASGs). RESULTS: In this pilot study, the response of the pharmaceutical industry was rather low but the impression is that they were willing to invest in DTC communication. The majority of the websites of PASGs did not link to websites of pharmaceutical companies. The PASGs had no opinion whether patients can make a good distinction between DTC advertising and information on websites of the pharmaceutical industry nor about the quality. PASGs did not think unambiguously about the impact on the patient-doctor relationship. CONCLUSION: The impact of DTC communication on prescription only medicines via the internet is not yet clear in the Netherlands.

Advertising↗
PubMed2003

Refractive errors and visual impairment in 900 adults with intellectual disabilities in the Netherlands.

PURPOSE: To collect data on refractive errors and visual impairment in adults with an intellectual disability (ID) in the Netherlands. PATIENTS: A randomized sample of 2100 participants was drawn from a base population of 9000 adults with intellectual disabilities in the Netherlands. This article reports on the first 900 participants. METHODS: All participants underwent a protocol-based on-site ophthalmological assessment carried out by skilled investigators. RESULTS: Co-operation was classified according to the number of tests that could be carried out reliably and was good or excellent in 80% of subjects, average in 13% and poor in 7%. Refraction could be reliably assessed in 505/900 (56%) subjects. There was an increased risk of visual impairment in all subgroups compared to the general Dutch population. Visual acuity (VA) was related to the level of ID, but refractive errors were not. New spectacles were prescribed in 106 cases (12%). Of 374 people in whom both monocular VA and the refractive error of the right eye could be reliably assessed, 153 (41%) had a pretest prescription, 16 (10%) of which we found to be inadequate. Of the 221 participants without a pretest prescription, 41 (19%) benefited from correction. Only 38/84 (45%) subjects aged 50 years or older, who could benefit from correction for near vision, had near spectacles. New correction increased the mean distant VA significantly from 0.44 to 0.65 (p < 0.0005). CONCLUSIONS: With some adaptations, visual screening is feasible in a majority of adults with ID. Visual impairment and refractive errors are much more prevalent in adults with ID than in the normal population. Accurate spectacle correction resulted in significant improvement in distant VA.

Adult↗
PubMed2002

Use of illicit substances in a psychosis incidence cohort: a comparison among different ethnic groups in the Netherlands.

OBJECTIVE: Use of illicit substances has been suggested as an explanation for the increased incidence of psychosis among some immigrant groups. The aim of the present study is to compare the rates of illicit substance use among immigrants with a first psychosis with that among non-migrants. METHOD: A population-based, first-contact incidence study in the Netherlands. Patients and key informants were interviewed about drug use in the preceding year. RESULT: One hundred and eighty-one subjects were examined. Proportions of patients who misused any illicit substance were 23% for Dutch, 17% for Moroccans, 27% for Surinamese, 30% for Turkish subjects, and 33% for other immigrants. Logistic regression analysis, controlling for age and sex, showed that ethnicity did not significantly contribute to the prediction of substance misuse. CONCLUSION: A higher rate of drug misuse is an unlikely explanation for the increased incidence of psychotic disorders among Moroccan and Surinamese immigrants to the Netherlands.

Adult↗
PubMed2000

Hepatitis C virus infection and oral lichen planus: a report from The Netherlands.

The reported frequency of anti-hepatitis C virus (HCV) antibodies in groups of cutaneous lichen planus (CLP) and/or oral lichen planus (OLP) patients varies from about 4% to 65%. Most of these studies have been performed in countries with a high overall prevalence of HCV infection in the general population, such as the southern European countries and Japan. Limited data are available from areas with a low prevalence of HCV infection. Therefore, we investigated the prevalence of HCV infection in a series of 55 patients with OLP in the Netherlands, which apparently has a low prevalence of HCV infection. None of the 55 patients revealed serological evidence of antibodies to HCV. The present data suggest that HCV infection in OLP patients in the Netherlands is probably not very common. A larger study group with a sex- and age-matched control group is required to advise against routine serological examination for HCV infection in Dutch OLP patients.

Adult↗
PubMed2004

Trends in the usage of adjuvant systemic therapy for breast cancer in the Netherlands and its effect on mortality.

Adjuvant systemic therapy was introduced in the Netherlands as a breast cancer treatment in the early 1980s. In this paper, we describe the trends in the usage of adjuvant systemic treatment in the period 1975-1997 in the Netherlands. The main aim of our study was to assess the effects of adjuvant tamoxifen and polychemotherapy on breast cancer mortality, compared to the effects of the mammography screening programme. The computer simulation model MIcrosimulation SCreening ANalysis, which simulates demography, natural history of breast cancer and screening effects, was used to estimate the effects. Use of adjuvant therapy increased over time, but since 1990 it remained rather stable. Nowadays, adjuvant therapy is given to 88% of node-positive patients aged 50-69 years, while less than 10% of node-negative patients receive any kind of adjuvant treatment. Adjuvant treatment is given independent of the mode of detection (adjusted by nodal status and size). We predict that the reduction in breast cancer mortality due to adjuvant therapy is 7% in women aged 55-74 years, while the reduction due to screening, which was first implemented in women aged 50-69 years in 1990-97, will be 28-30% in 2007. In conclusion, although adjuvant systemic therapy can reduce breast cancer mortality rates, it is anticipated to be less than the mortality reduction caused by mammography screening.

Age Distribution↗
PubMed2006

Dairy consumption and ovarian cancer risk in the Netherlands Cohort Study on Diet and Cancer.

Ovary cancer risk in relation to consumption of dairy products was investigated using a self-administered questionnaire on dietary habits and other risk factors for cancer, which was completed in 1986 by 62 573 postmenopausal women participating in the Netherlands Cohort Study. Follow-up for cancer was implemented by annual record linkage with the Netherlands Cancer Registry and a nationwide pathology registry. After 11.3 years of follow-up, data of 252 incident epithelial ovarian cancer cases and 2216 subcohort members were available for analysis. No association was seen between consumption of milk, yoghurt, cheese or fermented dairy products and ovarian cancer risk. The multivariable adjusted relative risk of epithelial ovarian cancer for women in the highest compared to the lowest quintile of intake of lactose or dairy fat was 0.93 (95% confidence interval (CI)=0.60-1.45; P(trend)=0.32) and 1.53 (95% CI=1.00-2.36; P(trend)=0.11), respectively. Lactose or dairy fat intakes were not associated with serous ovarian cancer risk. Our results do not support an association between consumption of dairy products or lactose intake and ovarian cancer.

Aged↗
PubMed2006

The role of socio-economic status in the decision making on diagnosis and treatment of oesophageal cancer in The Netherlands.

In the United States (USA), a correlation has been demonstrated between socio-economic status (SES) of patients on the one hand, and tumour histology, stage of the disease and treatment modality of various cancer types on the other hand. It is unknown whether such correlations are also involved in patients with oesophageal cancer in The Netherlands. Between 1994 and 2003, 888 oesophageal cancer patients were included in a prospective database with findings on the diagnostic work-up and treatment of oesophageal cancer. Socio-economic status of patients was defined as the average net yearly income. Linear-by-linear association testing revealed that oesophageal adenocarcinoma was more frequently observed in patients with higher SES and squamous cell carcinoma in patients with lower SES (P=0.02). Multivariable logistic regression analysis showed no correlation between SES and staging procedures and preoperative TNM stage. The adjusted odds ratio (OR) for stent placement was 0.82 (95% CI 0.71-0.95), indicating that with an increase in SES by 1200 [euro], the likelihood that a stent was placed declined by 18%. Patients with a higher SES more frequently underwent resection or were treated with chemotherapy (OR: 1.15; 95% CI 1.01-1.32 and OR: 1.16; 95% CI 1.02-1.32, respectively). Socio-economic factors are involved in oesophageal cancer in The Netherlands, as patients with a higher SES are more likely to have an adenocarcinoma and patients with a lower SES a squamous cell carcinoma. Moreover, the correlations between SES and different treatment modalities suggest that both patient and doctor determinants contribute to the decision on the most optimal treatment modality in patients with oesophageal cancer.

Adenocarcinoma↗
PubMed1998

Prevalence of self-reported food hypersensitivity among school children in The Netherlands.

OBJECTIVES: To provide national figures on the prevalence of self-reported food hypersensitivity (S-FH), and the association with socio-demographic variables and some health indicators in schoolchildren in The Netherlands. DESIGN: As part of the Child Health Monitoring System, data were collected from 4450 children, who were invited for a routine health assessment (response 97%). A questionnaire on food hypersensitivity was completed by the parents of the children in primary school and by the children in secondary school themselves. The measurements on health status were taken by the school physician or nurse during the school health assessment. SUBJECTS: Children aged 4-15 y in The Netherlands in three groups in primary school, and in the second year of secondary school. RESULTS: The prevalence of S-FH was 7.2%. Food additives and chocolate were most frequently avoided. Of the children with S-FH, 40% avoided food exclusively either on their own accord or on advice of relatives. School absence due to illness, use of medication, and medical treatment were more prevalent in children with S-FH, and their health status was more often considered moderate or poor by the school physician or nurse. CONCLUSION: Seven percent of school-aged children avoid certain types of food or ingredients because of S-FH. The prevalence of food allergy or food intolerance is probably lower, since many children with S-FH had not undergone any diagnostic tests. To prevent unnecessary food restriction, more information for parents is needed about the possible effects of food restriction on the health of their children, and they should be encouraged to seek further diagnosis.

Absenteeism↗