Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “NETHERLANDS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 703 records · Page 39Linked to original sources
PubMed2003

Development of teaching and tuition in the specialty of neurology in the Netherlands.

After a short survey of the early history of neurology and psychiatry in the Netherlands, the development of the specialty of neurology is discussed. During the 20th century the training of neurologists and the certification of specialists evolved from an informal master-fellow organization towards a strongly reglemented and legally based procedure. A nationwide Specialist Registration Commission supervises the quality of the training of specialists. Registered neurologists in the Netherlands are subject to a re-certification programme that controls the requirements to be fulfilled by the specialists such as their active involvement in patient care (for at least 16 h a week), attendance of the annual postgraduate courses in neurology (5-year cycle) and regular participation in international congresses of neurology. The undergraduate training in neurology, the neurology clerkship and the postgraduate training in neurosciences are described. Measures taken in order to maintain the balance between the supply of and the demand for neurological care in the near future are reported.

Certification↗
PubMed2001

Patterns of ergotamine and sumatriptan use in the Netherlands from 1991 to 1997.

The objective of this study was to assess usage patterns of ergotamine and sumatriptan over a period of 6 years, primarily to evaluate the impact that sumatriptan has had on the prescription of ergotamine. This study used ergotamine and sumatriptan prescription data representing inhabitants of eight cities in the Netherlands and covering the period of 1991-1997. The yearly incidence of new users between 1991 and 1997 was estimated for both drugs as well as for the drug of first choice to be prescribed to patients initiating specific abortive migraine treatment with either ergotamine or sumatriptan. Intra-individual ergotamine and sumatriptan usage patterns, characterized by single (incidental), continuous (rate of retention) or switch use, were examined for five patient cohorts, each for a follow-up period of 1 year. During the year of sumatriptan introduction (1991-1992), the overall incidence of new use for both drugs was highest (5.4 per 1000 inhabitants). Hereafter, a substantial reduction of more than 50% was observed. From 1992 to 1996, the yearly incidence of ergotamine first-time use was significantly higher than that of sumatriptan and up to 1996 ergotamine was more than twice as likely than sumatriptan to be prescribed to patients initiating specific abortive treatment. Hereafter, sumatriptan was as likely as ergotamine to be prescribed as the drug of first choice, which coincided with the full reimbursement of sumatriptan tablets. Overall, neurologists were more likely than general practitioners (GPs), to prescribe sumatriptan as the drug of first choice. Approximately half of the total study population were identified as single-time users. This phenomonen occurred more frequently in the ergotamine cohorts. The sumatriptan cohorts displayed a slight yet significant stronger retention rate compared with the ergotamine cohorts. The overall impact of sumatriptan on ergotamine use in The Netherlands was marginal, predominantly due to GP's adherence to migraine treatment guidelines and reimbursement policies concerning sumatriptan tablets. Overall, incidental use was relatively high and may reflect the reported difficulties in diagnosing migraine, lack of patient-doctor consultation, or that anticipated benefits of the drug were not achieved. Further study is required to clarify these issues.

Adolescent↗
PubMed2002

Cost-effectiveness of a family and DNA based screening programme on familial hypercholesterolaemia in The Netherlands.

AIMS: To estimate the cost-effectiveness of the current screening programme on Familial Hypercholesterolaemia (FH) in relatives of diagnosed FH-patients in The Netherlands. METHODS AND RESULTS: Data from 2229 screened FH-relatives, including age, sex, risk factor status and screening outcome, were combined with the Framingham risk function and national disease-specific cost data to arrive at a model-based comparison of survival and costs, with and without the screening programme. Cost-effectiveness ratios were computed for various treatment strategies, with no screening as reference. Costs per life year gained varied between 25.5- and 32-thousand Euros, depending upon the precise treatment strategy after a positive screen. The costs for screening (tracing the FH-positive individuals) were much lower than the follow-up costs (treatment), of which 80% were costs for statins. Consequently, the costs per life year gained of alternative screening programmes are about the same. CONCLUSION: The cost-effectiveness ratio of FH screening is within the range requiring explicit political consideration in The Netherlands. As the costs of statin treatment are the single most important determinant of costs, policy decisions reduce to decisions on the acceptability of statin treatment for this risk group. Pending major changes in statin price, clear guidelines should be developed on how screen positive individuals should be treated, since not all of them have an elevated cholesterol level.

Adolescent↗
PubMed2003

The use of inhaled corticosteroids in the United Kingdom and the Netherlands.

This study examined the utilisation patterns of inhaled corticosteroids in England/Wales and the Netherlands. Computerised medical records from the GPRD (U.K.) and PHARMO (the Netherlands) databases were used. It included 284733 English/Welsh and 27761 Dutch adult patients who were prescribed inhaled corticosteroids during the 10-year study period. Our results showed that, in both study populations, overall use of inhaled corticosteroids increased over the period studied, with its prevalence rising steeply with age and declining in extreme old age. Decreased use of bronchodilators and oral corticosteroids in the early treatment of asthma was noted in our findings. In addition, a trend towards the decreasing use of oral corticosteroids concomitant with inhaled corticosteroid therapy was also observed for both groups. Our study found that only 42.1% of the GPRD and 31.1% of the PHARMO patients received a repeat prescription within the expected duration ofthe preceding inhaled corticosteroid prescription. In conclusion, our study found many similarities in the prescribing and use of inhaled corticosteroids between the two study populations. The observation of irregular use of inhaled corticosteroid among a substantial number of patients highlights a need for further study into the reasons for irregular use and its consequences on the effectiveness of treatment.

Adult↗
PubMed2004

Cost-effectiveness analysis of the genetic screening program for familial hypercholesterolemia in The Netherlands.

Familial hypercholesterolemia (FH) is associated with pronounced atherosclerosis leading to premature cardiovascular disease and untimely death. Despite the availability of effective preventative drug treatments, many affected individuals remain undiagnosed and untreated until they become symptomatic with cardiovascular disease. To assess the cost-effectiveness of systematic genetic screening of family members of persons diagnosed with FH, an analysis was conducted using data from a nationwide screening program for the identification of individuals with FH, instituted in The Netherlands in 1994, and from other sources. There was DNA testing of families with a known genetic defect to identify new cases of FH in the presymptomatic stage of the disease. After identification, most newly identified patients were started on cholesterol-lowering statin treatment. On average, new cases diagnosed by the screening program gained 3.3 years of life each. Twenty-six myocardial infarctions would be avoided for every 100 persons treated with statins between the ages of 18 and 60 years. The average total lifetime incremental costs, over all age ranges and both sexes, including costs for screening and testing, lifetime drug treatment, and treatment of cardiovascular events, was US dollars 7500 per new case identified. Cost per life-year gained was US dollars 8700. Therefore, systematic genetic screening of family members of persons diagnosed with FH is cost-effective in The Netherlands and should be considered for other settings.

Adolescent↗
PubMed1996

Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995.

BACKGROUND: In 1991 a new procedure for reporting physician-assisted deaths was introduced in the Netherlands that led to a tripling in the number of reported cases. In 1995, as part of an evaluation of this procedure, a nationwide study of euthanasia and other medical practices concerning the end of life was begun that was identical to a study conducted in 1990. METHODS: We conducted two studies, the first involving interviews with 405 physicians (general practitioners, nursing home physicians, and clinical specialists) and the second involving questionnaires mailed to the physicians attending 6060 deaths that were identified from death certificates. The response rates were 89 percent and 77 percent, respectively. RESULTS: Among the deaths studied, 2.3 percent of those in the interview study and 2.4 percent of those in the death-certificate study were estimated to have resulted from euthanasia, and 0.4 percent and 0.2 percent, respectively, resulted from physician-assisted suicide. In 0.7 percent of cases, life was ended without the explicit, concurrent request of the patient. Pain and symptoms were alleviated with doses of opioids that may have shortened life in 14.7 to 19.1 percent of cases, and decisions to withhold or withdraw life-prolonging treatment were made in 20.2 percent. Euthanasia seems to have increased in incidence since 1990, and ending of life without the patient's explicit request to have decreased slightly. For each type of medical decision except those in which life-prolonging treatment was withheld or withdrawn, cancer was the most frequently reported diagnosis. CONCLUSIONS: Since the notification procedure was introduced, end-of-life decision making in the Netherlands has changed only slightly, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the number of decisions or of less careful decision making.

Data Collection↗
PubMed1996

Evaluation of the notification procedure for physician-assisted death in the Netherlands.

BACKGROUND: In the Netherlands, a notification procedure for physician-assisted death has been in use since 1991. It requires doctors to report each case to the coroner, who in turn notifies the public prosecutor. Ultimately, the Assembly of Prosecutors General decides whether to prosecute. Although physician-assisted death remains technically illegal, doctors are extremely unlikely to be prosecuted if they comply with the requirements for accepted practice. In 1995, the ministers of health and justice commissioned an evaluation to determine the adequacy of the notification procedure. METHODS: A random sample of 405 physicians were interviewed. We also interviewed 147 physicians who had reported cases of physician-assisted death and 116 coroners, and we reviewed 353 judicial files of reported cases. In addition, we interviewed 48 public prosecutors and reviewed the minutes of the Assembly of Prosecutors General for 1991 to 1995 and all published court decisions from 1981 through 1995. RESULTS: In 1995, about 41 percent of all cases of euthanasia and physician-assisted suicide were reported. There were no major differences between reported and unreported cases in terms of the patients' characteristics, clinical conditions, or reasons for the action. Most patients had cancer and were described as suffering "unbearably" and 'hopelessly." Of the 6324 cases reported during the period from 1991 through 1995, only 13 involved prosecution of the physician. The majority of respondents in the groups interviewed thought that all cases of physician-assisted death should be reviewed, although most doctors thought the review should be performed by other doctors, and there was substantial concern about the burden associated with the reporting procedure. CONCLUSIONS: Substantial progress in the oversight of physician-assisted death has been achieved in the Netherlands. The reporting procedure could be more streamlined and less threatening.

Attitude of Health Personnel↗
PubMed1997

Physician-assisted death in psychiatric practice in the Netherlands.

BACKGROUND: In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in psychiatric practice in the Netherlands. METHODS: In 1996, we sent questionnaires to 673 Dutch psychiatrists - about half of all such specialists in the country - and received 552 responses from the 667 who met the study criteria (response rate, 83 percent). We estimated the annual frequencies of requests for physician-assisted suicide by psychiatrists and actual instances of assistance. RESULTS: Of the respondents, 205 (37 percent) had at least once received an explicit, persistent request for physician-assisted suicide and 12 had complied. We estimate there are 320 requests a year in psychiatric practice and 2 to 5 assisted suicides. Excluding those who had ever assisted, 345 of the respondents (64 percent) thought physician-assisted suicide because of a mental disorder could be acceptable, including 241 who said they could conceive of instances in which they themselves would be willing to assist. The most frequent reasons for refusing were the belief that the patient had a treatable mental disorder, opposition to assisted suicide in principle, and doubt that the suffering was unbearable or hopeless. Most, but not all, patients who had been assisted by their psychiatrists in suicide had both a mental disorder and a serious physical illness, often in a terminal phase. Thirty percent of the respondents had been consulted at least once by a physician in another specialty about a patient's request for assisted death. The annual number of such consultations was estimated at 310, about 3 percent of the estimated 9700 requests for euthanasia or physician-assisted suicide in medical practice. CONCLUSIONS: Explicit requests for physician-assisted suicide are not uncommon in psychiatric practice in the Netherlands, but these requests are rarely granted. Psychiatric consultation for medical patients who request physician-assisted death is relatively rare.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands.

BACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death. RESULTS: In 114 cases, the physician's intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5). CONCLUSIONS: There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In The Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.

Adult↗
PubMed2002

Euthanasia and physician-assisted suicide among patients with amyotrophic lateral sclerosis in the Netherlands.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a disease that causes progressive paralysis leading to respiratory failure. Patients with ALS may consider physician-assisted suicide. However, it is not known how many patients, if given the option, would actually decide to end their lives by physician-assisted suicide or euthanasia nor at what stage of the disease they would choose to do so. METHODS: We identified physicians of 279 patients in the Netherlands with a diagnosis of ALS who died between 1994 and 1999. Physicians were asked to fill out a validated questionnaire about the end-of-life decisions that were made. Of 241 eligible physicians, 203 returned the questionnaire (84 percent). RESULTS: Of the 203 patients, 35 (17 percent) chose euthanasia and died that way. An additional six patients (3 percent) died as a result of physician-assisted suicide. Patients to whom religion was important were less likely to have died as a result of euthanasia or physician-assisted suicide. The choice of euthanasia or physician-assisted suicide was not associated with any particular characteristics of the disease or of the patient's care, nor was it associated with income or educational level. Disability before death was significantly more severe in patients who died as a result of euthanasia than among those who died in other ways. Physician-assisted suicide appeared to occur somewhat earlier in the course of the disease than did euthanasia. An additional 48 patients (24 percent) received palliative treatment, which probably shortened their lives. CONCLUSIONS: In the Netherlands, we found that one in five patients with ALS died as a result of euthanasia or physician-assisted suicide.

Advance Directives↗
PubMed1989

Intraregional income distribution and poverty: some investigations for the Netherlands, 1960-81.

"This paper is addressed to intraregional income inequalities in the Netherlands. Various concepts are used to measure the degree of regional poverty. In addition, dissimilarity between intraregional income distributions is studied. At the provincial level, relatively small and decreasing dissimilarities are observed. However, at lower spatial levels (especially within metropolitan areas) much larger dissimilarities in mean income and income distribution occur. In the Netherlands, urban poverty has become a more intense and widespread phenomenon than rural poverty."

Demography↗
PubMed2005

Intermarriage and the risk of divorce in the Netherlands: the effects of differences in religion and in nationality, 1974-94.

A textbook hypothesis about divorce is that heterogamous marriages are more likely to end in divorce than homogamous marriages. We analyse vital statistics on the population of the Netherlands, which provide a unique and powerful opportunity to test this hypothesis. All marriages formed between 1974 and 1984 (nearly 1 million marriages) are traced in the divorce records and multivariate logistic regression models are used to analyse the effects on divorce of heterogamy in religion and national origin. Our analyses confirm the hypothesis for marriages that cross the Protestant-Catholic or the Jewish-Gentile boundary. Heterogamy effects are weaker for marriages involving Protestants or unaffiliated persons. Marriages between Dutch and other nationalities have a higher risk of divorce, the more so the greater the cultural differences between the two groups. Overall, the evidence supports the view that, in the Netherlands, new group boundaries are more difficult to cross than old group boundaries.

Adult↗
PubMed2006

First aid and basic life support of junior doctors: A prospective study in Nijmegen, the Netherlands.

According to the Dutch medical education guidelines junior doctors are expected to be able to perform first aid and basic life support. A prospective study was undertaken to assess the level of first aid and basic life support (BLS) competence of junior doctors at the Radboud University Nijmegen Medical Centre (RUNMC), the Netherlands. Fifty-four junior doctors (18%), of the medical students in their final years, were submitted to a theoretical test, composed of multiple-choice questions concerning first aid and basic life support. This test was followed by a practical test consisting of two out-of-hospital first aid and basic life support scenarios including cardiopulmonary resuscitation (CPR). In total, 19% of the junior doctors passed the theoretical test. The first scenario was performed correctly in 11%. The CPR situation was correctly performed by 30% of the students as observed by the examiners but when assessed by the checklists of Berden only 6% of the students performed correct CPR. It is concluded that the level of first aid and basic life support of the junior doctors at the RUNMC is low and does not meet the required level as stated in the guidelines for practice of medical education in the Netherlands.

Cardiopulmonary Resuscitation↗
PubMed2001

Midwifery in The Netherlands: vestige or vanguard?

The midwifery system of the Netherlands, where nearly one-third of births occur at home, is widely admired by birth activists. Why has the Netherlands maintained this way of birthing babies when all other European countries have shifted to hospital-based maternity care? In this article, I examine the societal forces - both structural and cultural--that allowed the Dutch to hold on to a way of delivering maternity services that other modernizing nations discarded earlier in the first half of the 20th century.

Attitude of Health Personnel↗
PubMed1982

Prevalence of antibodies to toxoplasma in farm animals in the Netherlands and its implication for meat inspection.

A serological survey on toxoplasmosis was carried out amongst horses, sheep, cattle, pigs and poultry in the Netherlands. Sera were obtained from slaughter animals and the results were compared with those of previous studies of this kind in the Netherlands. In horses and cattle the percentage of seropositive animals remained the same in the past 20 years. In sheep and particularly in pigs, however, a remarkable decline of seropositive animals was found. This is probably due to the age of the animals examined and a change in present day methods of farming. In poultry it was shown that only free scratching hens were seropositive in up to 30 per cent of the animals tested, whereas broilers and battery animals were seronegative. Since as yet no individual control measures in the slaughterhouse exist with regard to toxoplasmosis it is recommended to carry out periodic epizootiological surveys amongst farm animals to be able to follow trends of the infection.

Abattoirs↗
PubMed1988

The occurrence of Mycoplasma conjunctivae in The Netherlands and its association with infectious keratoconjunctivitis in sheep and goats.

The occurrence of Mycoplasma conjunctivae in the Netherlands is reported for the first time. M. conjunctivae was detected in all five sheep flocks examined with clinical signs of infectious keratoconjunctivitis (IKC) and in none of five sheep flocks without these clinical signs. These observations suggest a primary aetiological role of this organism in IKC in the Netherlands. M. conjunctivae was also detected on a goat farm with clinical signs of IKC. Experiences in culturing this organism are reported. From each sheep flock at least one strain was isolated and characterised in more detail. All Dutch strains, including two strains of M. conjunctivae isolated from sheep milk, as well as type strain HRC 581, formed film and spots which is in contrast with the description of the type strain. All strains, including the type strain, failed to grow in an anaerobic atmosphere generated by GasPak anaerobic system (BBL). Moraxella ovis was detected in nearly all flocks and was apparently not associated with IKC. Mycoplasma arginini was also isolated from ovine eyes.

Animals↗
PubMed1991

Salmonella contamination of poultry flocks in The Netherlands.

The contamination of poultry in the Netherlands with Salmonella enteritidis was tested. For this, different methods (detection of S. enteritidis in faecal samples of 25 g; detection of S. enteritidis in cloacal swabs; detection of S. enteritidis by serological testing of antibodies in serum) were compared for their efficiency to detect S. enteritidis in flocks of poultry. Testing of faecal samples clearly yielded the best results. This method was used in a transmission study, in which 14 flocks descending from a contaminated primary mother flock were screened for the presence of S. enteritidis. The method was also used for screening 49 flocks of laying hens and 52 flocks of broiler chickens throughout the Netherlands. From the transmission study it became clear that S. enteritidis, phage type 2 (Dutch phage set) was isolated both from the mother flock and from five of the descendent flocks. Screening of poultry flocks for the presence of salmonella revealed that salmonella was present in 47% of the layer flocks and in 94% of the broiler flocks. S. enteritidis was isolated from 15% of the flocks screened.

Animals↗
PubMed1995

Prevalence of antibodies to Toxoplasma gondii in cattle and swine in The Netherlands: towards an integrated control of livestock production.

Serological surveys of the prevalence of antibodies against Toxoplasma gondii were carried out amongst swine and cattle in the Netherlands. Data were analysed according to the different categories of animals. The results show very low seroprevalences of Toxoplasma gondii in finishing pigs (1.8%) and in fattening calves (1.2%). In sows and dairy cattle, respectively, seroprevalences of 30.9% and 27.9% respectively, were found, demonstrating clearly the environmental infection pressure and illustrating the importance of housing and management in establishing low infection rates. Substantially different seroprevalences were found between dairy cattle sampled in the North and in the South of the Netherlands (13.1% and 42.6%, respectively). The infection rates in the samples from finishing pigs, fattening calves, and dairy cattle demonstrate that seroprevalences in individual farms or herds may differ considerably. Investigation of the factors involved can be useful in determining the causes of infection and for developing measures with regard to prevention. The very low seroprevalences in finishing pigs and fattening calves indicate, however, that the production of toxoplasma-free meat may be well within reach in modern husbandry. Since farm animals easily are infected, serological screening of individual farms or herds for the absence of T. gondii infection, as a part of the Integrated Quality Control programme, can be helpful in determining the quality of livestock production and in developing certain standards of hygiene for individual farms.

Animals↗