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PubMed2000

The prevalence and incidence of hepatitis C virus infections among dialysis patients in the Netherlands: a nationwide prospective study.

A nationwide prospective survey on hepatitis C virus (HCV) infections among dialysis patients in The Netherlands was performed. Patients were recruited from 34 dialysis centers and were tested for antibodies and HCV RNA in 1995 and 1997. Seronegative serum samples were analyzed by reverse-transcriptase polymerase chain reaction in pools. HCV-RNA-positive serum samples were genotyped and were partly sequenced. In the first and second rounds, 67 (2.9%) of 2281 and 76 (3.4%) of 2286 patients were HCV positive, respectively. Of 960 patients with paired serum samples, 35 were HCV positive in both rounds, and 9 HCV-positive cases were newly identified in the second round. The incidence of HCV infection was 0.5 per 100 dialysis years. Phylogenetic analysis revealed clustered sequences that indicated nosocomial transmission. Sixty percent of HCV infections, however, can be attributed to 4 interdependent risk factors (i.e., hemodialysis before 1992, kidney transplantation before 1994, and birth or dialysis in a foreign country). In conclusion, the prevalence of HCV infections in The Netherlands does not decline, and transmission within dialysis units continues. Adequate screening of HCV infections and strict enforcement of universal infection control practices are required.

Case-Control Studies↗
PubMed2002

Cluster of cases of acute hepatitis associated with hepatitis E virus infection acquired in the Netherlands.

Increasing evidence suggests that hepatitis E virus (HEV) infection may occur in developed countries and that swine may act as a reservoir. We report a cluster of 2 confirmed cases and 1 presumptive case of hepatitis associated with HEV. The typed strain from 1 case was related to HEV strains found in North America and Europe, and it was also related to a cluster of swine HEV strains found in The Netherlands. Our findings indicate that locally acquired HEV infections in industrialized countries may be overlooked. Routine testing for HEV infection in patients with acute hepatitis in The Netherlands should be considered before a diagnosis of autoimmune hepatitis is reached and steroid therapy is initiated.

Acute Disease↗
PubMed2000

Prevalence and determinants of fecal colonization with vancomycin-resistant Enterococcus in hospitalized patients in The Netherlands.

OBJECTIVE: To determine the prevalence and determinants of fecal carriage of vancomycin-resistant enterococci (VRE) in intensive care unit (ICU), hematology-oncology, and hemodialysis patients in The Netherlands. DESIGN: Descriptive, multicenter study, with yearly 1-week point-prevalence assessments between 1995 and 1998. POPULATION: All patients hospitalized on the testing days in ICUs and hematology-oncology wards in nine hospitals in The Netherlands were included. METHODS: Rectal swabs obtained from 1,112 patients were screened for enterococci in a selective broth and subcultured on selective media with and without 6 mg/L vancomycin. Resistance genotypes were determined by polymerase chain reaction. Further characterization of VRE strains was done by pulsed-field gel electrophoresis (PFGE). We studied possible determinants of VRE colonization with a logistic regression analysis model. Determinants analyzed included gender, age, and log-transformed length of prior hospital stay. RESULTS: The results showed that 614 (55%) of 1,112 patients were colonized with vancomycin-sensitive enterococci, and 15 (1.4%) of 1,112 carried VRE. No increase in VRE colonization was observed from 1995 to 1998. Eleven strains were identified as Enterococcus faecium and four as Enterococcus faecalis. All E faecium and one E faecalis carried the vanA gene; the other E faecalis strains harbored the vanB gene. PFGE revealed that three vanB VRE isolated from patients hospitalized in one single ICU were related, suggesting nosocomial transmission. Though higher age seemed associated with VRE colonization, exclusion of patients with the nosocomial strain from the regression analysis decreased this relation to nonsignificant. Duration of hospital stay was not associated with VRE colonization. CONCLUSION: VRE colonization in Dutch hospitals is an infrequent phenomenon. Although nosocomial spread occurs, most observed cases were unrelated, which suggests the possibility of VRE acquisition from outside the hospital. Prolonged hospital stay, age, and gender proved unrelated to VRE colonization.

Adolescent↗
PubMed1997

Penicillin-resistant Streptococcus pneumoniae in the Netherlands: results of a 1-year molecular epidemiologic survey.

The molecular epidemiologic characteristics of penicillin-resistant pneumococci in the Netherlands were investigated in 1995. Dutch electronic surveillance data showed that 0.7% of all pneumococci were intermediately resistant and 0.4% were highly resistant to penicillin. From March 1995 to March 1996, 89 penicillin-resistant isolates were collected by 39 medical microbiology laboratories. Thirty different genotypes were observed by restriction fragment end labeling. Twenty-one DNA types were unique, whereas 9 distinct genotypes were shared by > or = 2 isolates. Different serogroups were found within 6 of the 9 genetically identical clusters of penicillin-resistant isolates, suggesting that horizontal transfer of capsular genes is common. Finally, nosocomial transmission of penicillin-resistant pneumococci was observed among 21 elderly adults with chronic obstructive pulmonary disease. This study demonstrates that multiple clones of penicillin-resistant pneumococci have been introduced in the Netherlands, a country with a low prevalence of pneumococcal infection. Some clones spread among the population in and outside hospitals.

Aged↗
PubMed1997

The incidence and genetic variability of small round-structured viruses in outbreaks of gastroenteritis in The Netherlands.

Small round-structured viruses (SRSV) are a group of RNA viruses that can cause gastroenteritis in persons of all ages. To determine the incidence of SRSV-associated gastroenteritis in The Netherlands and to study the genetic variability of outbreak strains, all outbreaks that were reported to the epidemiologists of the regional health services in 1996 were investigated using a standardized protocol. In 60 (87%) of the 69 reported outbreaks, SRSV could be detected, showing the etiologic significance of SRSV in outbreaks of gastroenteritis in The Netherlands. Of these outbreaks, 84% occurred in semiclosed communities, such as nursing homes (59%) and hospital wards (25%). Sequence analysis of the outbreak strains revealed that the majority of the strains from January to November 1996 formed a tight cluster within genogroup II SRSV. In November 1996, a shift toward genogroup I SRSV occurred, suggesting a change to a new predominant strain.

Age Factors↗
PubMed2006

Glandularity and mean glandular dose determined for individual women at four regional breast cancer screening units in the Netherlands.

The nationwide breast cancer screening programme using mammography has been in full operation in The Netherlands since 1997. There is concern that the mean glandular doses due to mammography might be differing between different regions of the country due to differences in glandularity and compressed breast thickness. To investigate regional differences, glandularity, compressed breast thickness and mean glandular dose were determined for individual breasts during screening at mammography units at four locations in The Netherlands. Differences in glandularity were observed, which could be related qualitatively to differences in age of the participants at the different locations. Mean glandular dose depends on compressed breast thickness, glandularity and technical conditions of screening. The lowest average value of the mean glandular dose was found for the unit in Amsterdam. This is most likely due to the use of the Mo/Rh anode/filter combination at this unit, in addition to the Mo/Mo combination. At the other three units, almost exclusively the Mo/Mo anode/filter combination was used. Differences in mean glandular dose averaged per unit could be related mainly to differences in tube-current exposure-time product values. Consequently, it is concluded that differences in mean glandular dose at different units are marginal.

Aged↗
PubMed2002

Biotechnology in the Netherlands: controversy or consensus?

This paper addresses the issue of public perception of modern biotechnology in the Netherlands. Contrary to expectations, data from the 1999 Eurobarometer on biotechnology indicate that the position of the Dutch public in general is rather ambiguous, which is in contrast to many of its neighboring countries. The issue is described in terms of differences between the Netherlands and other European countries on political-economic, social-cultural, or media coverage indicators. On many indicators, the Dutch population differs from that of other European countries, and the Dutch opinion-leading media present a rather balanced perspective on modern biotechnology.

Biotechnology↗
PubMed2005

Psychotropic co-medication among stimulant-treated children in The Netherlands.

OBJECTIVES: The aim of this study was to examine stimulant use from 1998 to 2002 among children in the Dutch pediatric population with emphasis on psychotropic co-medication. METHODS: A drug utilization study was based on community pharmacy-dispensing data from 1998 to 2002 for children aged 0-19 years in the northern and eastern part of The Netherlands. RESULTS: The prevalence of stimulant use increased from 0.6% in 1998 to 1.2% in 2002. Duration of stimulant treatment was longest in children aged 5-14 years. The use of any psychotropic co-medication in stimulant users increased from 12% in 1998 to nearly 15% in 2002. Of those youths who were prescribed stimulant medication in 2002, the most co-prescribed class was the antipsychotics (7.9%). In 1998, none of the stimulant-treated children received antidepressants for co-medication; in 2002, this was 1.8%. CONCLUSION: The prevalence of stimulant use among children in The Netherlands has increased in recent years, mainly as a result of the duration of stimulant treatment. Psychotropic co-medication among stimulant-treated children increased moderately.

Adolescent↗
PubMed2006

Parents report on stimulant-treated children in the Netherlands: initiation of treatment and follow-up care.

OBJECTIVES: The aim of this study was to describe current practices around initiation and follow-up care of stimulant treatment among stimulant-treated children in a nationwide survey among parents. METHODS: A total of 115 pharmacies detected current stimulant users <16 years old in their pharmacy information system and sent parents a questionnaire regarding their child's stimulant treatment. RESULTS: Parents returned 924 of 1,307 questionnaires (71%). The median age of the stimulant users was 10 years and 85% were boys. In all, 91% were diagnosed with attention-deficit/hyperactivity disorder (ADHD). In 77% of the cases, the child or parents received other therapies besides stimulants-21% received psychotropic co-medication, with melatonin (11%) and antipsychotics (7%) being mentioned most frequently. Stimulant use was primarily initiated by child psychiatrists (51%) and pediatricians (32%), but most children received repeat prescriptions from general practitioners (61%). Of these 924 children, 19% did not receive any follow-up care, and transfer of prescribing responsibility increased the risk of not receiving follow-up care. The 732 children (79%) who were monitored visited a physician approximately twice a year. During follow-up visits, pediatricians performed physical check ups significantly more often. CONCLUSION: Stimulant treatment in The Netherlands is initiated mainly by specialists such as child psychiatrists and pediatricians. In the current study, follow-up care for stimulant-treated children in The Netherlands appeared to be poor, suggesting an urgent need for improvement.

Adolescent↗
PubMed2006

Syndromic surveillance in the Netherlands for the early detection of West Nile virus epidemics.

West Nile virus (WNV) is an arthropod-borne flavivirus that is endemic in Africa, Europe, and Eastern Asia. The recent introduction and rapid dissemination of the virus in the United States as well as an increase in WNV outbreaks in Europe, has raised concerns for its spread in Europe. A surveillance system was developed to allow timely detection of an introduction of WNV infections in The Netherlands. This program focuses on cases presenting with neurological disease and includes the monitoring of hospital discharge diagnoses, trends in cerebrospinal fluid (CSF) diagnostic requests, laboratory testing of CSF, and monitoring of neurological disease in horses. Retrospective data from the hospital discharge records showed yearly peaks of unexplained meningitis and (meningo)encephalitis in the summer. A total of 781 CSF samples from humans and 71 serum and/or CSF samples from horses presenting with neurological disease of suspected viral etiology tested negative for the presence of specific antibodies to WNV. With a coverage rate of 59% in 2003, the probability that a cluster of five WNV cases presenting with neurological symptoms would have been detected was 99%. We conclude that, from 1999 to 2004, no evidence of WNV infection could be found in either humans or horses in The Netherlands.

Animals↗
PubMed2001

Evaluation of the relation between n-3 and n-6 fatty acid status and parity in nonpregnant women from the Netherlands.

BACKGROUND: We previously observed an inverse relation between parity and docosahexaenoic acid (DHA) status in pregnant women in the Netherlands. This implies that maternal DHA status may not fully normalize after a mature pregnancy. OBJECTIVE: The objective was to investigate the relation between the essential fatty acid status (in particular the DHA status) of nonpregnant women and the number of completed pregnancies and whether the number of previous pregnancies is associated with a lower DHA status in women from the Netherlands. DESIGN: This was a cross-sectional study of 129 healthy nonpregnant women who completed 0, 1, 2, 3, or 4 mature, uncomplicated, singleton pregnancies. RESULTS: The relative amount of DHA in the plasma phospholipids of nulliparous women and of mothers who completed 1-4 pregnancies (duration since last pregnancy: 3.9 +/- 2.4 y) was not significantly different; a significant correlation between parity and the percentage of DHA in the phospholipids was not observed either. The percentage of DHA in the phospholipids of erythrocytes of mothers was significantly lower than the percentage in the erythrocytes of the nulliparas (P = 0.013), but no significant correlation between the percentage of DHA in the phospholipids of erythrocytes and parity was found. The time interval between the different pregnancies did not influence maternal DHA status. CONCLUSIONS: No relation was found between DHA status and parity in the nonpregnant Dutch women whose last pregnancy was completed > or = 1 y previously. Maternal DHA status, as reflected in plasma and erythrocyte phospholipids, probably normalized within 1 y after the last partus. Whether this is true for other tissues remains to be determined.

Adult↗
PubMed2001

Plant sterol intakes and colorectal cancer risk in the Netherlands Cohort Study on Diet and Cancer.

BACKGROUND: Plant sterols in vegetable foods might prevent colorectal cancer. OBJECTIVE: The objective was to study plant sterol intakes in relation to colorectal cancer risk in an epidemiologic study. DESIGN: The study was performed within the framework of the Netherlands Cohort Study on Diet and Cancer in 120852 subjects who completed a baseline questionnaire in 1986. After 6.3 y of follow-up, 620 colon and 344 rectal cancer cases were detected. A case-cohort approach was used to calculate confounder-adjusted rate ratios (RRs) and their 95% CIs for quintiles of plant sterol intake. RESULTS: The total mean (+/-SD) intake of campesterol, stigmasterol, beta-sitosterol, campestanol, and beta-sitostanol was 285 +/- 97 mg/d. Major contributors to plant sterol intake were bread (38%), vegetable fats (26%), and fruit and vegetables (21%). For men, there was no clear association between intake of any of the plant sterols and colon cancer risk when age, smoking, alcohol use, family history of colorectal cancer, education level, and cholecystectomy were controlled for. Adjustment for energy did not alter the result. For rectal cancer, adjustment for energy resulted in positive associations between risk and campesterol and stigmasterol intakes. For women, there was no clear association between intake of any of the plant sterols and colorectal cancer risk. CONCLUSION: A high dietary intake of plant sterols was not associated with a lower risk of colon and rectal cancers in the Netherlands Cohort Study on Diet and Cancer.

Aged↗
PubMed2006

High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands.

BACKGROUND: Vitamin D deficiency is common in dark-skinned persons living in northern countries. Vitamin D deficiency during pregnancy may have serious consequences for both mother and child. OBJECTIVE: The objective was to ascertain the prevalence of vitamin D deficiency in pregnant women of several ethnic backgrounds who were living in The Hague, a large city in the Netherlands. DESIGN: Midwives whose practice was visited by a large number of non-Western immigrants added the assessment of serum 25-hydroxyvitamin D [25(OH)D] to the standard blood test given to women who visited the practice during week 12 of pregnancy. Subsequently, the Municipal Health Service collected additional data from the midwives' files (June 2002 through March 2004): background variables, use of tobacco or alcohol or drugs, and infectious diseases. The women were grouped ethnically as Western, Turkish, Moroccan, and other non-Western. RESULTS: The vitamin D concentrations of 358 women were found in the midwives' files. Of these women, 29% were Western, 22% were Turkish, and 19% were Moroccan. Mean serum 25(OH)D concentrations in Turkish (15.2 +/- 12.1 nmol/L), Moroccan (20.1 +/- 13.5 nmol/L), and other non-Western women (26.3 +/- 25.9 nmol/L) were significantly (P </= 0.001) lower than those in Western women (52.7 +/- 21.6 nmol/L). Serum 25(OH)D was below the detection limit in 22% of the Turkish women. The differences between ethnic groups were not confounded by other determinants such as age, socioeconomic status, or parity. CONCLUSIONS: The prevalence of vitamin D deficiency in pregnant non-Western women in the Netherlands is very high, and screening should be recommended.

Adolescent↗
PubMed2000

Psychiatric and sociodemographic predictors of attrition in a longitudinal study: The Netherlands Mental Health Survey and Incidence Study (NEMESIS).

This article discusses the effects of sociodemographics and the presence of psychiatric disorders diagnosed in the 12 months before the first interview by using the Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, third edition, revised, on three types of attrition (failure to locate, refusal to participate, morbidity/mortality) in the second wave (1997-1998) of the Netherlands Mental Health Survey and Incidence Study, a longitudinal, general population survey of psychopathology among 7,076 subjects aged 18-64 years. Compared with those reinterviewed successfully, persons not located at the 1-year follow-up (n = 219) were more often younger, poorly educated, urban, not cohabiting with a steady partner, and born outside the Netherlands. Refusers (n = 923) had a lower educational level. Morbidity/mortality (n = 72) was associated with higher age, lower educational level, not being employed, and somatic disorders. After adjustment for sociodemographics, none of the disorders was positively associated with refusal. Failure to locate was linked to agoraphobia, alcohol abuse, and the categories of mood, substance use, and eating disorders. Morbidity/mortality was linked to dysthymia, agoraphobia, simple phobia, obsessive-compulsive disorder, and the category of anxiety disorders. Overall attrition was only slightly higher among respondents with one or more disorders (odds ratio = 1.20, 95% confidence interval: 1.04, 1.38). Thus, psychopathology has only weak-to-moderate effects on attrition and is mainly related to failure to locate and morbidity/mortality but not to refusal.

Adolescent↗
PubMed2003

Height, weight, weight change, and ovarian cancer risk in the Netherlands cohort study on diet and cancer.

Although many studies have been conducted to investigate the relation between anthropometry and the risk of ovarian cancer, their results have been inconsistent. 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 women. Follow-up for cancer was implemented by annual record linkages with the Netherlands Cancer Registry. After 7.3 years of follow-up, 172 incident cases of invasive epithelial ovarian cancer were available for analysis. Multivariate analysis yielded a rate ratio of ovarian cancer for women with adult height of more than 175 cm, compared with those with height of less than or equal to 160 cm, of 2.17 (95% confidence interval: 1.14, 4.13; p trend = 0.01). The rate ratio for women with a body mass index of more than 30 kg/m(2) was 1.69 (95% confidence interval: 1.00, 2.86), compared with women with a Quetelet index of less than 25 kg/m(2), with p trend = 0.06. Rate ratios for weight and body mass index at age 20 years were nonsignificantly increased in the intermediate categories. These data support a positive association between height (and to a lesser extent body mass) and ovarian cancer risk in this population of postmenopausal women.

Aged↗
PubMed2004

Relation of height, body mass, energy intake, and physical activity to risk of renal cell carcinoma: results from the Netherlands Cohort Study.

Data from the Netherlands Cohort Study on Diet and Cancer were used to investigate the association between anthropometry, energy intake, and physical activity and risk of renal cell carcinoma (RCC). The Netherlands Cohort Study on Diet and Cancer consists of 120,852 men and women aged 55-69 years who completed a self-administered questionnaire at baseline (1986). A case-cohort approach was used. After 9.3 years of follow-up, 275 microscopically confirmed incident cases were available for analysis. Incidence rate ratios for RCC were estimated using Cox proportional hazards models. Height was associated with RCC risk only in women (per 5-cm increment, rate ratio (RR) = 1.23, 95% confidence interval (CI): 1.03, 1.46). Body mass index (weight (kg)/height (m)(2)) was associated with increased risk of RCC (per 1-kg/m(2 )increment, RR = 1.07, 95% CI: 1.02, 1.12) for men and women, as was gain in body mass index from age 20 years to baseline (per 1-kg/m(2 )increment, RR = 1.06, 95% CI: 1.01, 1.10). Energy intake was not related to RCC risk, while a possible protective effect was observed for physical activity in men. These results suggest that body mass index and gain in body mass index since age 20 are associated with increased risk of RCC.

Aged↗
PubMed1993

Prevention and control of chemical exposures in the rubber manufacturing industry in The Netherlands.

In a survey in the rubber manufacturing industry in The Netherlands both the chemical and physical exposure of operators as well as company policies on working conditions were assessed. Defining the effectiveness of control measures was a part of this study and is the subject of this article. A method of solution-directed workplace analysis was applied to compare and evaluate the control measures within this branch of industry. Elimination of sources appears to be a strategy for prevention which has been adopted on only a limited scale. Control of exposure to particulates is more frequently applied, with local exhaust ventilation as the most important control measure. Both qualitative and quantitative analysis confirmed that local exhaust ventilation has a limited effect. Dust-free forms of chemicals, especially those with health risks, are used on only a moderate scale. In addition to hazard identification and evaluation based on exposure levels, the foreseeable risks associated with the design and requirements of production processes were established. The forthcoming industrial agreement for the rubber manufacturing industry in The Netherlands will, amongst other measures, stimulate use of source related strategies.

Environmental Monitoring↗
PubMed2003

Evaluation of The Netherlands breast cancer screening programme.

The Netherlands breast cancer screening programme for women aged 50-75 years was gradually implemented during 1989-1997. Short-term indicators for this mammography screening are 80% attendance (800 000 examinations yearly), and for the subsequent screening examinations 7.4 referrals for clinical assessment per 1000 women screened, 4.7 biopsies and 3.6 breast cancers detected. Breast cancer mortality in The Netherlands has been decreasing since 1997 after having been stable for decades. The challenge now is to disentangle the relative contributions of mammographic screening, earlier clinical diagnosis, less aggressive tumours, treatment advances and risk factors towards this decline.

Age Distribution↗