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PubMed2000

Nutrient flows for poultry production in The Netherlands.

Government targets for ammonia emission and for N and P loss per hectare (ha) of agricultural land were used to assess carrying capacity for poultry production in The Netherlands with data from 1990. In addition, the effect of alternative management strategies on carrying capacity was determined. Ammonia emission from poultry production in 1990 [20.5 gigagrams (Gg) N] exceeded the target for 2000 (i.e., 6.9 Gg N). Targets defined for 2000 and 2010 (i.e., 4.6 Gg N) can be achieved, however, without reducing poultry numbers, assuming national introduction of measurements studied. Measures that reduced ammonia emission directly, i.e., introduction of low-emission housing or manure application techniques, were most effective. In 1990, N and P losses equalled 215 kg/ha for N and 31 kg/ha for P. The N loss was slightly lower than the target for 2000 (219 kg N/ha) but exceeded the target for 2010 (144 kg N/ha). Reduction of application of artificial N fertilizer, however, reduced N loss effectively from 215 to 22 kg/ha. National P loss in 1990 exceeded the target for 2000 (15.3 kg P/ha). Reduction of application of artificial P fertilizer reduced P loss most effectively from 31 to 14 kg/ha. To achieve the target for 2010 (8.7 kg P/ha), additional reduction in P excretion by poultry is required. This reduction can be achieved by use of phytase in layer and broiler feed and by use of a coarse Ca source in layer feed. Unlike pig production, carrying capacity for poultry production in The Netherlands is not limited by governmental targets for acidification, eutrophication, or drinking water contamination.

Ammonia↗
PubMed2000

Prevention of unhealthy behaviour by youth health care in The Netherlands.

BACKGROUND: In this study the effect is assessed of (repeated) well-care visits and freely accessible consultation hours at secondary schools on the prevalence of adolescent health-compromising behaviour and later obesity. METHODS: An ecological case-referent study design was used with data from the Netherlands Bureau of Statistics, the Ministry of Defence, the 1992 High-School Student Study, all youth health care departments in The Netherlands and relevant census. Data from the High-School Student Study included 4,569 students aged 12-18 years, of whom 4,167 had answered all questions on health-compromising behaviour and eating habits. The data from the Ministry of Defence included 1,004 cases with a body mass index greater than 27 of a total of 12 251 male conscripts. The census of 18- and 19-year-old males in the regions of the relevant youth health care departments served as referents. RESULTS: Except for the use of alcohol, the effect of more well-care visits was in all cases negative, and for the use of tobacco even significantly so [odds ratio (OR) = 1.15, 95 per cent confidence interval (CI) = 1.01-1.33]. The availability of open consultation hours had an adverse effect on use of alcohol (OR = 1.29, 95 per cent CI = 1.11-1.50). The OR for obesity in male conscripts showed an adverse effect of a greater number of well-care visits (OR = 2.46, 95 per cent Cl = 1.74-3.46) and the availability of open consultation hours (OR = 1.97, 95 per cent CI = 1.72-2.25). CONCLUSIONS: This study does not support the hypothesis that, at a population level, preventive activities of youth health care departments such as (more) frequent well-care visits or offering open consultation hours at secondary schools, have a beneficial effect on prevention of health-compromising behaviour or obesity.

Adolescent↗
PubMed1992

Lyme borreliosis: a very infrequent cause of arthritis of undetermined aetiology in the southern part of The Netherlands.

Seventy-three patients with undiagnosed arthritis of undetermined aetiology, 94 patients with classified arthritis (rheumatoid arthritis, ankylosing spondylitis, etc.) and 70 controls were studied for clinical and serological manifestations of Lyme borreliosis. The patients were recruited from the three rheumatology units in the most southern part of The Netherlands. A clinical diagnosis of possible Lyme borreliosis was made in seven of 73 patients with arthritis of undetermined aetiology, in four of 94 patients with classified arthritis and in one of the controls. A definite diagnosis of Lyme borreliosis could be made in only one patient who belonged to the arthritis of undetermined aetiology group. This patient had erythema migrans, arthritis of the knee joint and showed positive antibodies to B. burgdorferi. In the southern part of The Netherlands, Lyme arthritis does not seem to be a frequent cause of arthritis of undetermined aetiology.

Adolescent↗
PubMed1999

Familial aggregation of rheumatoid arthritis in The Netherlands: a cross-sectional hospital-based survey. European Consortium on Rheumatoid Arthritis families (ECRAF).

OBJECTIVES: To study the familial aggregation of rheumatoid arthritis (RA) in The Netherlands and to analyse the effect of proband characteristics on the concordance rates for RA. Secondary aims were to compare the characteristics of patients in an early RA inception cohort with those of regular patients and to select Dutch families for the genome-wide scan carried out by the European Consortium on RA families (ECRAF). METHODS: A cross-sectional, hospital-based survey aimed to identify affected sibpair (ASP) families among our whole RA population. Familial RA, or an ASP family, was defined by the presence of at least two siblings fulfilling the 1987 ACR criteria for RA. RESULTS: The estimated prevalence for familial RA was 9.8% and similar to that found in previous hospital series. The true-positive reporting rate for RA in sibs was 60%. Sibship size in ASP families (mean +/- S.D. = 7.8+/-3.3) was significantly larger than in the Dutch population. Probands with familial RA were more often rheumatoid factor positive and had a longer follow-up. Male gender and history of joint replacements were associated with higher concordance rates for RA. However, regression analysis showed that, correcting for sibship size, the concordance rate for RA was largely not explained by proband characteristics. Compared to regular RA patients, our inception cohort encompassed more male and/or rheumatoid factor-negative patients, but had similar performance in the study and rate of familial aggregation. CONCLUSIONS: The familial aggregation of RA in The Netherlands is not increased and occurs preferentially in large sibships. Among proband characteristics, sibship size is most clearly related to the recurrence of RA in particular families. Patients' recognition of RA manifestations in relatives is not optimal.

Adult↗
PubMed1993

The effectiveness of condom use in heterosexual prostitution in The Netherlands.

OBJECTIVES: To assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined. SUBJECTS AND METHODS: One hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991. RESULTS: Of those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant. CONCLUSIONS: In view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms.

Condoms↗
PubMed1993

Greater diversity of the HIV-1 V3 neutralization domain in Tanzania compared with The Netherlands: serological and genetic analysis.

OBJECTIVE: To compare variation in the HIV-1 V3 neutralization domain in Tanzania and The Netherlands. METHODS: For serologic analysis, the specificity of anti-V3 antibodies (immunoglobulin G) for a panel of V3 peptides was determined in sera from 55 symptomatic HIV-1-infected Tanzanians and 51 Dutch AIDS patients. For genetic analysis, viral RNA was isolated from 15 of the Tanzanian sera and six of the Dutch sera. The V3 encoding region was reverse-transcribed, polymerase chain reaction-amplified and bacterially cloned, and sequences were determined over a stretch of at least 207 nucleotides. RESULTS: Thirty-five per cent of the Tanzanian sera, versus 2% of the Dutch sera, showed the highest reactivity to a V3 sequence of Zairian origin (RKSIHVGPGQAFYATG). Twenty-nine per cent of the Tanzanian sera, versus 82% of the Dutch sera, showed the highest reactivity to V3 sequences of US/European origin (RKSIXIGPGRAFYTTG; X = H, P or N). The Tanzanian RNA sequences showed greater diversity (mean distance, 19%) than the Dutch RNA sequences (10%). The measured anti-V3 specificities of the Tanzanian sera did not match accurately with the V3 sequences recovered from these sera. However, reactivity to the Zairian V3 peptide was associated with the sequence GPGQ, found in the centre of the V3 in 50% of the Tanzanian sequences. Sera from both countries that showed similar reactivities to the peptide panel contained RNA sequences that were relatively distant. CONCLUSIONS: The diversity of the HIV-1 population in Tanzania is much greater than that in The Netherlands. An indication of the HIV-1 V3 variation in a particular geographic region can be obtained by serological methods, but sequence analysis should not be omitted.

Adolescent↗
PubMed1998

HIV-1 strains specific for Dutch injecting drug users in heterosexually infected individuals in The Netherlands.

OBJECTIVE: To study the molecular epidemiology of HIV-1 subtype B amongst heterosexually infected individuals in The Netherlands. DESIGN: The study population comprised 54 individuals infected by subtype B viruses through heterosexual contacts. Serum samples were collected between 1988 and 1996. METHODS: Sequences of the gp120 V3 region were obtained from serum samples and analysed by using the signature pattern and phylogenetic methods. RESULTS: In 22 (41%) out of 54 subtype B sequences from heterosexually infected individuals, the synonymous nucleotide substitution in the second glycine codon at the tip of the V3 loop (the GGC pattern), previously identified as specific for Dutch injecting drug users (IDU), was found. The other previously described IDU sequence patterns were observed significantly more often among GGC- than among non-GGC-containing sequences. In addition, we identified another amino-acid change specific for the GGC sequences. In the phylogenetic and principal coordinate analyses, the GGC sequences from heterosexually infected individuals clustered separately from the non-GGC sequences and together with the IDU consensus sequence. Both the nonsynonymous and particularly the synonymous distances amongst the GGC sequences were significantly lower than amongst the non-GGC sequences. CONCLUSIONS: Our data provide evidence for a common origin of the viruses in Dutch IDU and the GGC viruses in heterosexuals. We suggest that a considerable proportion of the viruses in heterosexually infected individuals in The Netherlands may have originated from Dutch IDU.

Adult↗
PubMed1988

Population radiation absorbed dose from nuclear medicine procedures in The Netherlands.

The mean radiation absorbed dose per patient and for the whole population per caput per year in the Netherlands from diagnostic nuclear medicine procedures has been estimated using patient data from 10 large hospitals during either 1984 or 1985. The mean effective dose equivalent and the mean gonad dose equivalent per patient were 2.7 mSv and 1.7 mSv, respectively. Extrapolating these figures to all diagnostic nuclear medicine procedures in the Netherlands, the mean effective dose equivalent and the mean gonad dose equivalent per caput per year were 0.037 mSv and 0.024 mSv, respectively.

Female↗
PubMed1995

Characteristics of patients from hospital-based in-patient rehabilitation in The Netherlands.

The University Hospital Dijkzigt in Rotterdam is one of the first hospitals in The Netherlands to have a rehabilitation department providing multidisciplinary, hospital-based-in-patient rehabilitation (HBIR). The main goals of HBIR are to estimate the final optimum level of patient's functioning, to investigate the most appropriate treatment setting to achieve this and to fulfil requirements for discharge from hospital as soon as possible. One of the central issues in rehabilitation in the Netherlands is to obtain more insight into the current daily practice of HBIR. The aim of this study was to describe the characteristics of the patients treated in HBIR in Dijkzigt Hospital. Registered data from 1967 HBIR patients treated between 1988 and 1990 were analysed retrospectively. The patients were on average 53.1 ( +/- 19.7) years old; the men (63%) were significantly younger than the women (mean age of 50.8 and 57.0 years, respectively). The main diagnostic groups were stroke (27%), progressive and regressive neurological conditions (17%), hand injuries (9%), spinal cord lesion (9%), orthopaedic injuries (8%) and amputation of lower extremity (8%). The median duration of HBIR and hospitalization were 13 days and 33 day, respectively. Most patients were discharged home (63%), or to a nursing home (14%) or a rehabilitation centre (8%). The results of this study can be used in policy discussions on HBIR and provides a description of the population which needs to be studied longitudinally in future research on the outcomes of HBIR.

Activities of Daily Living↗
PubMed1998

Undertreatment of hypertension in a population-based study in The Netherlands.

OBJECTIVE: To estimate the level of undertreatment of hypertension in a population-based study by taking into account the co-existence of additional cardiovascular risk factors in untreated hypertensives, uncontrolled blood pressure among pharmacologically treated hypertensives and within-person variability in blood pressure and total cholesterol. DESIGN: Cross-sectional. SETTING: Two population-based surveys on cardiovascular disease risk factors conducted during 1987-1995 in The Netherlands. PARTICIPANTS: 56 026 men and women aged 20-59 years. MAIN OUTCOME MEASURES: Prevalence of hypertension, of treatment and of undertreatment of hypertension. Undertreated hypertensives were those who were treated pharmacologically, but whose blood pressure was still elevated and those who inappropriately received no medication for the treatment of hypertension. RESULTS: During the past decade in The Netherlands, 30% of the hypertensive women and 47% of the hypertensive men aged 20-59 years were undertreated for hypertension. In both men and women treated pharmacologically, 42 and 29%, respectively, still had elevated blood pressure levels. Of those hypertensive men and women not treated pharmacologically, 53 and 34%, respectively, should have been treated when additional cardiovascular risk factors were taken into account Among those diagnosed but untreated for hypertension, 58 and 31% of the men and women, respectively, should have been treated pharmacologically. CONCLUSION: A considerable proportion of hypertensives were undertreated for hypertension. To decrease the undertreatment of hypertension, it is necessary to obtain better control of blood pressure in patients already being treated, increase the detection of hypertension and improve adherence to the current guidelines.

Adult↗
PubMed1996

Amenorrhea in ballet dancers in the Netherlands.

The prevalence of amenorrhea was studied among 113 professional and student ballet dancers in the Netherlands (mean age 23.3 yr, SD 4.8). Sixty-one dancers not on oral contraceptives were included in the subsequent analyses. Six cases (prevalence 9.8 percent, 95 percent confidence interval: 2.4-17.2) with secondary amenorrhea (< or = 4 cycles per year; previous menstruation > or = 3 months prior to the study; menarche > or = 1 yr prior to the study) were found. Two dancers had primary amenorrhea (no menarche at the age of > or = 16). There was a negative correlation between the age of menarche and the number of menstrual cycles during the 12 months preceding the study (r = -0.46, P = 0.001). Body composition (four-compartment model), amount of dancing (recorded), resting energy expenditure (ventilated hood), dietary intake (recorded), and indices of eating disorders (Eating Disorders Inventory, EDI) were studied in 15 of the dancers, 5 amenorrheic and 10 eumenorrheic. No significant differences were found between the amenorrheic and eumenorrheic dancers. An explanation for the lower prevalence of amenorrhea in ballet dancers in the Netherlands, compared with U.S. dancers, was not obvious. Relatively low EDI scores (25.8, SD 14.5) in a subsample of 24 dancers could indicate less rigid emphasis on leanness and dieting.

Adult↗
PubMed1995

Neonatal transport by helicopter in The Netherlands: a 7-year overview.

In the Netherlands, neonatal intensive care is provided in 10 neonatal intensive care centres. Although antenatal transport is preferred, each year more than 1000 newborns are transported to the centres, in the majority of cases by ambulance. Transport by helicopter became available in 1987. From June 1987 till December 1993, 583 infants were transported by helicopter (median gestational age 32 weeks, range 24-43). Forty-four per cent had a gestational age of less than 32 weeks. Four hundred and forty-six infants were mechanically ventilated. No baby died in transfer. After admission, 101 infants died (18.4%). There were no accidents during transport Ten per cent of the requested flights was cancelled because of weather conditions. The mean transport time of the babies was 36 min (range 10-145), and the mean transport time of the transport teams was 128 min (range 20-345). The transports carried out from 1987 to 1989 were recalculated with regard to duration and cost, assuming they were carried out by ambulance instead of by helicopter: for the babies, the mean transport time by helicopter was 75% less than the calculated mean transport time by ambulance. However, the financial costs per transport were on average Dutch florins (DFL) 3000 higher by helicopter than by ambulance. In the Netherlands, the use of a helicopter for neonatal transport reduces the transport time, but doubles the costs.

Air Ambulances↗
PubMed1995

Emergency ambulance assistance in The Netherlands: is the Dutch situation optimal?

The system of prehospital trauma care in the Netherlands is the subject of great concern. Although many improvements have been achieved in the last decade, there are still some deficits. Legislation concerning the minimal level of education for ambulance attendants was recently upgraded to 'registered nurse', a standard which must be achieved by 1997. Standardization with regard to extrication techniques, equipment and methods of treatment in prehospital trauma care does not yet exist. Although aware of the fact that large regional differences exist throughout the USA, a system of care in accordance with the advanced trauma life support (ATLS) standard of the American College of Surgeons (ACS) and by means of prehospital and advanced trauma life support (PHTLS) given according to the standards of the National Association of Emergency Medical Technicians (NAEMS) was considered to be the 'golden standard'. Nineteen ground ambulance and two helicopter services in different states of the USA, working according to ACS/NAEMS standard, were visited to analyse the system of care, with special reference to (para)medical education, communication, logistics, and immobilization materials and techniques. In the Netherlands all 41 central post ambulance services (CPAs) were asked to return a questionnaire. This resulted in a 90% (37 out of 41) response. The deficits of the Dutch system of care related to the PHTLS/ATLS standard are pointed out, resulting in recommendations to improve the Dutch system. The requirements of the dispatcher are far inferior to the optimal situation, which, together with the lack of technical equipment, results in serious communication problems. The Dutch ambulance attendant education, in which in the present system the education level reaches 'registered nurse' in only 91% and specialized courses are not mandatory, should be upgraded to the PHTLS level of care.

Air Ambulances↗
PubMed2006

Depressive symptoms as risk factor of cardiovascular mortality in older European men: the Finland, Italy and Netherlands Elderly (FINE) study.

BACKGROUND: Depressive symptoms have been suggested to increase the risk of cardiovascular diseases, but this may reflect reversed causality. We investigated to what extent depressive symptoms are a true risk factor for cardiovascular mortality in elderly men. DESIGN: The Finland, Italy and Netherlands Elderly (FINE) study is a prospective cohort study conducted in Finland, Italy and The Netherlands. METHODS: Depressive symptoms were measured with the Zung self-rating Depression Scale in 799 elderly men, aged 70-90 years, free from cardiovascular diseases. Using Cox models, hazard ratios (HRs) were calculated for specific cardiovascular mortality endpoints. The analyses were adjusted for potential confounders, stratified on country and repeated after exclusion of men who died from cardiovascular diseases up to 5 years after baseline. RESULTS: During 10-years of follow-up 224 (28%) men died from cardiovascular diseases. The adjusted hazard for a five-point increase in depressive symptoms was 1.15 [95% confidence interval (CI) 1.08-1.23] for cardiovascular mortality. This risk was stronger for mortality from stroke (HR 1.35; 95% CI 1.19-1.53) and heart failure (HR 1.16; 95% CI 1.00-1.35) in comparison with mortality from coronary heart disease (HR 1.08; 95% CI 0.97-1.20) and other degenerative heart diseases (HR 1.06; 95% CI 0.91-1.23). Exclusion of men who died from cardiovascular diseases within 5 years after baseline did not change the strength of the associations. There were no significant differences in HRs between northern and southern Europe. CONCLUSIONS: This study provides further and more convincing prospective evidence for depressive symptoms as a risk factor for cardiovascular mortality in elderly men.

Adult↗
PubMed2004

Starting a crossover kidney transplantation program in the Netherlands: ethical and psychological considerations.

On April 15th, 2003, the first crossover kidney transplantation took place in The Netherlands. In September of the same year, a national database was established to facilitate kidney exchange between two donor-recipient couples. During 2004, kidneys from living donors will be exchanged between the seven university medical centers in The Netherlands. One of the conditions for successfully implementing this program was the need to address the ethical and psychologic implications involved. In this article we will discuss the ethical and psychologic considerations that are accompanying the practical preparations for the first Dutch crossover transplantation program. We identified five topics of interest: the influence of "donation by strangers" on the motivation and willingness of donor-patient couples, the issue of anonymity, the loss of the possibility of "medical excuses" for unwilling donors, the view that crossover is a first step to commercial organ trade, and the interference with existing organ donation programs. We concluded that whether viewed separately or in combination, these issues do not impede the efficient organization of a crossover program or raise worrying ethical issues.

Anonyms and Pseudonyms↗
PubMed2005

Operational storm surge forecasting in the Netherlands: developments in the last decade.

The accurate forecasting of storm surges is an important issue in the Netherlands. With the emergence of the first numerical hydrodynamic models for surge forecasting at the beginning of the 1980s, new demands and possibilities were raised. This article describes the main phases of the development and the present operational set-up of the Dutch continental shelf model, which is the main hydrodynamic model for storm surges in the Netherlands. It includes a brief discussion of applied data-assimilation techniques, such as Kalman filtering, the model calibration process and some thoughts on quality assurance in an operational environment. After further describing some select recent investigations, the paper concludes with some remarks on future developments in a European context.

Computer Simulation↗
PubMed1993

Developments in drinking behavior in The Netherlands from 1958 to 1989, a cohort analysis.

Alcohol consumption in the Netherlands increased at a very fast rate from 1960 to 1975, especially among young men. The question is raised whether members of the cohort that started drinking during the 1960s show a lasting deviation from cohorts born earlier with respect to drinking behavior. Cohort analysis is used to assess the effects of aging, period and cohort membership on changes in abstinence, mean consumption and heavy drinking in the Netherlands in the last three decades. Social interaction theory (Skog, 1980) is used as an interpretative framework. Conclusions are that abstinence is related to aging, while mean consumption and heavy drinking are associated with period effects. Populations of men and women appear to change drinking behavior collectively. Results on women are more regular than those on men.

Adult↗
PubMed2006

Declining incidence of peptic ulcer but not of its complications: a nation-wide study in The Netherlands.

BACKGROUND: Despite reports of decreasing hospitalizations and mortality due to peptic ulcer, it is unclear whether the incidence has truly declined over time. AIM: To investigate time trends in the incidence of and in hospital admission rates for peptic ulcer in the Netherlands. METHODS: The nationwide registry of pathology reports (PALGA) and the national registry of hospital admissions (Landelijke Medische Registratie) were used. Standardized morbidity ratios were calculated to assess the magnitude of the changes. RESULTS: The age-adjusted incidence of gastric ulcer halved for both men (standardized morbidity ratio 0.48; CI 0.46-0.49) and women (standardized morbidity ratio 0.49; CI 0.47-0.51). Although the number of gastric biopsies obtained at endoscopy increased, the proportion with a diagnosis of peptic ulcer decreased by more than 50% (standardized morbidity ratio 0.47; CI 0.46-0.49). The admission rate for peptic ulcer more than halved between 1980 and 2003. In contrast, admission rates for complicated ulcers barely changed and slightly increased among women. CONCLUSIONS: The incidence of histopathologically confirmed gastric ulcer halved between 1992 and 2003 in the Netherlands. As the number of gastric biopsies increased in this period, a true decrease is likely. Hospital admissions for peptic ulcer declined dramatically between 1980 and 2003, but remained unchanged or slightly increased for complicated ulcers.

Biopsy↗