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PubMed2004

Recent trends in (under)treatment of hypercholesterolaemia in the Netherlands.

AIM: To assess recent trends in undertreatment of hypercholesterolaemia (1998-2002). METHODS: Data were obtained from the third cross-sectional examination of the Monitoring Project on Risk Factors for Chronic Diseases (n = 4878; age 31-70 years), conducted in the Netherlands. Treatment eligibility was established according to Dutch guidelines. Data from the second examination (1993-1997) were used to assess time trends. The association between demographic variables, cardiovascular disease risk factors, drug use and lipid-lowering medication was assessed using multivariable logistic regression. RESULTS: Overall, 45.9%[95% confidence interval (CI) 41.4, 50.4] of respondents eligible for treatment were treated, and 17.4% (95% CI 13.9, 20.9) were both treated and controlled (1998-2002). Treatment increased significantly after 1995, showed a slight decrease in subsequent years until 2000, when treatment increased again. Subgroups less frequently treated for primary prevention included among others males [odds ratio (OR) = 0.08; 95% CI 0.03, 0.21], younger patients (OR = 0.93 per year; 95% CI 0.88, 0.98), diabetics (OR = 0.19; 95% CI 0.07, 0.56), untreated hypertensives (OR = 0.21; 95% CI 0.09, 0.49) and current smokers (OR = 0.09; 95% CI 0.03, 0.25). In secondary prevention, patients with a history of stroke were less likely to receive treatment (OR = 0.41; 95% CI 0.18, 0.94) compared with patients with a history of ischaemic heart disease. CONCLUSIONS: Treatment of hypercholesterolaemia has steadily increased over the past 10 years in the Netherlands. However, at present still less than one out of two eligible for treatment is treated, and only about one out of six is both treated and controlled.

Adult↗
PubMed2005

Treatment of hypopharyngeal carcinoma: analysis of nationwide study in the Netherlands over a 10-year period.

OBJECTIVE: To analyse different treatment strategies and treatment results of hypopharyngeal carcinoma in the Netherlands. DESIGN: Retrospective study. SETTING: Eight head and neck centres in the Netherlands. PARTICIPANTS: A total of 893 patients were treated between 1985 and 1994. Patients were mostly treated with radiotherapy alone, combined surgery and radiotherapy and surgery alone. RESULTS: The 5-year survival for the whole group was 26%. The 5-year survival for patients treated with curative intention was 32% and treated with palliative intention was 5%. The 5-year disease-free survival after radiotherapy alone was 37%, after surgery alone 41% and after combined therapy 47%. The role of chemotherapy could not be investigated because of a small number of patients treated with chemotherapy in this period. CONCLUSION: Combined therapy with surgery and radiotherapy has a better survival for patients with a hypopharyngeal carcinoma in comparison with radiotherapy alone. The N-stage is more important for the prognosis than the T-stage.

Adult↗
PubMed1991

Continuing education in endodontology in The Netherlands.

The Netherlands Society for Endodontology has developed a 5-year plan for continuing education that served as a guideline for two basic courses in endodontology. The 2-day basic course has been attended by over 2000 dentists, and has been very much appreciated according to the evaluation outlined in this article. The development and content of these courses are described. Over the past 10 years it has been shown that there is a high demand for continuing education in endodontology in The Netherlands, and that a properly designed and presented course may be very successful.

Education, Dental, Continuing↗
PubMed1990

Creative international networking towards academic nursing education and research in The Netherlands.

This article describes the changes occurring in nursing education in The Netherlands. The key factors influencing this process are addressed. Nurse education in The Netherlands still takes place mainly in hospital schools of nursing. In 1972 an important innovation was realized when the first two undergraduate nursing education programmes were started within institutions for higher education. Today there are 18 such programmes in the country and since 1980 there is also one graduate programme at the University of Maastricht. Another major event occurred in 1986 when the University of Utrecht and the local School for Higher Education together initiated the development of a graduate programme in nursing education. A collaborative master's degree course was created with the University of Wales, United Kingdom. Meanwhile, three Dutch universities have joined efforts and are presently working together with regional schools for higher professional education on a national plan. The aims are to establish (part-time) master and doctoral degree programmes in nursing and academic nursing research within the next few years.

Education, Nursing↗
PubMed2006

Massage to prevent pressure ulcers: knowledge, beliefs and practice. A cross-sectional study among nurses in the Netherlands in 1991 and 2003.

BACKGROUND: Pressure ulcers are a major problem in all areas of health care in the Netherlands. National guidelines for the prevention and treatment of pressure ulcers were originally developed in 1985 and revised in 1991 and 2002. The value of these guidelines can be questioned because it seems they are not in line with the beliefs and practice of the caregivers and only 5% of them are evidence-based. AIMS AND OBJECTIVES: To get a better insight into nurses' current knowledge, beliefs and performed practices relating to massage, a study was designed to assess changes in these three aspects after the publication of the 2002 Dutch national guidelines. The outcome was compared with the situation in 1991, the year in which the previous guidelines were published. DESIGN AND METHOD: A cross-sectional comparative study was designed using written questionnaires. Questions were formulated regarding knowledge and beliefs about prevention methods and the actual use of these methods in the prevention of pressure ulcers. The 2003-survey population consisted of nurses working in the Netherlands and was approached at random via subscriptions to Nursing News (i.e. Verpleegkunde Nieuws), a Dutch professional journal or via affiliations to an institution participating in the 2003 National Prevalence Survey of Pressure Ulcers. RESULTS AND CONCLUSIONS: Compared with the 1991 findings, the 2003 results show an improvement for the topic of pressure ulcers, but a deterioration regarding dehydration. It is obvious that the knowledge of the current CBO-guidelines on massage is still not widely distributed as it should be. Our overall conclusion is that the differences in responses between 1991 and 2003 are significant and suggest that the nurses were better informed in 2003. RELEVANCE TO CLINICAL PRACTICE: For the improvement of health care in the domain of pressure ulcer preventions, we need more than an accurate implementation of new or existing guidelines. Guidelines should also be based on qualitative, methodological well-designed studies to be evidence-based.

Adult↗
PubMed2005

Ethnic differences in congenital malformations in the Netherlands: analyses of a 5-year birth cohort.

Congenital malformations are among the major causes of perinatal mortality and morbidity at present. Research into the ethnic diversity of congenital malformations can form a basis both for aetiological studies and for health care advice and planning. This study compared the overall prevalence of congenital malformations, the prevalence in different organ systems and of several specific malformations between different maternal ethnic groups in the Netherlands using a 5-year national birth cohort (1996-2000) containing 881 800 births. Maternal ethnic groups considered were Dutch; Mediterranean (Moroccan/Turkish); other European; Black; Hindu and Asian. Mediterranean women had a 20% higher risk of having a child with a congenital malformation than Dutch women (age-adjusted OR = 1.21 [95% CI 1.16, 1.27]). They showed an increased risk of malformations in several organ systems such as the central nervous system and sensory organs, the urogenital system and skin and abdominal wall. Further, they had an increased risk of the group of chromosomal malformations/multiple malformations/syndromes. For the specific group of multiple malformations the maternal age adjusted OR was 1.80 [95% CI 1.47, 2.20]. The Black group showed a significantly increased risk of skeletal and muscular malformations (age adjusted OR = 1.76 [95% CI 1.53, 2.02]) with a sixfold increased risk of polydactyly compared with the Dutch group. For Mediterranean women, the largest and fastest growing group of immigrants in the Netherlands, this study demonstrated an increased risk of congenital malformations.

Abdominal Wall↗
PubMed2005

Cost-effectiveness of pathogen inactivation for platelet transfusions in the Netherlands.

The objective of this study is to estimate cost-effectiveness of pathogen inactivation for platelet transfusions in the Netherlands. We used decision tree analysis to evaluate the cost-effectiveness of the addition of pathogen inactivation of pooled platelets to standard procedures for platelet transfusion safety (such as, donor recruitment and screening). Data on transfusions were derived from the University Medical Centre Groningen (the Netherlands) for 1997. Characteristics of platelet recipients (patient group, age, gender and survival) and data/assumptions on viral and bacterial risks were linked to direct and indirect costs/benefits of pathogen inactivation. Post-transfusion survival was simulated with a Markov model. Standard methods for cost-effectiveness were used. Cost-effectiveness was expressed in net costs per life-year gained (LYG) and estimated in baseline- and sensitivity analysis. Sensitivity was analysed with respect to various assumptions including sepsis risk, reduction of the discard rate and discounting. Stochastic analysis to derive 90% simulation intervals (SIs) was performed on sepsis risk. Net costs per LYG for pathogen inactivation were estimated 554,000 euro in the baseline-weighted average over the three patient groups (90% SI: 354,000-1092,500 euro). Sensitivity analysis revealed that cost-effectiveness was insensitive to viral risks and indirect costing, but highly sensitive to the assumed excess transfusions required and discounting of LYG. Given relatively high net costs per LYG that are internationally accepted for blood transfusion safety interventions, our estimated cost-effectiveness figures for pathogen inactivation may reflect acceptable cost-effectiveness in this specific area. Two main assumptions of our model were that the pathogen inactivation was 100% effective in preventing transmission of the pathogens considered and was not associated with major and/or costly adverse reactions. Validation of several crucial parameters is required, in particular the Dutch risk for acquiring and dying of transfusion-related sepsis.

Adolescent↗
PubMed1985

Volumetric aerobiological survey of conidial fungi in the North-East Netherlands. I. Seasonal patterns and the influence of metereological variables.

In order to obtain actual data about the qualitative and quantitative occurrence of airborne fungi in The Netherlands, a viable-volumetric sample survey with the Andersen sampler was undertaken. From April 1981 to the end of June 1983, one day a week samples were taken on the unobstructed rooftop of a hospital in the N-E Netherlands. An average of 268 Colony Forming Units (CFU), per sample, per cubic metre of air were found. Almost three-quarters of the total catch consisted of seven genera, Cladosporium predominating. Botrytis showed in surprisingly high numbers when compared with other surveys, while Alternaria occurred in very low concentrations. Most atmospheric airborne spora were found between May and September. Aspergillus and Penicillium prevailed in the autumn and winter months, although were present the year-round. Momentary weather conditions seemed less important for the overall spore picture than the average meteorological characteristics for a whole season. The obtained aero-mycological information may be useful in determining clinical strategies for skin testing and serological investigations in patients with suspected mould allergies.

Air Microbiology↗
PubMed1986

Birch pollen asthma in The Netherlands.

The occurrence of birch pollen asthma is related to high birch pollen concentrations in the air, and therefore this type of asthma is rather common in Scandinavia. High birch pollen concentrations are rare in The Netherlands, but in the spring of 1984 extremely high levels were reached, whereas the concentrations of alder and hazel pollen were very low. During this period nine pollinosis patients known to the allergist developed asthmatic complaints. The appearance and disappearance of the asthmatic symptoms in these patients showed strong correlation with the course of the birch pollen concentration in the air, which strongly suggests that birch pollen asthma can occur in The Netherlands. The significance of this finding may be that this type of asthma can be observed regularly when the birch pollen concentrations are very high. This may also hold for other western European countries.

Adult↗
PubMed1992

Bladder cancer mortality in The Netherlands, 1955-1988.

In 1955, 234 men and 116 women died from bladder cancer in the Netherlands. In 1988 the numbers were 794 and 317 respectively. After adjusting for the ageing of the Dutch population since 1955, female mortality rates per 10(5) person-years appear to be very stable: 2.9 from 1955 to 1959 and 3.0 from 1985 to 1988. By contrast, an increasing trend exists in males. From 1955 to 1959 and from 1985 to 1988, bladder cancer mortality rates per 10(5) person-years were 7.5 and 12.4 respectively. For men in particular, increasing mortality (and incidence) rates are seen all over the world. In many cases this increasing trend is thought to originate from a higher risk of dying from bladder cancer in successive birth cohorts rather than from a higher risk in successive calendar periods. This so-called cohort effect is explained by changes in smoking behaviour in the male population. Statistical modelling of bladder cancer mortality data from 1955 to 1988 in the Netherlands shows that the increasing temporal trend in men can also be described as a cohort effect. The risk of dying from bladder cancer increases from the 1875 birth cohort to the 1910 birth cohort, but decreases thereafter. It is concluded that this decreasing risk for generations born after 1910 will probably result in a decreasing trend in mortality in the near future, when more and more of these "youngsters" reach the age of 70+.

Age Factors↗
PubMed2005

Predicted effects on antibiotic use following the introduction of British or North American guidelines for community-acquired pneumonia in The Netherlands.

This study evaluated the possible changes in antibiotic use that might follow the implementation of British or North American guidelines for the treatment of community-acquired pneumonia (CAP) in The Netherlands. Patients admitted for mild, moderate and severe CAP were evaluated prospectively. Volume of antibiotic use, based upon guidelines of the British Thoracic Society (BTS), the Infectious Diseases Society of America (IDSA) or the American Thoracic Society (ATS), was estimated and compared to current practice. For 248 patients, current antibiotic use was 3087 defined daily doses. Antibiotic use would increase by 38% if based on ATS guidelines, by 23% if based on IDSA guidelines, and by 21% if based on BTS guidelines. The most significant increase in antibiotic use would occur for cases of moderate CAP, with incremental antibiotic costs of 1 750 000-3 500 000 Euros in The Netherlands.

Adult↗
PubMed2005

The effect of the Term Breech Trial on medical intervention behaviour and neonatal outcome in The Netherlands: an analysis of 35,453 term breech infants.

OBJECTIVE: To examine the effects of the Term Breech Trial on the medical behaviour of Dutch obstetricians and on neonatal outcomes. DESIGN: Retrospective observational study. SETTING: The Netherlands. POPULATION: Infants born at term in breech presentation in the Netherlands between 1998 and 2002, with birthweights < or =4000 g (n= 33,024) and >4000 g (n= 2429), respectively. Multiple pregnancies, antenatal death and major congenital malformations were excluded. METHODS: Data derived from the Dutch Perinatal Database were used to compare modes of delivery and neonatal outcome of infants born in breech position in the 33 months preceding publication of the Term Breech Trial and in the 25 months thereafter. MAIN OUTCOME MEASURES: Incidence of planned and emergency caesarean section, vaginal breech delivery, perinatal death, 5-minute Apgar score and birth trauma. RESULTS: Within two months after publication of the Term Breech Trial, the overall caesarean rate increased from 50% to 80% and has remained stable thereafter. In the group of infants < or =4000 g, this was associated with a significant decrease of perinatal mortality from 0.35% to 0.18%, a decrease of the incidence of a 5-minute Apgar score <7 from 2.4% to 1.1% and a decrease of birth trauma from 0.29% to 0.08%. In the (small) group of infants >4000 g, a similar trend was observed. CONCLUSIONS: The Term Breech Trial has resulted in an exceptionally rapid change in medical behaviour by Dutch obstetricians. This change was followed by improved neonatal outcome.

Apgar Score↗
PubMed2005

Physicians' experiences with demented patients with advance euthanasia directives in the Netherlands.

OBJECTIVES: To estimate the incidence of (compliance with) advance euthanasia directives of patients suffering from dementia in the Netherlands and to gain knowledge about the experiences of physicians. DESIGN: Retrospective interview study. SETTING: Physicians in the Netherlands. PARTICIPANTS: Four hundred ten physicians. MEASUREMENTS: Physicians were interviewed about their demented patients who had an advance euthanasia directive. Nursing home physicians were interviewed more extensively. RESULTS: Approximately 2,200 demented patients with an advance euthanasia directive die annually after being treated by a physician who knows about this directive. In 76% of such cases, compliance with the directive was discussed, but euthanasia was seldom performed. In two-thirds of the cases of demented nursing home patients with an advance euthanasia directive, the physician was able to identify during the course of the disease a situation for which the patient had intended the directive. One-quarter of the nursing home physicians thought that their most recent patient suffered unbearably to a (very) high degree, and half of them thought that the patient suffered hopelessly to a (very) high degree. In three-quarters of the cases, the relatives did not want the nursing home physician to comply with the directive, but they did want to respect the patient's wishes by forgoing life-prolonging treatment, which occurred in approximately 90% of cases. CONCLUSION: Most nursing home physicians think that the suffering of patients with dementia can be unbearable and hopeless as a consequence of dementia, but most physicians do not consider dementia to be grounds for euthanasia, unless perhaps the patient has an additional illness.

Advance Directives↗
PubMed1995

Perception of nuclear energy and coal in France and The Netherlands.

This study focuses on the perception of large scale application of nuclear energy and coal in the Netherlands and France. The application of these energy-sources and the risks and benefits are judged differently by various group in society. In Europe, France has the highest density of nuclear power plants and the Netherlands has one of the lowest. In both countries scientists and social scientists completed a questionnaire assessing the perception of the large scale application of both energy sources. Furthermore, a number of variables relating to the socio cultural and political circumstances were measured. The results indicate that the French had a higher risk perception and a more negative attitude toward nuclear power than the Dutch. But they also assess the benefits of the use of nuclear power to be higher. Explanations for these differences are discussed.

Attitude↗
PubMedDate not supplied

The Netherlands' Maternal-Child Health Program: implications for the United States.

The Netherlands has infant mortality rates that are consistently lower than those of the United States. The United States ranked 22nd in infant mortality in 1989, whereas the Netherlands ranked 5th. Several components of the Dutch health care system could be adapted in the United States to lower the infant mortality rate. The maternity care helper program is one such service.

Female↗
PubMed1997

Maternal mortality after cesarean section in The Netherlands.

BACKGROUND: To assess cesarean section-related maternal mortality in The Netherlands during 1983-1992. METHODS: A nationwide confidential enquiry into the causes of maternal death. RESULTS: The risk of dying after vaginal birth was 0.04 per 1000 vaginal births (65/1.763.999) compared to 0.53 per 1000 cesarean births (57/108.587). The direct risk of dying from cesarean section was 0.13 per 1000 operations (14/108.587). In some women cesarean section did not initiate, but contributed to, the train of events leading to death. Adding this associated risk to the direct risk gives a fatality rate of 0.28 per 1000 cesarean births (30/108.587). CONCLUSIONS: Although cesarean section is a relatively safe procedure nowadays, birth by cesarean section in The Netherlands is seven times more hazardous than vaginal birth. Keeping the cesarean birth rate as low as possible is therefore in the interest of women of reproductive age.

Adult↗
PubMed1993

The prevalence of transsexualism in The Netherlands.

The prevalence of transsexualism in the Netherlands was estimated by counting all the subjects who were diagnosed as transsexuals by psychiatrists or psychologists and were subsequently hormonally treated and generally underwent sex-reassignment surgery. At the end of 1990, 713 Dutch-born transsexuals received treatment (507 men, 206 women). This amounts to a prevalence of 1:11,900 for male-to-female transsexualism and 1:30,400 for female-to-male transsexualism (population age 15 and above in both groups). The sex ratio was about 2.5 men to 1 woman. The most important reason for this relatively high prevalence seems to be the benevolent climate for the treatment of transsexualism in the Netherlands.

Adolescent↗
PubMed1997

Prevalence of long-term mental health care utilization in The Netherlands.

The objective of this study is to estimate the proportion of the population in The Netherlands who receive long-term care for chronic psychiatric problems. The care needs of this population are assessed in terms both of diagnosis and of specific impairments and disabilities. Data from three surveys and two psychiatric case registers in five different areas of The Netherlands provide an estimate of about 3.5 long-term users of psychiatric care per 1000 members of the population aged 20 years or over. One-third of them receive a diagnosis of schizophrenia and related psychotic disorders. Patients most frequently suffer from impairments of mood and affect, volition and drives. Nearly all patients are disabled in their occupational role (work), and about half of the population have problems with self-care and household tasks. Long-term care is to a large extent (40%) provided in hospitals and sheltered accommodation, and the role of day services is relatively insignificant.

Adult↗