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PubMed2001

Comparative study of preceding Campylobacter jejuni infection in Guillain-Barré syndrome in Japan and The Netherlands.

A comparative study was made in Japan and The Netherlands of the presence of preceding Campylobacter jejuni infections in Guillain-Barré syndrome (GBS). It was conducted in two laboratories using different serological criteria. The Japanese results showed no significant difference in the frequency of C jejuni infection between the Japanese (17/88, 19%) and Dutch (21/132, 16%) patients with GBS. The Dutch investigation showed a higher frequency in Dutch patients (45/132; 34%) than in Japanese patients(20/88; 23%), but the difference did not reach significance. Although the frequencies of preceding C jejuni infection have been reported to be higher in Asian countries than in western countries, the findings of this collaborative study show that the incidence of antecedent C jejuni infection in GBS in Japan is not higher than in The Netherlands and that serological assays vary considerably between laboratories.

Campylobacter Infections↗
PubMed1997

Priorities in occupational health research: a Delphi study in The Netherlands.

OBJECTIVES: To achieve a coherent programme of topics for research in occupational health and safety, with well founded priorities and to relate them to perceived gaps and needs in The Netherlands. METHODS: In the first phase of the study 33 key informants were interviewed. In the second phase questionnaires were sent to 150 Dutch experts (including the key informants). Four groups were recruited, originating from: occupational health and safety services; scientific research institutes; governmental and other administrative bodies; and companies. Using the Delphi technique, the experts were asked to prioritize several topics, which were placed under different headings. In the third phase five workshops were organised to elaborate on the highly prioritized topics. RESULTS: The response rates were 86% for the first and 81% for the second questionnaire. In the second round consistency was reached and consensus proved to be satisfactory; so that the Delphi process was stopped. There were surprisingly few differences in opinion between the four groups. The most important heading was "design/implementation/evaluation of measures", in which the topic cost-benefit analysis of measures had the highest score. "Assessment of relations between exposure and effect" was the second most important heading. Under this heading, topics on work stress were generally judged to be more important than topics on safety and biological, chemical, and physical hazards. The headings "occupational rehabilitation/sociomedical guidance" and "occupational health care/occupational health services" had about the sam priority, closely following the heading "assessment of relations between exposure and effect". CONCLUSIONS: The general agreement on priorities should provide a sufficiently broad basis for decision makers to initiate a long term programme for occupational health research and development in The Netherlands.

Delphi Technique↗
PubMed1988

Serovar distribution of urogenital Chlamydia trachomatis strains in The Netherlands.

The distribution of serovars in 208 Chlamydia trachomatis strains of urogenital origin isolated from 185 patients attending a sexually transmitted disease clinic in Rotterdam, The Netherlands, was assessed. Typing by monoclonal antisera using a dot enzyme linked immunosorbent assay (ELISA) showed that the most common serovars were E (found in 45 strains), F (39), D (34), and K (28). Other serovars detected were H (21), G, I, I', J (two to 12), and B (one strain). Mixed infection with two serovars was detected in two patients. These results indicate that most genital infections with C trachomatis result from a small number of serovars, and that those serovars are similar in The Netherlands and Seattle, USA.

Adult↗
PubMed1989

Early yaws, imported in The Netherlands.

Early yaws in a 9 year old girl from Ghana, diagnosed as imported disease in The Netherlands is reported. She had lived in The Netherlands for six months. Tropical non-venereal treponematoses are rarely seen in Europe, and only a few case reports have been published. Migration and travelling may confront the medical profession with cases of tropical diseases such as yaws. Positive serological reactions in non-venereal tropical or venereal treponematoses cannot be distinguished at present.

Arm↗
PubMed1990

Declining gonorrhoea rates in The Netherlands, 1976-88: consequences for the AIDS epidemic.

The national notification gonorrhoea data are analysed over the period 1976-88 in conjunction with detailed data from the two STD clinics in Amsterdam in order to get an insight into the underlying reasons for the downward trend of gonorrhoea in The Netherlands. Possible effects of variations in reporting bias, seasonality, resistance against antibiotics, and sexual behaviour on gonorrhoea rates are considered. In 1981 the incidence of gonorrhoea started to decrease, thus preceding the onset of the AIDS epidemic in The Netherlands. Since 1983 the decline in gonorrhoea further accelerated and has been most apparent among homo- and bisexual men, presumably as a result of behavioural changes because of AIDS. There is less evidence for massive (AIDS related) behavioural changes among heterosexuals. The increasing percentage of gonorrhoea patients with recurrent episodes of STDs in Amsterdam may suggest that highly sexually active individuals continue to put themselves at risk of STDs and persist in acquiring and transmitting gonorrhoea.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Cost of care of patients with cystic fibrosis in The Netherlands in 1990-1.

BACKGROUND: Research on the cost of care of patients with cystic fibrosis is scarce. The aim of this study was to estimate the costs using age-specific medical consumption from real patient data. METHODS: The age-specific medical consumption of patients with cystic fibrosis in The Netherlands in 1991 was estimated from a survey of medical records and a patient questionnaire. A distinction was made between costs of hospital care, hospital and non-hospital medication, and home care. Costs per year were obtained by multiplying the yearly amount of care and the costs per unit. RESULTS: On average the annual cost of a patient with cystic fibrosis in 1991 was 10,908 pounds (hospital care 42%, medication 37%, home care 20%). The cost of care of cystic fibrosis in The Netherlands, with approximately 1000 patients, is estimated at 10.9 million pounds per year, which is 0.07% of the total health care budget. The cost of care of a patient up to the age of 35 is estimated at 614,587 pounds. When year-to-year survival is taken into account and future costs are discounted to the year of birth with a yearly discount rate of 5%, the cost of care of a patient with cystic fibrosis is estimated at 164,365 pounds for 1991. This estimate will be used in a prospective evaluation of screening for cystic fibrosis carriers. CONCLUSIONS: The cost of care of patients with cystic fibrosis estimated by age-specific medical consumption of real patients is higher than that estimated by non-age-specific medical consumption and/or expert opinions.

Adolescent↗
PubMed1993

Prevalence and incidence of scrapie in The Netherlands: a questionnaire survey.

Two independent nationwide surveys of randomly selected sheep farmers were conducted: in one a questionnaire was mailed to farmers and in the other the farmers were interviewed. The questionnaire was designed to obtain data on the occurrence of scrapie in the national sheep flock of the Netherlands. Farmers owning 30 or more ewes were selected from a database at the Ministry of Agriculture, Nature Management and Fisheries, resulting in 10,000 addresses. Two lists of names were compiled at random. In the postal survey 700 questionnaires were distributed, and 137 farmers were interviewed directly. The response rate in the postal survey was 37 per cent and in the interview survey 100 per cent. The results from the two surveys did not differ significantly. Six per cent of the farmers indicated that they had at some time observed signs of scrapie in their flock. For the total sheep population in the Netherlands, the prevalence of flocks with sheep showing signs of scrapie was between 3.8 per cent and 8.4 per cent (with 95 per cent certainty). In 1989 and 1990 the incidence rate within infected flocks was 1.27 cases/100 ewes/year, and the incidence rate for the total sample population was 0.1 case/100 ewes/year.

Animals↗
PubMed1998

Medical and educational fields in logopedics in The Netherlands: a comparison in historical and European perspective.

This study describes differences between medical and educational fields in logopedics practice in The Netherlands. This dichotomy of fields is also found in other Western European countries and may result from the historical development of the profession. The four settings where logopedists work the most (institutional care, private practice, community care and special schools) were studied. One hundred and seventy-two logopedists in 103 practices or departments collected data on 1,761 patients. For each patient a standard registration form was filled in, containing information on (i) patient characteristics, (ii) logopedic diagnostic assessment, and (iii) aspects of treatment. The historical dichotomy into medical and educational fields is still demonstrable in present-day logopedics in The Netherlands. However, the settings within each field also show some differences. Private practice shows a mixture of medical and educational characteristics.

Adolescent↗
PubMed1998

Incidence of primary central nervous system cancers in South and East Netherlands in 1989-1994.

About 2,000 patients with primary CNS cancers, as defined by the ICD-O, were registered in four adjacent cancer registries in South and East Netherlands in 1989-1994, covering a population of more than 5 million people. About 85% of the patients were registered through pathological laboratories, concentrated in four centers for neurosurgery. Patients with a clinical-radiological diagnosis only (about 50% in the age-group of 75 years and older) were mainly identified through medical records of hospitalized patients. World-standardized incidence rates of 6.5 and 4.4 per 100,000 person-years for males and females, respectively, were similar to those reported in other European cancer registries. Eighty-five percent of histologically verified primary CNS cancers were of glial origin, 6% were lymphomas and 4% embryonal tumors. Gliomas were mainly of astrocytic (about 85%) and oligodendroglial or mixed type (about 10%). Without additional review most astrocytic tumors could be classified into high-grade (70-75%) and low-grade astrocytomas (20-25%). Different grading systems were used for gliomas, but the dichotomy of astrocytomas according to differentiation grade seemed to correspond well with the definition of the WHO. Age-specific incidence rates for low-grade astrocytomas were remarkably constant. The incidence of high-grade astrocytomas increased sharply with age and declined after the age of 70, whereas the incidence of clinically diagnosed tumors continued to increase. Male/females-ratios were relatively high for these tumor types (1. 6-1.7). We conclude that the registration of primary CNS cancers in the Netherlands may be almost complete and valid for gliomas, embryonal tumors and lymphomas.

Adolescent↗
PubMed2000

Increase in incidental renal cell carcinoma in the northern part of the Netherlands.

OBJECTIVES: Evaluating in a retrospective survey the incidence of incidental and symptomatic renal cell carcinoma (RCC) between 1977 and 1994 in the northern part of the Netherlands and the mode of their detection. PATIENTS AND METHODS: Retrospectively, 173 patients surgically treated for RCC were divided into two groups according to the period of detection, 1977-1987 (n = 87) and 1987-1994 (n = 86). Because of the increase in abdominal ultrasound in 1987, this year was used as the cutoff date. In both periods the patients were grouped according to whether the tumor was found incidentally or whether the tumor was suspected. The mode of detection was recorded together with the tumor stage at presentation and survival. RESULTS: The incidental detection rate was 33% (29/87) in the 1977-1987 group and 49% (42/86) in the 1987-1994 group, showing a significant difference (p = 0.038). In the 1977-1987 group incidental tumors were detected with ultrasound in 83% and symptomatic tumors with ultrasound in 36%. Of the cases in the 1987-1994 group this percentage was 91 and 43%, respectively. Disease-free survival rates after a mean follow-up of 10 years were 63% in the incidental RCC group and 37% in the symptomatic RCC group (p = 0.0159). CONCLUSIONS: There is an increase in incidental tumors in this part of the Netherlands with ultrasound as the mode of detection. The disease-free survival is significantly better in the incidental tumor group.

Carcinoma, Renal Cell↗
PubMed2002

Economic analysis of galantamine, a cholinesterase inhibitor, in the treatment of patients with mild to moderate Alzheimer's disease in the Netherlands.

BACKGROUND: The economic impact of dementia on the Dutch health and social services is substantial. OBJECTIVE: To predict the long-term economic impact of galantamine, a cholinesterase inhibitor, in the treatment of Dutch patients with mild to moderate Alzheimer's disease. METHOD: A pharmacoeconomic model was used to predict long-term outcomes. It has two components: an initial module based on clinical trials of galantamine and a subsequent module that predicts when a patient will deteriorate to a level where full time care (FTC) is needed. The analyses take a broad perspective that includes all formal (paid) care, not just those covered by the Dutch health care system. Direct cost estimates were based on resource use profiles of patients with Alzheimer's disease in the Netherlands. Key inputs were tested in sensitivity analyses. RESULTS: After 10.5 years all patients are predicted to require FTC. For every hundred patients starting treatment on galantamine at the mild to moderate stage, it is predicted that 18 person-years of FTC will be avoided (14.4 discounted) and about 5 quality-adjusted years of life will be gained (3.9 discounted). Net savings for those starting treatment with galantamine are estimated at NLG 3,050 (1,676 UDS). The cost of galantamine accounts for only about 5.0% of the total cost of care for treated Alzheimer's patients. The direction of these results remained unchanged when input values and assumptions were tested in sensitivity analyses. CONCLUSIONS: The cholinesterase inhibitor galantamine is expected to bring savings in the direct cost of caring for patients with Alzheimer's disease in the Netherlands.

Alzheimer Disease↗
PubMedDate not supplied

Mendelian phenotypes in The Netherlands.

We report here a database listing Mendelian phenotypes described in the Netherlands and/or in populations originating from this country, and describe the results of a quantitative analysis of the database. The database is specifically directed at the presence, frequency and origin of the phenotypes. These are arranged according to their mode of inheritance: autosomal dominant (AD), autosomal recessive (AR) and X-linked. Only those phenotypes which have been reported in accessible sources were included. We entered 1,482 references up to January 1, 1991. At least 672 different loci were described in the Netherlands at this date: 321 (47.8%) AD, 283 (42.1%) AR and 68 (10.1%) X-linked. Almost 2.5% of all loci in our database have no comparable entry in McKusick [mendelian Inheritance in Man, ed 9. Baltimore, The Johns Hopkins University Press, 1990] (MIM). There is a significant difference (p < 0.01) according to the division into AD, AR, and X-linked phenotypes between our database and MIM, in which 61.7% of the phenotypes are AD, 31.5% AR and 6.8% X-linked. Dutch prevalence data for 38 monogenic disorders and 24 polymorphic systems are listed.

Databases, Factual↗
PubMed1995

Fungal infections in the Netherlands. Prevailing fungi and pattern of infection.

BACKGROUND: Species of fungi have specific characteristics in geographic distribution, and they have a predilection for certain body areas. OBJECTIVE: To obtain information about the prevailing fungi and their pattern of infection in the Netherlands. METHODS: An analysis was made of the results of mycological examinations carried out in subjects referred to the mycological laboratory of the Department of Dermatology, University Hospital Leiden, the Netherlands, in the period of 1972-1992. RESULTS: The feet, extremities and groin were most commonly infected. The feet and extremities were mainly infected with dermatophytes (Trichophyton rubrum), but in the groin Candida albicans accounted for 49.9% of the fungal infections. Onychomycosis ranked third in prevalence (17.3% of all fungal infections). The main etiologic agent in the toenails was T. rubrum, but in fingernails C. albicans seems to be at least as important as T. rubrum. On the trunk (mainly the chest, especially in women) and buttocks C. albicans was again the main etiologic agent for fungal infections. Dermatophytes accounted for only 32.4% and 14.2% of the fungal infections on the buttock and trunk, respectively. On the buttock and trunk T. rubrum was the main etiologic agent as far as dermatophytes are concerned. On the trunk, Microsporum canis and M. ferrugineum were of some importance as well. The prevalence of tinea capitis was very low and accounted for only 0.7% of all fungal infections. CONCLUSION: Cutaneous candidosis accounted for 30.3% of all fungal infections and is therefore important. On the chest, buttocks, groin and finger-nails, the prevalence of C. albicans is higher than that of dermatophytes.

Arthrodermataceae↗
PubMed1996

Changes in caries prevalence in children and young adults of Dutch and Turkish or Moroccan origin in The Netherlands between 1987 and 1993.

In 1987, an epidemiological study was started with the aim to evaluate the development of dental health in young people insured by "Health Insurance Funds'. In The Netherlands, insurance by such funds is compulsory for individuals earning less than some income criterion (in 1995 59,000 Dutch florins) and their families, together approximately 60% of the Dutch population. Dental health care is included in the insurance. Caries data were obtained in subjects aged 5-23 years in 1987, 1990 and 1993. Mean DMFS scores of groups aged 11, 17 or 23 years in 1993 were about 40% lower than in 1987. No significant differences in mean number of dmfs of 5-year-olds in 1987 and 1993 could be observed. A breakdown by country of birth of the mother showed that the difference between indigenous Dutch juveniles and juveniles of Turkish or Moroccan origin depended on year of birth. Caries prevalence of Turkish or Moroccan children born in 1982 or later was higher than that of Dutch children of equal age; no significant difference in DMFS could be demonstrated between ethnic categories in juveniles born in 1976. In cohorts born before 1976, DMFS scores of Turkish/Moroccan juveniles were much lower than those of Dutch juveniles. It is suggested that these opposite trends were caused by the fact that subjects in the youngest cohorts had been born in The Netherlands, while the oldest cohorts spent the first years of their life in those parts of Turkey or Morocco where caries prevalence of children is low. Between 1987 and 1993 caries prevalence in 5-year-old children of Turkish or Moroccan origin decreased significantly.

Adolescent↗
PubMedDate not supplied

Population-based cervical screening with a 5-year interval in The Netherlands. Stabilization of the incidence of squamous cell carcinoma and its precursor lesions in the screened population.

OBJECTIVE: To evaluate the outcome of population-based cervical screening at 5-year intervals. STUDY DESIGN: Results from the west region of the Netherlands (population 2 million) were used. The 1995-2000 round was compared with the first 2 years of the second (2001-2002). All results were prospectively collected in a central database. Positive cytologies and histoscores per 1,000 screened for preinvasive squamous cervical intraepithelial neoplasia (CIN) lesions and invasive squamous cell carcinoma were calculated. RESULTS: In the first round, 378,081 women were screened; in the second round, 100,561 women were screened. In both rounds the youngest screenees had the highest cytoscores. Cytoscores in the first round did not differ significantly from those in the second. The histoscore for CIN 1 and 2 was 1.42 per 1,000 in the first round and 1.18 per 1,000 (NS, P < .01) in the second. The histoscore for CIN 3 was 2.07 per 1,000 in the first round and 2.13 per 1,000 (NS, P < .01) in the second. Histoscores for invasive squamous cell carcinoma remained virtually the same (0.16 per 1,000 in the first, 0.14 per 1,000 in the second round). CONCLUSION: Population-based screening at 5-year intervals in the Netherlands may result in stabilization of positive cytology and of the incidence of CIN and (histologic) invasive squamous cell carcinoma. The program seems more cost effective than that of 2 decades ago, with a screening interval of 3 years.

Adult↗
PubMed2005

Modeling the future burden of stroke in The Netherlands: impact of aging, smoking, and hypertension.

BACKGROUND AND PURPOSE: In the near future, the number of stroke patients and their related healthcare costs are expected to rise. The purpose of this study was to estimate this expected increase in stroke patients in the Netherlands. We sought to determine what the future developments in the number of stroke patients due to demographic changes and trends in the prevalence of smoking and hypertension in terms of the prevalence, incidence, and potential years of life lost might be. METHODS: A dynamic, multistate life table was used, which combined demographic projections and existing stroke morbidity and mortality data. It projected future changes in the number of stroke patients in several scenarios for the Dutch population for the period 2000 to 2020. The model calculated the annual number of new patients by age and sex by using incidence rates, defined by age, sex, and major risk factors. The change in the annual number of stroke patients is the result of incident cases minus mortality numbers. RESULTS: Demographic changes in the population suggest an increase of 27% in number of stroke patients per 1000 in 2020 compared with 2000. Extrapolating past trends in the prevalence of smoking behavior, hypertension, and stroke incidence resulted in an increase of 4%. CONCLUSIONS: The number of stroke patients in the Netherlands will rise continuously until the year 2020. Our study demonstrates that a large part of this increase in the number of patients is an inevitable consequence of the aging of the population.

Age Factors↗
PubMed1997

Cost of stroke in The Netherlands from a societal perspective.

BACKGROUND AND PURPOSE: Cerebrovascular disorders are associated with a high level of morbidity and mortality and call for considerable resources. The objective of this study was to determine from a societal perspective the medical consumption (direct costs) and productivity losses (indirect costs) caused by cerebrovascular disorders in the Netherlands. METHODS: This study can be characterized as a cost-of-illness study based on prevalence data. All data gathered refer to 1993. Cerebrovascular disorders are defined according to the International Classification of Diseases, 9th Revision (ICD-9) classification. Data from medical registrations and national statistics have been analyzed. For both direct and indirect costs, volume and cost components are presented. To test the likelihood of the assumptions, a sensitivity analysis was performed. RESULTS: The cost of cerebrovascular disorders in the Netherlands in 1993 amounted to 2.5 billion Dutch guilders, of which 1.9 billion were spent on medical consumption. It was found that direct costs are generated mainly by the long-term care of inpatients (nursing homes and hospitals). The productivity losses were relatively low in comparison with other diseases, probably due to the fact that most patients with cerebrovascular disorders are elderly. CONCLUSIONS: More than 3% of the Dutch annual healthcare budget is spent on patients suffering from cerebrovascular disorders. Costs in the future may be influenced by, among other things, demographic changes, new therapies, and cost-reduction programs introduced by the government.

Cerebrovascular Disorders↗
PubMed2005

Conjunctival melanoma in the Netherlands: a nationwide study.

PURPOSE: To evaluate risk factors for local recurrence, regional and distant metastases, and mortality associated with conjunctival melanoma. METHODS: This was a retrospective study of 194 patients with histologically confirmed conjunctival melanoma diagnosed between 1950 and 2002 in the Netherlands. Data were collected from all university centers and many nontertiary hospitals, using the National Pathology and the Leiden Oncologic Registration Systems. Based on the number of incidences, this study included 70% of the conjunctival melanomas in The Netherlands. Clinical and histopathological data for conjunctival tumors were reviewed and compared with data reported in the literature. Risk factors for local, regional, and distant metastases and survival were analyzed using the Kaplan-Meier and Cox regression analyses. RESULTS: Of 194 patients with conjunctival melanoma, 112 had a local recurrence (median, 1; range, 1-9) during follow-up (median, 6.8 years; range, 0.1-51.5). Location was the most important risk factor for development of local recurrence, and significantly more occurred with nonepibulbar (log rank, P=0.044) tumors. Significantly fewer local recurrences occurred with tumors initially treated with excision and adjuvant brachytherapy rather than with excision only (log rank, P=0.008) or with excision and cryotherapy (log rank, P <0.038). Forty-one (21%) patients had regional lymph node metastases, mostly to the parotid or preauricular lymph nodes (n=26; 13%). Risk factors for regional metastases were tumor thickness (log rank, P <0.001) and tumor diameter (log rank, P=0.010). Forty-nine (25%) patients (mean, 4.37 years) had development of distant metastases, mainly in the lung, liver, skin, and brain. Tumor-related survival was 86.3% (95% confidence interval [CI], 81.0-91.6) at 5 years, 72% (95% CI, 79.7-64.4) at 10 years, and 67% (95% CI, 58.9-76.1) at 15 years. The main mortality risk factors were nonepibulbar location (log rank, P <0.0001) and tumor thickness (log rank, P=0.0004). CONCLUSIONS: Nonepibulbar tumors more often recur locally and are associated with a shorter survival independent of other risk factors. Tumor thickness is also an important predictor of regional and distant metastases, as well as survival. A prospective study is needed to compare the effect of excision with radiotherapy and excision with cryotherapy on the number of local recurrences, exenteration rate, and survival.

Conjunctival Neoplasms↗