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PubMed2006

Incidence and treatment of tracheal cancer: a nationwide study in the Netherlands.

BACKGROUND: The aim of this study was to assess the incidence, characteristics, treatment, and survival of patients with tracheal malignancies in the Netherlands. METHODS: All cases of tracheal cancer entered into the database of the Netherlands Cancer Registry in the period 1989-2002 were selected. Data on histological type, age at time of diagnosis, treatment, and survival were analyzed retrospectively. RESULTS: The annual incidence was 0.142 per 100,000 inhabitants (308 cases, of which 15 were found incidentally at autopsy). Of these, 72% were men. In 52.9%, the histological type was squamous cell carcinoma and in only 7.1% adenoid cystic carcinoma (ACC). Mean age at time of diagnosis was 64.3 years. Of the 293 patients diagnosed while alive, 34 patients underwent surgical resection (11.6%), 156 patients received radiotherapy (53.2%), and 103 patients neither (35.4%). Median survival of all 293 patients was 10 months (mean 28 months) with 1-year, 5-year, and 10-year survival rates of 43%, 15%, and 6%, respectively. The prognosis of patients with ACC was significantly better. The 5-year survival rate in patients who underwent surgical resection was 51%, and the 10-year survival rate in these patients was 33%. CONCLUSION: The prognosis of patients with a tracheal malignancy is usually poor. Surgical treatment, however, can lead to good survival rates; still, this is currently only used in selected patients, even though it would seem to be possible in more cases in view of the technical advances in the field of tracheal surgery. Centralizing the care and treatment of tracheal cancers and implementing a more assertive attitude towards this disease could make surgery accessible to a larger number of patients. Data from the literature show that this would lead to better survival in patients with a tracheal malignancy.

Adult↗
PubMed2003

Caffeic acid phenethyl ester (CAPE) analogues: potent nitric oxide inhibitors from the Netherlands propolis.

The MeOH and water extracts of the Netherlands propolis were tested for their inhibitory activity toward nitric oxide (NO) production in lipopolysaccharide (LPS)-activated murine macrophage-like J774.1 cells. Both of the extract possessed significant NO inhibitory activity with IC(50) values of 23.8 and 51.5 microg/ml, respectively. Then 13 phenolic compounds obtained from the MeOH extract showing stronger NO inhibition were examined on their NO inhibitory activities. Caffeic acid phenethyl ester (CAPE) analogues, i.e., benzyl caffeate, CAPE and cinnamyl caffeate, possessed most potent NO inhibitory activities with IC(50) values of 13.8, 7.64 and 9.53 microM, respectively, which were two- to four-fold stronger than the positive control N(G)-monomethyl-L-arginine (L-NMMA; IC(50), 32.9 microM). Further study on the synthetic analogues of CAPE revealed that both of 3-phenylpropyl caffeate (18; IC(50), 7.34 microM) and 4-phenylbutyl caffeate (19; IC(50), 6.77 microM) possessed stronger NO inhibitory activity than CAPE (10) and that elongation of alkyl side chain of alcoholic parts of caffeic acid esters enhance the NO inhibitory activity. In addition, it was found that CAPE analogues having longer carbon chain (>C(5)) in alcoholic part showed toxic effects toward J774.1 cells. This NO inhibitory effect may directly correlate with antiinflammatory properties of the Netherlands propolis.

Animals↗
PubMed2002

The organization of STI control in the Netherlands - an overview.

The organization of STI-control in the Netherlands is described. STIs represent a relatively modest health problem in the Netherlands. Chlamydia trachomatis is the most frequent STI. Recent reports show that STIs are on the rise again, especially amongst gay men. The general health system deals with STIs, the main professionals are: the general practitioners, public health nurses and dermatovenereologists. The larger cities have specific STI-clinics. Prevention is a cornerstone in Dutch STI-control. At a regional level, the municipal health services play a major role in policy and prevention. At a national level, several specific organizations are active. In general the STI-system is of good quality. Future attention is needed for the financial arrangement, surveillance and the rising incidence of STIs.

Female↗
PubMed2002

Do Dutch dermatologists care for venereology? An inquiry among all non-academic dermatologists in The Netherlands.

The financing of STD outpatient clinics in The Netherlands is currently undergoing structural changes. Because these changes also have implications for the infrastructure of STD care as a whole, the STD committee of the Dutch Society for Dermatology and Venereology (STD committee NVDV) and the National Society of Municipal Health Services (GGD-Nederland) are currently exploring the possibilities and feasibility of intensified regional collaboration between Municipal Health Services (MHSs) and dermatologists. However, for fruitful collaboration it is essential that a substantial number of dermatologists has an interest in STD care. Therefore, the STD committee NVDV has conducted a structured survey in order to study the support of Dutch dermatologists for such a regional collaboration. In this paper, the results of the survey are presented. It appears that the majority of Dutch dermatologists is (still) interested in STD, and although a minority currently collaborates with local MHSs on a regular basis, a large group is willing to do so in the future. We conclude that the majority of dermatologists in the Netherlands (still) cares for venereology and that there is a sound basis for a fruitful cooperation with MHSs.

Attitude of Health Personnel↗
PubMed2003

Survey of posteroanterior chest radiography in The Netherlands: patient dose and image quality.

Council Directive 97/43/Euratom (Medical Exposure Directive) states that member States of the European Union shall promote the establishment and use of diagnostic reference levels for radio-diagnostic examinations. Dose surveys can form the basis for the establishment of diagnostic reference levels. In view of the implementation of the Medical Exposure Directive in the Netherlands, a survey of dose and image quality has been performed for posteroanterior (PA) chest radiography in 2001. In this survey, 25 participants were selected from a list of 175 Dutch hospitals, whereas in a previous PA chest survey (about 10 years ago) participation was voluntary and participants came predominantly from the south-western part of the Netherlands. For conventional screen-film PA chest radiography, the present results for patient dose and image quality are quite similar to those results from the previous survey. The fraction of conventional X-ray systems utilizing lung compensation filters has remained approximately the same. For dedicated digital chest radiography systems, image quality is better than for conventional systems, but doses vary and can assume relatively high values. The results indicate that there are still possibilities for dose reduction, without loss of image quality. The 75 percentile value of the entrance surface dose distribution is approximately 0.13 mGy.

Filtration↗
PubMed1999

Human health risk assessment in relation to environmental pollution of two artificial freshwater lakes in The Netherlands.

A human health risk assessment has been performed in relation to recreational activities on two artificial freshwater lakes along the river Meuse in The Netherlands. Although the discharges of contaminants into the river Meuse have been reduced in the last decades, which is reflected in decreasing concentrations of pollutants in surface water and suspended matter, the levels in sediments are more persistent. Sediments of the two freshwater lakes appear highly polluted and may pose a health risk in relation to recreational activities. To quantify health risks for carcinogenic (e.g., polycyclic aromatic hydrocarbons) as well as noncarcinogenic compounds (e.g., heavy metals), an exposure assessment model was used. First, we used a standard model that solely uses data on sediment pollution as the input parameter, which is the standard procedure in sediment quality assessments in The Netherlands. The highest intake appeared to be associated with the consumption of contaminated fish and resulted in a health risk for Pb and Zn (hazard index exceeded 1). For the other heavy metals and for benzo(a)pyrene, the total averaged exposure levels were below levels of concern. Secondly, input data for a more location-specific calculation procedure were provided via analyses of samples from sediment, surface water, and suspended matter. When these data (concentrations in surface water) were taken into account, the risk due to consumption of contaminated fish decreased by more than two orders of magnitude and appeared to be negligible. In both exposure assessments, many assumptions were made that contribute to a major degree to the uncertainty of this risk assessment. However, this health risk evaluation is useful as a screening methodology for assessing the urgency of sediment remediation actions.

Adult↗
PubMed2004

Increase of bone and joint tuberculosis in The Netherlands.

There has been an increase in the incidence of bone and joint tuberculosis (BJTB) in The Netherlands and we have carried out an epidemiological study in order to find an explanation for this increase. Data from 1993 to 2000 from The Netherlands Tuberculosis Register (NTR) were used. In 1993 there was a total of 52 patients with BJTB. This figure increased gradually to 80 in 1999 before decreasing to 61 in 2000. There was a total of 12447 patients with tuberculosis; BJTB was found in 532, accounting for 4.3% of all cases and 10.6% of all extrapulmonary cases. Localisation in the spine occurred in 56%. Certain immigrants, in particular from Somalia, were more likely to have BJTB than other immigrants or the native Dutch population. Increased age and female gender were associated with BJTB. Only 15% of BJTB patients also suffered from pulmonary tuberculosis. The usual long delay in the diagnosis of BJTB may be shortened if physicians are more aware of tuberculosis.

Adult↗
PubMed2002

Burnout and self-efficacy: a study on teachers' beliefs when implementing an innovative educational system in the Netherlands.

BACKGROUND: In the Netherlands, secondary education has seen radical changes that originated with the national authorities, including the Study-home system, a pupil-centred approach in which teachers help develop pupils' independent working and creative thinking in order to get them to take responsibility for their own academic achievements. As educational innovations are more often than not accompanied by stress, the present study focuses on the onset of burnout among teachers who recently implemented this innovative system in the Netherlands. AIMS: To test hypotheses that the extent to which teachers have a negative attitude towards the new instructional practices relates positively to their level of burnout, and that their self-efficacy beliefs regarding implementation of the practices and coping with stress involved in this relate negatively to their burnout levels. SAMPLE: A random sample of 490 teachers employed in the Study-home system participated in this study. METHODS: Three questionnaires were used. The Dutch version of the Maslach Burnout Inventory for teachers (Schaufeli & Van Horn, 1995) was used to assess the teachers' burnout level. Second, a specially developed self-efficacy questionnaire relating to the domains of: (1) guiding groups of students using the principle of differentiation, (2) involving pupils with tasks and (3) use of innovative educational practices. Last, a questionnaire on the teachers' attitudes concerning the usefulness and effectiveness of the Study-home as an educational innovation. RESULTS: Regression analyses showed that the self-efficacy beliefs for each of the three domains were significantly and negatively related to the depersonalisation and emotional exhaustion dimensions of burnout, and significantly positively related to the personal accomplishment dimension. Furthermore, the more negative the teachers' attitudes towards the Study-home appeared to be, the more they appeared to suffer from depersonalisation and emotional exhaustion, and the lower they scored on the personal accomplishment dimension of burnout. CONCLUSIONS: The study's results indicate that teachers' self-efficacy beliefs are related to their burnout level. Teachers with strong self-efficacy beliefs seem to be more prepared to experiment with, and later also to implement new educational practices.

Adolescent↗
PubMed2002

Netherlands Twin Register: a focus on longitudinal research.

In 1986 we began The Netherlands Twin Register (NTR) by recruiting young twins and multiples a few weeks or months after birth. Currently we register around 50% of all newborn multiples in The Netherlands. Their parents receive a questionnaire at registration and afterwards when the children are 2, 3, 5, 7, 10 and 12 years of age. Teachers are asked to rate the behavior of the children at ages 7, 10 and 12 years. Adolescent and young-adult twins were recruited through City Councils in the early 1990s. These twins, their parents and siblings participate in longitudinal survey studies that include items about health, fertility, lifestyle, addiction, personality and psychopathology, religion, socioeconomic status, and educational attainment. The total number of twins and multiples registered with the NTR is currently over 60,000. Subgroups of twins and siblings take part in studies of cognitive development, brain function and neuropsychological indices of attention processes, and molecular genetic studies of classical and behavioral cardiovascular risk factors. DNA samples are currently collected in selected twin families for two large linkage studies, which aim to find QTLs for anxious depression and for nicotine addiction. Sisters who are mothers of DZ twins contribute DNA samples for a linkage study of DZ twinning. Large cohorts of phenotyped family members from the general population are very valuable for genetic epidemiological studies and permit selection of informative families for gene finding studies.

Adolescent↗
PubMed2005

Environmental factors determine where the Dutch live: results from the Netherlands twin register.

The heritability of the degree of residential area urbanization in twins and their siblings in the Dutch population was examined. The postal code was known for 6879 twins and 2724 siblings registered with the Netherlands Twin Register and born between 1940 and 1983. Using data from Statistics Netherlands, these postal codes could be related to residential area characteristics, including urbanization level. The degree of urbanization was assessed on a 5-point scale: very heavy, heavy, moderate, low and not urbanized. Genetic model-fitting was carried out in three age cohorts: young adults (born 1975 to 1983), adults (born 1965 to 1974) and older adults (born 1940 to 1964). Twin and sibling resemblance in urbanization level was expressed in polychoric correlations. These correlations decreased from the youngest cohort (.66 to .86) to the oldest cohort (.20 to .58). In all 3 age cohorts, genetic factors did not contribute to familial resemblance. The influence of common environment decreased in importance from the young cohort (70% to 83%) to the old cohort (46% to 47%) and was lower in women than in men in all but the oldest age cohort. This study did not replicate Australian findings of a genetic contribution in the older cohorts; common environmental factors and, increasingly with age, unique environmental factors determine where the Dutch live. Future studies in European and other populations will reveal whether these results are specific to the Dutch population.

Adult↗
PubMed2005

Cardiac involvement in patients with pulmonary sarcoidosis assessed at two university medical centers in the Netherlands.

STUDY OBJECTIVES: We aimed to determine cardiac involvement in patients with pulmonary sarcoidosis (PS) followed up at two university medical centers in the Netherlands. DESIGN: We reviewed the findings in consecutive patients assessed by our departments during 1998 to 2004, and classified them as patients who had presented with symptoms of cardiac sarcoidosis (CS) [group A], and those who had been screened for this condition (group B). SETTING: Two university medical centers in the Netherlands. PATIENTS: One hundred one patients (69 men [mean age, 47.6 years] and 32 women [mean age, 47.3 years]) with biopsy-proven PS. INTERVENTIONS: Twelve-lead ECG (n = 101), ambulatory ECG (n = 74), echocardiography (n = 80), (201)Tl single-photon emission CT (n = 61), cardiac MRI (n = 87), coronary angiography to exclude coronary artery disease (n = 17), and endomyocardial biopsy (n = 9). MEASUREMENTS: ECG, structural, and functional cardiac abnormalities according to the modified guidelines of the Japanese Ministry of Health and Welfare (1993). RESULTS: Sixteen of 19 patients in group A and 3 of 82 patients in group B received a diagnosis of CS. During a mean follow-up of 1.7 years (range, 3 months to 4 years), four patients in group A died (20%) and nine patients received a pacemaker and/or an implantable cardioverter-defibrillator (47%), while the patients in group B had an uncomplicated course. CONCLUSIONS: Once symptomatic CS develops in PS patients, the prognosis becomes very grim. In contrast, the prognosis in asymptomatic cardiac involvement in PS patients is good. Considering the poor prognosis of symptomatic CS, pulmonologists should consider regular screening of their PS patients for cardiac involvement with straightforward detection methods.

Adult↗
PubMed2001

Public reactions to people with HIV/AIDS in The Netherlands.

A national telephone survey was conducted to (a) assess present-day public reactions to people with HIV/AIDS in the Netherlands, (b) measure how knowledge about highly active antiretroviral therapy (HAART) is related to public reactions to people with HIV/AIDS, and (c) investigate determinants of willingness to have personal contact with people with HIV/AIDS. Dutch adults (N = 751) participated in a telephone interview conducted to measure cognitive, emotional, and behavioral reactions to people with HIV/AIDS. This study has shown that public reactions to people with HIV/AIDS seem to be moderately positive in the Netherlands. Knowledge about HAART is related to lower risk perceptions, a positive attitude toward homosexuals, less fear, and more willingness to have personal contact with people with HIV/AIDS. In particular, cognitive and emotional factors are meaningfully related to willingness to have personal contact with people with HIV/AIDS. Implications for Dutch AIDS educational campaigns aimed at stigma reduction are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2005

End-of-life decisions in newborns: an approach from The Netherlands.

End-of-life decisions in newborns with incurable conditions are especially difficult for pediatricians if they regard the group of stable infants with a hopeless prognosis, not dependent on technology. If a life full of severe and sustained suffering that cannot be relieved by any other means is expected, deliberate ending of life can be an acceptable choice in the Netherlands under very strict conditions. To increase the quality of the decision-making process and facilitate the mandatory reporting of life-ending procedures, a set of medical and legal guidelines (the Groningen protocol) was made in our institution in collaboration with the district attorney. This protocol serves as a tool to bring newborn euthanasia under a regime of effective control. This article describes the present approach to life-ending measures in newborns in the Netherlands and gives an overview of the protocol.

Bioethics↗
PubMed2004

The highly pathogenic avian influenza A (H7N7) virus epidemic in The Netherlands in 2003--lessons learned from the first five outbreaks.

Clinical signs and gross lesions observed in poultry submitted for postmortem examination (PME) from the first five infected poultry flocks preceding the detection of the primary outbreak of highly pathogenic avian influenza (HPAI) of subtype H7N7 during the 2003 epidemic in the Netherlands are described. The absence of HPAI from the Netherlands for more than 75 yr created a situation in which poultry farmers and veterinary practitioners did not think of AI in the differential diagnosis as a possible cause of the clinical problems seen. Increased and progressive mortality was not reported to the governmental authorities by farmers or veterinary practitioners. It took 4 days from the first entry of postmortem material to notify the governmental authorities of a strong suspicion of an AI outbreak on the basis of a positive immunofluoresence test result. The gross lesions observed at PME did not comply with the descriptions in literature, especially the lack of hemorrhagic changes in tissues, and the lack of edema and cyanosis in comb and wattles is noted. The following lessons are learned from this epidemic: a) in the future, increased and progressive mortality should be a signal to exclude AI as cause of disease problems on poultry farms; b) intensive contact between the veterinary practitioner in the field and the veterinarian executing PME is necessary to have all relevant data and developments at one's disposal to come to a conclusive diagnosis; c) in an anamnesis, reporting of high or increased mortality should be quantified in the future (number of dead birds in relation to the number of birds brought to the farm to start production, together with the timing within the production cycle), or else this mortality cannot be interpreted properly; d) if clinical findings such as high mortality indicate the possibility of HPAI, the pathologist should submit clinical samples to the reference laboratory, even if PME gives no specific indications for HPAI; e) the best way to facilitate early detection of an HPAI outbreak is to have the poultry farmer and/or veterinary practitioner immediately report to the syndrome-reporting system currently in operation the occurrence of high mortality, a large decrease in feed or water intake, or a considerable drop in egg production; f) in order to detect low pathogenic avian influenza infections that could possibly change to HPAI, a continuous serologic monitoring system has been set up, in which commercial poultry flocks are screened for antibodies against AI virus of subtypes H5 and H7.

Animals↗
PubMedDate not supplied

Duration and functional outcome of spinal cord injury rehabilitation in the Netherlands.

This study describes the length of stay (LOS) and functional outcome of spinal cord injury (SCI) in the Netherlands and its determinants. Data of 157 patients from eight rehabilitation centers were available. Mean age was 40.0 years and 76.4% were traumatic injuries, 39.8% had tetraplegia, and 69.9% had a motor complete SCI. Median LOS was 240 days (interquartile range 164-322). Median motor Functional Independence Measure (FIM) scores at discharge were 37.3 for persons with complete tetraplegia and 69.7 for persons with complete paraplegia. Level and completeness of injury, bed rest because of pressure sores, and LOS were predictors of motor FIM scores. Duration of SCI rehabilitation in the Netherlands is long compared with the literature. Functional outcome appears slightly better in persons with complete tetraplegia, but not in persons with complete paraplegia when compared with data from the United States. International studies are necessary to reveal strengths and weaknesses of SCI rehabilitation systems in different countries.

Adult↗
PubMedDate not supplied

Equine herpesvirus type 1-associated myeloencephalopathy in The Netherlands: a four-year retrospective study (1999-2003).

Equine herpesvirus type 1(EHV-1)-associated myeloencephalopathy (EHM) is a rare disease affecting the central nervous system and, in particular, the spinal cord of horses. Epidemiologic data are limited, and usually are restricted to the description of a single outbreak. During an observational period of 4 years, we evaluated 9 outbreaks of EHM in The Netherlands. A risk factor analysis was done on the data from 6 outbreaks. Findings were: regular appearance of EHM outbreaks in The Netherlands (2-3/y); strong association of EHM with season; and risk factors, such as breed, sex, age, and fever. Female horses, aged horses, and specific breeds were at greater risk to develop severe neurologic disease. Other breeds and horses <3 years old were never observed to suffer from EHM during these outbreaks. It was concluded that breed variation, in addition to the presence of a specific EHV-1 strain, and environmental factors influence an outbreak of EHM on a premise.

Animals↗
PubMed2005

Ecological effects of pesticide use in The Netherlands: modeled and observed effects in the field ditch.

This study addresses the potential risks to the aquatic ecosystem posed by pesticides currently used in The Netherlands. The study used a novel method to predict aquatic exposure to pesticides based on a geographic information system (GIS) map of agricultural land use, comprising 51 crops used in open-canopy areas. Through the application of species-sensitivity distributions for aquatic organisms, in combination with rules for mixture-toxicity calculation, the modeled exposure results were transformed to risk estimates for aquatic species. The majority of the predicted risks were caused by pesticides applied to potato cropland, and approximately 95% of the predicted risk was caused by only 7 of the 261 pesticides currently used in The Netherlands. For risk verification, local toxic-risk estimates were compared with observed species composition in field ditches. The field verification study was not able to draw firm conclusions regarding the predicted impact of pesticide use on overall biodiversity. A toxicity-related shift from sensitive to more tolerant or opportunistic species could be observed for a few species.

Agriculture↗
PubMed2002

Lessons from the foot and mouth disease outbreak in The Netherlands in 2001.

The Netherlands had recently developed a new strategy for the eradication of foot and mouth disease (FMD). When FMD was confirmed in Great Britain and France, recent imports of susceptible animals from these countries were traced and preventive measures were taken. On 21 March 2001, FMD was confirmed in The Netherlands. The disease was introduced by calves which became infected at a staging post in Mayenne, France, where infected sheep from Great Britain were present. A total of 26 farms were infected. Emergency vaccination of all susceptible animals was applied. Suppressive vaccination was chosen, implying that all vaccinated animals had to be slaughtered. Ring vaccination of all susceptible animals within 2 km of an infected herd was the standard procedure. However, in the 'Noord Veluwe', vaccination had to be applied to a larger area. The last affected farm was confirmed on 22 April 2001. Emergency vaccination contained the FMD infection rapidly. The last vaccinated animal was slaughtered on 25 May 2001. Many farmers were not convinced that the killing of their healthy, vaccinated animals was justified and tried to prevent the culling, but without success. Politicians and the public at large are now strongly opposed to the large-scale slaughter of vaccinated animals should a future outbreak of FMD occur. The Office International des Epizooties (OIE: World organisation for animal health) should incorporate control of vaccinated animals with non-structural protein (NSP) tests in the chapter on FMD in the International Animal Health Code.

Animals↗