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PubMed2002

[Information provision for the biomedical sciences in the Netherlands faces an uncertain future].

The availability of biomedical information in the Netherlands is largely guaranteed by the libraries of the eight medical faculties and related university hospitals together with the Netherlands Institute for Scientific Information Services (Dutch acronym: NIWI). The acquisition of biomedical journals has always been coordinated at a national level. Up until now the NIWI has played a central role in filling in the gaps left by the other collections. It also functions as a national archive and a main document delivery centre. The NIWI receives financial support from the Dutch government to perform these tasks. Recently, NIWI announced that it intends to terminate its acquisition and document delivery service for the biomedical sciences. The remaining eight libraries foresee a number of negative effects if no alternatives to the present NIWI service are developed. We are of the opinion that this situation necessitates a national, biomedical information strategy.

Computers↗
PubMed2002

Implications of legalising euthanasia in The Netherlands: greater regulatory control?

Euthanasia has been decriminalised in The Netherlands for the last 30 years, but it was only in April 2001 that the Dutch Parliament legalised voluntary physician-assisted suicide. The legislation incorporates developments in case law, including scope for peer review, and provides common ethical principles for a clear system of control over doctors' actions in regard to patients who request euthanasia. The legalised regulatory system may prove more effective in controlling voluntary and non-voluntary euthanasia in The Netherlands than in countries where euthanasia remains illegal.

Attitude to Death↗
PubMed2003

Covenant between gastroenterology and internal medicine in The Netherlands: a major step forward.

Recently, The Netherlands Society of Gastroenterohepatology (Nederlands Genootschap Maag-Darm-Leverartsen; NGMDL) and the Netherlands Association of Internal Medicine (Nederlandse Internisten Vereniging; NIV) set up a covenant to optimise the collaboration between internists and gastroenterologists. Important points: certification of endoscopic skills; training of residents of internal medicine with regard to pathology of the stomach, intestines and liver as well as to endoscopy, and the training in internal medicine of residents in gastroenterology; defining competence of gastroenterologists for night and weekend duties in internal medicine.

Gastroenterology↗
PubMed2002

Inoculum sources of the tan spot fungus Pyrenophora tritici-repentis in The Netherlands.

Since 1994 the importance of tan spot of wheat has increased in the wheat growing areas of the Netherlands. The purpose of the present study was to determine inoculum sources of this disease caused by Pyrenophora tritici-repentis. Both in 1999 and 2000, the incidence of tan spot was assessed in 40 commercial fields of winter wheat scattered over the main wheat growing areas of the Netherlands. Adjoining fields were checked for presence of stubble or crops with straw covers and the surrounding vegetation was searched for grasses with leaf spots. Straw and affected leaves of wheat and grasses were examined for P. tritici-repentis. In greenhouse experiments the pathogenicity of isolates from alternative hosts was compared with that of isolates from wheat. The possible development of P. tritici-repentis perithecia on straw of crops other than wheat was explored for barley, oat, rye grass and rape grown in fields nearby a tan spot affected wheat field. Furthermore, dispersal of tan spot was studied in a field trial in which winter wheat was sown leeward to stubble of above-mentioned severely tan spot affected wheat crop. During the surveys three cases were found of wheat crops adjoining fields with P. tritici-repentis infested stubble or straw covers. It was only after flowering that the first symptoms of tan spot appeared in the three commercial wheat crops. Couch grass (Elymus repens) was often found as host of P. tritici-repentis. In the surroundings of more then half of the wheat crops affected by tan spot this weed was also infected. Pyrenophora tritici-repentis isolates from couch grass were found to be as pathogenic to wheat as isolates from wheat to both wheat and couch grass. The observations on straw of barley, oat, rye grass, rape and wheat revealed P. tritici-repentis perithecia only on wheat straw. In the field trial with wheat sown leeward to P. tritici-repentis infested stubble, first symptoms of tan spot appeared on wheat during April and May when the release of ascospores was at a maximum. Disease severity gradually decreased with increasing distance from the side adjoining the stubble. The results of this study indicate that straw covers and stubble from tan spot diseased wheat crops and cough grass are inoculum sources of P. tritici-repentis.

Ascomycota↗
PubMed2003

[Another case of West Nile fever in the Netherlands: a man with encephalitis following a trip to Canada].

Shortly after his return to the Netherlands from a trip to Ontario, a part of Canada where infection with West-Nile virus has been reported, a 69-year-old man became increasingly confused and generally unwell, accompanied by fever. The clinical picture was compatible with viral encephalitis and this was supported by EEG findings and the results of the cerebrospinal-fluid examination. MRI of the brain did not contribute to the diagnosis. The patient was treated with aciclovir because herpes simplex encephalitis was suspected, and he recovered from his illness within a few days. The EEG normalised as well. The most important remaining symptom was diminished short-term memory function. After the patient was discharged, rising antibody titres against West-Nile virus were found in two consecutive sera; there were no antibodies to other encephalitis-causing viruses (such as Q fever virus and St. Louis encephalitis virus). This case report concerns the second imported case of West-Nile fever in the Netherlands and the first one with encephalitis.

Aged↗
PubMed2003

[Methicillin resistant Staphylococcus aureus (MRSA) infection in a dog in the Netherlands].

In the Netherlands, methicillin resistant Staphylococcus aureus (MRSA) are regularly isolated from humans. We present the first isolation of MRSA from animal origin in the Netherlands. A coagulase positive staphylococcus was cultured from an infected wound in a Dutch dog that recently underwent surgery abroad. The staphylococcus was resistant to methicillin, ampicillin, amoxycillin + clavulanic acid, cephalexin, erythromycin, lincomycin, tetracycline, gentamicin and enrofloxacin. It was identified as S. aureus by fermentation of mannitol and Martineau-PCR. The presence of mecA was confirmed by PCR.

Animals↗
PubMed2003

Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33824 infants.

OBJECTIVE: To analyse neonatal mortality and morbidity in term infants born in breech presentation in relation to the mode of delivery (planned caesarean section, emergency caesarean section or vaginal delivery) and to compare these findings with those of the Term Breech Trial Collaborative Group [Hannah et al. Lancet 2000; October]. DESIGN: Retrospective observational study. SETTING: The Netherlands. POPULATION: Infants (n = 33824) born at term in breech presentation in the Netherlands between 1995 and 1999. Multiple pregnancies, antenatal death and major congenital malformations were excluded. METHODS: Data derived from the Dutch Perinatal Database were used to compare neonatal outcome of infants born in breech presentation in relation to the different modes of delivery (i.e. planned caesarean section, emergency caesarean section and vaginal delivery). Correction was made for differences in parity, duration of gestation and birthweight, using logistic regression. MAIN OUTCOME MEASURES: Intrapartum and first-week neonatal death, 5 minute Apgar score and birth trauma. Vaginal delivery and emergency caesarean section resulted in a sevenfold increase in low Apgar score, a threefold increase in birth trauma and a twofold increase in perinatal mortality when compared with the results of planned caesarean section. CONCLUSIONS: This study confirms the data found by Hannah et al. on an increase in early neonatal morbidity and mortality, following a trial of labour in cases of term breech presentation. These data require carefully weighed consideration against increased maternal (long term) risks due to a rise in caesarean sections.

Breech Presentation↗
PubMed2003

[Trends in the incidence and prevalence of cancer and in the survival of patients in southeastern Netherlands, 1970-1999].

OBJECTIVE: To describe the changes in incidence, mortality, survival and prevalence of cancer since 1970 in the south-eastern part of the Netherlands, the registration area of the Eindhoven Cancer Registry. DESIGN: Descriptive population-based study. METHOD: Data were collected on all patients diagnosed with cancer between 1970 and 1999 in the south-eastern part of the Netherlands, the registration area of the Eindhoven Cancer Registry. Trends in age-specific and age-adjusted incidence, mortality, prevalence and relative survival were calculated. The changes in incidence were compared with changes in exposure to risk factors, such as smoking, alcohol, diet, infections and sunlight, and with early detection. RESULTS: The incidence of cancer of the stomach and uterine cervix decreased in the study period. Among men, the incidence of lung cancer increased sharply until the mid 1980s, whereafter it decreased. Furthermore, the incidence of cancer of the oesophagus, colon, rectum, breast, prostate and lung (in women), cutaneous melanoma and non-Hodgkin's lymphoma also increased. The survival improved for patients with cancer of the rectum, breast, female genital tract, prostate, testis (non-seminoma), cutaneous melanoma and Hodgkin's disease. The improvement in survival could be explained in part by early detection and partly by the improvement in treatment strategies. The prevalence of the diagnosis 'cancer' in living subjects increased by almost 30%, which may be related to the increase in incidence and the improvement in survival. CONCLUSION: There was an alarming increase in tumours related to exposure to tobacco and alcohol, especially in women. Improved diagnostic techniques and treatment strategies coincided with improved prognosis. This was associated with an increased demand for health care.

Adolescent↗
PubMed1992

[Salmonella dublin on dairy farms in the North of the Netherlands].

During the last century many calves and cows with Salmonella dublin infections are diagnosed in the North of the Netherlands, especially in the province of Friesland. In this paper are retrospectively traced the problems by paratyphoid infections in cattle, from 1919 till now, the diagnosis of which was made at the Animal Health Service in Friesland and North-Netherlands. Over the decennia a decrease is noticed for the percentage of necropsies of calves with S. dublin infections, although some irregular peaks appear. However since 1988 an increase is observed in dairy farms with S. dublin problems, revealing high mortality in calves, abortions and sick cows.

Animals↗
PubMed2003

['Pharmacologic interventions in drug addiction': an advisory report from the Health Council of the Netherlands].

Addiction is a relapsing brain disease with a tendency towards chronicity. Biological, psychological and socio-cultural factors play a role in the onset and course of this disease. The Health Council of the Netherlands has issued a report on pharmacotherapeutic interventions. The treatment of addiction should be regarded as a medical intervention. A growing number of effective pharmacotherapies are becoming available for the treatment of heroin addiction, although not all of those are available in the Netherlands. Currently, no effective pharmacotherapies are available for the treatment of cocaine addiction. In polydrug addicts, pharmacotherapeutic interventions should be directed at the various separate addictions. In the majority of cases pharmacotherapy is part of an integrated treatment approach in which supportive psychosocial interventions are also important. The long-term continuation of treatment is usually indicated. The Health Council recommends that addiction physicians be put in charge of the multidisciplinary treatment. Medical schools should pay attention to the practical aspects of the treatment and management of addicts. The organisation and workforce of addiction treatment services should comply with the demands that are placed upon healthcare services. Public information campaigns about addiction and the treatment options for addicts can contribute to the destigmatisation of this patient category.

Cocaine↗
PubMed1992

Poliomyelitis--Netherlands, 1992.

From September 17 through October 9, 1992, five cases of poliomyelitis were reported in the Netherlands among members of religious groups that generally do not accept vaccination. This report summarizes investigations of these five cases by the Netherlands' Office of the Chief Medical Officer of Health, the Laboratory of Virology, National Institute for Public Health and Environmental Protection, and the Municipal Health Services in Rotterdam. The investigation indicated that none of the cases were epidemiologically linked; two of the cases (cases 1 and 2) had some history of receipt of polio vaccine, while three (cases 3-5) had no history of polio vaccination. This report summarizes the investigation of these cases.

Adolescent↗
PubMed1992

[AIDS epidemiology in The Netherlands in persons infected through heterosexual contact].

Ten years after the start of the AIDS epidemic in the Netherlands the proportion of persons infected by heterosexual contacts among the total of AIDS cases diagnosed is small (7.4%). Up to December 1991 the cumulative totals of females and males in the Netherlands reported with the diagnosis and infected by heterosexual contact were 55 and 93, respectively. Of the 55 heterosexual females, 69% had the Dutch nationality, of the 93 heterosexual males, 67%. Considerable proportions of the numbers of AIDS patients in this group (males 47%, females 45%) were diagnosed in the four largest cities (Amsterdam, Rotterdam, The Hague and Utrecht). The remaining cases of AIDS diagnosed in this group were scattered throughout the country. Among heterosexual females a gradual increase of the number of AIDS cases diagnosed was observed since 1985. In the males there was no clear trend in the number of diagnoses since 1984. Of the 55 females, 19 originated from an area endemic for AIDS or had had sexual contacts with a person from such a region (34.6%). Among the 93 males this number was 29 (31.2%). Nineteen of the 55 females (34.6%) were known to have sexual contact with a person from the known risk groups. The same held true of 12 males (12.9%). Of the remaining 17 females (30.9%) and 52 males (55.9%) it was only known that they were heterosexual without further risk factors or risk contacts.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed2003

[The termination of life in the Netherlands and in Europe].

Medical decisions concerning the end of life, including the termination of life, are taken not only in the Netherlands but in other European countries as well. In some of these countries, the social pressure to reform legislation is increasing. The World Medical Association remains strongly opposed to any involvement of physicians in bringing about people's death, but the rulings of the European Court of Human Rights so far do not prohibit national laws to regulate euthanasia. Whilst in other countries there is debate on whether permissive legislation should be adopted, in the Netherlands the emphasis is now on the development of instruments aimed at the quality and transparency of medical practice as well as on the improvement of the notification procedure, reducing the gap between medical and juridical reality.

Europe↗
PubMed2003

Recent trends in breech delivery in the Netherlands.

The effect of publication of the results of the Term Breech Trial in October 2000 on the mode of delivery of babies in breech presentation in the Netherlands was subject of this study. The results showed an immediate amplifying impact on top of the already existing trend of rising caesarean section rates for term singleton breech presentations. The willingness of obstetricians in the Netherlands to adopt the conclusions of the Term Breech Trial so quickly originate from scientific, legal, psychological and emotional sources. The same amplifying impact applied for all non-term breeches and breeches from multiple gestations, but not for babies in other than breech presentation.

Breech Presentation↗
PubMed2003

[Diagnosis and treatment of esophageal cancer in the Netherlands: wide variation in the second line].

OBJECTIVE: To survey the diagnostic procedures and treatment strategies currently employed in hospitals for patients with oesophageal cancer. DESIGN: Questionnaire. METHOD: A questionnaire was sent to all clinicians working in the field of gastroenterology in the Netherlands. This questionnaire focused on clinical preferences regarding diagnostic procedures and treatment strategies for oesophageal cancer. Also, six hypothetical patient vignettes were presented in order to investigate which factors affected choice of treatment, in particular surgical treatment. RESULTS: The response rate was 64% (426/667); 336 questionnaires were relevant to the investigation. Almost 90% of the clinicians treated fewer than 20 patients annually, usually in their own hospital. CT was the most frequently used staging procedure; endoscopic ultrasound was less frequently used (42% used it in less than half the patients). The treatment choice for the patient vignettes varied widely among clinicians. Factors influencing the choice to operate or not were: metastases, loco-regional tumour ingrowth, poor general health, and advanced age with 8, 22, 20, and 53%, respectively, of the clinicians still considering surgery in the presence of one of these factors as opposed to 99% if none of these factors were present. Surgeons opted for operation more often than internists and gastroenterologists. Stent placement was the most frequently chosen method to palliate malignant dysphagia. CONCLUSION: There is a wide variation in the use of diagnostic procedures and treatment strategies for patients with oesophageal cancer in the Netherlands. This stresses the need for scientifically based practice guidelines, taking into account specific patient and tumour characteristics.

Aged↗
PubMed2003

[Increased number of systematic reviews in the Netherlands in the period 1991-2000].

OBJECTIVE: To survey systematic reviews (SRs) as publication type in the Netherlands, with emphasis on differences between Cochrane reviews and SRs in printed journals. DESIGN: Bibliometric study. METHOD: A systematic search was carried out in Medline, EMBASE and the Cochrane Library for published systematic reviews of Dutch origin in the period 1991-2000. For each SR, the year of publication, the number of original articles included, the subject matter and the impact factor of the journal were identified. RESULTS: A total of 289 SRs were retrieved, of which 12% were Cochrane reviews. The number of SRs increased exponentially during this decade. The majority (56%) of the SRs concerned a therapeutic intervention. SRs were published in journals with a moderate to good impact factor (median impact factor 2.59). On average, compared to SRs published in the Cochrane Library, the SRs published in the general medical literature included significantly more original articles (28.8 versus 13.7; p < 0.05). This may be caused by the fact that the clinical questions for Cochrane reviews are more focused as compared with non-Cochrane SRs or by the fact that Cochrane review groups may have more stringent quality requirements for inclusion of an article in a review. CONCLUSIONS: The SR as a publication type showed a rapid growth in one decade and was published in important medical journals. Cochrane reviews represented a substantial proportion of the overall number of SRs in the Netherlands.

Bibliometrics↗
PubMed2004

Policy development for the reduction of pollution caused by traffic experiences from The Netherlands.

Road traffic is a diffuse source of heavy metals and oil that leads to pollution of verges and surface water in areas immediately surrounding roads. The Commission for Integrated Water Management (CIW) has drawn up a policy document addressing methods for managing this type of pollution. The document is based on results from numerous studies in The Netherlands targeting pollution caused by traffic. The Commission concludes that measures at the source are the only way to realise sustainable solutions. For example, attention should be devoted to the issue of zinc emissions from car tyres and crash barriers. The concept of controlled infiltration is recommended for combating pollution caused by spray and runoff from roads. This includes periodic chemical inspection of verge pollution and, where necessary, replacement of the verge's top layer. The application of porous asphalt on highways in The Netherlands has also proven highly effective in limiting pollution caused by traffic, with far less pollution caused by spray from the highway and runoff as compared to traditional asphalt.

Environment↗
PubMed2004

The prevention and treatment of overweight and obesity. Summary of the advisory report by the Health Council of The Netherlands.

This article presents the highlights of an advisory report on the prevention and treatment of overweight and obesity. The report, which was produced by the Health Council of The Netherlands, incorporates the most recent developments and projected scientific breakthroughs in this field. The prevalence of overweight and obesity has taken on epidemic proportions. In The Netherlands, as elsewhere, there is a steady rise in the number of individuals suffering from overweight or obesity. Since it is associated with serious health problems, obesity (and to a lesser extent overweight) leads to increased costs for the healthcare system. Food consumption surveys and studies on time trends in physical activity patterns have revealed that the increased prevalence of obesity is due to an increasing lack of exercise, combined with relative overconsumption. A healthy diet (including plenty of fruit, vegetables and cereal products) and at least one hour a day of moderate physical activity are recommended for the maintenance of energy balance and for the prevention of weight gain. While genetic factors play a part in the development of overweight and obesity, environmental factors appear to be of overriding importance. The so-called 'obesogenic environment' prompts individuals to eat more and to take less exercise. There are still no effective intervention strategies for the prevention of weight gain. However, the explosive increase in the prevalence of obesity and of its associated serious medical problems demands a common-sense approach involving preventive interventions, which are based on modern views of health promotion. These interventions require a broad coalition of actors, in which local and national authorities, industry, the healthcare system and the population at risk must each shoulder their own share of responsibility. The primary aim of obesity treatment should be a long-lasting weight loss of about 10%. Even this relatively small weight loss can produce significant health gains. Treatment methods must involve an integrated (lifestyle) approach, dependent on the amount of overweight involved and on the presence of comorbidity. Obesity should be treated chronically and prevention of weight regain must be part of any obesity treatment programme.

Adult↗