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PubMed2004

[Clinical spectrum and incidence of neuro-borreliosis in the Netherlands].

OBJECTIVE: To determine the clinical spectrum and incidence of neuroborreliosis in the Netherlands. DESIGN: Retrospective. METHOD: All neurological practices in 106 hospital locations in the Netherlands were asked to look for patients with the codes 'other neurological infections' or 'Borrelia burgdorferi' in their Diagnosis & Treatment Combinations registration or the Neurological Coding System, respectively, concerning the year 2001, then to identify the patients with neuroborreliosis and to send a copy of the correspondence with the family doctor and the laboratory data on these patients, after making them anonymous, for data extraction. Pleocytosis in the cerebrospinal fluid combined with a positive test for IgM or IgG antibodies of B. burgdorferi in the serum or cerebrospinal fluid was used as the criterion for the diagnosis neuroborreliosis. RESULTS: Forty-seven (44%) neurological practices did not respond and twenty-two (21%) either did not use any kind of diagnosis registration system or linkage between the registration and the patient file was impossible. Of the 37 (35%) neurological practices that provided information, 17 had diagnosed neuroborreliosis in 30 patients, 20 of whom met the specified criteria. Fifteen (75%) patients had a radiculopathy, 8 (40%) a peripheral facial palsy and 3 (15%) a myelopathy. CONCLUSION: The clinical spectrum of patients with neuroborreliosis was consistent with that described in Denmark. The incidence of neuroborreliosis found was 3.6 per million inhabitants. The real incidence was probably higher because the registration systems used allowed patients with neuroborreliosis to be booked under other (symptomatic) diagnostic codes, paediatricians were not involved in the study, and relatively few participating neurologists practiced in high-risk areas for tick bites and erythema migrans. The low incidence of neuroborreliosis in combination with a high background level of seropositivity in the population implies a low predictive value of positive Borrelia serology. It is therefore essential that when neuroborreliosis is suspected, the cerebrospinal fluid should always be investigated.

Adolescent↗
PubMed2004

[The risk of cancer in inhabitants of Weurt, the Netherlands].

OBJECTIVE: To analyze the risk of cancer in the population of Weurt, a village near Nijmegen, the Netherlands, using long-term data (13 years). DESIGN: Cluster analysis. METHOD: Anonymous data on newly diagnosed cases of cancer in the years 1989-2001 were obtained from the regional cancer registry. The region had about 1 million inhabitants and 263 postal code areas. The Dutch Central Statistical Office (Statistics Netherlands) provided age- and sex-specific population data for each postal code area. Ratios of observed and expected numbers of cancer cases were calculated (uncorrected standardized mortality ratio; SMR). A Bayesian analysis with a random effects model with spatial correlation was used to adjust the SMRs for cancer incidence in neighbouring postal code areas. RESULTS: In the years 1989-2001, a total number of 167 cases of cancer (97 in males and 70 in females) were diagnosed in Weurt. The number of cancers in the entire area was 58,126. In Weurt the adjusted SMR for all cancers was 1.18 (95% CI: 0.95-1.44) in males and 1.10 (95% CI: 0.86-1.39) in females. For lung cancer the adjusted SMR was 1.35 (95% CI: 0.88-1.94) in males and 1.00 (95% CI: 0.29-2.13) in females. None of the other types of cancer showed a statistically significant increase in incidence in Weurt. CONCLUSIONS: Although based on relatively small numbers of diagnosed cancers, these results are not suggestive of a real cancer cluster in Weurt. Lung cancer incidence was slightly increased in males and not in females, which may indicate that chance, lifestyle or occupational factors were more obvious causes than environmental factors. In general, it is advised to be reluctant to perform cluster analyses. Such analyses may only be valuable if specific hypotheses regarding causes of specific types of cancer are present.

Adult↗
PubMed2004

[Outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in the Rijnmond region: the largest outbreak in the Netherlands].

UNLABELLED: EPIDEMIC: The annual number of new MRSA isolates in the Netherlands tripled in 2002 compared with previous years. This increase was in part due to a MRSA outbreak in the Rijnmond region. The outbreak occurred in two merged hospitals and is the largest ever to occur in the Netherlands. From November 2001 till June 2003 MRSA was isolated from 381 patients and 113 hospital employees. The worst affected departments were Surgery and Internal Medicine. One MRSA strain (pulsed-field gel electroforesis (PFGE) type 16) remained initially unrecognised and was therefore able to spread unnoticed. Soon two additional epidemic MRSA strains (types 37 and 38) were discovered. DISCUSSION: Multiple factors played a role in the extent and duration of the outbreak. Because of the delayed detection and rapid spread of MRSA type 16, the outbreak grew too large once recognised to be resolved within the available infrastructure. Investments were needed at various fields, including the infection-control service and the microbiology laboratory. Employees had to be informed and motivated, and a separate MRSA ward and OPD were provided. New MRSA outbreaks occurred, despite extensive MRSA (contact) screening among patients and employees. The numbers of isolates began falling as from the beginning of 2003.

Cross Infection↗
PubMed2004

A serological survey for pathogens in old fancy chicken breeds in central and eastern part of The Netherlands.

To get an impression of the presence of pathogens in multi-aged flocks of old fancy chicken breeds in the Netherlands, plasma samples originating from 24 flocks were examined for antibodies against 17 chicken pathogens. These flocks were housed mainly in the centre and east of the Netherlands, regions with a high poultry density. The owners of the tested flocks showed their chicken at national and international poultry exhibitions. Antibodies against Avian Influenza, Egg Drop Syndrome '76 virus, Pox virus, Salmonella pullorum/gallinarum, Salmonella Enteritidis or Salmonella Typhimurium were not detected. However, antibodies against other Salmonella species, Mycoplasma gallisepticum, infectious bursal disease virus, infectious bronchitis virus, avian encephalomyelitis virus, chicken anaemia virus, infectious laryngotracheitis virus, and avian leukosis virus, subgroups A and B, and subgroup J were detected in a varying proportion of the flocks. This study shows that antibodies against many chicken pathogens are present among the flocks of old fancy chicken breeds that are exhibited at international poultry exhibitions.

Animals↗
PubMed2003

Development of research capability in Ethiopia: the Ethio-Netherlands AIDS research project (ENARP): 1994-2002, achievements, scientific findings and project goals.

In 1992, HIV/AIDS researchers in Amsterdam, the Netherlands, were invited to work in partnership with researchers in Ethiopia to build an HIV/AIDS research infrastructure in Addis Ababa. This project, which began in 1994, was envisioned to contribute meaningfully to fighting the HIV pandemic in the decades to come. Its immediate objective was to establish an HIV research laboratory to serve international partnerships pursuing HIV vaccine research in Ethiopia and to support national health authorities fighting the HIV epidemic in Ethiopia. The overall goal was to develop research capacity at the Ethiopian Health and Nutrition Research Institute (EHNRI) by improving facilities, training technical and academic personnel (at PhD, MSc, and MPH level), establishing cohort studies to study HIV infection progression, and helping the government to implement a national HIV surveillance program. In the period 1994-2002, the projected HIV/AIDS research laboratory was built and several existing sections of EHNRI were renovated and upgraded. An active HIV-research program was established. Staff grew to more than 60, including three Ethiopian and three expatriate research/managers. Two PhD. students have graduated in immunology and virology (University of Amsterdam, 2000), and five are currently in training. Several technical persons were trained and over 19 MSc/MPH-programs were supported at Addis Ababa University (AAU). The first Ethiopian PhD graduate became the national program manager for ENARP. Two ENARP cohort studies and several HIV-prevalence studies have helped to document the severity of the HIV epidemic in Ethiopia, assisting national authorities in formulation of national and regional policies to prevent HIV transmission. Initial funding for ENARP from the Netherlands government was projected for eight years, to end by 2003. It was expected that management responsibilities would then be transferred from expatriate to Ethiopian staff and all ENARP activities integrated into EHNRI.

AIDS Serodiagnosis↗
PubMed2004

[Identification of cadavers in the Netherlands].

The identification of cadavers of unknown persons is important from a humanitarian point of view but also for legal reasons and in connection with insurance. Various identification techniques are available today, such as fingerprinting, DNA profiling and the comparison of dental structures. Not all methods of identification are equally useful in practice and the ultimate identification is often made possible only by a combination of several techniques. Sometimes, the identification procedure cannot be completed successfully because one has no idea whatsoever who it might be and there is therefore no material available for comparison. In the Netherlands, identification is in principle a task of the police. In case of a mass disaster in the Netherlands, or abroad when Dutch citizens are involved, a special Disaster Identification Team is activated, consisting mainly of police officers supplemented by external experts. Major disasters in which such a team has been involved in the past are the air crash in Faro (Portugal) in 1992 (56 victims), the air crash in Eindhoven in 1996 (32 victims) and the explosion of the fireworks plant in Enschede in 2000 (21 victims).

Cadaver↗
PubMed2004

[Methods and results of in-vitro fertilisation in the Netherlands in the years 1983-1994].

OBJECTIVE: To describe methods and results of in-vitro fertilisation (IVF) treatment during the first 12 years after the introduction of IVF treatment in the Netherlands. Design. Retrospective cohort study. METHOD: A nationwide study was conducted among women who had had their first IVF cycle stimulated with gonadotrophins in 12 IVF centres in the Netherlands in the period 1 January 1983 to 31 December 1994 (n = 8, 184). RESULTS: The subfertility diagnosis related to tubal factors decreased from 70% in 1987 to 25% in 1994. The subfertility diagnosis related to a male factor increased from 8.7% in 1987 to 35.5% in 1994. The mean age at first IVF treatment remained roughly constant. During the introduction of GnRH agonists there was an increase in gonadotrophin dosages, the number of retrieved oocytes, the number of high responders and/or women who experienced an ovarian hyperstimulation syndrome (OHSS). The percentage of deliveries with at least one baby born alive after the first IVF cycle increased from 6% in 1984 to 18% in 1994. The number of live births per 100 transferred embryos increased from 2.5 in 1985 to 12 in 1994. Furthermore, the mean numbers of embryos transferred after the first IVF cycle decreased from 3.2 in 1987 to 2.2 in 1994. The overall success rate - defined as the proportion of women who had at least one child born alive after one or more IVF cycles - for women who had their first IVF treatment between 1983 and 1994 was 37.1%. The percentage of triplets or quadruplets decreased from 8.7 in 1989 to 1.2 in 1994. The percentage of twin deliveries remained about 25. CONCLUSION: The introduction of GnRH agonists and the higher dosages of gonadotrophins led to a higher oocyte harvest. During the first years of IVF treatment there was an increase in the success rate after the first treatment cycle. The overall success rate remained constant after 1991. The risk of developing an OHSS increased whereas the rate of twin deliveries remained constant.

Adult↗
PubMed2004

Enterotoxigenic Bacteroides fragilis (ETBF) strains isolated in The Netherlands and Poland are genetically diverse.

Gram-negative anaerobic rods isolated in The Netherlands and Poland from extraintestinal and intestinal sources were identified as Bacteroides fragilis (n = 210) on the basis of Gram staining, growth on selective Bacteroides Bile Esculine medium as black colonies, and biochemical characteristics. PCR-mediated assessment of the presence of the B. fragilis enterotoxin (fragilysin) gene in all strains identified 12 so-called enterotoxin-positive B. fragilis (ETBF) strains (15%) among the Dutch strains and 16 ETBF among the Polish strains (13%). NotI Pulsed Field Gel Electrophoresis (PFGE) analysis revealed that these strains are genetically heterogeneous. Among the Dutch strains an identical pair and a set of four indiscriminate strains were identified. This suggests that limited nosocomial spread of ETBF can be observed. However, there was no identity obeserved when strains from The Netherlands were compared to their Polish counterparts. The antimicrobial susceptibility testing revealed that one Polish strain isolated from a patient with antibiotic associated diarrhoeae (AAD) was simultaneously highly resistant to clindamycin and cefoxitin (MIC>256 mg/L). Two other strains appeared to be clindamycin resistant. All resistant strains had different PFGE patterns, suggesting that resistance development occurred at independent occassions.

Bacteroides fragilis↗
PubMed2004

[Home nursing in the Netherlands since 1950].

This article describes home nursing in the Netherlands between 1950 and 2004. The developments in this period are described form the theoretical perspective on professions of Andrew Abbott: 'professions are exclusive occupational groups applying somewhat abstract knowledge to particular cases'. In 1950, home nursing was an all-round profession providing home nursing care and preventive care to all categories of patients, mainly in their own homes. It was - and still is - a profession situated in the 'periphery' of the health care system, where care and support to patients with pain, suffering and disabilities because of age or chronic illness are considered as belonging to a separate task domain, relatively independent of the mainly curative activities that are performed in the 'medical centre' of health care, especially in the academic hospitals. Typical compared to other countries is that an extensive network of private initiatives, in the form of Cross Organisations of different denominational signatures, existed in the Netherlands until 1990, covering the whole country with home nursing services. In that year, the provision of home nursing and home help were integrated and most home nursing organisations merged into large, regional home care organisations. In this article, six main social developments are described, that influenced the development of home nursing and resulted in the profession as it is now: a differentiated profession divided into different levels of care, working in an organisational, largely bureaucratic setting of home care organisations, where managers and external regional assessment organisations (RIO's) decide on the care to be provided. They now find themselves in a transmural setting, where boundaries between different forms of care no longer exist, and co-operation with other professionals, such as home helps, specialist nurses, GPs, and hospital physicians, is frequent. Currently, their professional autonomy and independent decision-making regarding diagnosis and therapy is affected, and elements of bureaucratisation and managementism (for example aspects such as time-writing) affect their daily work. However, home nursing can still be characterised as a relatively exclusive and independent profession, solving particular cases in the homes of patients by performing activities that are based on abstract, methodical knowledge.

History, 20th Century↗
PubMed2004

[Psychiatric training of nurses in the Netherlands since 1883].

This article describes the development since 1883 of training nurses for working with psychiatric patients. Knowledge of this development seems to throw a new light upon the nursing history in the Netherlands. To start with, the vocational training system in psychiatric hospitals developed during exactly the same time as the hospital based educational system for so called ' general nurses'. As a result, both these vocational training routes were acknowledged as 'basic learning routes for nurses' in the Dutch Nursing Law of 1921. The general route gave to Diploma A, the psychiatric route gave access to Diploma B. This double diploma system placed the Dutch training system for nurses in an isolated position. For most other countries - as well as the International Council of Nurses - considered psychiatry as a field of work in which a nurse could specialise only after having completed a basic training programme as a general nurse. In most countries, the specialization course in psychiatry only took one year. In comparison to those systems, the Dutch programme seemed to offer psychiatric nurses more years of specific training. After World War II, however, also in the Netherlands many people advocated a one diploma system in nursing, with possibilities to specialise. Nevertheless, it took the Dutch until 1997 to introduce this new system, so it seems the old training routes were defended vehemently. Maybe an historic description of the way this psychiatric route had developed, can shed new light upon the aspects of the old educational system that one longed to preserve.

Education, Nursing↗
PubMed1992

[Cerebrovascular accidents at a young age in Rendu-Osler-Weber disease; a survey in the Netherlands Antilles].

Thirty-two patients (17 men and 15 women) are presented in whom the diagnosis Rendu-Osler-Weber disease was established between 1980 and 1990 during hospitalisation in the Leeward Islands of the Netherlands Antilles. Among this group there were eight families, each of which contained two patients. Estimated point-prevalence rate in 1991 was 19.4/100,000, which is ten times higher than has been reported so far. Epistaxis, gastrointestinal blood loss and cerebrovascular accidents (CVA) were the main presenting symptoms. Mean age at diagnosis was 53.2 years. Arteriovenous fistulae in the lung developed in 11 patients (34%). Eleven patients experienced a total of 12 CVAs at a mean age of 48 years; four of these patients had an ischaemic CVA in the presence of pulmonary fistulae, while three patients had a haemorrhagic stroke in the presence of a cerebral arteriovenous malformation. Thus, cerebrovascular accidents at an early age are common complications in Rendu-Osler-Weber disease and warrant further investigation of this disease among inhabitants of the Leeward Islands of the Netherlands Antilles.

Adult↗
PubMed2004

[The disquieting consequences of granting patents on human genes for healthcare and scientific research in The Netherlands].

The granting of a patent by the European Patent Office to Myriad Genetics on the sequence of the BRCA-1 gene in 2001 prompted the Dutch Minister of Healthcare and the Minister of Education, Culture and Science to ask for advice. The Royal Netherlands Academy of Arts and Science (KNAW) prepared a report in 2003 entitled: 'The consequences of granting patents on human genes for scientific research in The Netherlands'. Another recommendation (by Van de Bunt) entitled: 'A code of gene patenting' was also published in 2003. The KNAW report recommends, among others: a redefinition of the 'research exemption' and renewed discussion on a 'grace period'. The Van de Bunt report concludes, among other things, that some holders of gene patents cause unwanted side effects, but that the patent system itself provides sufficient possibilities to prevent these side effects. In a comment on both reports, the Dutch Ministry of Healthcare concluded: 'There is no reason to change the current patent system'. One should be more critical, however, and favour the possibility of a 'diagnostic exemption' in which DNA-diagnostics would be excluded from patenting.

Biomedical Research↗
PubMed2004

[Surgery and follow-up 131I therapy in patients with differentiated thyroid carcinoma in the south-east of the Netherlands, 1983-1996, compliance with the 1987 consensus guidelines: additional data].

In a previous study using data from the regional cancer registry of the Comprehensive Cancer Centre South, Eindhoven, The Netherlands, we concluded that in the majority of cases surgical treatment was in accordance with the consensus recommendations, but that about 40% of patients with differentiated thyroid cancer from a number of regional hospitals had not been referred for 131I therapy. However, in a subsequent study using patient data from these hospitals, it became clear that almost all patients had in fact been referred for therapy but to centres outside the 131I therapy region. The conclusion of the study should therefore be altered: the great majority of patients with differentiated thyroid cancer in the south-east of The Netherlands (1983-96) were referred for 131I treatment and therefore the primary surgical and the follow-up treatment complied with the 1987 consensus guidelines.

Carcinoma↗
PubMed2004

Lymphogranuloma venereum among men who have sex with men--Netherlands, 2003-2004.

Lymphogranuloma venereum (LGV) is a systemic, sexually transmitted disease (STD) caused by a variety of the bacterium Chlamydia trachomatis that rarely occurs in the United States and other industrialized countries; the prevalence of LGV is greatest in Africa, Southeast Asia, Central and South America, and Caribbean countries. However, in the Netherlands, which typically has fewer than five cases a year, as of September 2004, a total of 92 cases of LGV had been confirmed during the preceding 17 months among men who have sex with men (MSM). The first 13 cases, diagnosed during April-November 2003, were reported by local health authorities in Rotterdam in December 2003. An alert was sent to the Early Warning and Reporting System of the European Union and to the European Surveillance of Sexually Transmitted Infections Network (ESSTI). In April 2004, a report was made to CDC, and state and local health departments were alerted. Of the 92 cases confirmed in the Netherlands, 30 occurred during 2003 and 62 during 2004. This report describes the ongoing investigation of the LGV outbreak. Health-care providers should be vigilant for LGV, especially among MSM exposed to persons from Europe, and prepared to diagnose the disease and provide appropriate treatment to patients and their exposed sex partners.

Disease Outbreaks↗
PubMed2004

[Highly active antiretroviral therapy (HAART) in HIV-positive pregnant women in the Netherlands, 1997-2003: safe, effective and with few side effects].

OBJECTIVE: To assess the side effects, safety and efficacy of highly active antiretroviral therapy (HAART) in a cohort of HIV-infected pregnant women in the Netherlands. DESIGN: Retrospective. METHOD: Data were collected from the medical records of HIV-infected pregnant women who received HAART during pregnancy in the period 1 January 1997-1 June 2003 at 14 HIV-specialized centres in the Netherlands. The inclusion criteria were at least a triple drug regimen and birth at 20 or more weeks of gestation. Information was collected about patient characteristics, HAART prescribed, side effects, viral load response, mode of delivery and HIV-status of the neonate. RESULTS: A total of 267/413 women satisfied the inclusion criteria. Most women (n = 199) had not previously received anti-retroviral therapy and started HAART between weeks 21 and 28 of the pregnancy. The two most frequently used regimens contained nelfinavir (57%) or nevirapine (31%). Gastrointestinal side effects were more frequently observed in the nelfinavir group, while rash and hepatotoxicity were more frequently reported in the nevirapine group. Efficacy and pregnancy outcome were similar in both groups. Two infants (0.7%) were HIV-infected. CONCLUSION: HAART regimens containing nelfinavir or nevirapine in HIV-infected pregnant women were safe, effective and well tolerated.

Adolescent↗
PubMed1992

[Shifts in the species spectrum of mycoses in The Netherlands from 1970-1990].

A review is presented of yeast and mould infections occurring in humans in the Netherlands. The occurrence of the dermatophytes Trichophyton rubrum and T. mentagrophytes tends to increase, while Microsporum canis and particularly Epidermophyton floccosum have become less common. The yeast Candida glabrata is particularly often involved in infections of the urinary tract. Candida krusei, C. parapsilosis and C. tropicalis have become less significant. Remarkable differences are found between the spectra of Aspergillus species causing infections in lungs and in ears; an entirely different pathogenesis is to be presumed. The number of systemic mycoses in the Netherlands is underestimated. The possibility of hundreds of cases each year cannot be excluded.

Dermatomycoses↗
PubMed2004

[Stagnation in mortality decline among elderly in The Netherlands].

PURPOSE: To assess whether the stagnation in old age (80+) mortality decline observed in the Netherlands in the 1980s, continued in the 1990s and which factors contributed to this stagnation. Emphasis is on the role of smoking. METHODS: Poisson regression with linear splines was applied to total and cause-specific (3-digit) mortality data by age, year of death (1950-1999) and sex. Age-period-cohort analysis was conducted to determine whether the trends followed period and/or cohort patterns. ICD Revisions were bridged using a concordance table. RESULTS: A sudden reversal in old age mortality occurred around 1980, leading to a stagnation in the decline and even an increase during the 1980s and 1990s. Smoking related cancers, COPD and diseases specifically related to old age contributed to this stagnation. Trends in smoking-related cancers and COPD showed a cohort pattern--especially for males. When excluding these smoking related diseases, the trends in old-age mortality in the Netherlands showed an increasing stagnation for both sexes. IMPLICATIONS: Generation-wise changes in smoking can only partly explain the stagnation in mortality. Other factors like increased frailty and changes in medical and social services for the elderly probably have played a more decisive role in explaining the recent stagnation.

Age Distribution↗
PubMed2005

[Deliberate termination of life in newborns in The Netherlands; review of all 22 reported cases between 1997 and 2004].

OBJECTIVE: To gain insight into the reporting and assessment of active termination of life in newborns in The Netherlands. DESIGN; Retrospective. METHOD: Data on all cases of deliberate termination of life in newborns up to the age of 6 months, reported to the public prosecutor as from 1997 onward, were collected and compared. RESULTS: In January 1997-June 2004, 22 cases of deliberate termination of life in newborns were reported. All cases concerned newborns with spina bifida and hydrocephalus. Deliberate termination of life was acceptable to the physicians because of the presence of hopeless suffering, with no means of alleviating the suffering. In all cases, at least 2 doctors were consulted outside the medical team. In 17 of 22 cases, a multidisciplinary spina bifida team was consulted. All parents consented to the termination of life; in 4 cases they explicitly requested it. In 14 cases a combination of analgesics, sedatives and paralyzing drugs were used, in 8 cases only analgesics and sedatives were administered. For the public prosecutor the termination of life was acceptable if 4 requirements were properly fulfilled: the presence of hopeless and unbearable suffering, consent of the parents to termination of life, consultation having taken place and a careful execution ofthe termination. The mean time between reporting of the case and the decision concerning prosecution was 5.3 months. None of the cases led to prosecution. CONCLUSION: Three cases of deliberate termination of life in newborns were reported in The Netherlands annually. The public prosecutor used fixed criteria to assess the case and all cases of active termination of life reported were found to be in accordance with good practice.

Decision Making↗