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PubMed1995

Validity of food intake measurement of adult Turkish immigrants in The Netherlands.

OBJECTIVE: To study the validity of the reported food intake in a study which was designed to assess exposure to dioxins from food sources. DESIGN: Repeated diet recalls were used to collect food intake data within a period of four months. Data on energy intake were related to computed basal metabolic rate (BMR). SETTING AND SUBJECTS: A group of 69 Turkish immigrants (30 men and 39 women aged 18-59 years) from two municipalities in the Eastern part of the Netherlands, whose selected basic socio-demographic characteristics reflect those of adult Turkish living in the Netherlands. RESULTS AND CONCLUSIONS: A mean energy intake (EI) to BMR ratio of 1.32 for women (mean EI = 8.1 MJ/day) and 1.36 for men (mean EI = 10.6 MJ/day) was found. Subjects in the lower and upper tertile of EI/BMR ratio differed only in body mass index (BMI: kg/m2). Pearson's correlation coefficient between EI/BMR and BMI was -0.39 (P < 0.05). The observed high prevalence of obesity in adult Turkish people complicates, as in other cultures, an accurate assessment of food intake.

Adult↗
PubMed1995

[Absence of meningitis caused by Haemophilus influenzae type b in The Netherlands following twofold vaccination].

OBJECTIVE: To determine the two-year results of nationwide vaccination with Haemophilus influenzae type b (Hib) vaccine on the occurrence of Hib meningitis in the Netherlands. DESIGN: Retrospective controlled study. SETTING: The Netherlands. METHOD: Children born since April 1, 1993 are vaccinated at the age of 3, 4, 5 and 11 months to protect them from infections with Hib. The number of Hib meningitis patients in the period 1 April, 1993 to 1 April, 1995, among infants born in this period who were offered the Hib vaccine (study group), was compared with the number of Hib meningitis patients in the period 1 April, 1991 to 1 April, 1993 among children born in last-mentioned period (control group). RESULTS: Twenty-one cases of meningitis by Hib were observed in the study group. Twelve children who, as a consequence of their age, had only been vaccinated once or not at all; 7 children were not vaccinated for several reasons. In addition one patient was infected by H. influenzae type f strain and one by a non-typable strain. In the control group 185 cases of Hib meningitis occurred. CONCLUSION: Hib meningitis was not observed among infants who had been vaccinated at least twice.

Haemophilus Vaccines↗
PubMed1994

Trends in smoking prevalence from 1974 to 1986 in young adults in The Netherlands.

Data of two screening projects for cardiovascular risk factors were used to analyse trends in smoking behaviour in the Netherlands between 1974 and 1986. In 1974-1980 about 30,000 men and women aged 37-43 years and in 1981-1986 about 80,000 men aged 33-37 years in five different towns were screened. Among men, smoking prevalence decreased significantly during the study period in three of the five towns and remained more or less constant in the other two. The decrease was stronger in 1974-1980 (ca. 2 percentage points per year) than in 1981-1986 (ca. 1 percentage point per year). Among women, smoking prevalence decreased at different rates in three of the towns and increased considerably in one town in the period 1974-1980. The smoking prevalence in 37-43 year old Dutch men and women amounted to 58-66% and 48-57% respectively in 1980. In 1986, the smoking prevalence was 48-58% in 33-37 year old men. Comparison with data from other countries showed that smoking prevalence among both men and women in the mid eighties was still high in the Netherlands.

Adult↗
PubMed1994

A prospective cohort study on Allium vegetable consumption, garlic supplement use, and the risk of lung carcinoma in The Netherlands.

The association between the consumption of onions and leeks (vegetables belonging to the Allium genus), garlic supplements, and the risk of lung carcinoma was investigated in a large-scale prospective cohort study on diet and cancer in the Netherlands. The Netherlands Cohort Study was started in 1986 among 120,852 men and women, ages 55-69 years, by collecting information on usual diet and important life-style characteristics. After 3.3 years of follow-up, 550 incident lung carcinoma cases were observed. Information on Allium vegetable consumption was available for 484 lung carcinoma cases and 3123 members of a randomly sampled subcohort. In stratified analysis, a lower lung carcinoma risk was observed in the highest onion intake category [rate ratio (RR) = 0.65; 95% confidence interval, 0.45-0.95] compared to the lowest consumption category. After including other, dietary and nondietary, determinants of lung carcinoma in the multivariable models and using pack years for past and current smoking, instead of using smoking status categorized as never, ex-, and current smoking, the rate ratio in the highest intake category increased to 0.80 and was no longer significantly different from unity (95% confidence interval, 0.52-1.24). Leek consumption was not associated with risk for lung carcinoma (RR = 1.08; 95% confidence interval 0.80-1.45 in the highest intake category, compared to the lowest). No statistically significant trends in the rate ratios associated with increasing consumption of these vegetables were detected for lung carcinoma or the four histological subtypes. A higher lung carcinoma risk was observed for those subjects who used exclusively garlic supplements (RR = 1.78; 95% confidence interval, 1.08-2.92), compared to those not taking dietary supplements. A lower lung carcinoma risk was seen for those using garlic supplements together with any other supplement (RR = 0.93; 95% confidence interval 0.46-1.86) compared to those using any other supplement. In conclusion, we found no evidence of a relation between the consumption of onions or leeks and the risk of lung carcinoma or any of the histological subtypes. Garlic supplement use seems not associated with a lower risk of lung carcinoma.

Aged↗
PubMed1994

[Disease burden of nervous system disorders in The Netherlands].

OBJECTIVE: To determine the prevalence and the burden of diseases of the nervous system in the Netherlands. DESIGN: Descriptive. SETTING: Institute of Public Health Care, Rotterdam, the Netherlands. METHOD: Data from medical registrations and statistics concerning diseases of the nervous system from different tiers of health care (general practitioners, hospital, nursing homes) and effects on patient and community (mortality, sickness absenteeism, occupational disablement and costs of illness) were analysed. RESULTS: In general practice, 3-5% of total consultation consisted of neurological diseases (450,000-750,000 cases per year), of which migraine and epilepsy instituted a relatively large group. Of all the hospital admissions, 7% were because of a neurological disease. Neurological disease accounted for 70% of all nursing home admissions. Cerebrovascular accident and hernia nuclei pulposi instituted the largest groups in all sectors. Diseases of the nervous system accounted for 14% of total mortality, 6% of total sickness absenteeism and 14% of total health care costs (f 3.8 billion). CONCLUSION: Estimating the burden of diseases is difficult because of imperfect medical registration, variations in structure of patient referral and influence of secondary diagnoses. Taking into account the current aging of the population, the prevalence of some neurological diseases, such as CVA, Parkinson's disease and dementia will rise. Priority setting for care and treatment is hampered by differences in burden of illness on the individual and on the community level.

Absenteeism↗
PubMedDate not supplied

The polio epidemic in The Netherlands, 1992/1993.

Starting September 1992, an outbreak of poliomyelitis occurred in the Netherlands. Until now a total of 67 cases have been notified. These were the first indigenous cases since 1978. None of the patients had been vaccinated before, and all but one belong to small Protestant groups that refuse vaccination for religious reasons. The age of the patients varies from several days to 61 years (mean age 19) and the male to female ratio is 1.6:1.0. The epidemic is caused by wild poliovirus type 3. Partial genomic sequencing showed closest resemblance to a virus isolated in India in 1991. The epidemiological characteristics of the present outbreak are similar to those of previous outbreaks in the seventies. Although vaccination coverage in the Netherlands is excellent (97% coverage for the first series of three doses with IPV vaccine), outbreaks can be expected because some socially closely interrelated small groups refuse vaccination (totalling about 200,000 persons) for religious reasons. Experience from this epidemic, from previous epidemics, and preliminary results of random stool and sewage sampling indicate very little circulating virus among the general population. Changes in (implementation of) the vaccination policy, including a mixed strategy with OPV and IPV, are being considered to reduce the risk of similar outbreaks in the future.

Adolescent↗
PubMed1994

[Trends in mortality and morbidity among the elderly in The Netherlands, 1970-1989].

OBJECTIVE: Analysis of the trends in mortality and morbidity among the elderly to see whether there has been a 'compression' of mortality and morbidity in the older age groups during the past two decades. METHOD: Data on mortality (by age, sex and cause of death; 55-84 years; 1970-1989), hospital admissions (by age, sex and discharge diagnosis; 55-84 years; 1972-1987) and self-reported morbidity (65+ years) were extracted from publications by the Netherlands Central Bureau of Statistics, and analysed on an age-specific and age-standardised basis. RESULTS: A decline in mortality for men and women was seen in all age groups between 1970 and 1989. Diseases of 'circulatory organs' and 'accidents and intoxications' accounted for the major part. In contrast, hospital admission rates increased for men and women in all age groups between 1972 and 1987, mainly due to diseases of 'circulatory organs' and 'neoplasms'. No correlation was found between decline of mortality and increase of hospital admissions per disease cluster. Questionnaire data revealed no major changes in health problems. CONCLUSION: Whereas mortality declined in all age groups, hospital admissions rose, and prevalence rates of self-reported health problems remained essentially the same. We conclude that there has probably been a compression of neither mortality nor morbidity during the past two decades in the Netherlands.

Aged↗
PubMed1993

[Poliomyelitis in The Netherlands, 1979-1991: immunity and exposure].

An overview is presented of serological and virological studies on poliovirus immunization and circulation in the Netherlands, performed between 1979 and 1991. In this period, only three patients with poliomyelitis were notified. All had acquired the infection abroad. The vaccinations in the national immunization programme, using inactivated poliovirus vaccine, build a strong immunity. This can also be seen in age-stratified serological profiles of the Dutch population. In these surveys, persons from the time at which vaccination was offered have neutralizing antibodies. Older persons, especially those born between 1930 and 1945, sometimes lack antibodies. However, 85-90% of them show a rapid booster response upon vaccination, demonstrating immunological memory. Hence, they will be protected against poliomyelitis upon contact with wild poliovirus. Virological data show a regular import of poliovirus, especially in adoptive children tested on entry into the Netherlands, coming from developing countries. Nearly all other virus isolates in Dutchmen were related to import from such countries. None of the imported patients or other persons in whom poliovirus was detected spread the virus over the country. It demonstrates that as a rule the herd immunity of the well-vaccinated Dutch population is good. Exceptions occur, however, as demonstrated by the epidemics in 1978 and 1992. Large socio-geographic clusters of susceptible people who refuse vaccinations are not sufficiently protected.

Antibodies, Viral↗
PubMed1993

[Obstetrical outcome in teenage pregnancies in The Netherlands].

OBJECTIVE: To compare the course of teenage pregnancies and deliveries with that in women between the ages of 20 and 29. DESIGN: Observational. SETTING: The Netherlands. METHOD: Using data from the 1989 National Obstetric Database (LVR), 4500 teenage pregnancies were studied, to compare the risk of preterm birth, low birth weight and delivering a small for gestational age (SGA) baby between teenagers and older women. RESULTS: Women between the ages of 13 and 19 ran one and a half times as high a risk of having a preterm baby as women between the ages of 20 and 29 years (p < 0.0001). The risk of intrauterine death was 4 times as high for age 13-17 and 2 times as high for age 18-19 compared with older women (p < 0.0001). These results were found for teenage mothers of Dutch origin as well as for young mothers of foreign descent. Deliveries by teenagers were more often spontaneous, were of shorter duration and less often needed assistance than deliveries in older mothers (p < 0.001). CONCLUSION: Even in the Netherlands, with the lowest teenage pregnancy rate in the Western world and a prenatal care system generally considered of high quality, teenage pregnancies have less favourable outcomes than those in older women. Since we had no information on cultural background, socioeconomic status or life style, further research into determinants of outcomes of Dutch teenage pregnancies is indicated.

Adolescent↗
PubMed1993

[Serological study of the occurrence of L. hardjo in sheep in The Netherlands].

Sheep (3918) from 137 farms in the regions of North-, West- and Mid-Netherlands and Gelderland were serologically investigated for the presence of antibodies against Leptospira hardjo. Antibodies were detected in 3.3% of the sheep. There were large regional differences with respect to both the percentage of positive sheep and the percentage of positive flocks. All sera from sheep in Gelderland were negative. In West- en Mid-Netherlands there were 0.9 and 6.5% positive sera, respectively, and 19.4 and 32.7% positive flocks. The percentage of positive sheep per positive flocks varied from 1 tot 51.6. Serological positive sheep were from farms with and without cattle. On farms with cattle, there was no clear relationship between serologically sheep and the presence of hardjo antibodies in cattle. It thus seems plausible that sheep can be infected with hardjo independently of cattle.

Animals↗
PubMed1993

The Netherlands brain bank--a clinico-pathological link in aging and dementia research.

The number of sophisticated neurobiological techniques which can be applied on human brain has rapidly increased and causes an increased demand for post-mortem human brain tissue for research purposes. Brain banks, which collect post-mortem tissue from patients who suffered from neurological and psychiatric disorders, have become an important link between clinicians, scientists and neuropathologists involved in aging and dementia research. Due to the large variability of the material, there are many drawbacks in the use of post-mortem brains. Therefore, collecting human brain tissue for research should include matching for several factors, both ante-mortem and post-mortem. Some of the most important ante-mortem factors include age, sex, agonal state, seasonal alterations, circadian variation and clock time of death. The post-mortem factors which should be matched for include the post-mortem delay, fixation and storage time and lateralization. The material and data on aging and dementia, collected by the Netherlands Brain Bank in the past six years will serve in the present paper to illustrate the wide variety of potentialities and pitfalls in the use of post-mortem human brain tissue. Brain Bank organizations for various neurological diseases form at present an important clinico-pathological link in aging and dementia research and the availability of post-mortem human brain tissue makes it possible to investigate those diseases for which no animal model is available. In order to provide research groups with post-mortem brain tissue from Alzheimer's disease (AD) patients and controls, a brain bank was established by the end of 1985 in The Netherlands Institute for Brain Research. This brain bank is based upon research projects submitted in advance, specifying a variety of requirements such as: total number of brains needed, kind of fixation, agonal state, post-mortem delay, exact anatomical boundaries of the brain region, kind of fixation and other treatment requirements of the tissue. This Brain Bank has got two unique features: 1. Human brain tissue is obtained by means of rapid autopsies with a very short post-mortem delay, ranging between 2-4 hour. 2. Fresh brain dissection procedure is used, which is a difficult regime to establish, requiring qualified staff at inconvenient times. This dissection procedure is necessary for the immediate use of fresh tissue and advantageous in increasing the range of morphological, neurochemical, immunocytochemical, metabolic and other procedures which can be applied to tissues fixed in a different way or rapidly frozen brain tissue free of freezing artifacts.

Aging↗
PubMed1993

A sudden increase in factor VIII inhibitor development in multitransfused hemophilia A patients in The Netherlands. Dutch Hemophilia Study Group.

The development of antibodies to factor VIII (inhibitors) in response to clotting-factor concentrates administration in hemophilia is common during the first few years of treatment but rare in multitransfused patients. We have investigated the possible association of a recently introduced factor VIII concentrate (Factor VIII CPS-P) in The Netherlands with the occurrence of inhibitors. To this effect, we conducted two studies. First, we performed a national multicenter study in which clinical information and inhibitor test results were obtained for 447 hemophilia A patients over the period 1988 through 1991. Secondly, for a baseline comparison we estimated the frequency of inhibitor development in a closely followed cohort of 144 patients, from 1984 through 1989. Before the introduction of Factor VIII CPS-P, the incidence of new inhibitors was 4.4/1,000 patient-years in the national study from March 1988 through May 1990, and 3.9/1,000 patient-years in the cohort followed from 1984 through 1989. These figures are similar to the incidence of new inhibitors that was found in a large cohort of patients in the United States followed in the 1970s. In the period that the new concentrate Factor VIII CPS-P was on the market, from June 1990 through November 1991, 11 clinically relevant inhibitors were detected, which yielded an incidence over this interval of 20.1/1,000 patient-years, a 4.5-fold increase compared with the previous interval (C195: 1.4 to 14.3). Nine of these 11 patients had in their lifetime received over 250 infusions with factor VIII preparations. whereas all of the inhibitors detected in the previous time interval, and all of the 24 inhibitor patients described in the US study, had received less than 250 infusions in their lifetime. All patients who developed inhibitors after June 1990 had been exposed to Factor VIII CPS-P, whereas only 75% of the patients who did not develop an inhibitor had been exposed to this product. In a prospective extension of the study, with a second inhibitor measurement after 3 months, we found that one additional inhibitor had developed during 52.5 patient-years of Factor VIII CPS-P use. In conclusion, there has been a sudden increase in the frequency of inhibitor patients, for a large part among multitransfused patients. It seems more than likely that this increase is associated with the introduction of a new factor VIII concentrate in The Netherlands.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1995

Dietary intake in five ageing cohorts of men in Finland, Italy and The Netherlands.

OBJECTIVE: To obtain insight into dietary habits of elderly people and how these habits have evolved from middle to old age. DESIGN: Cross-sectional study of dietary patterns around 1990; retrospective cohort study of changes in dietary intake since middle age. SETTING: Five cohorts: East and West Finland, Zutphen (Netherlands), Crevalcore (Italy), and Montegiorgo (Italy). SUBJECTS: Men aged 70-90 years around 1990. METHODS: Food intake was estimated using a cross-check dietary history adjusted to the local situation. RESULTS: (i) Cross-sectional: Significant differences were observed between the countries for all food groups, energy and nutrients (P < 0.05). The Finnish diet was characterised by a high consumption of animal products and potatoes, the Italian diet by a high consumption of cereals, vegetables, fruits and alcohol. The Dutch diet was generally intermediate. (ii) Longitudinal: The decrease in energy intake since middle age varied from 4.2 MJ/day in the Finnish cohorts to 2.1 MJ/day in Italy. Also the consumption of most food groups decreased but the consumption of vegetables and fruits increased. Saturated fatty acid intake decreased by 3 E% in the Finnish cohorts and decreased by < 1 E% in Italy. Alcohol intake decreased by approximately 7 E% in Italy while it increased by 2.5 E% in the Netherlands. CONCLUSIONS: Although the general patterns of dietary intake of the different cultures still can be recognised at old age, the variation between them has become smaller. Compared to their dietary intake at middle age, however, the dietary pattern of the Finnish and Dutch cohorts has changed slightly in the direction of a healthy diet, while the diet of the Italian men remained Mediterranean, and thus more healthy, at old age.

Aged↗
PubMed1996

[3 emerging protozoal infections in The Netherlands: Cyclospora, Dientamoeba, and Microspora infections].

Increased international travelling, an increased number of patients with immunosuppression caused by HIV infection, and renewed interest in known but little studied microorganisms, resulted in a more frequent finding of certain medically important parasites. Three emerging protozoal infection, Cyclospora cayetanensis, Dientamoeba fragilis and Microspora (Enterocytozoon bieneusi and Encephalitizoon) are causative agents of diarrhoea. Encephalitozoon infections are also associated with hepatitis, hepatoconjunctivitis and nephritis. C. cayetanensis infection was diagnosed in 28 patients in the years 1992-1995 in the Academic Medical Centre in Amsterdam, half of these patients returning from a visit to Indonesia. D. fragilis has a prevalence in the Netherlands of 8% among patients with diarrhoea lasting longer than one week referred for parasitological investigation. The prevalence of E. bieneusi in HIV positive patients with diarrhoea was 8-10% in the Academic Medical Centre in the last five years. Infection with Encephalitozoon appears to be endemic in the Netherlands.

Animals↗
PubMed1995

The use of quinine for treatment and control of malaria in The Netherlands.

The manufacturing of quinine in The Netherlands began shortly after 1820; large scale production started with the foundation of the Amsterdam Chinine Factory in 1881. The quantity of sold quinine in the Province of North-Holland leads retrospectively to the conclusion that an epidemic of malaria had occurred around 1880. At the start of a new epidemic in 1899, it was demonstrated that quinine killed the bloodforms of tertian malaria immediately. However, 50% of the patients experienced a relapse, particularly after interruption of treatment. The length--f the course did not change the chance of relapse. With the beginning of another epidemic in 1919, scientific work and education of the people started in an organized fashion and patients were urged to use quinine only at the prescription of physicians. Because of the inability to prevent relapses, an alternative to quinine was badly needed. In 1930 plasmochin became available, which proved to be useful in combination with quinine. It was not until 1934 that the asymptomatic carriers were recognized as a problem for control because their unobserved parasitic relapses were considered a major source of infection for mosquitoes. In 1939 it was proposed to apply autumnal quininization, which meant a scrupulous screening of the population. The early forties brought yet another major epidemic. Both quinine and Quiniplex were used until the fifties, when endemic malaria disappeared. The new schizonticidal drugs came too late to challenge the primate of quinine in the era of temperate zone Plasmodium vivax in The Netherlands.

Antimalarials↗
PubMed1995

Crime, disorder and legal pressure as a result of addiction problems in The Netherlands.

Coercing drug users into treatment might seem contrary to the philosophy of drug addiction care, which sets great store by the user's own motivation. Nevertheless, legal pressure and even force are increasingly being brought to bear in the Netherlands to persuade users to attend drug care programmes. The criminal justice system and the addiction care services have various means at their disposal to motivate addicts to come off drugs. This article discusses the relationship between addiction and crime. It begins with a brief description of how the addiction problem has evolved in the Netherlands over the years. This is followed by an explanation of how crime has developed during the same period and the effect this has had on social services for addicts. The article concludes with some recent policy proposals concerning diversion, coercion and pressurization strategies.

Coercion↗
PubMed1995

Follow-up after colorectal cancer: current practice in The Netherlands.

OBJECTIVE: To assess the current practice of follow-up after operations for colorectal cancer in The Netherlands in comparison with other countries. DESIGN: Postal survey. SETTING: All surgical departments in The Netherlands. MAIN OUTCOME MEASURES: Attitudes of surgeons towards detection and treatment of recurrences after colorectal cancer. RESULTS: Of the 139 questionnaires sent out, 136 (98%) were returned. History taking, physical examination, and colonoscopy for local recurrence and metachronous tumours were used by 90% of the hospitals. Attitudes towards screening for hepatic and pulmonary metastases and regional recurrence varied considerably between hospitals. Similar findings were found in seven surveys from other countries. CONCLUSION: There is no consensus among surgeons regarding the follow-up of patients with colorectal cancer. Randomised controlled trials comparing different follow-up strategies and cost-effectiveness analyses are needed to identify groups of patients that will benefit most from follow-up. Identification of these patients may lead to more agreement between surgeons.

Colorectal Neoplasms↗
PubMed1996

[Blood lead levels in young children in The Netherlands].

OBJECTIVE: Determination of lead content in blood (Pb-B) of young children in the Netherlands, to assess the influence on Pb-B of the ambient environment and to verify a surmised decrease of Pb-B. DESIGN: Cross-sectional study. SETTING: Centres and suburbs of Rotterdam and Amsterdam villages in the Geul Valley (Limburg), neighbourhoods in urban areas in Limburg and Flevoland. METHOD: Randomly selected children aged 1-6 years, residing for at least 2 months in the aforementioned areas, provided a venous blood sample, in which Pb-B was determined. RESULTS: Pb-B of 559 children investigated, varied from 20 micrograms/l through 224 micrograms/l and showed no clear association with age. Mean Pb-B of girls (48.5 micrograms/l) was slightly lower than that of boys (52.5 micrograms/l). Mean Pb-B was highest in children from the centre of Rotterdam, followed by that in children from the centre of Amsterdam, the suburbs of Rotterdam and Amsterdam, the Geul Valley and Lelystad, while children from Flevoland and the neighbourhoods in urban areas in Limburg had the lowest Pb-B. In children from the city centres Pb-B had decreased since 1979 by 62% (Amsterdam) and since 1981 by 52% (Rotterdam). In children from the suburbs of these cities these decreases amounted to 57% and 39% respectively. CONCLUSION: Pb-B of young children in the Netherlands has decreased to a mean of 64 micrograms/l in children from the city centres and to a mean of 45 micrograms/l in children living outside the city centres. Among the children from the inner cities, 2.7% had a Pb-B higher than 150 micrograms/l and 6.7% a Pb-B higher than 100 micrograms/l.

Child↗