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PubMed1993

Contribution to scientific research in paediatrics in The Netherlands: evaluation according to subspeciality over a 10-year period.

The board of the Dutch Paediatric Association requested a survey of the scientific research performed in all academic and non-academic paediatric hospitals, authorized to train medical doctors in paediatrics in the Netherlands. Contributions to the international and the Dutch scientific literature, in the form of regular publications, chapters in books, contributions to proceedings and Ph.D. theses were counted over two 5-year periods, i.e. 1981-1985 and 1986-1990. The quality of publications in the international journals was assessed using the average impact factor of the journals over the 10-year period. The number of publications in the international literature doubled during the observation period 1986-1990 compared to the period 1981-1985. Nevertheless, the quality of the publications remained the same. Metabolism, oncology/haematology, immunology/infectious diseases and cardiology are the subspecializations in which scientific research takes place in four or more academic paediatric hospitals. In total, 84 Ph.D. theses were produced in which a paediatrician was either the project leader (mostly a professor in paediatrics) or the investigator-in-charge. Insight into structure and major research efforts of paediatric hospitals in other countries of Europe may lead to exchange of views and, maybe, profitable co-operation.

Netherlands↗

PubMed1988

Comparison of antibiotic resistant and sensitive strains of Haemophilus influenzae type b in The Netherlands by outer-membrane protein subtyping.

The percentage of beta-lactamase producing Haemophilus influenzae strains from patients with meningitis in The Netherlands increased from 0% in 1975/1976 to 4.6% in 1985/1986 (n = 1559). Twenty-three isolates resistant to ampicillin, penicillin, chloramphenicol, rifampicin and/or tetracycline were subtyped to determine if one resistant strain was spreading. (Sub)typing was performed by capsular typing, analysis of the major outer membrane protein patterns on sodium dodecylsulfate gels (SDS-PAGE subtypes), lipopolysaccharide serotyping and biotyping. The (sub)types of the resistant strains were similar to those of sensitive strains, thus indicating that antibiotic resistant strains develop at random.

Anti-Bacterial Agents↗

PubMed1992

Monitoring of antibiotic resistance in shigellae isolated in The Netherlands 1984-1989.

During surveillance of antimicrobial resistance in Shigella strains isolated in the Netherlands from 1984 to 1989 and forwarded to the National Institute of Public Health and Environmental Protection for typing, sensitivity to twelve antimicrobial agents was assessed. High rates of resistance to the older drugs of choice in treating shigellosis were found, i.e. ampicillin and trimethoprim-sulfamethoxazole. Ampicillin resistance varied from 33 to 53% among Shigella flexneri strains and from 10 to 17% among Shigella sonnei strains. Trimethoprim and trimethoprim-sulfamethoxazole resistance increased from 8% to about 25% among Shigella flexneri and from 16 to 46% among Shigella sonnei isolates. All strains were susceptible to the newer quinolones, but five strains resistant to nalidixic acid showed decreased susceptibility to norfloxacin. Approximately 10% of the isolates were resistant to the combination of ampicillin, trimethoprim and sulfamethoxazole.

Ampicillin↗

PubMed1991

Distribution, antibiotic susceptibility and tolerance of bacterial isolates in culture-positive cases of endocarditis in The Netherlands.

During a two-year period data were collected nationwide in The Netherlands on 438 episodes of bacterial endocarditis (BE) in 432 patients. Of the strains isolated in these patients 419 were available for analysis. Of these, 326 were isolated in native valve endocarditis (NVE) and 93 in prosthetic valve endocarditis (PVE). Viridans streptococci, staphylococci and enterococci together constituted 87% of the isolates. More than 46% of the viridans streptococci consisted of Streptococcus sanguis. Enterococcus faecalis and Staphylococcus aureus were the predominant species in the late form of PVE. The majority of the viridans streptococci and haemolytic streptococci were highly susceptible to penicillin. Five of 35 strains of coagulase negative staphylococci were resistant to methicillin. Eleven percent of a random sample of the streptococci collected were tolerant to penicillin. After repeated exposure to a concentration gradient of an appropriate beta-lactam antibiotic, this figure increased to 49%. Of the staphylococci, 5-6% of the strains were tolerant before induction and 16-20% after induction. Of the Enterococcus strains (n = 40), 12.5% showed high-level resistance to one or more aminoglycoside.

Drug Resistance, Microbial↗

PubMed1994

The dynamics of oral contraceptive use in The Netherlands 1990-1993.

Data from an ongoing series of surveys on contraceptive use in the Netherlands were analyzed with respect to the percentages of oral contraceptive (OC) users who annually started use, discontinued use or switched to another OC type. The surveys had been conducted between 1990 and 1993 among samples of women aged 15-49 who belonged to a survey panel. Response rates of the surveys were 89-90% and the sample sizes ranged from 4560 to 4621 women. The assessed OC use rates reflected those of the Dutch population reasonably well. Of all respondents who had used OCs during the 12 months prior to the surveys, 12-15% discontinued use within this period, mainly in order to get pregnant, 12-16% were starters and 9-14% switchers. Of all starters 37% switched to another OC type within the first 12 months after starting. Switching was mainly related to the experience of perceived side-effects and wishes for better cycle control. The results highlighted the relevance of closely monitoring the individual woman's satisfaction with her OC. Since OC use appeared in many cases to be characterized by an active seeking for the most acceptable OC type, a wide range of OC types available and the development and introduction of new types is highly relevant for tailoring contraceptive use to individual needs.

Adolescent↗

PubMed1995

Intracranial tuberculosis in The Netherlands: four paediatric cases.

UNLABELLED: Since 1987 a resurgence of tuberculosis is occurring in the Netherlands in analogy to the situation in other industralised countries. So far this has not been associated with an increased incidence of tuberculous meningitis, which is still a rare complication of the disease. Four cases of intracranial tuberculosis were recently diagnosed in our hospital. All children were from middle-class Dutch families with no identified risk for tuberculosis. An extensive contact identification search could identify a contact in two patients. Two children were in an advanced stage of disease before diagnosis. Skin tests were repeatedly negative in all cases which delayed treatment in two cases for almost 2 weeks. One patient developing a cerebral tuberculous focus during therapy responded well to a second course of corticosteroids. Three children developed severe neurological sequelae. CONCLUSION: This report illustrates that suspicion of intracranial tuberculosis is warranted in the case of an ill-defined inflammatory neurological syndrome.

Antitubercular Agents↗

PubMed1990

The value of screening and central registration of families with familial adenomatous polyposis. A study of 82 families in The Netherlands.

In 1984 a national registry of families with familial adenomatous polyposis was set up in The Netherlands to promote screening in those families. Eight-two families had been registered by the end of 1988. Analysis of the pedigrees showed that 204 family members at risk had not yet been screened. The diagnosis of familial adenomatous polyposis was histologically confirmed in 230 patients. These patients were subdivided into two groups. Group A comprised patients with familial adenomatous polyposis referred because they were symptomatic, and Group B relatives of these patients who were found by screening to have familial adenomatous polyposis. The authors compared these groups with respect to the occurrence of colorectal carcinoma. Fifty-four patients were found to have a colorectal carcinoma at the time of diagnosis of familial adenomatous polyposis, i.e., 49 of the 104 patients in Group A (47 percent) and five of the 126 patients in Group B (4 percent). The average age at diagnosis of the 104 patients in Group A was 35 years (range, 13 to 66 years) and that of the 126 patients in Group B was 24 years (range, 8 to 59 years). By the age of 40 years, 90 percent of the patients in group B had been diagnosed. Late onset of familial adenomatous polyposis was found in four families. Endoscopy and/or radiography of the upper digestive tract were (was) performed in 44 of the 230 patients. Nineteen patients (43 percent) were found to have polyps in the stomach or duodenum, or both. In our series, only one patient died from cancer of the upper digestive tract (ampullary carcinoma). These results show conclusively that screening leads to the early detection of familial adenomatous polyposis. The value of a national registry is proved by the finding of many at-risk family members who had not previously been screened. Screening should start between the ages of 10 and 12 and should continue up to the age of 50. In the rare cases of families with an apparently late onset of familial adenomatous polyposis, screening should be continued up to age 60. More studies are needed to determine the natural history of polyps in the upper digestive tract.

Adenomatous Polyposis Coli↗

PubMed1989

Prevention of congenital toxoplasmosis; experience in The Netherlands.

Prevention is the pre-eminent strategy to control congenital toxoplasmosis. In a trial study in the province South-Holland a program of both primary and secondary prevention during pregnancy was applied. 28000 women were enrolled. 55% of them were seronegative, and only 55 primary infections were traced amongst them. Although a conclusive evaluation of the results of the study has not yet been accomplished, this low figure will be discussed within the scope of certain logistic and organizational obstacles incurred in the so-called TIP (Toxoplasma Infection Prevention)-study in the Netherlands.

Antibodies, Protozoan↗

PubMed1977

Incidence of resistance to ampicillin, chloramphenicol, kanamycin and tetracycline among Salmonella species isolated in the Netherlands in 1972, 1973 and 1974.

The resistance of Salmonellae to drugs has been studied in the Netherlands since 1958. In 1972, 1973, and 1974 respectively, 14241, 13086, and 22927 strains were tested for resistance to ampicillin, chloramphenicol, kanamycin and tetracycline. From 1973 all strains were also tested for resistance to trimethoprim. In the period covered, the yearly incidence of resistance to at least one of the above drugs ranged from 39.2% to 45.6% of all strains obtained from various sources (humans, animals, animal products, sewage, etc.). A new finding in the period 1972 to 1974 was that many multiply resistant strains emerged in S. typhimurium and in S. dublin isolated from calves and cattle. In 1974, 64.4% of all strains of S. typhimurium from these animals appeared to be resistant to ampicillin, tetracycline, chloramphenicol and kanamycin, and 25.5% of those of S. dublin were found to be resistant to chloramphenicol and tetracycline. Of all strains of Salmonellae examined in 1973 and 1974 respectively, 0.15% and 0.22% were resistant to trimethoprim, the main component of the twin-drug cotrimoxazol. Of the 142 strains of S. typhi isolated in 1972 to 1974 two were resistant to tetracycline only, and one was resistant to all four antibiotics. The others had a normal susceptibility pattern.

Ampicillin↗

PubMed1983

Alkaloids in ergot found on different Gramineae in The Netherlands.

The alkaloid content and the composition of the alkaloid complex of thirteen samples of ergot sclerotia from different gramineous host species collected in The Netherlands were investigated. Two samples collected in France were also examined. Ergot of Glyceria fluitans (L.) R.Br. did not contain alkaloids. The total alkaloid content of ergot found on the other wild grasses was more than 0.2%. The ratio between the contents of water soluble and water insoluble alkaloids of the investigated ergot sclerotia varies between 1:10 and 1:20. The composition of the alkaloid complex in the sclerotia was studied by quantitative thin-layer chromatography. The sclerotia could be grouped into three main categories: --sclerotia of Lolium perenne L., Festuca arundinacea Schreb. and Arrhenatherum elatius (L.) P.B. ex J. et C. Presl, containing predominantly ergocornine, alpha- and beta-ergokryptine and ergosine; --sclerotia of Dactylis glomerata L., Phalaris arundinacea L., Alopecurus geniculatus L. and Holcus mollis L., containing predominantly ergosine, ergocristine and ergotamine; --sclerotia of Molinia caerulea (L.) Moench, containing predominantly ergocristine, ergosine and ergometrine. A great similarity was found between the composition of the alkaloid complex in ergot of Lolium perenne L. from different locations and also in ergot of Molinia caerulea (L.) Moench from different locations. This similarity was less in ergot of Dactylis glomerata L. collected from different locations.

Chromatography, Thin Layer↗

PubMed1990

Frequency of the delta F508 mutation and XV2c,KM19 haplotypes in cystic fibrosis families from The Netherlands: haplotypes without delta F508 still in disequilibrium.

We have determined the frequency of the major cystic fibrosis (CF) three base pair deletion (delta F508) mutation in 152 CF chromosomes from patients originating from the northern part of The Netherlands. In these patients, the deletion represents approximately 76% of CF mutations. Meconium ileus is strongly associated with homozygosity for the delta F508 mutation. The XV2c,KM19 haplotypes on the CF chromosomes without the delta F508 mutation are in disequilibrium with the population frequency, although showing an increased frequency of the 1 2 haplotype. The surplus of this haplotype is almost entirely made up by the pancreatic insufficient patients.

Cystic Fibrosis↗

PubMed2000

Borna disease virus and schizophrenia in Surinamese immigrants to the Netherlands.

Borna disease virus (BDV) has been suggested to play a role in the etiology of schizophrenia. We tested the hypothesis that markers of BDV infection are more frequent in Surinamese immigrants to the Netherlands, diagnosed with schizophrenia, than in Dutch-born healthy subjects. For reasons that are poorly understood there is an increased incidence of schizophrenia in this immigrant group. Blood was obtained from 29 male schizophrenic patients (DSM-IV criteria) and from 26 healthy males. For detection of anti-BDV antibodies an indirect immunofluorescence assay (IFA) was performed. A nested, reverse-transcriptase-PCR, using primers specific for the p24 and p40 BDV genes, was used to determine BDV-RNA in peripheral blood mononuclear cells. Contrary to our expectations, the frequencies of BDV markers in the group of healthy subjects, as determined by IFA and both PCRs, exceeded that in the group of patients. The results do not support an association between markers of BDV infection in blood and schizophrenia. It is unlikely that the high incidence of schizophrenia in Surinamese immigrants is caused by BDV, but the small number of subjects examined do not warrant definitive conclusions.

Antibodies, Viral↗

PubMed1996

[Behavioral symptoms of children and adolescents in Germany, the Netherlands and USA. A cross-cultural study with the Child Behavior Checklist].

The goal of the study was a cross-cultural comparison of the parent ratings of behavior problems of children and adolescents aged 4-18 years in Germany, The Netherlands and the United States using the Child Behavior Checklist (CBCL). The analyses were undertaken in a German community sample (n = 1622) and a Dutch community sample (n = 2076). The results were compared with the data published by Achenbach for the national US sample. The analyses were based on the scales of the 1991 CBCL version and were performed for four age and sex groups (4- to 11-year-old boys/girls and 12- to 18-year-old boys/girls). In general, relatively minor differences could be detected between the three random samples. The range in the different samples was between -0.04 and 0.35, which is in line with other cross-cultural analyses using the CBCL. As long as no representative norms for Germany are available, the American norms can serve as an orientation for German studies using the CBCL.

Adolescent↗

PubMed2000

[Psychiatrist, quo vadis? Differences between neurology and psychiatry, between molecular- and social engineering as exemplified by standards and continuing education for psychiatrists in the Netherlands].

Changes and growing uncertainty about the professional identity of Dutch psychiatrists can already be recognized in the early years following World War II. This is illustrated by a quotation from H.C. Rümke taken from his speech in 1954 entitled "A Flourishing Psychiatry in Danger." Thus the stage was set for the central theme of this article concerning the mental health care system typical for the Netherlands and the development of multidisciplinary teams. In anticipation of the present situation, some future prognoses are also mentioned from K.P. Kisker's "A Prognosis of Therapeutic Practice in Psychiatry" (German: "Prognose der psychiatrischen Therapeutik") of 1973 in the opening section as background to the question: from today's point of view and in the face of scientific developments threatening the field, how does the need for identity and continuity in psychiatry relate to social, sociopolitical, and cultural factors? The first part of the discussion describes the development from combined neurological specialization to the separate fields of psychiatry and neurology. The second describes present day professional training in psychiatry. The conclusion highlights the efforts of the Dutch Psychiatry Association to use a so-called psychiatrist's profile (1996) to establish a consensus on long-term general acceptance in the comprehensive and multifaceted Dutch psychiatric care system. On the one hand, efforts are being made to maintain the unity of psychiatry, both as a professional field and as a special discipline. On the other hand, it is assumed that, at the end of their professional training, psychiatrists have an almost Protheus-like ability to develop and change in order to be successful in a wide variety of scientific subspecialties, professional roles, and institutional functions.

Curriculum↗

PubMed2002

Increased end-stage diabetic nephropathy in Indo-Asian immigrants living in the Netherlands.

AIMS/HYPOTHESIS: We aimed to investigate the risk of end-stage diabetic nephropathy due to Type II (non-insulin-dependent) diabetes mellitus in Indo-Asian immigrants from Surinam. METHODS: A demographically based case-control study was carried out in Surinamese Indo-Asian immigrants and Dutch Caucasian subjects. All patients with end-stage diabetic nephropathy who had started dialysis between 1990 and 1998 were identified through a national registry of all patients entering a renal replacement program in the Netherlands. The general population of native Dutch and Surinamese Indo-Asians were considered the control subjects. RESULTS: Among Indo-Asian immigrants, the age adjusted relative risk of end-stage diabetic nephropathy was 38 (95 % CI 16 to 91) compared with the native Dutch population. The duration of diabetes until the start of dialysis treatment was similar in both ethnic groups, about 17 years. CONCLUSION/INTERPRETATION: The Indo-Asian subjects had a nearly 40-fold increase in the risk for end-stage diabetic nephropathy due to Type II diabetes, compared with the native Dutch population. This was higher than expected on the basis of the eightfold higher prevalence of diabetes in the Indo-Asian population. The similar duration of diabetes until the start of dialysis treatment in both ethnic groups supports the hypothesis of a higher incidence of diabetic nephropathy in the Indo-Asian diabetic population. Early and frequent screening for diabetes and microalbuminuria is recommended in Indo-Asian subjects.

Age of Onset↗

PubMed2002

Iatrogenic depression in the elderly. Results from a community-based study in the Netherlands.

BACKGROUND: The aim of this study was to investigate the association between the use of medication and depression in the elderly. METHOD: A cross-sectional population-based study was conducted. Associations between the use of medication and depression are corrected for eight other etiological correlates of depression. The sample consisted of 2646 elderly people living in 11 municipalities in the Netherlands. Subjects were taken from the Longitudinal Aging Study Amsterdam, a 10-year longitudinal study on predictors and consequences of changes in well-being and autonomy in the older population. Associations are expressed in odds ratios (95 % Confidence Intervals) between the use of (groups of) medication and depression. Results are adjusted for age, sex, urbanicity, socioeconomic status, physical health, social and interpersonal support, comorbidity with other psychiatric disease and personality. The Population Attributable Risk percentage was calculated for selected groups of medication. RESULTS: After correction for competing risk factors of depression, 22 individual medications and nine groups of medications had unique associations with depression. CONCLUSIONS: The use of depressogenic medication is an independent etiological factor in the pathogenesis of depression.

Aged↗

PubMed2003

Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders--findings from the Netherlands Mental Health Survey and Incidence Study.

BACKGROUND: Little is known about the temporal sequencing of psychiatric disorders. The aim of this study was to obtain insight into patterns of co-occurrence of DSM-III-R mood disorders in relation to anxiety and substance use disorders, their temporal sequencing and the sociodemographic and long-term vulnerability predictors of this temporal sequencing. METHODS: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in a representative sample of 7,076 adults aged 18-64. RESULTS: Of those who had ever experienced a mood disorder, 46 % of males and 57 % of females had a history of anxiety disorders, and 43 % and 15 % of substance use disorders. Mood disorders were associated with all anxiety and substance use disorders, except with alcohol abuse among males. In the majority of anxiety-comorbid cases, the mood disorder arose after the anxiety disorder; the pattern for substance use-comorbid disorders was more variable. Deviation from the usual sequence of major depression and anxiety disorders was more often seen among females, subjects with a higher educational level, subjects who experienced childhood parental divorce, and subjects who experienced childhood emotional neglect. CONCLUSIONS: When comorbid with anxiety disorders, mood disorders clearly tend to be secondary. Few of the studied demographic factors, familial vulnerability factors and childhood life events predict the sequencing of mood disorders in relation to other disorders.

Adolescent↗

PubMed2003

Parent, teacher and self-reported problem behavior in The Netherlands: comparing Moroccan immigrant with Dutch and with Turkish immigrant children and adolescents.

BACKGROUND: Although literature leaves little doubt that migration from one country to another is stressful, empirical studies do not warrant general conclusions regarding the impact of migration on psychological development. Moroccans and Turks are two of the largest immigrant groups in The Netherlands, and share a similar migration history and religion. However, there are important differences between Turkish and Moroccan society, for example, in the level of education and illiteracy. In this study, emotional and behavioral problems of Moroccan immigrant children were compared to those of Dutch native children and Turkish immigrant children. METHODS: Our samples consisted of 819 Moroccan immigrant children, 2,227 Dutch native children and 833 Turkish immigrant children between the age of 4 and 18. Parent, teacher and self-reports were obtained, using the Child Behavior Checklist, Teacher's Report Form and Youth Self-Report. RESULTS: Moroccan parents reported as many problems as Dutch parents, but less problems than Turkish parents. Teachers, however, presented a different picture: substantially more externalizing problems were reported for Moroccan pupils compared to Dutch and Turkish pupils. Moroccan adolescents themselves reported less problems than Dutch and Turkish adolescents. CONCLUSIONS: The effects of migration on children and adolescents of two populations with a similar migration history and religion can be rather different. Problem levels vary widely with the informant questioned. The results of the present study may reflect true differences in children's behavior, both across ethnic groups and across the contexts of home and school. Perceptual biases, social desirability in answering patterns and differences in thresholds to report problem behaviors may also be responsible for the observed differences.

Adolescent↗