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At least 1,315 records · Page 73Linked to original sources
PubMed2006

Surgical techniques preventing chronic pain after Lichtenstein hernia repair: state-of-the-art vs daily practice in the Netherlands.

BACKGROUND: Morbidity associated with open inguinal hernia repair (IH repair) mainly consists of chronic pain. The aim of this study was to identify possible disparities between state-of-the-art Lichtenstein repair, and its application in general practice. METHODS: A questionnaire was mailed to all surgeons and surgical residents (n = 1,374) in the Netherlands in February 2005. The objective was to determine the state of general practice with respect to technical steps during the Lichtenstein repair that are suggested to be involved in the development of chronic pain, as recently updated by Lichtenstein's successor, Amid. RESULTS: More than half of the respondents do not act according to the Lichtenstein guidelines with respect to surgical steps that are suggested to be involved with the origin of chronic pain of somatic origin. Compliance with Amid's guidelines with respect to the handling of the nerves is variable. Surgeons conducting high numbers of IH repair are more likely to operate according to the key principles of the state-of-the-art Lichtenstein repair. CONCLUSION: There is a substantial disparity between the state-of-the-art Lichtenstein repair and its application in general practice with respect to steps that are suggested to play a role in the origin of chronic groin pain.

Chronic Disease↗
PubMed2004

Epidemiological features of invasive and noninvasive group A streptococcal disease in the Netherlands, 1992-1996.

A prospective, nationwide, laboratory-based surveillance of invasive group A streptococcal infections was conducted in the Netherlands from 1992 through 1996. Clinical and demographic data were obtained and all isolates were T/M typed. All noninvasive group A streptococcal isolates were registered from 1994 through 1996. A total of 880 patients with invasive streptococcal disease were identified. The annual incidence was found to be 2.2 per 100,000. Predominant M types were M1 (21%), M3 (11%), M6 (5%), M12 (5%), and M28 (8%). Particular age and M-type distributions were observed in different clinical entities. The case-fatality rate was 18% overall, but it reached 59% among cases of toxic shock-like syndrome. Older age, necrotizing fasciitis, sepsis without focus, pneumonia, infection with type M1 or M3 strains, and underlying cardiopulmonary disease were associated with fatality. A total of 10,105 patients with noninvasive group A streptococcal disease were registered. These patients differed significantly from patients with invasive disease with regard to age distribution and primary foci of infection.

Adolescent↗
PubMed2005

Lack of effect of shorter turnaround time of microbiological procedures on clinical outcomes: a randomised controlled trial among hospitalised patients in the Netherlands.

Shortening the turnaround time of microbiological procedures was associated with an improved clinical outcome in two studies performed in the USA. To study the clinical impact of a shortened turnaround time in a northwest European setting in which an automated system was used for bacterial identification and susceptibility testing, a single-blind, prospective, randomised controlled trial was conducted in a hospital in the Netherlands. All hospitalised patients with a bacterial infection confirmed by culture were randomly assigned to a control (conventional) group or an intervention (rapid) group. Overnight methods were used for identification and susceptibility testing in the control group, while the Vitek 2 system (bioMerieux, Marcy l'Etoile, France) was used in the rapid group. In each of three consecutive study periods, accelerating factors were added progressively to the laboratory workflow of the rapid group to increase same-day reporting, whereas methods remained identical in the conventional group. The turnaround time of the microbiological cycle using the Vitek 2 system as compared to conventional methods was studied and the clinical impact of a shortened turnaround time assessed in terms of mortality, morbidity, and cost. For the rapid groups, the turnaround time was significantly shorter for oral reporting of final susceptibility results in all three study periods and for reporting on paper in the third study period. There was no significant difference between groups in any of the clinical impact variables. Vitek 2 results were available for reporting significantly earlier as compared to conventional testing. For the overall patient group in our hospital setting, however, this had no clinical impact.

Aged↗
PubMed1999

An epidemic of pertussis among elderly people in a religious institution in The Netherlands.

An epidemic of pertussis is described among elderly people in a religious institution in the Netherlands in 1992. Subjects were evaluated for their vaccination status and for history and presence of respiratory symptoms. Specimens were collected for culture, polymerase chain reaction, and serological evaluation. None of the 75 residents and 19 of 24 nonresident personnel had been vaccinated against pertussis. The overall attack rate of clinical pertussis, defined as persistent cough lasting at least 2 weeks, was 49%. In five subjects with clinical pertussis, either culture or polymerase chain reaction or both were positive for Bordetella pertussis. A significant (at least 4-fold) change in specific antibody titre was observed in 85% (41/48) and 20% (10/49) of subjects with and without clinical pertussis, respectively (P < 0.0001, chi-square 41.1). The attack rate of laboratory-confirmed pertussis was 42% (41/98). This rate was 5% (1/19), 20% (1/5), and 53% (39/74) in vaccinated personnel, nonvaccinated personnel, and nonvaccinated residents, respectively (not significant). Among residents aged between 55-74 years and 75-94 years, the attack rates were 47% (17/36) and 58% (22/38), respectively (relative risk=0.8; 95% confidence interval 0.5-1.3). Four of 75 residents (5%) died from intracranial bleeding, while they were symptomatic for pertussis. It is concluded that the attack rate of pertussis was high among nonvaccinated elderly and that pertussis tended to increase with age. There may be a considerable risk of mortality from pertussis in this population. Physicians should be alert to the diagnosis of pertussis in the elderly with nocturnal and prolonged periods of coughing.

Adult↗
PubMed2005

A modified three-stage data envelopment analysis. The Netherlands.

In The Netherlands the care for the disabled accounts for 10% of total health care costs, or almost 1% of GNP. About half of these costs are devoted to the residential care for the mentally disabled. This study studied the amount of cost inefficiency in a sample of homes operating in 1998. We first apply a data envelopment analysis to our sample and then apply another stage-evaluating the nonradial slack of each input and the effects external factors have on them. After "correcting" for the external effects we find that technical and scale inefficiency disappears and cost efficiency increases by 6%. We attribute these findings with the strict regulation under which Dutch homes operate. Further, this approach can be applied to any service or market that faces governmental regulation.

Costs and Cost Analysis↗
PubMed2006

The future of imaging techniques for cancer patients in The Netherlands : A Delphi study.

There is a need in The Netherlands to understand the future prospects of imaging techniques in cancer care to deal with current and expected capacity decisions. For this, a Delphi research was performed with a panel of 35 noted experts. The panel anticipates that the application of imaging techniques (e.g., CT, MRI, PET) will gradually change; especially, their use will also include earlier stages, i.e., cancer screening and treatment. The increasing need and investments for these techniques will be partly balanced by new developments (e.g., faster technology). There will be a substantial decrease in the use of ultrasound, CT (except for screening), and conventional radiographic diagnostics. Radical new techniques and/or developments are not expected. The panel foresees increasing partial task substitution and subspecialization. Further, a profound impact on imaging techniques is expected from developments outside the imaging field such as digitalization, changing patient demands, and commercialization.

Biomedical Technology↗
PubMed2006

Generic versus specific competencies of entry-level public health graduates: employers' perceptions in Poland, the UK, and the Netherlands.

Constant changes in society and the public health domain force public health professionals into new roles and the development of new competencies. Public health professionals will need to be trained to respond to this challenge. The aim of this comparative study among Poland, the UK and the Netherlands is to identify competence needs for Master of Public Health graduates entering the labour market from a European perspective. A self-administered questionnaire was sent to employers in the three countries, rating the importance of competency in public health on a master's level. In all three countries, interpersonal competencies, like team working and communication skills, are rated as highly important. However, employers in the UK and Poland generally rate public health specific competencies as much more important than their Dutch colleagues. It is concluded that while public health specific knowledge is providing a useful starting point for entry-level public health professionals, employers increasingly recognise the value of generic competencies such as communication and team working skills. The results suggest a stronger emphasis on teaching methods that encourage active learning and the integration of skills, which is crucial for enhancing graduates' employability, and foster an open attitude to multidisciplinary working, which is essential in modern health care.

Education, Graduate↗
PubMed2007

A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer.

PURPOSE: In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of breast cancer of women who underwent breast cancer screening between 1995 and 2005. METHODS: We included all women aged 50-75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result. Follow-up lasted through the next biennial screening examination and was approximately two years for all referred women. RESULTS: Of 258,900 mammographic screening examinations, 3,064 (1.2%) were positive screens. The majority of women (92%) were analyzed in four regional hospitals and workup yielded breast cancer in 1,332 women. From 1995 to 2005, the percentage of breast cancer cases that underwent percutaneous biopsy prior to surgery, increased from 42.4 to 100%. The proportion of cancers with a preoperative diagnosis of malignancy by percutaneous biopsy, increased from 27.1% in 1995 to 92.7% in 2004. Preoperative breast cancer confirmation by fine needle aspiration cytology (FNAC) gradually decreased from 91.3% to 14.5%, whereas preoperative confirmation by ultrasound guided core biopsy (USCB) or stereotactic core needle biopsy (SCNB) increased from 8.7% to 69.1% and from 0 to 17.4% respectively. CONCLUSIONS: A preoperative diagnosis of breast cancer is currently obtained in more than 90% of breast cancer patients. The increase in preoperative breast cancer diagnosis through 1995-2004 is correlated with the introduction of SNCB and increased use of USCB at the expense of FNAC.

Aged↗
PubMed2005

Meat and fish consumption, APC gene mutations and hMLH1 expression in colon and rectal cancer: a prospective cohort study (The Netherlands).

OBJECTIVE: The aim of this study was to investigate the associations between meat and fish consumption and APC mutation status and hMLH1 expression in colon and rectal cancer. METHODS: The associations were investigated in the Netherlands Cohort Study, and included 434 colon and 154 rectal cancer patients on whom case-cohort analyses (subcohort n = 2948) were performed. RESULTS: Total meat consumption was not associated with the endpoints studied. Meat product (i.e. processed meat) consumption showed a positive association with colon tumours harbouring a truncating APC mutation, whereas beef consumption was associated with an increased risk of colon tumours without a truncating APC mutation (incidence rate ratio (RR) highest versus lowest quartile of intake 1.61, 95% confidence interval (CI) 0.96-2.71, p-trend = 0.04 and 1.58, 95% CI 1.10-2.25, p-trend = 0.01, respectively). Consumption of other meat (horsemeat, lamb, mutton, frankfurters and deep-fried meat rolls) was associated with an increased risk of rectal cancer without a truncating APC mutation (RR intake versus no intake 1.79, 95% CI 1.10-2.90). No associations were observed for meat consumption and tumours lacking hMLH1 expression. CONCLUSIONS: Our data indicate that several types of meat may contribute differently to the aetiology of colon and rectal cancer, depending on APC mutation status but not hMLH1 expression of the tumour.

Adaptor Proteins, Signal Transducing↗
PubMed2005

The estrogen receptor alpha gene and breast cancer risk (The Netherlands).

OBJECTIVE: In this study we aimed to investigate whether the PvuII, XbaI and B-variant polymorphisms in the estrogen receptor alpha gene (ER-alpha) are associated with an increased risk of breast cancer in postmenopausal women, and whether the effect of high estradiol (E2) levels on breast cancer risk is altered by these polymorphisms. The selection of these polymorphisms was based on previously published associations with osteoporosis and spontaneous abortions. METHODS: The effect of the three polymorphisms on breast cancer risk was studied using a case-cohort design nested within a large population-based cohort study (n = 9349) in the Netherlands (the DOM-cohort). In total 380 incident breast cancer cases and a subcohort of 422 women were genotyped by RFLP or ASO hybridization methods. RESULTS: Women with the PvuII pp genotype had a 1.5 times non significant increased risk of breast cancer (95% CI: 0.94-2.42; p(trend) = 0.09) compared to women with the PP genotype. The Pp or pp genotype in combination with high E2 levels raised breast cancer risk significantly when compared to women with low E2 levels and the PP genotype (RR=2.26; 95% CI: 1.24-4.13). This interaction was statistically significant on the multiplicative scale (p = 0.01). The XbaI genotype (RR(xx versus XX) = 1.19; 95% CI: 0.73-1.95) and the B' allele (RR(BB'+B'B' versus BB) = 0.87; 95% CI: 0.56-1.33) were not associated with breast cancer risk. CONCLUSION: The results of this study suggest that the PvuII polymorphism in the ER-alpha, or another mutation in linkage disequilibrium with PvuII, in combination with high E2 levels increases breast cancer risk in postmenopausal women.

Aged↗
PubMed2007

Transient caloric restriction and cancer risk (The Netherlands).

Over the past century, many animal experiments have shown that caloric restriction can reduce the risk of cancer, a finding that proved to be highly reproducible. Many papers have been published on its potential for human health, but until know little evidence is available on its actual effects in humans. In Utrecht, The Netherlands, we have been investigating the effects of the 1944-1945 Dutch famine on breast cancer risk factors and breast cancer risk, and paradoxically the relatively short-term famine seemed to be related to increased breast cancer risk in later life. One of the differences between the famine situation and the large body of evidence from animal experiments is the duration of caloric restriction. Almost all animal experiments investigated sustained caloric restriction and information on the effects of short-term transient caloric restriction is very scarce. A search in the literature identified some animal experiments on short-term transient caloric restriction and these seemed to be at least supportive to the famine findings. Because caloric restriction in humans for preventive health measures would be mostly short-term, it is important to extend animal research on short-term caloric restriction.

Animals↗
PubMed2005

Easy access echocardiography for the general practitioner: results from the Parkstad area in the Netherlands.

Heart failure has a low incidence in general practice but is not easy to recognize in this setting. Frequently a normal electrocardiogram and a normal level of brain natriuretic peptide can exclude heart failure as a cause for dyspnea. Unfortunately the positive predictive value of both techniques is low. Imaging with echocardiography can then give the clue to the correct diagnosis. Also correct diagnosis of cardiac murmurs is not easy in general practice. Therefore an open access echocardiographic service was established in the south of the Netherlands. According to the existing services in the United Kingdom general practitioners in this area were able to ask for an echocardiogram without referring the patient to the cardiologist. During a period of 19 months 131 patients were referred to the Centre of Medical Diagnostics for an echocardiogram. In 12% of the patients referred for dyspnea a left ventricular ejection fraction lower than 40% was found. Fourty nine percent of the patients had diastolic dysfunction. In 33% heart failure could be excluded. In 62% of the patients referred for a cardiac murmur cardiac pathology could be found. In 38% of the patients the cardiac murmur could be established as a functional murmur. The service was found to improve practice by most of the general practitioners.

Adolescent↗
PubMed2006

Chemical and biological evaluation of sediments from the Wadden Sea, The Netherlands.

We describe the results of an evaluation of marine sediments using chemical measurements and bioassays. Four groups of chemicals, i.e., heavy metals, PAHs, chlorinated aromatic compounds, and tin compounds, were measured at 16 locations in the Wadden Sea, The Netherlands. Extractions of sediments from each location also were assessed using five bioassays. Our objective was to identify chemicals likely to pose biological risks, characterize the relation between bioassay results and particular classes of chemical(s) and determine "clean" reference sites on the basis of the chemical and biological evaluations. A multivariate technique (Principal Component Analysis; PCA) was used to meet these objectives. Results of the PCA indicated that the response of the Microtox Solid Phase bioassay had a positive, significant relationship with the levels of PAHs and organotin compounds. The responses of the other bioassays did not consistently relate to the concentrations of the other measured chemicals. Our findings indicate that the organotin compounds may still be a stressor for aquatic invertebrates in the Dutch Wadden Sea. On the basis of the chemical and biological evaluations, four sites (Dantziggat, Malzwin, Richel and Lauwers) can be considered to be "clean" reference sites.

Biological Assay↗
PubMed2005

Determinants of response in a longitudinal health study following the firework-disaster in Enschede, The Netherlands.

Very few longitudinal health studies after disasters published data on the determinants of loss to follow up. However, these determinants provide important information for future disaster studies to improve their response and reduce selection bias. For this purpose we analyzed the data of a longitudinal health survey which was performed among residents and emergency workers, at 3 weeks (n = 3662) and at 18 months (n = 2769) after a major firework disaster in The Netherlands (Enschede, May 13, 2000). The response was lower among immigrants (54%) than among native Dutch (81%). Severe damage to the house due to the disaster (OR: 1.8; 95% CI: 1.1-3.0) and being involved as an emergency workers (OR: 2.1; 95% CI: 1.2-3.4) were associated with higher response among native Dutch, while this was not the case among immigrants. Non-western immigrants with health problems in the first study were more likely to participate in the second study (for example physical symptoms OR: 2.5: 95% CI: 1.4-4.4), while the native Dutch with these symptoms were less likely to participate (OR: 0.7; 95% CI: 0.5-0.9). In conclusion, disaster-related characteristics were associated with higher response in native Dutch. Health problems were associated with higher response among non-western immigrants and with lower response among the native Dutch.

Accidents↗
PubMed2006

Underreporting of meningococcal disease incidence in the Netherlands: results from a capture-recapture analysis based on three registration sources with correction for false positive diagnoses.

In order to come to a reliable evaluation of the effectiveness of the chosen vaccination policy regarding meningococcal disease, the completeness of registrations on meningococcal disease in the Netherlands was estimated with the capture-recapture method. Data over 1993-1998 were collected from (A) mandatory notifications (n = 2926); (B) hospital registration (n = 3968); (C) laboratory surveillance (n = 3484). As the standard capture-recapture method does not take into account false positive diagnoses, we developed a model to adjust for the lack of specificity of our sources. We estimated that 1363 cases were not registered in any of the three sources in the period of study. The completeness of the three sources was therefore estimated at 49% for source A, 67% for source B and 58% for source C. After adjustment for false positive diagnoses, the completeness of source A, B, and C was estimated as 52%, 70% and 62%, respectively. The capture-recapture methods offer an attractive approach to estimate the completeness of surveillance sources and hence contribute to a more accurate estimate of the disease burden under study. However, the method does not account for higher-order interactions or presence of false positive diagnoses. Being aware of these limitations, the capture-recapture method still elucidates the (in)completeness of sources and gives a rough estimate of this (in)completeness. This makes a more accurate monitoring of disease incidence possible and hence attributes to a more reliable foundation for the design and evaluation of health interventions such as vaccination programs.

Disease Notification↗
PubMed2005

Uncertainty assessment of VOC emissions from paint in The Netherlands using the NUSAP system.

We demonstrate an innovative approach to uncertainty assessment known as the NUSAP system, to assess qualitative and quantitative uncertainty for the case of emissions of volatile organic compounds (VOC) from paint in The Netherlands. Using expert elicitation, we identified key sources of error, critical assumptions, and bias in the monitoring process. We assessed pedigree and probabilistic uncertainty of all input quantities. We used four pedigree criteria to assess the strength of the knowledge base: proxy representation, empirical basis, methodological rigour and degree of validation. Using Monte Carlo analysis, we assessed sensitivity and propagation of uncertainty. Results for sensitivity and pedigree were combined in a 'NUSAP Diagnostic Diagram', which effectively highlighted the assumption for VOC percentage of imported paint as the weakest spot in the monitoring of VOC emissions. We conclude that NUSAP facilitates systematic scrutinization of method and underlying assumptions and structures creative thinking on sources of error and bias. It provides a means to prioritise uncertainties and focus research efforts on the potentially most problematic parameters and assumptions, at the same time identifying specific weaknesses in the knowledge base. With NUSAP, nuances of meaning about quantities can be conveyed concisely and clearly, to a degree that is not possible with statistic methods only.

Air Pollutants↗
PubMed2005

Nitrate leaching in agriculture to upper groundwater in the sandy regions of the Netherlands during the 1992-1995 period.

The Dutch National Monitoring Programme for Effectiveness of the Minerals Policy (LMM) was initiated to allow detection of a statutory reduction in nitrate leaching caused by a decreasing N load. The starting point, or baseline, was taken as the nitrate concentration of the upper metre of groundwater sampled on 99 farms in the 1992-1995 period in the sandy areas of the Netherlands, where predominantly grass and maize grow. We found here that a reduction in nitrate leaching of more than 20% in future would almost certainly be detected with the LMM. Detecting downward trends due to decreasing N load will require nitrate concentrations to also be related to soil drainage, precipitation excess leading to groundwater recharge and to location. Furthermore, we found that about 16% of the N load in the Dutch sandy regions was being leached to the upper metre of groundwater in the 1992-1995 period. The critical N load in approximately 1990 for exceeding the EC limit value for nitrate, NO3, (50 mg L(-1)) in the upper metre of groundwater for the mean situation for grassland, maize and arable land in the sandy area was found to be 210 kg ha(-1) a(-1). Because manure management has been altered, the critical load found will be lower than the current critical load.

Agriculture↗
PubMed2006

Cost assessment and price setting of inpatient care in The Netherlands. the DBC case-mix system.

In February 2005, a case-mix system based on 'diagnosis treatment combinations' (DBCs) was introduced in The Netherlands for the registration and reimbursement of hospital and medical specialist care. This paper describes the characteristics of the DBC system and how it is used for the reimbursement of hospitals. Prices for reimbursement are either based on fixed tariffs ('list A') or negotiated between health insurers and hospitals ('list B') and are partly based on information about unit costs of health care services. Because the DBC system is still under development we will describe the current situation (March 2006), but also focus on the most likely future developments.

Costs and Cost Analysis↗