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PubMed1996

Coccidial and helminth infections in goats kept indoors in the Netherlands.

An investigation was carried out on coccidial and helminth infections in goats kept indoors on five farms in the Netherlands. The goats were individually sampled. Coccidial oocysts were identified and nematode eggs counted. Larval cultures were made and infective larvae identified to the generic or species level. The goats were divided into three groups according to their age: kids, those weaned but not served, and older goats. Oocysts were found in 26 out of 27 kids (96.3%), in 52 out of 55 weaned but not served goats (94.5%), and in 72 out of 110 older goats (65.5%). Eimeria ninakohlyakimovae was the most common species in all groups with an overall prevalence of 82%, followed by Eimeria arloingi (78%) and Eimeria aspheronica (53.3%). Other species present were Eimeria alijevi (50%), Eimeria christenseni (39.3%), Eimeria caprina (38.7%), Eimeria hirci (28.7%) and Eimeria jolchijevi (7.3%). Nematode eggs were seen on four of the five farms. It appeared that on two farms some goats, although now kept indoors, had been on pasture in the past. These goats excreted low numbers of eggs of Ostertagia and/or Trichostrongylus, Strongyloides papillosus, Haemonchus contortus, Trichuris spp. and larvae of Muellerius capillaris. In goats that were kept exclusively indoors, infections with Strongyloides papillosus were found on two farms in the older group and on one farm also in the group weaned but not served. On two farms Skrjabinema ovis was incidentally observed by the farmer in older goats. This was confirmed by faecal examinations on one farm. All kids were free of nematode infection.

Animals↗
PubMed1992

Training in radiotherapy in The Netherlands.

The training in radiotherapy in The Netherlands is an example of a master apprentice system. In this overview we will discuss the organization and describe the official bodies involved in the Dutch training programs. Also the contents and the system of accreditation are presented.

Accreditation↗
PubMed1993

A veterinary antibiotic policy: a personal view on the perspectives in The Netherlands.

To reach a more adequate and responsible use of antibiotics in veterinary medicine a broad approach is required. The growing interest in the optimum use of antibiotics in veterinary medicine is stimulated by awareness of the necessity to prevent the emergence of resistance and the spread of resistant bacteria. This is a matter of primary importance to safeguard the efficacy of antibiotic therapy in animals now and in the future, but will also minimise possible public health risks. As resistance develops in rough relation to antibiotic use, the best way to minimise emergence of resistance, without interfering with optimal veterinary care, is to rationalize the use of antibiotics by, or under responsibility of, a veterinary surgeon. A second further improvement can be reached by developing a veterinary antibiotic policy to prevent emergence and spread of resistance as much as possible. Measures that must be taken in combination are: 1. Establishing a policy for the use of antibiotics jointly by veterinary practitioners and experts resulting in a formulary. 2. Systemic registration and analysis of patterns of bacterial resistance (not only of pathogens but of faecal flora as well) and the use (qualitative and quantitative) of antibiotics in veterinary medicine. 3. Regular feedback of these data to the veterinary practitioners and consultation about the efficacy of the formulary guidelines in daily practise. 4. Systemic monitoring and evaluation the impact of the antibiotic policy and, if indicated, updating of the formulary. 5. Continuous education of veterinary surgeons about infectious diseases and antimicrobial therapy and development of a veterinary audit system. The first step to rationalize the veterinary use of antibiotics was taken by publishing a veterinary antibiotic formulary in 1987, compiled by a group of experts. Despite the fact that this was a pure top down approach and bottom up input from veterinary practitioners was lacking, this first formulary was very well received. However the impact of this formulary on the veterinary use of antibiotics and prevalence of resistance has not been evaluated at this moment. Until now regular and nationwide systemic monitoring of resistance and registration of veterinary use of antibiotics is not practically feasible in the Netherlands. A new formulary, based on a veterinary antibiotic will be published by the end of 1992. However, to be able to evaluate the impact of this policy on the prevalence of resistance and, if necessary, to adapt the policy the development of facilities for resistance epidemiology is urgently needed.

Animals↗
PubMed1994

A multicenter survey of resistance in The Netherlands using the Etest.

To obtain data about the prevalence of resistance in bacterial isolates causing serious infections in the Netherlands, a multicenter survey was carried out using the Etest for quantitative susceptibility testing. More than 6000 isolates belonging to ten species were tested against eight antibiotics. Moreover, the Etest was validated against the agar dilution method and the reproducibility of the Etest was studied. In spite of pH differences between the agar plates used for Etesting and agar dilution testing, a good correlation (that is 86%-97% within log2 dilution steps) was found between both methods. Comparison of Etest values of the participating laboratories and the reference laboratory showed > 80% conformity within 1 log2 dilution step and 90% within 2 log2 dilution steps, indicating a sufficient reproducibility of the Etest. Resistance percentages were low for most species and antibiotics, relatively high percentages (10%-20%) indicating natural insusceptibility rather than development or increase of resistance.

Anti-Bacterial Agents↗
PubMed1984

Progressive medical care in disaster situations: a critical evaluation of the current situation in the Netherlands.

An overview of the plan for medical response in the event of a disaster in the Netherlands is presented. An idealized evaluation of the response capability, as well as the probable actual ability, is reviewed. The plan involves a response to the disaster site by teams comprising a surgeon, anesthesiologist, and two specially trained nurses from 1 or many of 20 participating hospitals as well as an ambulance response from associated district ambulance posts. An overview of disaster management in general is presented.

Disaster Planning↗
PubMed1990

Comparative analysis of patient education by four professions in The Netherlands and the United States.

This cross-national comparison study of four health professions is based on review and analysis of professional policy documents and explores the way these selected professions integrate and structure patient education as a professional function. Factors that are internal and external to each of these professions are discussed and compared between the two countries. Professional policy documents related to patient education in nursing, pharmacy, dietetics, and physical therapy are examined in light of changes in dominant concepts of care, changing norms of professional organizations, changes in professional preparation, changes in patient roles, changes in the organization of patient care, and the changes in the health care delivery environment. Differences and similarities between the Netherlands and the United States provide an impetus for developing hypotheses on cross-national developments in patient education and ways for several elements to interact and affect acceptance of and implementation of the patient education function by health professions.

Cross-Cultural Comparison↗
PubMed1994

Contraception in The Netherlands: the low abortion rate explained.

This article gives a review of the main factors that are related to the low abortion rate in the Netherlands. Attention is payed to figures on abortion and the use of contraceptive methods since the beginning of the 1960s up to the end of the 1980s. The strong acceptance of family planning was influenced by changing values regarding sexuality and the family, the transition from an agricultural to a modern industrial society, rapid economic growth, declining influence of the churches on daily life, introduction of modern mass media and the increased general educational level. The introduction of modern contraceptives (mainly the pill and contraceptive sterilization) was stimulated by a strong voluntary family planning movement, fear for overpopulation, a positive role of GPs, and the public health insurance system. A reduction of unwanted pregnancies has been accomplished through successful strategies for the prevention of teenage pregnancy (including sex education, open discussions on sexuality in mass media, educational campaigns and low barrier services) as well as through wide acceptance of sterilization. The Dutch experience with family planning shows the following characteristics: a strong wish to reduce reliance on abortion, ongoing sexual and contraceptive education related to the actual experiences of the target groups, and low barrier family planning services.

Abortion, Induced↗
PubMed1984

The drug problem in The Netherlands.

In the Netherlands, the drug problem among adolescents developed as a new phenomenon in the mid 1960s. Without remarkable success, methadone maintenance programs were introduced in 1968. Drug free treatment in therapeutic communities, developed since 1972, was successful after the first experimental years. This success provoked the illusion that drug related problems could be solved by treatment; low threshold programs, putting few demands on participants, were established to dispense methadone. The illusion was that addicts can be motivated into further treatment if they are brought into contact with professionals. As the addict population kept growing and their street crimes increased in number, Dutch drug policies changed in 1978, using methadone as a means to decrease criminal activities rather than to treat addicts. This also turned out to be an illusion. Currently, there is strong political pressure to distribute heroin to addicts to diminish the negative side effects of drug abuse. Dutch drug policies are characterized by the opinion that drug problems cannot be solved and have to be accepted.

Day Care, Medical↗
PubMed1990

Age and sex specific population doses (SED (somatic effective dose equivalent) and GSD (genetically significant dose equivalent)) due to nuclear medicine procedures in The Netherlands.

Age- and sex-specific data were obtained concerning nuclear medicine procedures performed in The Netherlands in 1984. The average annual per capita procedure frequency amounted to 0.011. Using recent organ dose data for a large number of common radiopharmaceuticals (ICRP, Publ. 52/53, 1987) the somatic effective dose equivalent (SED) and the genetically significant dose equivalent (GSD) were calculated. The collective SED yielded 575 person-Sv per annum. The annual per capita SED was 40 microSv. The Genetically Significant Dose turned out to be approximately 3.2 microSv per person per year.

Age Factors↗
PubMed1990

A large-scale prospective cohort study on diet and cancer in The Netherlands.

In 1986, a prospective cohort study on diet and cancer was started in The Netherlands. The cohort (n = 120, 852) of 55-69 year old men (48.2%) and women (51.8%) originates from 204 computerized municipal population registries. At baseline, participants completed a self-administered questionnaire on diet and potential confounding variables. In addition, about 67% of the participants provided toenail clippings. Cancer follow-up consists of record linkage to a pathology registry and to cancer registries. The initial interest is in stomach, colorectal, breast and lung tumors. A case-cohort approach is applied, in which detailed follow-up information of a random subcohort (n = 5000) provides an estimate of the person-time experience of the cohort. Exposure data of the subcohort will be combined with those of incident cases, yielding exposure-specific incidence rate ratios. The intraindividual variation in determinants is estimated by annually repeated measurements (n = 250) within the subcohort. The rationale, efficiency aspects and study characteristics are discussed.

Aged↗
PubMed1993

Regional lung cancer death rates unrelated to smoking? The case of The Netherlands.

It has been observed in various countries that regional variation in lung cancer mortality can hardly be explained by differences in current smoking. This paper addresses the question of whether mortality variation within. The Netherlands in 1980-1984 is due to differences in past instead of current smoking. A first indication of the role of past smoking is that, within male birth cohorts, regional mortality patterns have been very stable for over 30 years. Reliable data on smoking in 1972 explain 40% of the mortality variation among women, but only 2% of that among men. A crude indicator on smoking in 1930 explained 43% of the mortality variation among men aged 75+ years (correlation = 0.66). The lack of a relationship with smoking in 1972 appears to be due to a radical change in regional smoking differences, which caused smoking in 1972 to be unrelated to smoking in 1930; long time lags, so that these changes were not yet followed by changes in regional mortality differences. It is concluded that the explanation of regional lung cancer death rates sometimes has to go far back in time. Studying determinants of lung cancer by means of regional analyses requires a more detailed control for smoking history than has been usual.

Aged↗
PubMed1993

Breast cancer in the southeastern Netherlands, 1960-1989: trends in incidence and mortality.

Temporal trends in incidence and mortality in breast cancer were examined in the southeastern Netherlands using data from the population-based Eindhoven Cancer Registry. In the period 1960-1989 the incidence rate of first primary breast cancer approximately doubled in all age groups. The increase mainly occurred before 1975 and after 1985, when no screening activities were performed. This trend appeared to be a result of an average yearly increase in incidence of localised and distant tumours with both 4.6%, whereas the incidence of regional tumours did not change. Simultaneously, breast cancer mortality remained unchanged in women aged under 60, and only increased by a yearly average of 0.7% in women aged 60-74 and of 0.9% in women aged 75 and over. These differing trends in incidence and mortality, which can only partially be explained by earlier detection, suggest an improved survival of breast cancer.

Adult↗
PubMed1995

The management of cervical intra-epithelial neoplasia (CIN): extensiveness and costs in The Netherlands.

In order to provide greater insight into both the extensiveness and the medical costs of the diagnosis and treatment of screen-detected cervical intra-epithelial neoplasia (CIN) in general medical practice in The Netherlands, data from national registries and gynaecology departments were retrieved, and experts were interviewed. Of the 5060 women diagnosed with CIN in 1988, more than 50% were treated in hospital with conisation or hysterectomy, which on average took 5.5 days stay per admission. The assessed average duration of the total pre- and post-treatment period is 4.6 years. The average total medical costs in women with detected CIN III are Dfl 3700 per woman. The diagnosis of CIN I and II involves more medical procedures and time than CIN III, but fewer women have conisation or hysterectomy, resulting in lower total medical costs (Dfl 2572). The overall extent and costs of the management of CIN should be accounted for when balancing the benefits, unfavourable effects and costs of cervical cancer screening.

Female↗
PubMedDate not supplied

Physician-staffed HEMS dispatch in the Netherlands: Adequate deployment or minimal utilization?

INTRODUCTION: In the Netherlands, a physician-staffed helicopter emergency medical system (HEMS), called the Helicopter Mobile Medical Team (HMMT), provides prehospital care for severely injured patients in addition to ambulance services. This HMMT has proven to increase chances of survival and reduce morbidity. HMMT dispatch is performed following certain dispatch criteria. The goal of this study was to analyze actual dispatch rates and assess the protocol adherence of the emergency dispatchers in Rotterdam regarding HMMT dispatch. METHODS: All high priority ambulance runs between April 1 and July 1, 2003, were prospectively documented and cross-referenced to dispatch criteria. It was determined whether the emergency call warranted either immediate dispatch of the HMMT or a secondary dispatch after arrival of the first ambulance. When dispatch actually occurred, this was also documented. RESULTS: In The Studied Period A Total Of 5765 A1 Ambulance Runs During Daylight Were Documented. Of These, 1148 Runs Met Primary Dispatch Criteria And 38 Runs Met Secondary Dispatch Criteria. Actual Hmmt Dispatch Occured In 162/1186 (14%) Cases. CONCLUSIONS: HEMS dispatch rates and dispatch criteria adherence are low (14%). Better protocol adherence by emergency dispatchers could lead to a sevenfold increase of HMMT dispatches. The reasons for suboptimal protocol adherence remain unclear and persist, despite proven value of the HMMT in reducing patient mortality and morbidity.

Air Ambulances↗
PubMed2005

The café fire on New Year's Eve in Volendam, the Netherlands: description of events.

AIM OF STUDY: The café fire at Volendam occurred shortly after midnight on the first of January 2001 and resulted in one of the worst mass burn incidents in recent Dutch history. The aim of this study was to provide insight into medical and organisational requirements of a major burns incident. METHODS: Shortly after the fire, two university hospitals and a burn center in the region of the accident developed a plan for evaluation of medical care given during and after this major burn incident. A multidisciplinary research group investigated the management of victims at the scene, in the emergency departments (ED) and during admission in the hospitals. All 245 casualties were included in this study. RESULTS: A brief severe fire occurred in a crowded cafe with around 350 young visitors on a small embankment of a relatively isolated town, resulting in a unusually high number of severely injured burn victims. Four died immediately. The ensuing rescue effort was hampered by poor access and chaotic circumstances. At the scene of the incident, mobile medical teams ensured orderly transport and treatment priority for the injured. There were 245 victims with a median total body surface area burned of 12%. Inhalation injury was present in 96 patients. A total of 182 victims were admitted, with 112 to intensive care. Ten patients died in the hospital. Seventy-eight patients were secondarily transported, many to specialised centers in the Netherlands and abroad. In total, 36 hospitals in three countries participated. CONCLUSION: An incident with high numbers of burn victims poses a challenge to any health care system. The difficult circumstances at the site demonstrated the need for robust organisational structures. The primary and secondary distribution of patients required coordination, general hospitals were able to provide initial medical care to these major burn casualties.

Adolescent↗
PubMed2005

An integrated assessment of estrogenic contamination and biological effects in the aquatic environment of The Netherlands.

An extensive study was carried out in the Netherlands on the occurrence of a number of estrogenic compounds in surface water, sediment, biota, wastewater, rainwater and on the associated effects in fish. Compounds investigated included natural and synthetic hormones, phthalates, alkylphenol(ethoxylate)s and bisphenol-A. The results showed that almost all selected (xeno-)estrogens were present at low concentrations in the aquatic environment. Locally, they were found at higher levels. Hormones and nonylphenol(ethoxylate)s were present in concentrations that are reportedly high enough to cause estrogenic effects in fish. Field surveys did not disclose significant estrogenic effects in male flounder (Platichthys flesus) in the open sea and in Dutch estuaries. Minor to moderate estrogenic effects were observed in bream (Abramis brama) in major inland surface waters such as lowland rivers and a harbor area. The prevalence of feminizing effects in male fish is largest in small regional surface waters that are strongly influenced by sources of potential hormone-disrupting compounds. High concentrations of plasma vitellogenin and an increased prevalence of ovotestes occurred in wild male bream in a small river receiving a considerable load of effluent from a large sewage treatment plant. After employing in vitro and in vivo bioassays, both in situ and in the laboratory, we conclude that in this case hormones (especially 17 alpha-ethynylestradiol) and possibly also nonylphenol(ethoxylate)s are primarily responsible for these effects.

Animals↗
PubMed2006

Occurrence of phthalate esters in the environment of The Netherlands.

Overviews of levels of n-dibutylphthalate (DBP) and di(2-ethylhexyl)phthalate (DEHP) found in freshwater, marine water, sediment, and fish in the Netherlands are given. Sampling spanned a 9-month period (all seasons except winter) and allowed assessing whether phthalate levels are season dependent. Results obtained are compared to data reported for other Western European countries and a fugacity-based modeling approach is used to assess whether there is equilibrium among the various compartments. Highest levels of dissolved DBP and DEHP were found in freshwater samples, whereas these compounds were usually below the limit of detection (LOD) in marine water and sediment. Median levels were log-normally distributed; statistical analysis showed that sampling season is not a relevant determinant parameter. Similar results were obtained for the freshwater sediment compartment, with DEHP levels exceeding concentrations of DBP. DBP levels in fish were often below the LOD. Nevertheless, mean values around 1.8 microg kg(-1) wet fish were found for both DEHP and DBP. Fugacity calculations revealed that especially for DEHP there is no equilibrium among the compartments. DEHP emissions are directed to water, whereas the calculations reveal that sediments provide a sink for DEHP and there is net transport to air. Although it has been suggested that water is the primary compartment for DBP, fugacity plots suggest that air is the compartment to which emissions are directed dominantly. The data reported are in line with values found in Western Europe.

Animals↗