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PubMed2003

Neighbourhood infections of classical swine fever during the 1997-1998 epidemic in The Netherlands.

Data of the 1997-1998 epidemic of classical swine fever (CSF) in The Netherlands were analysed in survival analysis to identify risk factors that were associated with the rate of neighbourhood infections. The study population consisted of herds within 1000 m of exclusively one previously infected herd. Dates of virus introduction into herds were drawn randomly from estimated probability distributions per herd of possible weeks of virus introduction. (To confirm the insensitivity of the results for this random data-selection procedure, the procedure was repeated 9 times (resulting in 10 different data sets).) The data set had 906 non-infected and 59 infected neighbour herds, which were distributed over 215 different neighbourhoods. Neighbour herds that never became infected were right-censored at the last date of the infectious period of the infected source herd. Neighbour herds that became empty within the infectious period or within the following 21 days due to preventive depopulation or due to the implemented buying-out programme were right-censored 21 days before the moment of becoming empty. This was done as a correction for the time a herd could be infected without being noticed as such. The median time to identified infection of neighbour herds was 2 weeks, whereas the median time to right censoring of non-infected neighbour herds was 3 weeks. The risk factors, radial distance < or =500 m, cattle present on source herd and increasing herd size of the neighbour herd were associated multivariably with the hazard for neighbour herds to become infected. We did not find an association between time down wind and infection risk for neighbour herds. Radial dispersion of CSFV seemed more important in neighbourhood infections than dispersion along the road on which the infected source herd is situated. The results of this study support the strategy of preventive depopulation in the neighbourhood of an infected herd. Recommendations are presented to adapt the applied control strategy for neighbourhood infections.

Animal Husbandry↗
PubMed2005

Risk factors for the introduction of high pathogenicity Avian Influenza virus into poultry farms during the epidemic in the Netherlands in 2003.

An epidemic of high pathogenicity Avian Influenza (HPAI) occurred in the Netherlands in 2003. A census survey of 173 infected and 401 uninfected commercial poultry farms was carried out to identify factors associated with the introduction of the HPAI virus into poultry farms. Data on farm size, production characteristics, type of housing, presence of cattle and pigs were gathered by the National Inspection Service for Livestock and Meat from all farms included in this study. For each risk factor (RF) available for analysis, the Mantel-Haenszel odds ratio was calculated (stratified on farm size and housing type). We found an increased risk of HPAI virus introduction in layer finisher type poultry: OR = 2.05 (95% confidence interval, CI = 1.29-3.27). An explanation for this increased risk is the high number of contacts between these farms, especially via cardboard egg trays used for removal of eggs during the epidemic. Our analysis did not indicate significant differences between the infected and uninfected farms with regard to housing type, presence of cattle or pigs. Since layer finisher type farms are assumed to be at higher risk for HPAI virus introduction, more specific control measures might be applied in future outbreaks.

Animal Husbandry↗
PubMed2005

Stochastic efficiency analysis of bovine tuberculosis-surveillance programs in the Netherlands.

We constructed a stochastic bio-economic model to determine the optimal cost-efficient surveillance program for bovine tuberculosis. The surveillance programs differed in combinations of one or more detection methods and/or sampling frequency. Stochastic input variables in the epidemiological module described the dynamics of infection and the probability of detection. By means of an efficiency frontier, the trade-off between the expected cost and the epidemiological risk parameter relating to the outbreak size was evaluated. The surveillance scheme based on visual inspection of lesions on carcasses at slaughter was optimal given the current prevalence of the disease in the Netherlands if the objective was to minimise the expected costs. However, the efficient set also included two other schemes: slaughterhouse inspection in combination with GAMMA-interferon testing of blood samples and slaughterhouse inspection in combination with two-stage tuberculin testing. The choice ultimately will depend on the risk attitude of the decision-maker; a more-stringent surveillance scheme will be enforced if the expected outbreak size is to be constrained. In future scenarios, ELISA testing of bulk-tank milk in combination with the current slaughterhouse inspection procedure would outperform the surveillance scheme of solely slaughterhouse inspection if ELISA testing of bulk-tank milk becomes feasible.

Animals↗
PubMed2005

Risk factors for interdigital dermatitis and heel erosion in dairy cows kept in cubicle houses in The Netherlands.

Risk factors concerning both the pasture and housing seasons for interdigital dermatitis and heel-horn erosion (IDHE) were studied in dairy cows in a cross-sectional study in The Netherlands. The study population included 2,326 cows (41 herds) and 2,751 cows (46 herds) for the pasture and housing seasons, respectively. Of these animals, 545 (23%) showed serious lesions of IDHE (stages 2 and 3) at the end of the pasture season and 1,269 (46%) during housing. Logistic regression of the pasture study indicated that increased parity, solid concrete floor, restricted grazing time, and herd trimming at long intervals were associated with an increased odds of IDHE, while dry cows and lactating cows within 30 days after calving as well as cows on a slatted floor with manure scraper, and grassland with mixed type of soil were associated with lower odds. In the housing study, odds of IDHE increased with parity, administering low- or medium-energy roughage, and introduction of dry cows into the lactating herd at >2 weeks before calving. The presence of long cubicles, knee-bumpers installed in cubicles as well as rearing calves and heifers within the dairy cows' accommodation decreased the odds of IDHE.

Animals↗
PubMed2005

Risk factors for digital dermatitis in dairy cows kept in cubicle houses in The Netherlands.

The presence of digital dermatitis (DD) in dairy cows has increased considerably over the last 10 years in The Netherlands, resulting in a current prevalence of approximately 30% in cows kept in cubicle houses. Our objective was to evaluate a diversified sample of cow- and herd-related risk factors for DD in dairy cows housed in cubicle houses with different flooring systems. Associations were analysed in random-effects logistic-regression models using 2,134 cows (37 herds) and 2,892 cows (47 herds) in the pasture and housing studies, respectively. At cow-level, the odds of having DD were increased in the case of lower parity and lactation. Important risk factors at herd-level were: restricted grazing time, fast rise in concentrate amount after calving, feeding by-products, herd trimming only at long intervals, and introduction of dry cows into the lactating herd before calving. The odds for DD were lower if cows were housed on a slatted floor with manure scraper and provided long and wide cubicles, and if calves were reared in the dairy cows' accommodation.

Animals↗
PubMed2005

Diagnostic assays applied in BVDV control in The Netherlands.

In The Netherlands, a voluntary bovine virus diarrhoea virus (BVDV)-free certification programme was started in 1997. After an intake procedure in which all cattle are tested for the presence of BVD virus, a herd obtains the status "BVD-virus-free". To maintain this status a monitoring procedure is executed to verify absence of BVDV circulation in the herd. Several diagnostic tests are used: RT-PCR in bulk milk and pooled blood samples, antigen-ELISA (Ag-ELISA) and antibody ELISA in individual blood samples. Sensitivity and specificity of these tests are discussed. In addition, a diagnostic quick scan has been introduced, consisting of a combination of bulk milk tests for virus and antibody, and antibody tests in samples from young stock. Preliminary results are presented.

Animals↗
PubMed2005

Health status and the challenges for prevention in The Netherlands.

In 2002, the third Public Health Status and Forecasts report was published, containing up-to-date information about Dutch public health and health care. A striking finding was that although life expectancy (LE) in The Netherlands increased between 1980 and 2000, the LE of men is rising less rapidly than the European Union (EU) average. The LE of Dutch women is stagnating and has now fallen below the EU average. These and many other unfavourable trends in the health status of the Dutch population were found to be largely due to unhealthy behaviour. One of the policy recommendations therefore was to strengthen the investments in prevention in order to reverse the stagnation in health status. In response to the findings, the Ministry of Health, Welfare and Sport published the National Prevention Paper. This Paper states that the Ministry, within the existing prevention policy, will pay more attention to healthy behaviour, stressing the responsibility of citizens as well as the societal responsibility of other parties, such as business communities, schools, health insurers and care suppliers. The prevention of specific diseases (diabetes, psychosocial problems, heart diseases, cancer, musculosceletal disorders, asthma and chronic obstructive pulmonary disease) has been given priority status. In this article, we present the major findings regarding the health status of the Dutch population and discuss the implications for prevention policy.

Age Factors↗
PubMed2004

The presence of co-infections in pigs with clinical signs of PMWS in The Netherlands: a case-control study.

In this study, 60 pigs with clinical signs of post-weaning multisystemic wasting syndrome (PMWS) from 20 different pig herds and 180 control pigs (without clinical signs of PMWS) were examined to get more insights into the frequencies of porcine circovirus 2 infections and the presence of co-infections in pigs with and without clinical signs of PMWS in the Netherlands. Porcine circovirus type 2 was detected in 100% of the pigs with clinical signs of PMWS by virus isolation and/or PCR and in 50% of the pigs from PMWS-free herds. There was an association between the levels of infectious PCV2 and/or PCV2 DNA load and the severity of clinical signs as described for PMWS. A high variation in PCV2 antibody titres was found in the clinically affected pigs, and 27% of these pigs did not mount PCV2 antibody titres higher than 1:200. A concurrent infection of PCV2 and porcine reproductive and respiratory syndrome virus (PRRSV) was found in at least 83% of the pigs with clinical signs of PMWS and in 35% of the pigs from PMWS-free herds. Co-infections of European- and American-type PRRSV were detected only in PMWS herds and in one control herd with a history of PMWS clinical signs.

Animals↗
PubMed2006

Incidence of schizophrenia among ethnic minorities in the Netherlands: a four-year first-contact study.

There is only one previous report on the first-contact incidence of schizophrenia among immigrants in the Netherlands, which was based on a small number of cases, particularly for second generation immigrants. We conducted another two-year first-contact incidence study in the same geographical area, combined the data of both studies and compared risks over all four years. The incidence of schizophrenia was increased for all first generation non-Western immigrants. The risk was particularly high for second generation immigrants: the age- and gender-adjusted incidence rate ratio was 5.8 (95% CI, 2.9-11.4) for Moroccans, 2.9 (1.6-5.0) for Surinamese, 2.3 (1.0-5.4) for Turks, and 3.5 (1.8-6.8) for immigrants from other non-Western countries.

Adolescent↗
PubMed2004

The population genetic structure of Littorina littorea (Mollusca: Gastropoda) along a pollution gradient in the Scheldt estuary (The Netherlands) using RAPD analysis.

The population genetic structure of the periwinkle Littorina littorea was analysed using random amplified polymorphic DNA (RAPD). Three primers, coding for six putative polymorphic loci were surveyed to infer the genetic structure of seven populations located along the heavily polluted Western (i.e. in order of decreasing pollution load W1, W2, W3 and R1) and the relatively clean Eastern Scheldt (E1, E2 and E3) estuary (The Netherlands). A genetic distance based UPGMA (Unweighted pair group method with arithmetic mean) dendrogram revealed an estuary-related structuring, as Eastern and Western Scheldt sites formed two separate clusters. The Western Scheldt cluster was, however, much more heterogeneous, with three RAPD loci revealing a significant genetic heterogeneity compared to none when the Eastern Scheldt sites were compared. Overall mean heterozygosity levels were high, but did not reveal a difference between the estuaries. The current data (1) confirm the patterns of variation previously observed with electrophoretic analyses of esterases and (2) strongly support that these patterns of variation have a genetic basis, in the presence of intense gene flow. In addition, it is suggested that selection, rather than bottleneck effects, induced by the less favourable living conditions at W1, W2 and W3 are responsible for the genetic patterning.

Animals↗
PubMed2005

Mercury emissions from coal-fired power stations: The current state of the art in the Netherlands.

About 30% of the electricity produced in the Netherlands is generated by coal, all of which is imported. At the same time, the co-combustion of biomass is becoming increasingly important. For the last 25 years, the fate of the elements/trace elements in general and of mercury in particular has been studied in great detail. It appears that on average 50% of the mercury is removed in the ESP (particulate control) and 50% of the remainder is removed in the flue gas desulphurization (FGD), resulting in a total mercury removal of 75%. If a high dust selective catalytic reduction (SCR for NO(x) reduction) is present, the total removal can be up to 90%. The results indicate that on average the removal of mercury during the co-combustion of biomass is similar to that found for full coal-firing. The conclusion is that a modern coal-fired power station with the above-mentioned flue gas cleaning equipment also removes mercury up to 90%. These cleaning devices are being installed to reduce the emission of particulates, sulphur dioxide and nitrogen oxides. This means that mercury abatement can be increased while meeting the EU regulation for SO(2) and NO(x). The application of Best Available Technique (BAT) for coal-fired installations by 1-1-2008 will lead to a further increase in the construction and operation of FGD and DeNO(x) installations.

Air Pollutants↗
PubMed2006

Efficacy and safety of levetiracetam in clinical practice: results of the SKATE trial from Belgium and The Netherlands.

OBJECTIVE: Aim of the study was to assess the efficacy and safety of levetiracetam as add-on treatment in patients with partial-onset epilepsy in clinical practice. METHODS: In this observational, multi-centre study patients were treated with levetiracetam for 16 weeks. From a starting dose of 1000 mg/day, dose levels were adjusted at 2-weekly intervals in 1000-mg steps, to a maximum of 3000 mg/day, based on seizure control and tolerance. Analysis of efficacy was based on reduction in seizure frequency relative to baseline, 50% and 100% responder rates (for partial seizures and all seizure types combined) and percentage of patients using levetiracetam at the end of the study. Analysis of safety was based on occurrence of adverse events. RESULTS: The present analysis concerns the results of patients recruited in Belgium and The Netherlands. Of the 251 patients included in the study, 86.9% completed 16 weeks of treatment. Reduction in frequency of partial-onset seizures was 62.2%, with 19.3% of the patients becoming seizure free and 56.6% having a reduction in seizure frequency of > or = 50%. These percentages were more or less the same when calculated for all seizure types combined. Tolerance of levetiracetam treatment was good, with most adverse events being only mild to moderate in severity, and only 10.0% of the adverse events leading to discontinuation from the study. Asthenia, somnolence, dizziness and headache were the most frequently reported adverse events. CONCLUSION: Levetiracetam is effective and safe as add-on treatment for partial-onset seizures in clinical practice.

Adolescent↗
PubMed2004

"You're not going to dehydrate mom, are you?": Euthanasia, versterving, and good death in the Netherlands.

In 1996, a debate erupted in the Netherlands about versterven: dying as a result of abstaining from eating and drinking. This discussion initially appeared to be one of the many side-shows to the wider Dutch euthanasia debate, but it continued to dominate the debate for the next few years, with newspaper headlines reporting "involuntary dehydration" in nursing homes. Part of the reason for this was the term itself. Introduced to refer to terminal dehydration, the word versterven had peculiar connotations and this, together with the way in which it was used, caused much confusion and controversy. Was versterven related to euthanasia? Did it denote dying naturally and peacefully or a horrible death imposed on helpless psychogeriatric patients? Was it (could it be) voluntary? Was the patient in control? Was it good death? This paper examines the discussion about, and the media representations of, versterven, focusing on its ambiguity and its relationship to good death.

Attitude to Death↗
PubMed2005

The role of premorbid psychological attributes in short- and long-term adjustment after cardiac disease. A prospective study in the elderly in The Netherlands.

The role of mastery, self-efficacy expectancies and neuroticism in explaining individual differences in physical and psychological adjustment to cardiac disease was studied in 208 patients. Premorbid data were available from a community-based survey in the Netherlands. Hierarchical linear regression analyses showed that self-efficacy expectancies at baseline were significantly related to adjustment in terms of physical functioning in the short- and long-term and depressive symptoms in the short-term (six weeks after diagnosis). Mastery was significantly related to depressive symptoms and anxiety in the long-term (1 year after diagnosis). Neuroticism was a predictor for depressive symptoms and anxiety both in the short- and long-term. The results of this longitudinal study showed that premorbidly assessed psychological attributes do have a role in explaining individual differences in vulnerability to negative consequences of cardiac disease.

Adaptation, Psychological↗
PubMed2005

The impact of an organ donation registration information program for high school students in the Netherlands.

In 1998, a new organ donor registration system was implemented in the Netherlands to increase the number of potential donors. A high school education program was developed to prepare adolescents to make an informed decision about organ donation. A post-test only randomised controlled trial was conducted in 39 high schools including 2868 students. Students within schools were randomly allocated to either attend the organ donation education program or not. The impact of the program on students' intention to register their organ donation preference (and determinants thereof) were analysed using multivariate multileveling modelling (MlwiN). The results show that students who were exposed to the education program had more favourable registration intentions (B = .40), were more often willing to be donors (OR = 1.45), and had greater knowledge about (B = 3.84) and more positive social outcome expectations (B = .09) and self-efficacy regarding organ donation registration (B=.22). Lastly, they experienced significantly less negative outcome expectations related to organ donation registration (B = -.15). Students' evaluation of the school-based education program was favourable. The present organ donation registration program proved to be effective in changing determinants of organ donation registration, and a large-scale implementation in the Dutch high school curriculum is planned.

Adolescent↗
PubMed2005

Frequency and determinants of advance directives concerning end-of-life care in The Netherlands.

In the USA, the use of advance directives (ADs) has been studied extensively, in order to identify opportunities to increase their use. We investigated the prevalence of ADs and the factors associated with formulation of an AD in The Netherlands, using samples of three groups: the general population up to 60 years of age, the general population over 60 years of age, and the relatives of patients who died after euthanasia or assisted suicide. The associated factors were grouped into three components: predisposing factors (e.g. age, gender), enabling factors (e.g. education) and need factors (e.g. health-related factors). We found that living wills had been formulated by 3% of younger people, 10% of older people, and 23% of the relatives of a person who died after euthanasia or assisted suicide. Most living wills concerned a request for euthanasia. In all groups, 26-29% had authorized someone to make decisions if they were no longer able to do so themselves. Talking to a physician about medical end-of-life treatment occurred less frequently, only 2% of the younger people and 7% of the older people had done so. Most people were quite confident that the physician would respect their end-of-life wishes, but older people more so than younger people. In a multivariate analysis, many predisposing factors were associated with the formulation of an AD: women, older people, non-religious people, especially those who lived in an urbanized area, and people with less confidence that the physician would respect their end-of-life wishes were more likely to have formulated an AD. Furthermore, the enabling factor of a higher level of education, the need factor of contact with a medical specialist in the past 6 months, and the death of a marital partner were associated with the formulation of an AD.

Adult↗
PubMed2006

Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up.

This epidemiological investigation addresses the prevalence, course, and predictors of the psychological distress and behavioral problems of unaccompanied refugee minors living in the Netherlands. The legal guardians, teachers and minors themselves all reported on the mental health of the refugee minors (n=582) at baseline and follow-up approximately 12 months later. The self-reported psychological distress of refugee minors was found to be severe (50%) and of a chronic nature (stable for one year) which was confirmed by reports from the guardians (33%) and teachers (36%). The number of self-reported experienced adverse life events were strongly related to the severity of psychological distress. Baseline psychopathology was the largest predictor of psychological distress at follow-up reported by all informants accounting for 22-51% of the variance. The present study, which used a population-based sample, further enlarges the knowledge of mental health among refugee adolescents. The investigation is unique because of the large sample size, the longitudinal nature of the study, the use of multiple informants, and the culturally diverse sample.

Adolescent↗
PubMed2004

Dioxins, dioxin-like PCBs and non-dioxin-like PCBs in foodstuffs: occurrence and dietary intake in The Netherlands.

Data on occurrence of dioxins (polychlorinated dibenzo-p-dioxins [PCDDs] and dibenzofurans [PCDFs]), dioxin-like PCBs (polychlorinated non-ortho and mono-ortho biphenyls) and non-dioxin-like PCBs (as represented by the so-called indicator-PCBs: congeners 28, 52, 101, 118, 138, 153 and 180) in food products consumed in The Netherlands that were collected in measurement programs carried out during 1998 and 1999, and combined with food consumption data to assess the dietary intake of these persistent food contaminants. The estimated median life-long-averaged intake of the sum of dioxins and dioxin-like PCBs in the population is 1.2 pg WHO-TEQ (toxic equivalents) per kg body weight (bw) per day, while the estimated median life-long-averaged intake of indicator-PCBs is 5.6 ng per kg bw per day. The contribution of different food groups to the total intake of both dioxins + dioxin-like PCBs and non-dioxin-like PCBs is fairly uniformly distributed over the foods consumed: meat products (23% and 27%, respectively), dairy products (27% and 17%, respectively), fish (16% and 26%, respectively), eggs (4% and 5%, respectively), vegetable products (13% and 7%, respectively), and industrial oils and fats (17% and 18%, respectively). Compared with earlier intake estimations the present estimation shows a continued reduction in the intake of dioxins as well as PCBs. This reduction is related to the decrease in the concentration of these substances in the majority of foodstuffs. Nevertheless, a small part of the population still has a rather high life-long averaged intake: 8% of the population is exposed to intake levels above the tolerable weekly intake for dioxins and dioxin-like PCBs of 14 pg WHO-TEQ per kg bw per week, as recently derived by the Scientific Committee on Food of the European Commission. For the non-dioxin-like PCBs an internationally accepted maximum intake level is still lacking. However, to provide risk managers with a health-based guideline to prevent health effects of exposure to non-dioxin-like PCBs, the (international) derivation of a tolerable daily intake is recommended. Monitoring the dietary intake of PCBs is just as important as monitoring the intake of dioxins and dioxin-like PCBs, and attempts to decrease the exposure to both compound classes need continuous attention.

Adolescent↗