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PubMed2006

Experiences with frozen blood products in the Netherlands military.

For peacekeeping and peace enforcing missions abroad the Netherlands Armed Forces decided to use universal donor frozen blood products in addition to liquid products. This article describes our experiences with the frozen blood inventory, with special attention to quality control. It is shown that all thawed (washed) blood products are in compliance with international regulations and guidelines. By means of the -80 degrees C frozen stock of red cells, plasma and platelets readily available after thaw (and wash), we can now safely reduce shipments and abandon the backup 'walking' blood bank, without compromising the availability of blood products in theatre.

Blood Banks↗
PubMed2006

Assessing the introduction of universal varicella vaccination in the Netherlands.

Although varicella is seen as a benign disease in the Netherlands, about 40,000 visits to a general practitioner (GP) are made, over 200 hospital admission occur, and 2.3 persons die on average each year. Most of this burden of disease can be prevented by universal varicella childhood vaccination. Ten years after the introduction of the single-shot, single-component varicella childhood vaccination in the USA, a major reduction in hospitalization, mortality, and burden of disease has been reported. Using our recently vaccine evaluation model for the introduction of a new vaccine in our national immunization program, we have analyzed the feasibility of universal varicella vaccination by replacing the measles-mumps-rubella (MMR) vaccine with a measles-mumps-rubella-varicella (MMRV) vaccine. After structuring and reviewing the available data, two major points of uncertainty remain: (1) the influence of universal childhood vaccination on the incidence of zoster later in life; (2) the cost-effectiveness ratio for the Dutch situation. Despite these uncertainties it is clear that universal childhood vaccination will prevent most of the varicella related GP-visits, hospitalizations, and deaths.

Chickenpox↗
PubMed2006

Performance of the Brighton collaboration case definition for hypotonic-hyporesponsive episode (HHE) on reported collapse reactions following infant vaccinations in the Netherlands.

We reviewed collapse (sudden onset of pallor, limpness and hyporesponsiveness) following the first infant (DPTP+Hib) vaccination reported to the enhanced passive surveillance system of the Netherlands in 1994-2003. All 1303 reports identified by the current RIVM (National Institute for Public Health and Environment) case definition were captured by the Brighton Collaboration (BC) case definition, with in 17 (1.3%) reports insufficient information. Over the years the proportion of the highest level of diagnostic certainty (level 1) increased due to more complete data from 70% to over 90%. We checked the BC case definition also on a sample of cases (with pallor or hyporesponsiveness) not meeting RIVM's case definition for collapse at the time. Sixty out of 200 cases were captured by BC but again rejected by RIVM. The sensitivity BC levels 2 and 3 appeared too high. We recommend a more restrict case definition by the Brighton Collaboration with certain exclusion criteria to make it more specific. Furthermore a change in the specifications for levels 2 and 3 will increase specificity and accommodate for the loss of sensitivity.

Age Factors↗
PubMed2005

The prevalence of methicillin-resistant staphylococci in healthy horses in the Netherlands.

Two hundred healthy horses housed at 23 different farms and one clinic and 42 persons in close contact with these horses were screened for the presence of methicillin resistant staphylococci. Samples were taken from the nose and the pastern of the horses and from the nose and throat of the humans and incubated in selective media. Isolates were identified by standard techniques and their susceptibilities were tested using an agar diffusion method. Methicillin-resistant strains were tested for the presence of the mecA gene by PCR. In 45 horses (22.5%) and 15 humans (35.7%) mecA positive staphylococci were found. All isolates were coagulase negative staphylococci, except for one methicillin-resistant Staphylococcus aureus isolated from a veterinarian. Staphylococcus sciuri was the predominant species found among the methicillin resistant staphylococci (MRS) in the horses, whereas S. epidermidis predominated in the humans. From the horses, often more than one species of MRS could be isolated, resulting in a total of 175 mecA positive equine isolates. The equine isolates were predominantly susceptible to most antimicrobials tested, whereas the human isolates showed more resistance. In conclusion, no methicillin-resistant Staphylococcus aureus was found in healthy horses in the Netherlands, but methicillin-resistant coagulase negative staphylococci were found frequently. Further studies are needed in order to investigate whether horses can be a reservoir for MRS or the mecA gene for humans.

Animals↗
PubMed2004

The expected number of hospitalisations and beds needed due to pandemic influenza on a regional level in the Netherlands.

In order to minimise the effects of a potential influenza pandemic on the population, regional authorities in the Netherlands are in the process of development of a plan to be prepared to cope with mass illness and to ensure health care services. The objective of this study is to calculate the expected numbers of hospitalisations and the maximum number of beds needed per day on a regional level. As many uncertainties are involved in this type of studies, we have performed a scenario analysis of the expected number of hospitalisations and beds needed during an influenza pandemic. The analysis gives insight into the impact of the pandemic in terms of how many will be hospitalised, how many beds are needed during the pandemic and in the effect of a possible intervention by therapeutic use of antivirals in terms of hospitalisations and beds needed. It can be concluded that our scenario analysis will be helpful in designing and planning on a regional level.

Adolescent↗
PubMed2005

Escherichia coli O157:H7 in drinking water from private water supplies in the Netherlands.

The microbiological quality of drinking water from 144 private water supplies in the Netherlands was tested and additionally the occurrence of Escherichia coli O157 was examined. Faecal indicators were enumerated by using standard membrane filtration methods. The presence of E. coli O157 was determined using a specific enrichment method. Eleven percent of the samples contained faecal indicators whereas E. coli O157:H7 was isolated from 2.7% of the samples that otherwise met the drinking water standards. The E. coli O157 positive water supplies were located on camp-sites in agricultural areas with large grazer densities. Pulsed field gel electrophoresis (PFGE) analysis suggested that cattle might have been the cause of contamination. Our results indicate that compliance with microbiological quality standards obtained in routine monitoring does not always guarantee the absence of pathogens. The presence of pathogens such as E. coli O157 may suggest possible health consequences; however, a risk assessment process should be performed as the monitoring of both faecal indicator parameters and pathogens do not predict the effect of microbial contamination of drinking water on a population.

Electrophoresis, Gel, Pulsed-Field↗
PubMed2006

Treatment and prognosis of post term choriocarcinoma in The Netherlands.

INTRODUCTION: Antecedent term pregnancy is an adverse prognostic factor in Gestational Trophoblastic Disease (GTD). In The Netherlands, patients with post term choriocarcinoma are considered high-risk independent of WHO score. In the present study, we assessed whether post term choriocarcinoma always has to be considered high-risk, requiring first line treatment with combination chemotherapy, or whether a subgroup of patients is distinguishable in which single-agent Methotrexate is a safe alternative. PATIENTS AND METHODS: The study is a retrospective multicenter cohort study. Patients registered by the Dutch Working Party on Trophoblastic Disease between 1986 and 2004 with choriocarcinoma after a non-molar pregnancy were eligible. Hospital and outpatient records of the patients were reviewed. RESULTS: In total, 68 patients with non-molar choriocarcinoma were registered of whom 44 had an antecedent term pregnancy. Most post term patients (77%) were high-risk according to the WHO staging system. The majority of patients presented with metrorraghia and high hCG levels. Lung and liver metastases were common (respectively 64% and 28%), probably caused by a delay in diagnosis (median interval 16 weeks). Patients were often Methotrexate-resistant (75%). Overall survival was 86% in patients with a post term choriocarcinoma. CONCLUSIONS: Although term pregnancy is an adverse prognostic factor in GTD, current survival is comparable to the general survival in high-risk patients. A subgroup of patients in which monotherapy would be sufficient could not be identified. Immediate administration of combination chemotherapy seems justified, even in those few cases when scoring systems would suggest low- or medium-risk disease.

Adult↗
PubMed2005

A breast-feeding promotion and support program a randomized trial in The Netherlands.

BACKGROUND: In the Netherlands, the initiation rate of breast-feeding (BF) was 80% in 2002, but only 35% of the mothers continued to breast-feed for 3 months. This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding. METHODS: A cluster-randomized intervention trial was used. Ten child health care centers in three regions of the home health care were randomly allocated to the program or usual care. Elements in the program were health counseling, measures to enhance cooperation, early signaling of breast-feeding problems and continuity of care, and lactation consultancy. Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum (n = 683). The primary outcome measure was the continuation of breast-feeding until at least 3 months. RESULTS: The 3-month breast-feeding rate was 32% in the intervention and 38% in the control groups (OR = 0.79, 95% CI = 0.58-1.08). CONCLUSION: The program was not effective. We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program, such as the categories of caregivers involved and the number and duration of contacts after parturition.

Breast Feeding↗
PubMed1998

Eating habits of young children with Down syndrome in The Netherlands: adequate nutrient intakes but delayed introduction of solid food.

OBJECTIVES: To investigate nutritional status, pattern of being breast-fed, age at introduction of solid food, and adequacy of energy and nutrient intakes in children with Down syndrome in The Netherlands. DESIGN: Nutritional status was assessed by height and weight measurements. The dietary history method was used to collect information on the diet. Data obtained from children with Down syndrome were compared with data from control subjects and from the general population of Dutch children. Adequacy of energy and nutrient intakes was assessed by comparison to US recommendations. SUBJECTS: Forty-four Dutch children with Down syndrome (newborns to 4-year-olds) and 37 healthy control subjects without this syndrome. STATISTICAL ANALYSES: The prevalence of breast-feeding of children with and without Down syndrome was compared using the chi 2 test. To compare ages at which solid food was introduced, the log-rank test and Kaplan-Meier curves were used. Anthropometric data and mean dietary intake were compared between the groups using 2-way analysis of variance. Comparison to recommended levels of dietary intake was performed using 95% confidence intervals. RESULTS: Heights and weights of the children with Down syndrome were in the normal range. Down syndrome does not affect the prevalence of breast-feeding of children or the adequacy of their energy and nutrient intakes, but it does significantly delay the age at which solid food is introduced, which can be deleterious to oral-motor development. APPLICATION: If late introduction of solid food is observed in children with Down syndrome, pre-speech therapy should be considered.

Age Factors↗
PubMed1999

Late onset polio sequelae: disabilities and handicaps in a population-based cohort of the 1956 poliomyelitis outbreak in The Netherlands.

OBJECTIVE: To investigate the prevalence of new neuromuscular symptoms, disabilities, and handicaps in a group of polio survivors. DESIGN: A self-constructed health questionnaire about neuromuscular complaints and disability and handicap levels during the stable period after recovery from polio and at present. SUBJECTS: Three hundred fifty subjects, derived from the 1,784 polio cases registered during the 1956 polio outbreak in The Netherlands. RESULTS: Respondents totaled 260 (74%), 27 of whom denied or did not recall having had paralytic poliomyelitis. The remaining 233 subjects comprised the study group (mean age, 44yrs; range, 39 to 77; SD = 6.3). Frequency of all neuromuscular complaints at present time was significantly higher than that during the stable period after polio (range in p of .001 to .004). Fifty-eight percent of cases reported an increase in muscle weakness in comparison with muscle condition during the stable period. Fifty-six percent reported an increase in disabilities, mainly a restriction in gait functions. Fifty-three percent reported increased handicaps with regard to occupation and social integration, and there was an increased need for adaptive measures and devices. CONCLUSION: Nearly 60% of a sample of Dutch survivors of the 1956 polio outbreak experience late onset polio sequelae, resulting in increased severity of disabilities and handicaps.

Adult↗
PubMed2006

Compliance with the guidelines for acute ankle sprain for physiotherapists is moderate in the Netherlands: an observational study.

QUESTION: What is the compliance with guidelines for acute ankle sprain for physiotherapists? DESIGN: Survey of random sample of physiotherapists. PARTICIPANTS: 400 physiotherapists working in extramural health care in the Netherlands. OUTCOME MEASURES: Questions covered attitude towards guidelines in general, familiarity with the guidelines for acute ankle sprain,compliance with the guidelines, advantages and disadvantages of the guidelines, and factors relating to compliance with the guidelines. RESULTS: The majority of the physiotherapists were familiar with the content of the guidelines to some degree and 66%applied it to more than half of their patients with acute ankle sprain. The recommendations to determine both the prognosis and the necessity of treatment by using the function score were the least followed. Some physiotherapists thought the function score was not completely clear, which may have been a barrier for implementation. Factors relating positively to compliance were a positive attitude towards guidelines in general, and having colleagues who implemented the guidelines for acute ankle sprain. CONCLUSION: Although compliance with the guidelines for acute ankle sprain was fair/moderate, compliance may be enhanced by improving clarity of the function score, including it in the short version and improving the attitude of physiotherapists towards guidelines in general.

Acute Disease↗
PubMed1999

The prevalence of seasonal affective disorder in The Netherlands: a prospective and retrospective study of seasonal mood variation in the general population.

BACKGROUND: The aim of the present study was to assess the prevalence of seasonal affective disorder (SAD) in The Netherlands. METHODS: The subjects (n = 5356), randomly selected from community registers, were given the Seasonal Pattern Assessment Questionnaire and the Centre for Epidemiological Studies Depression Scale over a period of 13 months. The response rate was 52.6%. RESULTS: Three percent of the respondents met the criteria for winter SAD, 0.1% for summer SAD. The criteria for subsyndromal SAD, a milder form of SAD, were met by 8.5%, 0.3% of whom showed a summer pattern. Younger women received a diagnosis of SAD more often than men or older women. CONCLUSIONS: SAD subjects were significantly more often unemployed or on sick leave than other subjects. Respondents who met winter SAD criteria were significantly more depressed than healthy subjects, in both winter and summer. Finally, month of completion had no influence on the number of subjects meeting the SAD criteria.

Absenteeism↗
PubMed1998

Oral contraceptive use before and after the latest pill scare in The Netherlands. Changes in oral contraceptive use and how users change.

In October 1995, a "pill scare" developed in Europe. In the Netherlands, the recommendations given were 1) to not alarm women without risk for deep vein thrombosis (DVT), and 2) to be reserved in prescribing third generation oral contraceptives (OC) for young women who were beginning OC use. To determine whether there is a change in the prescription of third generation OC after the latest pill scare, prescription data from 1/10/94 to 1/10/96, covering a population of +/- 120,000 persons, were studied with respect to OC use before and after the pill scare. Trend analyses revealed a significant decline in third generation compared with total OC prescribing only in the youngest age category (p = 0.0034). Further, switch behavior was studied. Switches from third to second generation OC were more prevalent after the pill scare than before (odds ratio = 2.63; 95% confidence interval 1.84-3.75) and switches from second to third generation OC were significantly less prevalent after the pill scare. This indicates that Dutch prescribers have reacted to the pill scare in the way that the government recommended.

Adolescent↗
PubMed1997

Amyotrophic lateral sclerosis: mortality risk during the course of the disease and prognostic factors. The Netherlands ALS Consortium.

We performed a historical cohort study of 307 untreated patients with probable or definite amyotrophic lateral sclerosis in order to investigate whether the mortality risk changed during the disease course and to identify prognostic factors at diagnosis. Patients were diagnosed in one of the academic hospitals in The Netherlands and followed-up for at least 6 years after diagnosis. The median survival from diagnosis was 1.4 years (95% confidence interval, 1.3-1.6 years) with an estimated 5- and 10-year survival of 20 and 8%, respectively. Mortality was at its maximum in the second year after diagnosis and declined considerably thereafter. Observed mortality approached the expected mortality in patients who survived diagnosis 6 or more years. In univariate and multivariate analyses, young age, limb onset, and a long delay between initial weakness and diagnosis were associated with lower mortality. The better prognosis of limb-onset patients was not observed in females. Patients with initial respiratory muscle weakness, had the worst prognosis with a median survival of only 2 months. The significantly greater mortality of older patients proved not to result from a rise in expected mortality only. In conclusion, the annual mortality risk in ALS does not remain constant throughout the disease and depends on age at diagnosis, site of onset, diagnostic delay, but also on the time since diagnosis. These findings may have consequences for the planning of symptomatic care and the design and analysis of therapeutic trials.

Age Factors↗
PubMed2001

PCB concentrations and metabolism patterns in common terns (Sterna hirundo) from different breeding colonies in The Netherlands.

PCB levels in blood of common terns (Sterna hirundo) from Terneuzen, a breeding colony in The Netherlands with relatively low breeding success, were significantly higher than in birds from two Dutch reference colonies, one nearby (Oesterdam) and one further away (the Isle of Griend). However, a detailed analysis of the patterns of PCB congeners in birds from the different colonies indicated that birds from Terneuzen and to a lesser extent birds from the Oesterdam showed Ah-receptor mediated activity of P450 iso-enzymes. It is concluded that the induction of this enzyme activity in Terneuzen may be related to PCBs as well as other non-identified compounds. In contrast to this, it is likely that at the Oesterdam non-identified compounds are mainly responsible for the enzyme activity, resulting in a shift of PCB congener patterns.

Animals↗
PubMed1996

Prevalence of foot-and-mouth disease antibodies in dairy herds in The Netherlands four years after vaccination.

A total of 298 serum samples were collected from Dutch cattle born in 1988 or before, and examined in the virus neutralisation test for antibodies against foot-and-mouth disease virus types A10 Holland. O BFS, and C1Detmold. All the cattle had been vaccinated at least twice during the annual vaccination programme, which stopped in 1991. Antibody titres equal to or higher than the titre at which 95 per cent of the cattle would be expected to be protected against challenge, were found in 57 to 73 per cent of the younger age groups, and in 100 per cent of the older animals. Since the animals tested constituted only 10.5 per cent of the total cattle population on the farms tested, it is concluded that should the virus be introduced, foot-and-mouth disease would be detected as easily in the Netherlands as in a country with no history of vaccination.

Animals↗
PubMed2003

Responses in sediment bioassays used in the Netherlands: can observed toxicity be explained by routinely monitored priority pollutants?

In order to identify the cause of toxicity in sediments and suspended matter, a large number of samples with different degrees of contamination was taken at various locations in The Netherlands. Standard acute bioassays were carried out with the bacterium Vibrio fischeri, the rotifer Brachionus calyciflorus and the anostracan Thamnocephalus platyurus. Chronic standard tests were performed using the water flea Daphnia magna and larvae of the midge Chironomus riparius. Some novel bioassays were performed as well. Most toxic effects observed in standard bioassays with sediments from polluted sediments (class 3 and 4 on a scale of 0-4 according to the Dutch criteria) could be partly explained by toxic concentrations of known persistent priority pollutants, mainly heavy metals and occasionally polycyclic aromatic hydrocarbons. In some of the samples, ammonia toxicity was a confounding factor during testing. Suspended matter from the Meuse river at Eijsden, which may be considered as 'new' sediment (pollution class 2), was moderately to highly toxic in almost all bioassays. This could have been associated with a combination of heavy metals, PAHs and ammonia. At two locations from the Lake IJssel area with no apparent persistent pollution, moderate and strong effects were nonetheless observed in invertebrate tests. This might have been due to agricultural run-off of pesticides, which are not routinely measured in sediments. A few effects on V. fischeri in canals and a small stream could not be explained with standard chemical analysis, but seemed associated with the outlets of sewage water treatment plants and industrial effluents. Additional chemical analysis of pore water samples from five selected sediments yielded more identified substances such as phtalates, decanes, cosanes and fragrances, but it was estimated that their contribution to the effects observed on V. fischeri, D. magna and C. riparius was negligible.

Animals↗
PubMed2002

Environmental risk assessment of phosphonates, used in domestic laundry and cleaning agents in The Netherlands.

In the long-term cooperative project Voluntary Plan of Action (1990) between the Dutch Soap and Detergent Association (NVZ) and the Dutch Ministry of Housing, Spatial Planning and the Environment (VROM) environmental risk assessments of several main components of laundry cleaning formulations were completed. As a part of that project the environmental risk assessment of HEDP, ATMP, EDTMP and DTPMP phosphonates used in detergent applications has been carried out according to the EU Technical Guidance Document for Environmental Risk Assessment for New and Existing Chemicals. All PEC/PNEC ratios were well below 1. Results of this assessment based on the total industry volumes from 1995 and 1998 indicate that the environmental risk of these phosphonates is low in The Netherlands with properly functioning sewage treatment plants.

Chelating Agents↗