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PubMed1999

Signs and symptoms of Duchenne muscular dystrophy and Becker muscular dystrophy among carriers in The Netherlands: a cohort study.

BACKGROUND: Carriers of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) may show muscle weakness or dilated cardiomyopathy. Studies focusing on skeletal-muscle involvement were done before DNA analysis was possible. We undertook a cross-sectional study in a population of definite carriers to estimate the proportion and to assess the clinical profile of carriers with symptoms. We also assessed a possible correlation between genotype and phenotype. METHODS: Carriers of DMD and BMD, aged 18-60 years, were traced through the files of the central register kept at the Department of Human Genetics in Leiden, Netherlands. For each carrier who agreed to participate a medical history was taken, and muscle-strength assessment by hand-held dynamometry and manual muscle testing and cardiological assessment were done. FINDINGS: 129 carriers of muscular dystrophy (85 DMD, 44 BMD) participated in the study. In 90 women from 52 (70%) families, 37 different mutations were found. 28 (22%) women had symptoms. 22 (17%) had muscle weakness, varying from mild to moderately severe. Muscle weakness was found in carriers of DMD and BMD, but dilated cardiomyopathy was found only in seven (8%) carriers of DMD, of whom one had concomitant muscle weakness. There was an unexpectedly high proportion of left-ventricle dilation (18%). No genotype-phenotype correlation was found. INTERPRETATION: Clinical manifestation of muscle weakness, dilated cardiomyopathy, or both can be found in about a fifth of carriers of DMD and BMD. If left-ventricle dilation is taken into account, the proportion of carriers with symptoms is even higher, amounting to 40%.

Adolescent↗
PubMed2001

Intersex and sterility in the periwinkle Littorina littorea (Mollusca: Gastropoda) along the Western Scheldt estuary, The Netherlands.

In this study we present the results of an intersex survey of Littorina littorea along the heavily polluted Western Scheldt estuary (the Netherlands), and record for the first time the intersex phenomenon in L. littorea from Dutch waters. Intersex differed significantly between localities and was the highest in the vicinity of the harbours of Antwerp and Vlissingen, as reflected by the I

Animals↗
PubMed2003

Physical child abuse and social change. Judicial intervention in families in The Netherlands, 1960-1995.

OBJECTIVE: To show changes in the way juvenile judges and judicial child protection workers deal with physical child abuse in the period 1960-1995 in the Netherlands. METHOD: The study is based on an analysis of files on adolescent and younger children placed by juvenile judges in the Dutch judicial child protection system during the 1960s, 1970s, 1980s, and 1990s. RESULTS: The prevalence of very severe physical violence against children was lower in the recent files than in the older files. Spanking and other minor violence acts were noted more often than in the older files. In the 1960s files, the parents talked still rather openly about the physical punishments they used in child rearing. In spite of the growing attention for and increasing concern about child abuse among professionals, judicial child protection workers intervened less harshly in recent cases of physical child abuse than in the 1960s. CONCLUSION: The decrease in severe physical child abuse may indicate that physical child abuse is actually becoming a less serious problem in the Dutch judicial child protection system. But that may not be the case because of the increased reluctance of parents to report and changes in intervention practices. Other than expected, the growing sensibility for child abuse did not mean more effective control by judicial child protection workers. Possible reasons for these changes are discussed, including the strengthening of the position of perpetrators in law proceedings and the emancipation of children and women in society.

Child↗
PubMed2002

A retrospective analysis of costs and patterns of treatment for external genital warts in The Netherlands.

BACKGROUND: External genital warts (EGWs) are one of the most common sexually transmitted infections, but little is known about the treatment patterns or resources used in the management of this condition. OBJECTIVE: The purpose of this retrospective analysis is to examine the patterns of treatment, resource utilization, and costs for EGWs in 3 dermatology clinics in the Netherlands. METHODS: A total of 530 completed episodes of care for EGWs were analyzed to identify patterns of treatment and resources used. Costs of care were calculated based on 4 cost components for each visit: labor costs, material costs, indirect costs, and extra costs. RESULTS: Across the 3 sites, men required an average of 5.78 clinic visits to achieve a completed episode of care; women required an average of 6.52 visits. The distribution of visits is highly skewed, however, with a median of 4.56 visits for men and 5.55 for women. More than 80% of patients were initially treated with monotherapy. Podophyllin and cryotherapy were the principal choices for initial therapy. The mean cost, in euros, of completing an episode of care was 221.34 euro for men and 292.29 euro for women. The cost per completed or successful episode of care was 395.92 euro for men and 485.05 euro for women. The distribution of costs was also skewed, with a relatively small group of patients accounting for a considerable proportion of overall costs. Although only 31.4% of male patients recorded > or = 6 visits for a completed episode of care, this group accounted for 57.3% of the total costs of treatment for male patients. Among female patients, 43.4% had > or = 6 visits, which accounted for 73.9% of the total costs of care for female patients. Costs also varied markedly by therapy sequence chosen. Patients who remained on their initial monotherapy or combination therapy had the lowest costs; the extent to which patients switched therapies substantially affected overall costs. For those patients initially treated with podophyllin, the mean total costs of treatment, taking into account the proportion who required a change in therapy, were 204.84 euro for men and 386.38 euro for women. For those initially treated with cryotherapy, the mean cost of treatment was 193.60 euro for men and 169.23 euro for women. CONCLUSION: Current treatment options for EGWs do not appear to minimize resource utilization or help achieve complete episodes of care at the lowest possile cost.

Adult↗
PubMed1994

The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study.

PURPOSE: The objective of this study is to assess the prevalence of primary open-angle glaucoma (POAG) in a defined population in Rotterdam, The Netherlands. METHODS: The Rotterdam Study is a single-center prospective cohort study of a total population of more than 10,000 people, 55 years of age or older. For the current analysis, the first 3062 consecutive, unselected, noninstitutionalized participants were examined according to standard protocols, including perimetry. The diagnosis of POAG was based on the presence of a glaucomatous visual field defect combined with either a vertical cup: disc ratio of 0.5 or more or a cup:disc ratio asymmetry of 0.2 or more, or an intraocular pressure (IOP) more than 21 mmHg, with open and normal anterior chamber angles. RESULTS: The overall prevalence of POAG in the current study was 1.10% (95% confidence interval [CI]: 1.09, 1.11). Age-specific prevalence figures increased from 0.2% (95% CI: 0.16, 0.24) in the age group of 55 to 59 years to 3.3% (95% CI: 2.57, 4.04) in the age group of 85 to 89 years. Men had a more than three times higher risk of having POAG than women (odds ratio, 3.6). In 52.9% of the patients, POAG had not been diagnosed previously. Of these patients, 38.9% had IOPs of 21 mmHg or lower. In 8.8% of the eyes (2.9% of patients), visual acuity was 20/200 or less due to POAG. CONCLUSION: The overall prevalence of POAG in the current study was 1.1%. The prevalence of POAG was higher in men than in women. Of the untreated patients, 38.9% had IOPs of 21 mmHg or lower.

Age Factors↗
PubMed1986

Meningococcal disease in The Netherlands, 1959-1981: the occurrence of serogroups and serotypes 2a and 2b of Neisseria meningitidis.

By means of a filter radioimmunoassay and the use of monoclonal anti-2a and anti-2b antibodies, we have serotyped 3164 of 3688 strains of Neisseria meningitidis isolated from patients in The Netherlands between 1959 and 1981. Serotypes 2a and 2b were distributed differently among the major serogroups A, B, C, and W-135. Neither of the types was found among group A strains. Type 2b strains of serogroup B emerged in 1965, causing a country-wide epidemic which reached a peak incidence in March and April of 1966 and continued to predominate within group B until 1979. Type 2a strains of serogroup C were responsible for a substantial number of sporadic cases over a long period without any association with outbreaks or with a shift in the pattern of the serogroup. After the appearance of group W-135 in 1971, W-135 strains caused a small non-focal epidemic wave. The upsurge of disease due to virulent sub-populations of strains B:2b and C:2a appeared to be closely related to a basic pattern of regular cyclical waves with peak intervals which differed for serogroups A, B, and C. In recent years both serotype 2a and 2b strains within the different serogroups fell to insignificant numbers. Our results show that retrospective large-scale serotyping of collected strains provides insight into the epidemiological patterns of endemic meningococcal disease.

Antibodies, Bacterial↗
PubMed1987

Types and subtypes of 73 strains of Haemophilus influenzae isolated from patients more than 6 years of age with meningitis in The Netherlands.

Strains of Haemophilus influenzae isolated in The Netherlands between 1975 and 1984 from patients with meningitis were analysed in order to determine whether older patients are infected with particular types or subtypes of the organism. Of 1154 patients with H. influenzae meningitis 73 (6.3%) were more than 6 years of age. Thirty-one strains (42%) were of serotype b, one strain was of serotyped, one strain was of serotype f and 40 strains (55%) were non-typable. Twenty-eight type b strains were available for subtyping by analysis of the major outer-membrane proteins by sodium dodecylsulphate (SDS)-polyacrylamide gel electrophoresis (PAGE), by serotyping of their lipopolysaccharides and by biotyping. Twenty-one strains were outer-membrane protein subtype 1,24-lipopolysaccharide serotype 1 and 24 biotype I. Seventeen strains (61%) combined these characteristics. This percentage did not differ significantly from the percentage found for strains isolated from patients of all age groups (80%). The 32 non-typable H. influenzae strains analysed had different outer-membrane protein patterns as seen by SDS-PAGE. Five biotypes were found, among which biotype II was predominant (21/32). The results indicated that (i) patients more than 6 years of age were infected by subtypes of H. influenzae b strains which were not significantly different from the strains isolated from younger patients, (ii) non-typable strains of H. influenzae were much more common (55%) in the older age group than in the younger (1.2%) and (iii) that these non-typable strains were not of a particular subtype.

Adolescent↗
PubMed1999

Meningococcal carriage in relation to an outbreak of invasive disease due to Neisseria meningitidis serogroup C in the Netherlands.

BACKGROUND: a cross-sectional study on meningococcal carriage was performed in Putten, a small rural town in the Netherlands where an unusual high incidence of invasive meningococcal disease (IMD) due to Neisseria meningitidis C:2a:P1.5 occurred. The outbreak was controlled by mass vaccination of all inhabitants aged 2 to 20 years. METHODS: meningococcal carriage was studied in three groups: (1) a systematic age-specific sample of 2-20 year olds who visited the immunization clinic in Putten (January 1998: n=411); (2) children and adolescents in the same age range recruited through a kindergarten and schools in Venlo, a town where the causative strain of IMD had not been encountered (February 1998; n=374); (3) all initial carriers in Putten and a sample of non-carriers in that town (March 1998: n=145). Oropharyngeal swabs were taken for the purpose of isolating N. menigitidis. RESULTS: the prevalence of carriage was 12.4% in Putten and 18.2%, in Venlo, but the prevalence of group C meningococci was higher in Putten (1.7%) than Venlo (0.5%). N. meningitidis C:2a:P1.5 was isolated twice in Putten and not at all in Venlo. A second examination in Putten showed that 18 of the 22 repeatedly tested carriers were still carriers, and six new carriers were found among the 55 initial non-carriers. Of the two known carriers of C:2a:P1.5, one was still carrying the same strain, and the other did not participate in the second investigation. Carriage was associated with increasing family size, discotheque visits and visits to youth clubs and sports clubs. In contrast, visits to the swimming pool appeared to be related to a lower risk, as was recent antibiotic use. CONCLUSION: the prevalence of carriage with the invasive strain C:2a:P1.5 was low in the population that experienced a community-wide outbreak recently: the specific strain was not found in the reference population. This indicates a relatively high risk of developing the invasive disease for those who become infected with such strains.

Adolescent↗
PubMed2003

Levels of disability in major depression: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).

BACKGROUND: Information on the distribution of disability associated with major depression (MD) across different groups of patients is of interest to health policy and planning. We examined the associations of severity and type (a single or recurrent episode) of MD with disability in a Dutch general population sample. METHODS: We used data from the first wave (1996) of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). MD 'severity' and 'type' were diagnosed with the help of the Composite International Diagnostic Interview according to DSM-III-R criteria. SF-36 scores, days ill in bed and days absent from work were taken as indicators of disability. The differences in these variables were studied by means of variance and regression analysis. RESULTS: Recurrent MD was found not to be associated with more disability than single episode MD. Higher 'severity' classes were associated with more disability. However, the degree of disability between 'moderate' and 'severe' MD differed only very slightly. The difference in disability between non-depressed and mildly depressed individuals had a larger effect than between each successive pair of 'severity' classes. CONCLUSIONS: Three groups of MD can be distinguished based on the associated degree of disability: 'mild', 'moderate to severe' and 'severe with psychotic features'. In the future, these groups can be used to describe the distribution of disability in the depressed population. The marked difference between 'mild' MD and no MD suggests that 'mild' cases should be considered relevant.

Adult↗
PubMed2004

What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).

BACKGROUND: Depression is generally regarded as a serious, incapacitating illness. Although effective treatment strategies are available, timely recognition remains a stumbling block. We investigated the rates of health service uptake among depressed people and the specific depressive symptoms associated with service use, after adjustment for other illness characteristics and sociodemographic variables. METHODS: In a representative sample (n=7076) of the Dutch adult population, we identified 1572 subjects with lifetime major or minor depression, using the Composite International Diagnostic Interview. RESULTS: The majority (73%) of subjects with depression had sought specialised mental health care, or to a lesser extent primary care. As expected, those with more severe (vegetative), complex (anxiety-comorbid) or dangerous symptoms (suicidal ideation) were more likely to be treated in the specialised mental health sector. However, subjects with comorbid substance use dependence were less likely to receive care, especially primary care, and those with more education were more likely to receive specialised care, even after adjustment for illness characteristics. LIMITATIONS: The use of lifetime measures of depression and service use may have introduced slight recall bias, but it made the assessments less vulnerable to selection bias for chronic cases and to misclassification of subjects with some lifetime treatment experience. CONCLUSIONS: Although care for people with depression is readily accessible in the Netherlands, people with less education and people with comorbid substance use dependence remain unnecessarily out of reach of the care services. Primary care services need to be strengthened to enable the broad-scale application of stepped-care strategies.

Adolescent↗
PubMed2003

Current indications for (adeno)tonsillectomy in children: a survey in The Netherlands.

OBJECTIVE: Despite the fact that (adeno)tonsillectomy is one of the procedures most frequently performed on children, studies of current indications are scarce. The purpose of this study is to determine the indications for (adeno)tonsillectomy in children younger than 15 years of age according to Dutch ENT surgeons and general practitioners (GPs). METHODS: During a period of 8 months, 18 ENT surgeons in seven ENT practices and 210 referring GPs filled out standard questionnaires for 349 children listed for tonsil surgery. RESULTS: Apart from recurrent tonsillitis (ENT: 40%, GP: 35%), findings such as enlarged tonsils (ENT: 42%, GP: 24%) and tonsillar crypt debris (ENT: 29%, GP: 17%) and non-specific symptoms such as listlessness (ENT: 28%, GP: 19%) and poor appetite (ENT: 28%, GP: 16%) were considered important criteria for surgery. Symptoms of obstructive sleep apnea were present in 25% (ENT) and 6% (GP) of patients but were considered indicative for surgery in only 11% (ENT) and 4% (GP). In contrast to ENT surgeons, GPs considered otitis media and hearing loss relatively important for (adeno)tonsillectomy. CONCLUSIONS: Apart from the generally accepted indications such as recurrent tonsillitis and obstructive sleep apnea, other indications play an equally important role in the decision to perform tonsil surgery in The Netherlands.

Adenoidectomy↗
PubMed2002

Simulated effect of pig-population density on epidemic size and choice of control strategy for classical swine fever epidemics in The Netherlands.

We examined the importance of pig-population density in the area of an outbreak of classical swine fever (CSF) for the spread of the infection and the choice of control measures. A spatial, stochastic, dynamic epidemiological simulation model linked to a sector-level market-and-trade model for The Netherlands were used. Outbreaks in sparsely and densely populated areas were compared under four different control strategies and with two alternative trade assumptions. The obligatory control strategy required by current EU legislation was predicted to be enough to eradicate an epidemic starting in an area with sparse pig population. By contrast, additional control measures would be necessary if the outbreak began in an area with high pig density. The economic consequences of using preventive slaughter rather than emergency vaccination as an additional control measure depended strongly on the reactions of trading partners. Reducing the number of animal movements significantly reduced the size and length of epidemics in areas with high pig density. The phenomenon of carrier piglets was included in the model with realistic probabilities of infection by this route, but it made a negligible contribution to the spread of the infection.

Animal Husbandry↗
PubMed1998

An epidemiological and economic simulation model to evaluate the spread and control of infectious bovine rhinotracheitis in The Netherlands.

Bovine herpesvirus type I (BHV1), causing infectious bovine rhinotracheitis (IBR), was introduced in the Netherlands in 1971. In 1993, about 42% of the dairy cows had antibodies against BHV1. In the future, stricter requirements are anticipated regarding the health status of exported breeding cows and material. To support policymakers in their decisions on IBR eradication, a simulation model was developed in which the epidemiological and economic consequences of various control strategies were evaluated. This paper describes the model and provides an overview of some important outcomes. In the model, dairy herds were classified into different disease states based on (1) the reproduction ratio of the disease (R, defined as the number of secondary cases caused by one infectious animal) (2) the within-herd prevalence, within each value of R and (3) the expected number of infectious animals in an infectious herd within each prevalence range. The dynamic transition probability of a herd going from one state to another per week depends on direct contacts between animals, and other contacts such as transmission through fomites, indirect transmission through other species, airborne transmission and minor disease-specific routes such as venereal or iatrogenic transmission. Five control strategies, including both a voluntary vaccination program and a compulsory vaccination program for all dairy herds were evaluated. A voluntary vaccination program with 50% participation is not expected to lead to eradication of IBR. It appears that compulsory vaccination would be necessary to reach an IBR-free status.

Animals↗
PubMed1999

Laboratory decision-making during the classical swine fever epidemic of 1997-1998 in The Netherlands.

The National Reference Laboratory for classical swine fever (CSF) virus in The Netherlands examined more than two million samples for CSF virus or serum antibody during the CSF epizootic of 1997-1998. The immense amount of samples and the prevalence of border disease (BD) virus and bovine viral diarrhoea (BVD) virus infections in Dutch pig herds necessitated the diagnostic efforts of the laboratory to be focused on generating CSF specific test results throughout the eradication campaign. Detection of 82% of the 429 outbreaks was achieved through the combined use of a direct immunofluorescence and peroxidase assay (FAT/IPA) with samples (tonsils) collected from clinically-suspected pigs. This suggests that in the majority of the outbreaks, the pigs had clinical signs that were recognised by the farmer and/or veterinarians, indicating the presence of CSF virus in a pig herd. A positive diagnosis of 74% of all the tissue samples (tonsils) collected at infected pig holdings was established by FAT. More than 140,000 heparinised blood samples were examined by virus isolation, resulting in the detection of 4.5% of the infected herds. CSF virus was isolated in approximately 29% of all the blood samples collected from pigs at infected or suspected farms. Several serological surveys--each done within a different framework--led to the detection of 13.5% of the total number of outbreaks. The detection of CSF virus antibody in serum was carried out by semi-automated blocking ELISA. Approximately 28.5% of the sera which reacted in the ELISA were classified as CSF virus-neutralising antibody positive and 26.5% as positive for other pestiviruses following the virus neutralisation test (VNT). We concluded that two of the CSF laboratory diagnostic methods described were determinative in the eradication campaign: first, the FAT for the screening of diseased pigs; and second, the ELISA and VNT when millions of predominantly healthy pigs needed to be screened for the presence of CSF serum antibody. Decision-making on the basis of results generated by either method can, however, be seriously hindered when samples are examined from pig herds with a high prevalence of non-CSF pestiviruses.

Animals↗
PubMed1999

Transmission of classical swine fever virus within herds during the 1997-1998 epidemic in The Netherlands.

In this paper, we describe the transmission of Classical Swine Fever virus (CSF virus) within herds during the 1997-1998 epidemic in The Netherlands. In seven herds where the infection started among individually housed breeding stock, all breeding pigs had been tested for antibodies to CSF virus shortly before depopulation. Based upon these data, the transmission of CSF virus between pigs was described as exponential growth in time with a parameter r, that was estimated at 0.108 (95% confidence interval (95% CI) 0.060-0.156). The accompanying per-generation transmission (expressed as the basic reproduction ratio, R0) was estimated at 2.9. Based upon this characterisation, a calculation method was derived with which serological findings at depopulation can be used to calculate the period in which the virus was with a certain probability introduced into that breeding stock. This model was used to estimate the period when the virus had been introduced into 34 herds where the infection started in the breeding section. Of these herds, only a single contact with a herd previously infected had been traced. However, in contrast with the seven previously mentioned herds, only a sample of the breeding pigs had been tested before depopulation (as was the common procedure during the epidemic). The observed number of days between the single contact with an infected herd and the day of sampling of these 34 herds fitted well in the model. Thus, we concluded that the model and transmission parameter was in agreement with the transmission between breeding pigs in these herds. Because of the limited sample size and because it was usually unknown in which specific pen the infection started, we were unable to estimate transmission parameters for weaned piglets and finishing pigs from the data collected during the epidemic. However, from the results of controlled experiments in which R0 was estimated as 81 between weaned piglets and 14 between heavy finishing pigs (Laevens et al., 1998a. Vet. Quart. 20, 41-45; Laevens et al., 1999. Ph.D. Thesis), we constructed a simple model to describe the transmission of CSF virus in compartments (rooms) housing finishing pigs and weaned piglets. From the number of pens per compartment, the number of pigs per pen, the numbers of pigs tested for antibodies to CSF virus and the distribution of the seropositive pigs in the compartment, this model gives again a period in which the virus most probably entered the herd. Using the findings in 41 herds where the infection started in the section of the finishers or weaned piglets of the age of 8 weeks or older, and of which only a single contact with a herd previously infected was known, there was no reason to reject the model. Thus, we concluded that the transmission between weaned piglets and finishing pigs during the epidemic was not significantly different from the transmission observed in the experiments.

Animals↗
PubMed1999

Quantification of the transmission of classical swine fever virus between herds during the 1997-1998 epidemic in The Netherlands.

In this study, we describe a method to quantify the transmission of Classical Swine Fever Virus (CSFV) between herds from data collected during the 1997-1998 epidemic in The Netherlands. From the contacts between infected herds and the serological findings shortly before depopulation, we estimated the week of virus introduction and the length of the period over which the herd emitted virus for each CSFV-infected herd. From these data, we estimated the infection-rate parameter beta (the average number of herds infected by one infectious herd during one week) and the herd reproduction ratio, Rh (the average total number of secondary outbreaks caused by one infectious herd, i.e. in its entire infectious period), using a SIR-model for different sets of CSF control measures. When Rh > 1, an epidemic continues to grow. On the other hand, when Rh < 1 an epidemic will fade out. During the phase before the first outbreak was diagnosed and no specific measures had been implemented, beta was estimated at 1.09 and Rh at 6.8. In the subsequent phase infected herds were depopulated, movement restrictions were implemented, infected herds were traced forward and backward and the herds in the protection and surveillance zones were clinically inspected by the veterinary authorities (regional screening). This set of measures significantly reduced beta to 0.38. However, Rh was 1.3 and thus still > 1. Consequently, the number of outbreaks continued to grow. After a number of additional measures were implemented, the value of Rh was reduced to 0.5 and the epidemic came to an end. These measures included pre-emptive slaughter of herds that had been in contact with infected herds or were located near an infected herd, increased hygienic procedures, replacement of transports of pigs for welfare reasons by killing of young piglets and a breeding ban, and regional screening for CSF-infected herds by local veterinary practitioners.

Animal Husbandry↗
PubMed1999

The 1997-1998 classical swine fever epidemic in The Netherlands--a survival analysis.

The aim of this analysis was to characterise the temporal pattern of infection during the 1997/98 classical swine fever (CSF) epidemic in The Netherlands and hence identify and quantify risk factors for infection in different enterprise types and areas. Survival analysis and Cox proportional hazards regression were used to describe the epidemic. Substantial differences in temporal survival patterns (herd breakdown rate) were found between areas where different control policies operated. Factors with a significant influence on the infection hazard of individual herds included: sow numbers as a percentage of total sows and fatteners (HR = 3.38 for mixed herds (0.1-60% sows) vs. fattening herds (0% sows) and HR = 2.74 for breeding herds (60-100% sows) vs. fattening herds), the number of 'transport contacts per month' (>0.3 vs. <0.3; HR = 4.11), pig density (pigs/km2) in the area (HR1000 pigs 1.48) and herd size (HR100 pigs = 1.01). Pre-emptive slaughter in an area appeared to be associated with lower subsequent disease levels. Higher frequency of transport contacts for welfare slaughter during the epidemic, however, well regulated and controlled, was associated with a substantially higher risk of becoming infected. The positive association of a higher pig density with CSF indicates the potential importance of local spread as a factor in disease transmission and emphasizes that dilution of the pig population can contribute to reduction in CSF occurrence. This analysis suggests however, that if pre-emptive slaughter can promptly be applied effectively in an area after initial diagnosis, pig density is then not a significant factor. Mixed and breeding herds had a higher probability of becoming infected than fattening herds, possibly due to different types and frequencies of inter-herd contacts. These contacts continue to some extent during the epidemic, despite the standstill of animal movements.

Animal Husbandry↗
PubMed2003

Infrastructure of radiotherapy in the Netherlands: evaluation of prognoses and introduction of a new model for determining the needs.

BACKGROUND AND PURPOSE: In the Netherlands, the radiotherapy infrastructure is regulated by a Governmental license system. This requires timely and realistic prognostication of the needs for radiotherapy. In the present study, the latest prognoses (1993) and the realized changes in infrastructure are evaluated and a new prognosis for the period until 2010, which has been calculated using a new model, is presented. MATERIALS AND METHODS: Data on cancer incidence and use of radiotherapy were obtained from various published national reports and from a survey of all radiotherapy departments. RESULTS: The cancer incidence over the period 1993-1997 was about 10% higher than predicted. In 1996 and 1997, the percentage of new cancer patients treated with radiotherapy was 45.6 and 48.2%, respectively. The absolute number of newly irradiated patients was about 10% higher than foreseen in the prognosis. The needs for radiotherapy infrastructure not only depend on epidemiological data and changes in indications for radiotherapy, but also on changes in types of treatment with different workloads. A new model, which uses four categories for teletherapy and four categories for brachytherapy is described and a new prognosis for the required number of linear accelerators and staff up to the year 2010 is presented. CONCLUSION: The original prognosis on cancer incidence and radiotherapy patients underestimated the actual figures considerably. The new prognosis, based on a model, which not only accounts for an increase in number of patients, but also for changes in treatment techniques, is expected to more accurately predict and acquire the required radiotherapy capacity.

Aged↗