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PubMed1987

Dose intercomparison at the radiotherapy centres in The Netherlands. 1. Photon beams under reference conditions and for prostatic cancer treatment.

In 1985, a dosimetry intercomparison was performed at all 20 radiotherapy centres in The Netherlands. Absorbed dose was determined with an ionization chamber under reference conditions in a water phantom for cobalt-60 gamma-ray and megavoltage X-ray beams. The mean difference between measured and stated dose values was 0.5% with a standard deviation of 1.9%, but up to 6% at maximum. As soon as all institutes apply a common dosimetry protocol, this maximum difference will reduce to about 2%. In addition, an anthropomorphic phantom was irradiated to simulate the treatment of a prostatic cancer. The dose, determined with an ionization chamber at the isocentre and thermoluminescent dosimeters (TLD) powder at several points situated in the target volume, the bladder and the rectum, was compared with the stated dose calculated with the local planning system. Only small differences were found between the measured and stated dose at the isocentre: on the average 1.5%, with a standard deviation of 1.5%. The difference between stated and measured dose at several points situated in the target volume was on the average 0.4%, with a standard deviation of 5.2%. Almost the same result was found for a point situated in the bladder. In the rectum, the average difference was about 4%, however, with a large standard deviation, 18%, due to the relatively steep dose gradient at these points.

Gamma Rays↗

PubMed2003

Health care use by diabetic patients in the Netherlands: patterns and predicting factors.

AIMS: Diabetic patients require care from a variety of health care providers, but little is known about their actual use of health care. Aims of this study were to (1) obtain information on health care use by diabetic patients in the Netherlands, (2) distinguish patterns of health care utilisation among these patients, and (3) develop insight into the factors predicting these patterns. METHOD: Data on 388 diabetic patients were extracted from a nationally representative database of patients with chronic disease. Data on health care utilisation and background variables were collected in 1998 by means of a survey. Patients' GPs registered information about medical diagnosis, illness duration and co-morbidity. Analysis included descriptive statistics, as well as cluster and logistic analysis. RESULTS: Diabetic patients use a wide range of services, but large differences exist. Four patterns of health care utilisation could be distinguished: a pattern of low consumption, one of moderate consumption with a central role for internal medicine, one of more extensive diabetes care consumption, and one of high medical and home care consumption. Type 1 diabetes appeared to be an important determinant of the moderate, mainly internal medicine pattern and the more extensive diabetes care pattern. The pattern of high medical and home care was not predicted by diabetes type, but by the presence of co-morbidity and by poor self-rated health. CONCLUSION: Despite the fact that diabetic patients use a wide range of health care services, there seems to be a problem of under utilisation, especially among type 2 diabetic patients.

Adult↗

PubMed1996

Diabetes monitoring system in The Netherlands.

Under the aegis of the European Regional Offices of the World Health Organization (WHO) and the International Diabetes Federation (IDF) a joint action programme to contest the growing burden of diabetes has been drawn up. The St. Vincent Declaration (1980) specifies targets for diabetes care, the reduction of complications, the integration into society and the education of the diabetic individual. The WHO/IDF have drawn up a data set to monitor progress in reaching the targets of the St. Vincent Declaration. The objective of the project Diabetes Monitoring System is to examine the possibilities for implementing a longitudinal-based and standardised diabetes monitoring system in the Netherlands. Although computerised recording systems for diabetes are seldom used and the agreement with the WHO/IDF data set varies substantially, the willingness of physicians to participate is clearly sufficient. This principally explorative project will hopefully lead to the implementation of a monitoring system in which a widely accepted data set is recorded to establish improvements in quality of care and to perform epidemiological research.

Data Collection↗

PubMed2000

Diabetes nephropathy in the Netherlands: a cost effectiveness analysis of national clinical guidelines.

BACKGROUND: In the Netherlands a program on quality assurance in medical care has started in 1996. Clinical professionals, patient organizations and health services researchers formulate evidence based guidelines with a concomitant cost-effectiveness analysis. OBJECTIVES: To examine the cost-effectiveness of guideline recommendations for prevention of nephropathy in diabetes mellitus type 1 and 2. RESEARCH DESIGN: A semi-Markov compartment model was developed. Data from international publications on epidemiological surveys and randomized trials, together with national data on health care use and costs, were used to feed the model. A cohort of diabetes patients without renal disease enters the model. MEASURES: Complication (end-stage renal disease) free years, QALY's, and life-time medical costs per patient treated according to guideline recommendations or current anti-diabetic strategy. RESULTS: Guideline treatment for type 1 diabetes yields 4.2 complication free life years, at a cost-effectiveness ratio of 13 500 (Dutch guilders) NLG per QALY. Type 2 diabetes patients gain 0.2 complication free life years at a cost-effectiveness ratio of 31 000 NLG per QALY. CONCLUSION: Guideline development for diabetes nephropathy, with concomitant cost-effectiveness calculations, has resulted in a transparent guideline with explicit information on long-term cost and effects. The project has brought health care providers and health services researchers together.

Adolescent↗

PubMed2003

Client demands and the allocation of home care in the Netherlands. A multinomial logit model of client types, care needs and referrals.

The purpose of this paper is to estimate the volume and composition of referrals to home care on the basis of applicant characteristics. The relationships between the background and care needs of applicant groups on the one hand and the referral of home care packages on the other, are studied by means of a multinomial logit model. The model is estimated on the basis of more than 7000 requests for home care in the northern part of the Netherlands. Home health care institutions have to deal with clients who arrive from many different branches of the health care system. As a result the services or products provided by home health care institutions are characterized by wide variation. In the modeling emphasis has, therefore, been placed on the differentiation of clients and products. We find for instance that elderly chronically ill applicants have a greater chance of being referred for domestic help only, while applicants with psychosocial disorders are more liable to be offered packages that include social support. Patients discharged from hospital have a greater chance of a referral to domestic help only when they are slightly disabled, and are more likely to be offered packages including physical care when they are more disabled. The model has a range of policy applications in assessing the impact of changes in the health care system on the volume and structure of the demand for home care services. Examples are presented of the consequences of the ageing population and earlier discharge from hospitals on demand for home care packages.

Activities of Daily Living↗

PubMed2003

Development of integrated care in England and the Netherlands: managing across public-private boundaries.

This paper addresses the impact of the public-private mix in the Dutch and English health and social care systems on the development and delivery of integrated care. Integrated care is conceived of as an organisational process of coordination which seeks to achieve seamless and continuous care, tailored to the patients' needs and based on a holistic view of the patient. We describe both systems' structures and characteristics from a historical perspective, which means that developments and processes within the systems are put in the spotlight. We demonstrate that the dividing- or fault-lines, such as the financial split between short-term and long-term care in the Netherlands and the divisions between health and social care as well as between the public, private and voluntary sectors in England have hindered integrated care development and delivery in both countries. Contradictory interests, differences in professional and organisational cultures, power relations, and mistrust between and within these sectors have had a clear impact on integrated care development and delivery within networks of public authorities and public and/or private providers. We explain these phenomena in terms of network theory as a basis for drawing lessons for policy makers and those developing integrated care networks.

Attitude to Health↗

PubMed1996

Diffusion of six surgical endoscopic procedures in the Netherlands. Stimulating and restraining factors.

The diffusion of six surgical endoscopic procedures in the Netherlands was investigated. Questionnaires were sent to 138 laparoscopic surgeons. They were asked which of the following laparoscopic procedures they had adopted in their hospital: cholecystectomy, appendicectomy, Nissen fundoplication, inguinal hernia repair, large bowel resection and thoracoscopic procedures. Furthermore, they were asked to indicate the influence of 13 pre-defined factors: "budget', "competition', "conference', "extra benefit', "media', "nature of the technology', "patient demand', "planning/logistics', "reimbursement', "service industry', "support industry', "surgical technique' and "training/course' on the adoption of those procedures. The adoption rates for the procedures were: 100%, 69%, 19%, 43%, 19% and 52%, respectively. In general, factors were assessed more positively by adopters than by non-adopters. Significant differences were mainly found for "extra benefit', "nature of the technology', "surgical technique' and "conference'. The surgeon's perception of the additional benefits of an endoscopic technique and, to a lesser degree, of its technical aspects were the most important factors in deciding whether or not to adopt a procedure. In an ideal diffusion model, a description is given of when and how the 13 factors can influence the diffusion of an endoscopic procedure in the desired direction. In this model, the extra benefit of a new procedure must be proven before other factors are allowed to influence the diffusion.

Budgets↗

PubMed1987

Infections with Coxiella burnetii in man and animals in The Netherlands.

A serological survey using an indirect micro-immunofluorescence test among people considered to be at risk of contracting an infection with C. burnetii yielded 75.9% seropositives, whereas controls from three geographical regions in the Netherlands showed a mean of 45.5% with considerable differences per region and sex. A comparable retrospective sample from 1968 showed 46% seropositives. Sera from people aged 0 to 19 years yielded 38.3% positives (8). The preliminary data of a survey among cattle using an indirect ELISA showed antibodies against C. burnetii in 21.4% of 1160 animals in 234 dairy herds and lower percentages in other types of herds. Among 3603 sheep from 191 flocks, 3.5% appeared to be seropositive and a limited survey among goats demonstrated specific antibodies in less than 1%. A total of 219 dogs and 26 cats was examined with negative results. The results of a clinical and epidemiological study of 51 cases of human Q fever are summarized. Of these patients, 13 were female and 18 were younger than 3 years of age. In 29 cases the infection could be associated with direct or indirect contact with animals or animal products of different species. Family and other contacts of 29 patients were serologically examined and 61% were positive for specific IgG and 10% also for IgM. In addition, 22 babies from seropositive mothers were serologically examined and none was found positive for specific IgM. The epidemiological implications of these observations are discussed.

Adolescent↗

PubMed1991

Melanoma/skin cancer screening clinics: experiences in The Netherlands.

In 1989 and 1990 we conducted two free melanoma/skin screening clinics in Oss and Arnhem in the Netherlands. The study was carried out along the lines of the recent campaigns supported by the American Academy of Dermatology. Of 2564 persons screened, 53 had melanoma or nonmelanoma skin cancer (2.1%). Compliance with follow-up for persons with suspected melanoma/skin cancer was adequate (93 of 103; 90.3%).

Basal Cell Carcinoma↗

PubMed1999

National guidelines for infection control in The Netherlands.

National guidelines for the prevention of hospital infections in The Netherlands were established by the Working Group on Infection Prevention (WIP) in 1981. Since 1992 these guidelines have functioned as national standards for infection control applicable in all hospitals. The organization of the WIP, the process of developing guidelines and the current guidelines are described. The working group has also produced guidelines for nursing homes, institutions for the mentally handicapped and dentists.

Cross Infection↗

PubMed1989

Submersion cases in The Netherlands.

Epidemiologic analysis of submersion cases admitted to the intensive and respiratory care unit showed that several interrelated factors preceded submersion. Accidental submersion and traffic accidents represented one third of the causes of submersion. Other relevant causes were illness (29.9%), psychosocial causes (20.1%), alcohol (18.1%), and suicide (9.1%). Age distribution, gender, and mortality rate were different in each group. Young age, submersion during recreational activities, summer months, and normothermia were epidemiologic factors with a favorable prognosis. Our data were compared with national data. WHO-ICD code 994.1 (drowning and nonfatal submersion) is the best entrance for epidemiologic analysis. Five hundred twenty deaths and 690 hospital admissions due to submersion occur in The Netherlands each year. About 460 victims die before they reach a hospital.

Accidents↗

PubMedDate not supplied

The public and private problem of euthanasia. A comparison of The Netherlands and the United States.

Euthanasia is an emerging public problem. The recent "medicalization" of the dying process in industrialized nations has engendered a fear of a painful and undignified death and the loss of control over one's final days. For people who live in societies with advanced medical resources and technology, euthanasia seems the only sure way to have "a good death." This article examines the public and private faces of euthanasia and provides another moral lens through which to view the issue. The article includes an interview with the son of a 78-year-old man who had active euthanasia performed by a family physician in the Netherlands.

Aged↗

PubMed2001

Low prevalence of GAD and IA2 antibodies in schoolchildren from a village in the southwestern section of the Netherlands.

Glutamic acid decarboxylase (GAD) and insulinoma antigen 2 (IA2) antibodies are increasingly used as a tool to predict type I diabetes in children and as a differential diagnostic tool to distinguish type I and type II diabetes in adults. However, the background frequency of these antibodies in the general population has not been extensively studied and may differ between countries. The current study aims to establish the frequency of GAD and IA2 antibodies in an unselected population of schoolchildren and confirm the previously reported low prevalence of islet cell antibodies (ICA) in the general Dutch population. The study population consisted of 1403 unselected schoolchildren. All children were tested for GAD antibodies, and 1085 children were analyzed for IA2 antibodies by radiobinding assay. Development of diabetes was recorded during a 7-year follow-up. Five children (0.4%) were positive for GAD antibodies, one child (0.1%) was positive for IA2 antibodies. Two children developed diabetes during follow-up, one was positive for GAD antibodies only, the second was positive for both GAD and IA2 antibodies. The frequency of GAD and IA2 antibodies in the southwestern part of The Netherlands is low. This observation is in concordance with earlier studies on ICA in Dutch schoolchildren. For future diabetes prediction and intervention trials it is important to establish the background frequencies and predictive power of antibody screening in different populations.

Autoantibodies↗

PubMed1996

Home births in The Netherlands: midwifery-related factors of influence.

OBJECTIVE: identification of midwifery-related factors influencing the varied percentage of home births in the practice of Dutch midwives. DESIGN: cross-sectional study. SETTING: independent midwifery practices in the Netherlands. PARTICIPANTS: 115 independent midwives. MEASUREMENTS: recordings of time spent on professional activities over three weeks. Questionnaires were completed on practice characteristics and opinion regarding the place and risks of birth. FINDINGS: attending home births is no more time consuming for midwives than assisting at short-stay hospital births. The percentage of home births in a practice is not related to the average number of hours worked per week, nor to the size or type of practice. The percentage of home births is lowest in major cities. Midwives who think more positively about home births and do not consider these to involve greater risks assist at more home births. IMPLICATIONS FOR PRACTICE: the assumption that a heavy workload will interfere with the policy of de-medicalising birth is found to be false. The opinion of a midwife about the desirability and safety of home confinement has a slight positive effect on the percentage of home births in her practice. Those attempting to promote an increase in births at home must take these factors into account.

Attitude of Health Personnel↗

PubMed2003

Polybrominated diphenyl ethers in influents, suspended particulate matter, sediments, sewage treatment plant and effluents and biota from the Netherlands.

Polybrominated diphenyl ethers (PBDEs) have been determined in 133 samples of suspended particulate matter (SPM), sediments, sewage treatment plant (STP) influents and effluents, fish and mussels from various locations in The Netherlands, as a part of a large Dutch national study on estrogenic contaminants in the aquatic environment (LOES project). Some PBBs were also analysed but not found in any of the samples at detectable levels. PBDEs and PBBs were included in this study because indications of long term effects on the balance of endocrine systems were found in the literature. High concentrations of decaBDE (up to 4600 g/kg dry weight) were found in SPM from the Western Scheldt. These levels are possibly related to spillage during use of PBDEs in industries upstream the river Scheldt in Belgium. SPM was identified as an important carrier for higher brominated diphenyl ethers in the aquatic environment. DecaBDE was not found at detectable levels in flounder, bream and mussels. The bioaccumulation of decaBDE in these fish and shellfish samples is apparently limited. Lower brominated PBDE congeners (tetra/penta) were also found in the Western Scheldt as well as in the Rhine delta and the river Meuse, but in much lower concentrations than the decaBDE. In contrast with decaBDE, the tetra and pentaBDEs were found in biota. It was concluded that at least a small part of the PBDE can pass STPs.

Animals↗

PubMed2003

The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD )-2.

BACKGROUND: The guidelines from the US National Kidney Foundation Dialysis Outcomes Quality Initiative on peritoneal dialysis (PD) assume equivalence between the peritoneal and the renal solute clearance. The authors examined in a prospective cohort study of incident dialysis patients the relative contribution of residual renal function and peritoneal clearance to patient survival and quality of life (QoL). METHODS: The authors analyzed the longitudinal data on residual renal function, clearance by dialysis, and QoL of those patients who were treated with PD 3 months after the start of dialysis and participated in a prospective multicenter study in the Netherlands (n = 413). RESULTS: The mean age was 52 years, the mean residual glomerular filtration rate (rGFR) at 3 months was 4.1 mL/min/1.73 m2 (SD: 2.7), and the mean peritoneal creatinine clearance (pCrCl) at 3 months was 4.1 mL/min/1.73 m2 (SD: 1.1). The 2-year survival was 84%. For each mL/min/1.73 m2 increase in rGFR, a 12% reduction in mortality rate was found (relative risk of death [RR] = 0.88, P = 0.039). In contrast, no significant effect of pCrCl on patient survival was established (RR = 0.91, P = 0.47). The differential impact of rGFR and pCrCl was confirmed in an analysis on combined patient and technique survival and in an analysis on a number of generic and disease-specific dimensions of QoL. CONCLUSION: The beneficial effect of renal clearance and the absence of an effect of peritoneal clearance in the range of values common in current practice on patient outcome indicate that the 2 components of total solute clearance should not be regarded as equivalent. Higher peritoneal clearance targets do not necessarily improve patient outcome.

Adult↗

PubMed2001

The marginal success of regulated competition policy in the Netherlands.

In the second half of the 1980s the government in the Netherlands adopted a regulated competition policy as part of a comprehensive programme designed to restructure the health care system. The programme was a product of its social and political context, promoted by a group of political entrepreneurs and created to improve efficiency. Despite the initial political support and a long political debate the government had to acknowledge by 1992 that the restructuring would not take place. But changes fostered limited competition between sickness funds and more extensive competition in the small market for supplementary policies. This, however, has not led to sickness funds becoming powerful purchasers that forced hospitals and doctors to improve their efficiency. Rather, they compete for subscribers, become part of large insurance conglomerates, and market more supplementary options. Culturally, health care institutions have become more entrepreneurial, taken up more business concepts, and made the language of markets, products and consumer sovereignty more common. The impact of these changes on the health care system is still unknown, but they create pressure for more health care services, leaving the government with problems that equal those of the 1980s.

Government↗

PubMed2002

Combining a job and children: contrasting the health of married and divorced women in the Netherlands?

The research question of this paper is whether the combination of paid employment and taking care of children promotes or damages the health of married and divorced women in the Netherlands. To answer this question, data are used from 936 women aged 30-54 years who were either living with a partner (N = 431) or divorced and living alone 505). The findings show that combining a job outside the home and childcare does not harm women's health, irrespective of the length of the working week and the age of the children. In fact, some work-childcare combinations are associated with better health. This is true for both married and divorced women and especially holds true in the case of a part-time job and having older children. Two effects are responsible for the findings: enjoying good health enables mothers to work outside the home (selection effect) and working outside the home promotes mothers' health (health effect).

Adolescent↗