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PubMed1998

Confidential enquiry into maternal deaths in The Netherlands 1983-1992.

OBJECTIVE: To determine the causes of maternal death in The Netherlands. STUDY DESIGN: Nationwide Confidential Enquiry into the Causes of Maternal Deaths during the period 1983-1992. RESULTS: Of 192 direct and indirect maternal deaths, 154 (80%) were available for the Enquiry. The most frequent direct causes were (pre-)eclampsia, thrombo-embolism, obstetrical haemorrhage and sepsis. Cerebro- and cardiovascular disorders were the most frequent indirect causes of death. Age above 35 years and parity 3 or more are related to higher maternal mortality. Women from non-caucasian origin are more prone to death in comparison to caucasian women. Autopsy was performed in 88 cases (57%). Of the 24 women where labour started at home, the place of birth played a significant role in delay in four. CONCLUSIONS: More efforts should be made to have a higher percentage than 80% available for the Confidential Enquiry as in the UK where only 1-4% of deaths are not available for similar purposes. Also, the autopsy rate of 57% is much lower than in the UK (82%). Special strategies should be developed to improve maternal health of populations at higher risk such as women of high age and parity and immigrant populations.

Adolescent↗

PubMed2003

Costs of prostate cancer, metastatic to the bone, in the Netherlands.

OBJECTIVE: To quantify medical costs associated with bone metastases in patients with prostate cancer. Bone metastases in patients with prostate cancer are associated with considerable morbidity, negatively impact quality of life, and can add substantially to medical costs, given a median survival of 30-35 months from diagnosis of bone metastases. METHODS: A retrospective cost analysis from both a community and university hospital in The Netherlands was conducted. Twenty-eight patient records (14 from each hospital) were investigated to assess the impact of skeletal-related events (SREs), including fractures, spinal cord compression, and radiotherapy, on total direct medical costs and cost of hospitalization. Costs are given in EUROS (Euros). RESULTS: The average total cost of treatment was Euros 13,051 per patient over the 24-month follow-up period, which includes an average cost of Euros 6973 per patient to treat SREs. Treatment of SREs more than doubled total treatment costs. Patients in this analysis experienced, on average, one SRE per year, and the cost of SREs varied from Euros 1187 to Euros 40,948. CONCLUSIONS: Occurrence of SREs contributes significantly to the cost of care for patients with advanced prostate cancer. These data suggest that bisphosphonates, which can reduce pain and SREs, may reduce healthcare costs.

Aged↗

PubMed2000

Cross-sectional serological survey on gastrointestinal and lung nematode infections in first and second-year replacement stock in the netherlands: relation with management practices and use of anthelmintics.

A cross-sectional survey was carried out on 86 farms randomly distributed in The Netherlands. After housing following the first and the second grazing season (FGS and SGS) serum samples were collected to determine IgG levels against Cooperia oncophora and Dictyocaulus viviparus, and the pepsinogen content. A questionnaire was used to inquire on grazing management practices and the use of anthelmintic drugs. On 80.7 and 60.2% of the farms FGS and SGS animals, respectively, were treated at least once with an anthelmintic drug. The percentage for the SGS animals indicates that the use of anthelmintic drugs in those animals has increased enormously over the last 10-15 years. Generally, parasitic nematode control in the FGS is good on most farms, but it can be characterised as being overprotective. There is a tendency that if anthelmintic drugs are used in the FGS they also are used more often in the SGS. On 12 farms (14%), no anthelmintic drugs were given in the FGS and the SGS. These farms did not differ from the others with respect to management practices in any obvious way. The serological results were in general very low, indicating low levels of exposure to gastrointestinal nematode infection in both FGS and SGS animals. This was not surprising in view of the good to high level of nematode control practices reported by the farmers. Although not statistically significant, a consistent result was that serological results for the SGS animals were more often positive or on average higher on those farms where FGS parasite control tended to be excessive. For D. viviparus, a prevalence rate of 41% positive farms was found. Following comparison with previous data, it is speculated that lungworm (sero-)prevalence in replacement stock may be declining as a result of continuing high levels of parasite control in replacement stock. It is concluded that the results confirm previous surveys, lending support to the conclusion that parasitic nematode control on Dutch dairy farms, certainly in FGS calves, is good but tends to be overprotective.

Animal Husbandry↗

PubMed2000

Resistance of Fasciola hepatica against triclabendazole in cattle and sheep in The netherlands.

In the winter of 1998/1999, sheep on a farm in the province of North Holland, The Netherlands, died from subacute and chronic liver fluke disease despite four previous treatments with triclabendazole (TCBZ). Faecal examinations of sheep and cattle on the farm showed high number of liver fluke eggs. In a randomised clinical trial, the fluke egg output was monitored weekly for 3 weeks in sheep which were treated with TCBZ or with closantel; in dairy cows treated with TCBZ or with clorsulon; and in heifers treated with TCBZ or clorsulon. The results showed a significant reduction of 99.7, 98.1 and 99.2%, respectively, in fluke egg output at 21 days in all non-TCBZ treated animals. TCBZ treatment produced percentage decreases of 15.3, 4.3 and 36.6%, respectively. These results are highly indicative of the presence of TCBZ-resistant Fasciola hepatica in sheep and cattle on this farm.

Animals↗

PubMed1997

Variation in infection levels with gastrointestinal nematodes in first-year grazing calves in The Netherlands.

ELISAs with crude adult Ostertagia and crude adult Cooperia antigens were used in a survey to monitor the levels of gastrointestinal nematode infections of 21 dairy calf herds. This survey was performed at the end of the grazing season of 1994 in The Netherlands. The mean extinction value of antibody levels of each herd was compared with those of four groups of reference sera of animals that had experienced moderate infection levels (one group), low infection levels (two groups) or no infection (permanently housed group). This was based on faecal examination, pasture larval counts, serum pepsinogen values and worm counts in tracer and main trial calves. The results of the ELISAs indicated a wide variation in infection levels. Most herds (90%) had infection levels equal to, or even lower than, those of the low infection-reference groups. Herds that had been moved every 2 or 3 weeks had lower infections than set stocked herds. The length of the grazing season showed a positive correlation with Ostertagia, but not Cooperia, antibody titres. There was no evident correlation between infection levels and anthelmintic treatment. The implications of these observations in relation to management and nematode control are discussed.

Animal Feed↗

PubMed1998

Management practices and use of anthelmintics on dairy cattle farms in The Netherlands: results of a questionnaire survey.

In December 1996, a questionnaire about farm management and parasite control measures in calves was sent to 956 randomly chosen dairy cattle farmers in The Netherlands. Another 150 farmers in the vicinity of Deventer who had vaccinated their calves in 1995 against lungworm were approached with the same questions. Our object was to investigate the consequences on worm control of the withdrawal of the lungworm vaccine from the market for reasons of possible BSE contamination of the vaccine. OF the returned questionnaires, 411 (43%) of the 'at random' group and 89 (59.3%) of the 'Deventer' group were valid. The most important data with regard to the farms of the 'at random' group (41) were: mean area 31.6 ha, mean number of calves 23, heifers 23 and milking cows 53. Sheep (mean 37) were present on 18.3% of the farms. With regard to management: 74.5% of the farmers turned the calves in their first year onto pasture, 25.5% kept them indoors. The average time on pasture was ca. 5 months. Rational grazing was practise on 81.4% of the farms, on 18.6% calves were set stocked. The first pasture of the calves was mown before turn-out on 72.9% of the farms. On 48.2% of these farms, calves were always moved to mown pastures. With regard to treatments: 33.8% of the farmers vaccinated their calves against lungworm in the years 1993, 1994 and 1995. Despite the withdrawal of the vaccine from the market in 1996, 7.2% of the farmers vaccinated their calves as recommended, with two doses, and 13.1% with a single dose. At turn-out, 41.5% of the farmers gave the calves a preventive anthelmintic treatment. Of these treatments, 66.9% were sustained of pulse release long acting device. During the grazing season, 36.6% of the farmers treated their calves. After housing 50.3% of the farmers gave a treatment. Signs of lungworm infection were noticed on 18.6% of the farms. Of the 'Deventer' group (89 farmers), 96.6% turned the calves out, Of these farmers, 86.0% had used the lungworm vaccine in 1995. In 1996, 52.7% of the farmers had vaccinated the calves:36.5% with a single dose and 16.2% with the double dose. Of the 35 farmers who did not vaccinate in 1996, 62.9% gave a preventive treatment at turn-out. Clinical signs of lungworm infection were not observed on the 12 farms which vaccinated the calves twice. On 11% of the farms which vaccinated once and on 14% of the farms which did not vaccinate, signs of lungworm infection were observed. It is concluded that more than 80% of Dutch dairy cattle farmers take appropriate measures to control gastrointestinal nematode and lungworm infections in calves in their first grazing season by grazing on aftermath, rotational grazing on mown pastures combined or not with preventive anthelmintic treatments. However, combinations of aftermath grazing and preventive treatment occurred on 30% of the farms. This may be overprotective and may prevent sufficient build up of immunity, causing worm problems at a later age. The withdrawal of the lungworm vaccine from the market did not cause a rise in lungworm problems. Some farmers did vaccinate, despite the withdrawal. The majority used other preventive treatment measures, mainly the application of long acting boli.

Animals↗

PubMed1991

Incidence of medically treated burns in The Netherlands.

During the period January 1988 to December 1989, medically treated burn injuries in The Netherlands were recorded prospectively by three registration systems. These systems cover patients treated in burn units, in general and university hospitals, and by general practitioners. Incidence rates and 95 per cent confidence intervals were calculated, and basic epidemiological data about severity and localization of the burns and about accident circumstances were collected. The overall incidence rate of medically treated burns over all levels of medical care is estimated to be about 280 per 100,000 persons per year. This overall incidence figure appeared to be about three times as high for 0-4-year-old children: 775 per 100,000 per year. At all levels of medical care, scalds are the most frequent type of burn, resulting in an overall incidence rate among 0-4-year-old children of 430 per 100,000 per year. Incidence rates are lowest among the elderly (55 years and over), but this age group suffers a higher mortality from burns. Furthermore, it appeared that males are more prone to serious burns than females, whereas female are more often treated for less severe burns. Most of the accident circumstances for serious burns were related to professions, whereas most of the circumstances for less severe burns were related to household activities.

Adolescent↗

PubMed1997

Infrastructure for radiotherapy in The Netherlands: development from 1970 to 2010.

In 1993 the radiotherapy advisory committee of the Dutch Health Council published its report on the developments of infrastructure for radiotherapy in The Netherlands during the last 10 years and the prognosis for future needs until 2010. Based on demographic trends, the expected incidence of cancer, the role of radiotherapy in the treatment of cancer, and the workload assessment in a model department, two scenarios are presented for the development of infrastructure. According to the committee, the Quality Scenario would be the most appropriate.

Cancer Care Facilities↗

PubMed1996

The history of radiotherapy in The Netherlands.

Soon after the discovery of x-rays by W. C. Roentgen in 1895, a publication on fluoroscopy and x-ray pictures/films appeared in the Dutch medical literature in February 1896. The present article reviews the subsequent developments in the field of therapeutic radiology in The Netherlands and, in particular, the evolution of radiation oncology as a distinct medical specialty.

History, 19th Century↗

PubMed2000

The 1997/1998 epizootic of swine fever in the Netherlands: control strategies under a non-vaccination regimen.

The 1997/1998 epizootic of classical swine fever (CSF) in an area with high pig density in the Netherlands is described. The epizootic, which numbered 429 outbreaks, was controlled and finally eradicated after 14 months without resorting to vaccination. A further almost 1300 herds (1.1 million pigs) at close proximity of confirmed outbreaks were preventively culled because of the risk of having been infected. The pros and cons of this so-called "pre-emptive slaughter" are discussed. The long-lasting movement restrictions caused severe overcrowding especially in breeding farms. For reasons of animal welfare 6.5 million weaners and adult pigs had to be killed and destroyed, whereas another 2.6 million 3-17 days old piglets were euthanised to save long-term destruction capacity. The presumed routes of infection and factors influencing the epizootic are explained, as well as the various methods to bring the epizootic to a halt. The strategy for detecting outbreaks in an early stage, and the type of samples to be collected for laboratory diagnosis are emphasised from the general point of application. The direct costs of the epizootic, losses of exports not included, are estimated at US$ 2 billion.

Animals↗

PubMed1998

A comparative study of serological tests for use in the bovine herpesvirus 1 eradication programme in The Netherlands.

We compared a gB-ELISA, a gE-ELISA and a Danish test system (consisting of a blocking and an indirect ELISA) for their specificity and sensitivity to detect antibodies against BHV1. The Danish test system showed the highest sensitivity and the gE-ELISA the lowest; the gB-ELISA showed an intermediate sensitivity. If the doubtful zone (25-50% blocking) of the gB-ELISA was considered as positive (gB-ELISA+), the sensitivity almost reached that of the Danish test system. The specificity of all tests appeared to be very high, 99.7, 96.7, 100, 99.7% for the gB-ELISA, gB-ELISA+, gE-ELISA and the Danish test system, respectively. Seroconversion was detected in the gE-ELISA up to 3 weeks later than in the gB-ELISA and the Danish test system. It is concluded that the combination of a gB-ELISA (for screening) and the Danish test (for confirmation) system used in the BHV1 eradication programme in the Netherlands, provides for very high sensitivity (> 99.0%) (Kramps et al., 1994) and a very high specificity (> 99.9%).

Animals↗

PubMed1999

Salmonella infections in finishing pigs in The Netherlands: bacteriological herd prevalence, serogroup and antibiotic resistance of isolates and risk factors for infection.

Salmonellae are wide spread in man and animals world wide and are of increasing significance as causative agents of foodborne diseases in man. The European Union, national authorities and the pig industry are therefore more and more interested in the Salmonella status of the pig population. The aim of this study was to estimate the bacteriological prevalence of Salmonella in finishing pig herds, the serogroup and the resistance to antibiotics of the isolated Salmonellae and a preliminary risk analysis of factors associated with infection. For this, 317 finishing pig herds were randomly selected from a database containing 1500 herds in the southern part of the Netherlands. In each herd 24 samples of fresh faeces were collected from two compartments with pigs close to market weight. Per compartment 12 samples of faeces were pooled into one pooled sample. Pooled samples were cultured in duplicate. Salmonella spp. were recovered from 71 out of 306 herds (23%) in which two compartments could be sampled. A total of 108 isolated Salmonella's were serotyped: 71 serogroup B, 3 serogroup C1, 6 serogroup C2, 22 serogroup D1, and 6 isolates neither serogroup B, C or D1. Of a total of 115 Salmonella isolates tested, none were resistant to colistin, enrofloxacin, flumequin or gentamicin. Automated liquid feeding of by-products, and membership of an Integrated Quality Control (IQC) production group were associated with a decreased risk of infection, while use of trough feeding was associated with an increased risk of infection. It is necessary to test these presumed risk factors in intervention studies to evaluate their potency to reduce the Salmonella prevalence in finishing pigs and thereby reduce the risk of Salmonellosis in people consuming pork.

Animals↗

PubMed2000

Palliative care services in The Netherlands: a descriptive study.

In this paper several types of specialized palliative care services in The Netherlands are presented. These include palliative care units in homes for the elderly, in nursing homes, in a general hospital and in an oncology clinic. In addition, a description is given of private hospices and of a home specializing in the care of terminally ill children. Furthermore, a number of other services relevant to palliative care are presented, such as professional and volunteer services for patients dying at home. Although many different types of services can be distinguished, regional distribution is not always optimal. The policy of the Dutch government on palliative care is also discussed. This policy is characterized by a strong emphasis on the further integration of palliative care in the regular health care system.

Humans↗

PubMed2000

The prevention of euthanasia through palliative care: new developments in The Netherlands.

Dutch palliative care stands on the eve of important changes. Further development of palliative care has become part of official national health care policy. One of the aims is prevention of euthanasia. Through an expansion and improvement of palliative care facilities it is trying to rule out the possibility that future requests of euthanasia might be brought about through insufficient and inadequate palliative care. This paper focuses on these new developments in The Netherlands. It first discusses the recent developments with regard to euthanasia. Thereafter, it describes the dynamic setting of palliative care. Finally, the issue of prevention of euthanasia through palliative care is analyzed. With regard to this topic, two questions need to be carefully distinguished. On the one hand, there is the factual question of whether a further development of palliative care can prevent euthanasia, on the other hand we have the normative question of whether palliative care should be further developed to prevent euthanasia. Both questions are analyzed.

Ethics, Medical↗

PubMed2001

Patient education in The Netherlands.

This article presents the development of patient education (PE) in The Netherlands from a historical perspective. A description is given of the first pioneering years from the 70s till the late 80s, in which early topics like the organization of PE, the orchestration of PE between different disciplines, the role of the social environment, the provision of PE in difficult patient groups and--most of all--the technical development of educational materials took the time and attention of the growing group of professionals that were engaged in patient education. Recent developments concern the legal aspects of PE, national policy, the role of health insurance, the position of patient organizations and the development of patient education in specific professional groups, e.g. general practitioners, nurses, physiotherapists, pharmacists, and dentists. There is no doubt that patient education has been professionalized considerably during the last decades. Nevertheless, new issues emerge and some old issues still need to be solved. The effective use of information material, the need for counseling as part of PE, and the relevance of coordination of care are longtime, but still actual problems in PE. More recent issues are the pressures on PE because of capacity restraints, the influence of the media and perhaps most of all: the apparent need for a patient-centered attitude and a more two-sided way of communication. Finally, the future policy topics in the Dutch patient education are discussed.

Health Plan Implementation↗

PubMed2004

The effects of AIDS prevention programs by lay health advisors for migrants in The Netherlands.

Two studies describe the effectiveness of acquired immunodeficiency syndrome (AIDS) prevention programs by lay health advisors (LHAs) for migrants in The Netherlands. The effects of such AIDS programs were evaluated (Study 1) and compared with the effects of professional health advisors (PHAs, i.e. medical doctors or nurses) (Study 2). The first study concerned Turkish and Moroccan migrants and showed positive effects on knowledge, behavioral control, and social norm towards condom use. Iraqi refugees participated in the second study that concerned a direct comparison of LHA- and PHA-based programs. Both programs result in positive effects in terms of attitude change and knowledge, but the LHA program resulted in a stronger intention to discuss AIDS with children. Analyses predicting intention to use condoms provide evidence that LHA programs lead to a stronger relation between attitudes and intention. This suggests that LHA-based AIDS programs are more successful in inducing internally motivated intentions to safe sex practices, such as condom use.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Long-term prognosis of breast cancer: an analysis of 462 patients in a general hospital in south east Netherlands.

In this study the long-term prognosis was analysed of all 462 consecutive female breast cancer patients who were diagnosed and carefully staged between 1970 and 1980 in a 600-bed community hospital in Eindhoven, south east Netherlands. Follow-up of recurrence and causes of death was obtained until 1 January 1993. Observed survival rates at 5, 10 and 20 years were 66%, 45% and 32%, respectively, and the corresponding breast cancer-specific survival rates were 71%, 54% and 44%. The yearly risk for a recurrence of breast cancer after treatment steadily decreased from 10% the first year to 1% after 10 years. In a multivariate survival analysis both tumour size and nodal status appeared to be equally important prognostic factors in the first 5 years after diagnosis. After 5 years only tumour size had independent prognostic value, which was not significant any more after 10 years. In patients with a tumour size < or = 2 cm and without lymph node involvement at diagnosis, the risk for a recurrence was found to be negligible after 10 years. Those patients may be considered cured, although a search for early diagnosis of a second primary breast cancer in this group is still advisable.

Adult↗

PubMed1996

Anorectal melanoma in The Netherlands: a report of 63 patients.

A retrospective analysis was performed of the clinical features and results of surgical treatment modalities of 63 cases of anorectal melanoma collected in The Netherlands. Most tumours presented in an advanced stage due to the obscure location and lack of specific symptoms. There were 34 patients with clinical stage I disease who were treated by either local sphincter-saving surgery (n=16) or who had undergone an abdominoperineal resection (APR) (n=18). We could not find a survival advantage for either one of these two treatment modalities. However, after a local procedure far more local recurrences were seen (12:1), but this did not influence the clinical course of these patients, as they often rapidly succumbed to distant metastases. It is concluded that, in the future, patients presenting with an anorectal melanoma should be treated with a sphincter-saving surgical approach whenever possible.

Adult↗