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At least 1,603 records · Page 89Linked to original sources
PubMed2003

Survey non-response in the Netherlands: effects on prevalence estimates and associations.

PURPOSE: Differences in respondent characteristics may lead to bias in prevalence estimates and bias in associations. Both forms of non-response bias are investigated in a study on psychosocial factors and cancer risk, which is a sub-study of a large-scale monitoring survey in the Netherlands. METHODS: Respondents of a cross-sectional monitoring project (MORGEN; N = 22,769) were also asked to participate in a prospective study on psychosocial factors and cancer risk (HLEQ; N = 12,097). To investigate diverse aspects of non-response in the HLEQ on prevalence estimates and associations are studied, based on information gathered in the MORGEN-project. RESULTS: A response percentage of 45% was obtained in the MORGEN-project. Response rates were found to be lower among men and younger people. The HLEQ showed a response percentage of 56%, and respondents reported higher socioeconomic status, better subjective health and healthier lifestyle behaviors than non-respondents. However, associations between smoking status and either socioeconomic status or subjective health based on respondents only were not statistically different from those based on the entire MORGEN-population. CONCLUSION: Non-response leads to bias in prevalence estimates of current smoking, current alcohol intake, and low physical activity or poor subjective health. However, non-response did not cause bias in the examined associations.

Adult↗
PubMed1998

Quality management in medical specialties: the use of channels and dikes in improving health care in The Netherlands.

BACKGROUND: In 1989 a Dutch national policy was instituted to ensure that quality management is the responsibility of both health care professionals and management, with input from insurers and patients. In turn, quality management of medical specialists remained to a large extent self-regulatory, with accountability toward third-party payers and patients. Three programs for quality management-peer review, guidelines, and visitation-have sufficiently persuaded patient organizations and care insurers about medical specialists' ability to ensure the quality of the care they provide. PEER REVIEW: Operational since 1976, the national program for peer review in hospitals has stressed the need for explicit evaluative mechanisms. This program led to the foundation of the National Organization for Quality Assurance in Hospitals (CBO), which conducts peer review activities but also support efforts aimed at quality assurance in hospitals. Once it is linked with the other two quality management programs, peer review will realize its full potential as a profession-based method for standardizing and rationalizing medical specialty practice. PRACTICE GUIDELINES: Since 1982, more than 60 consensus guidelines have been developed for and by medical professionals, with input from patient organizations and third-party payers. Medical specialty associations have also created their own guidelines. Although the guidelines' impact has not been evaluated systematically, studies have shown effects on behavioral change and health outcomes. Solid, credible guidelines continue to be developed, although the successful implementation of these guidelines needs to be studied. VISITATION PROGRAM: Visitation, or onsite assessment of specialty practice sites (in training and non-training hospitals), has been a hot issue in Dutch medical quality assurance. All 28 scientific societies have visitation programs, focusing on areas for improvement such as process management, use of guidelines, and evaluation of patient satisfaction and treatment outcomes. Closely linked to other medical quality assurance activities, visitation programs also incorporate clinical guidelines into evaluations. CONCLUSIONS: Profession-driven peer review, practice guidelines, and visitation programs have been effective support tools for quality management in The Netherlands. Future challenges involve creating more synergy among these programs and between the profession-based quality management approaches and recently introduced hospital-based quality systems and maintaining the trust between third-party payers and patients.

Delivery of Health Care↗
PubMed1996

The primary aortoenteric fistula in The Netherlands--the unpublished cases.

OBJECTIVE: Primary aortoenteric fistula is a rare disorder of which only four patients have been reported in the Dutch literature so far. The objective of our study was to obtain more realistic figures on the incidence of this condition, with data on the clinical presentation, diagnostic procedures, treatment and results in a group of patients not previously reported as "case histories". METHODS: A questionnaire was sent to all surgical clinics in The Netherlands. Out of 180 questionnaires, 102 have been returned reporting 27 patients to which data of eight others treated in our own institution were added. RESULTS: In all but one of these 29 patients the fistula was caused by an atherosclerotic aneurysm, the one exception being caused by an ingested cocktail pin. Gastrointestinal haemorrhage was the predominant symptom, being present in 28 of the patients, while the complete triad of haemorrhage, pain and a pulsating mass was found in only eight patients. Twenty-seven patients were treated with an in situ graft of which 14 are doing well at long term follow-up. CONCLUSIONS: Primary aortoenteric fistula is far more common than one would expect from the number of patients reported in literature. A high index of suspicion based on a complete physical examination remains the key to a correct diagnosis. Direct closure of the intestine and in situ grafting of the aorta is the treatment of first choice.

Aged↗
PubMed1997

Family breakdown in nineteenth-century Netherlands: divorcing couples in The Hague.

This is an analysis of divorce trends in the Netherlands in the second half of the nineteenth century. "Use was made of a case-control research design in which the social characteristics of all marriages which ended in divorce were compared with those of a random sample from the marriages which ended in widowhood. The author analyzed a group of 2,300 marriages contracted in The Hague from their inception until their dissolution by death or divorce. All migrants were followed to their new place of residence. Multivariate (proportional hazards) analysis showed that the highest probability of divorce was found among persons who had already gone through a divorce before. Other factors related to divorce were high mobility, low ages at marriage, and large age and religious differences between spouses. Higher social classes had relatively high divorce risks."

Age Factors↗
PubMed1999

The proper age to marry: social norms and behavior in nineteenth-century Netherlands.

"The article compares publicly discussed norms concerning the proper age at marriage for men and women in nineteenth-century Netherlands, and the actual trends present in the empirical evidence about marriage age. Medical professionals (the hygienists) expressed the belief that marriage at too young an age was damaging both to public hygiene and the family's health; other commentators stressed the connection between young marriages and poverty. Yet such norms were put forward vaguely, allowing other influences on marriage age to come into play. Consequently, data on marital behavior suggest considerable diversity in the population, with age at marriage varying strongly by class, sex, and region. Generally, age at marriage did not begin to fall until the period 1860-1870, and even after that decade class differences remained strong."

Attitude↗
PubMed2003

Euthanasia in the Netherlands: 25 years of experience.

This article gives an impression of the experience with legal euthanasia practices in the Netherlands for approximately 25 years. Some figures are presented about the medical presence at the end of life. Also the legal and moral aspects of euthanasia are addressed. The article starts with a description of the background of the debate on euthanasia and gives some conditions for a really open and serious debate in a society on this subject.

Attitude to Death↗
PubMed1998

Epidemiology of cancer of the lip in The Netherlands.

Descriptive epidemiological data of new cases of squamous cell carcinoma of the vermilion border of the lip in the Netherlands from 1989-94 inclusive are presented. Lip cancer represented 0.47 and 0.09% of all new malignancies in males and females, respectively. The lower lip was the most frequently affected site. The majority of the lip cancers were diagnosed in tumour stage I. The median age at diagnosis in males was 68 years, 5 years less than in females. The overall male-to-female ratio was 5.7. Age-adjusted incidence rates in males and females were 2.2 and 0.3 per 100,000 (ESR), respectively. The cumulative lifetime risk for developing lip cancer was 0.15 for males and 0.03 for females. Mortality/incidence ratios in males and females were 0.05 and 0.07, respectively. Differences in lip cancer incidence were observed between an urban and a rural area. There was a positive association between the occurrence of lip cancer and rural residence; rate ratios were 3.3 among males and 3.5 among females.

Adolescent↗
PubMed2002

Statistical analysis of the nursing minimum data set for The Netherlands.

The purpose of this overview is to examine and illustrate the feasible options for the statistical analysis of nursing minimum data sets (NMDSs). After explaining the need for these data collections, examples from different countries are discussed and examples of the methods used for statistical analysis are summarized. Distinct purposes for information uses and for the presentation of information requires different approaches for data collection and statistical analysis. The feasible options for the nursing minimum data set for the Netherlands (NMDSN) have been described to illustrate the different methods available. Six studies are discussed, illustrating their goals, data collection methods, data analysis, and results. These studies include visualizing nursing care by means of frequencies of nursing diagnoses and interventions, RIDIT (relative to an identified distribution) analysis, fingerprints, and graphs from multidimensional scaling techniques. In addition, using data sets for workload measurement and testing of instruments is presented. The overview ends with general recommendations for data collection and analysis of NMDSs.

Data Collection↗
PubMed1999

Evolution of an integrated HIS in The Netherlands.

This article considers the 26 years history of an integrated hospital information system (HIS). The system emerged from an experimental government sponsored project in the Leiden University Hospital and is now the leading HIS in The Netherlands. The evolution during these 26 years is presented and discussed in this article with an emphasis on the organisational setting and financing besides the aspects functionality, technology/architecture and evaluation aspects. Recently HISCOM was acquired by the BAAN-group completing the evolution and bringing the HIS to the international health care IT market.

Computer Communication Networks↗
PubMed2006

Implementing Six Sigma in The Netherlands.

BACKGROUND: Six Sigma, a process-focused strategy and methodology for business improvement, can be used to improve care processes, eliminate waste, reduce costs, and enhance patient satisfaction. EXPERIENCE WITH SIX SIGMA IN THE NETHERLANDS: Six Sigma was introduced in 2001 at the 384-bed Red Cross Hospital (Beverwijk). During the Green Belt training, every participant was required to participate in at least one Six Sigma project. The hospital's total savings in 2004 amounted to 1.4 million dollars, for an average savings of 67,000 dollars for each of the completed 21 projects. THREE EXAMPLES OF SUCCESSFUL PROJECTS: In one project, the team designed a new admission process for the operating rooms, resulting in an average starting time nine minutes earlier. This relatively minor improvement made it possible to operate on an additional 400 patients a year and to achieve a net savings of >273,000 dollars. A second project reduced the number of patients receiving intravenous (IV) antibiotics by switching to oral administration, yielding annual savings, based on medication costs alone, of >75,000 dollars. A third project reduced the length of stay in the delivery room from 11.9 to 3.4 hours, yielding an annual savings of 68,000 dollars. The "Ultimate Cure?": Six Sigma, which entails involvement of health care workers; use of improvement tools (from industry); creation of trained project teams to tackle complex, often cross-departmental processes; data analyses; and investment in quality improvement may prove the "ultimate cure" to the current cost, quality, and safety issues that challenge health care.

Anti-Bacterial Agents↗
PubMed2003

Perinatal mortality in Utrecht, The Netherlands, 1880-1940.

The secular trend of perinatal mortality in Utrecht between 1880 and 1940 and its causes are examined in this study, based on patient records of two maternity clinics, those of the city's academic hospital, and of its outpatient clinic. The sample includes 17,111 deliveries. Over the period the proportion of births in the city occurring in the two institutions rose from 3 to 90%. The perinatal mortality rate in the hospital declined and then rose slightly at the end of the 19th century, but remained constant, even if cyclical, thereafter in both the hospital and the outpatient clinic. Rates differed substantially between the two maternity services. Logistic regression analysis reveals a cluster of factors related to perinatal death. Low birth weight had a powerful association with perinatal mortality in both samples. Most of the other factors associated with perinatal mortality were related to the health of the patients, to obstetric problems related to deliveries, and to infant sex and maternal age. Relationships between perinatal mortality and other measures of human welfare in The Netherlands are explored.

Adult↗
PubMed2001

Long-term trends in marital status mortality differences in The Netherlands 1850-1970.

This article describes the long-term trends in marital status mortality differences in the Netherlands using a unique dataset relating to the period 1850-1970. Poisson regression analysis was applied to calculate relative mortality risks by marital status. For two periods, cause-of-death by marital status could be used. Clear differences in mortality by marital status were observed, with strongly increasing advantages for married men and women and a relative increase in the mortality of widowed compared with non-married people. Excess mortality among single and formerly married men and women was visible in many cause-of-death categories, and this became more widespread during the last decades of the nineteenth century. Hypotheses are formulated that might explain why married men and women underwent a stronger decrease in mortality up until the end of World War II.

Cause of Death↗
PubMed1995

Prevalence and habitat specificity of steinernematid and heterorhabditid nematodes isolated during soil surveys of the UK and the Netherlands.

Entomopathogenic nematodes were isolated from soil samples collected during three separate surveys, two in the United Kingdom and one in the Netherlands. The nematodes were identified by their restriction fragment length polymorphisms on hybridization of Southern blots with a ribosomal DNA repeat unit clone. A total of eight steinernematid species/RFLP types and two heterorhabditids were isolated. The distributions of the majority of these species/RFLP types were significantly different between the three surveys and some of the species displayed a close association with certain habitat types.

Animals↗
PubMed1978

The hygienic quality of vegetables grown in or imported into the Netherlands: a tentative survey.

Samples of 61 home grown and 199 imported vegetables of different varieties were examined for Escherichia coli, faecal streptococci and, when E. coli was present, for salmonellas. Eleven per cent of samples contained greater than 10(4) E. coli per 100 g, and 14% greater than 10(6) faecal streptococci per 100 g. Salmonellas were isolated from 23 out of 103 samples examined. Salmonellas were isolated from 8% of 76 samples with E. coli less than 10(4)/100 g, but from 63% of 27 samples with E. coli exceeding 10(4)/100 g; from 6% of 65 samples containing less than 10(6) faecal streptococci/100 g but from 51% of 37 samples containing more than 10(6)/100 g. S. typhi was isolated from one sample of vegetables imported from the tropics. To our knowledge this is the first isolation of S. typhi from food in the Netherlands. Products from tropical countries were found to present the highest level of contamination. The hygienic quality of Dutch products is sometimes inferior to that of similar imported products, although the different seasons of sampling may have influenced the result. For the prevention of risk to the consumer of vegetables, good kitchen hygiene would appear to be the most important factor.

Escherichia coli↗
PubMed1977

The germicidal effect of the open air in different parts of The Netherlands.

Using the microthread technique the survival of Escherichia coli MRE 162 in open air was measured in different parts of The Netherlands. The presence of bactericidal compounds (open air factor = OAF) could be demonstrated on several days and quantitated in relative units of OAF concentration. In the absence of ozone the OAF concentration was always low. In the presence of ozone the OAF concentration was dependent on wind direction. At the selected microthread exposure sites air from areas with high traffic intensity contributed more to OAF production than air from industrial areas. OAF production is probably related to the nature of hydrocarbons in the air.

Air Microbiology↗
PubMed1986

Non-neonatal meningitis due to less common bacterial pathogens, the Netherlands, 1975-83.

In the Netherlands, case histories of 160 patients aged more than 1 month, with meningitis due to bacteria other than Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae were reviewed in order to look for associations between the bacteriological data and the course of disease. The incidence of such cases was about 0.8/100,000/year. Escherichia coli and Listeria monocytogenes each accounted for about 15% of the cases. The case-fatality rate was 18.8% (Gram-negative bacteria, 25%; Gram-positives, 15%) and sequelae occurred in 13.3% of the surviving patients (14 and 13% Gram-negative and Gram-positive, respectively). Hearing loss was the most prevalent sequela (5.0%). Predisposing factors were present in 70% of patients (69 and 71% respectively), especially in meningitis due to enteric Gram-negative bacteria (except for salmonella) and due to staphylococci. Surveillance is important because the incidence of meningitis due to these micro-organisms is likely to increase and because the problems in antibiotic treatment have not yet been solved.

Adolescent↗
PubMed2002

Costs of deinstitutionalization in a rural catchment area in The Netherlands.

BACKGROUND: In contrast to many other countries, The Netherlands left the initiative in deinstitutionalizing mental health care to the traditional providers of mental health services. The goal of this study is to determine the effect of this policy on the allocation of mental health care resources to services. METHOD: All 20- to 64-year old users and their use of community- and hospital-based services between 1990 and 1999 were retrieved from the Groningen case register. Service utilization was combined with the direct unit costs of these services for the 1999 price level. Changes in the population as to size and age were taken into account. RESULTS: In 1999 the direct costs of mental health care were Euro 268 per adult inhabitant of the register area, which is 9% higher than in 1990. Costs increased most in the early 1990s before deinstitutionalization policy took effect. From 1993 and onwards the reduced length of stay in the hospital was the main cause for the decreased costs of in-patient care. These savings equalled the increased expenditures for day-treatment, sheltered residences and home-treatment, even though the unit costs of these types of community care are much lower than the unit costs of admissions. This was not caused by an increasing number of new clients, but was a result of longer periods of care during a larger number of years. CONCLUSIONS: These findings are in accordance with Dutch mental health care policy, which aims at prolonged care and aftercare outside the hospital whenever possible.

Adult↗