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PubMed1983

The risk of tuberculous infection in The Netherlands from 1967 to 1979.

Estimates of the annual risks of tuberculous infection in the Netherlands from 1910 to 1966 were made by Stýblo et al. [1] from tuberculin surveys in recruits and schoolchildren. The risk decreased particularly steeply after about 1940 (the annual decrease in log risk was about 13%), and forward projections of the risk were made on this basis to 1980. Tuberculin test results in male recruits and in secondary or primary schoolchildren between 1966 and 1979 have now been used, alone and in conjunction with the earlier material, to estimate the trend in the risk of tuberculous infection in the Netherlands up to 1979, and to study the sex and age patterns in the risk. The risk of infection has continued to decrease steeply with calendar year in the Netherlands. Among the recruits the log risk, estimated only from the data from 1966 to 1979, decreased annually by 10.4%, compared with the estimate of 13.7% from the earlier data from 1956 to 1966; this difference is non-significant. Analysis of the complete data on schoolchildren from 1956 to 1979 shows a decrease in their log risk of infection of 15.0% each calendar year. The risks of infection were similar for boys and girls up to age 10, but were higher for boys than for girls (by 10.2%) during adolescence. In addition there was an increase in log risk of about 6.1% for each year of age up to age 20. According to this analysis, the annual risks of tuberculous infection in 1979 in the Netherlands were estimated to be 6, 9, 12, and 16 in 100 000 boys aged 5, 10, 15 and 20 years respectively, and 6, 9, 11 and 15 in 100 000 girls.

Adolescent↗
PubMed1989

Development of consultation-liaison psychiatry in The Netherlands. Its social psychiatric heritage.

Dutch consultation-liaison psychiatry (C-L psychiatry) has followed a developmental line separate from the American system. First, C-L psychiatry in the Netherlands has been less influenced by psychosomatic medicine than by social psychiatry. Second, the presence of psychiatric units in general hospitals that appear to be correlated with the growth of C-L psychiatry in the United States occurred later in the Netherlands. Third, little government support for clinical care, research, and especially for training has been available to Dutch psychiatry. Consequently, there has been little recent financial pressure on C-L psychiatry from reduced government support, as occurred in the United States. Finally, the relationship between primary and secondary health care in the Netherlands allows C-L psychiatry to have a direct impact on several inpatient and ambulatory levels in the health care chain. A nationally accepted database form for the computerized registration of the Psychiatric Consultations at the eight university hospitals and ten other general hospitals is currently in use. To facilitate standardization and recording the psychiatric consultation process, the Netherlands Consortium for C-L psychiatry (NCCP) was formed.

Humans↗
PubMed2006

Implementation of hysteroscopic surgery in The Netherlands.

OBJECTIVE: This study was conducted to assess the degree of diffusion of hysteroscopic surgery in gynaecological practice in The Netherlands in order to guide further implementation. The diffusion was objectified by defining the percentage of hospitals performing hysteroscopic procedures and the number of different procedures performed per gynaecologist. STUDY DESIGN: In 2003 all Departments of Gynaecology (n=102) in The Netherlands were sent a questionnaire. The questionnaire addressed the number and type of all hysteroscopic procedures that were performed in each hospital in 2002. Data from this study were compared to previously published data from 1997. RESULTS: Responses were received from 80% of all gynaecological departments in The Netherlands. Diagnostic hysteroscopy was performed in almost all hospitals in both 1997 and 2002. The percentage of hospitals that adopted polypectomy, myomectomy and endometrial ablation increased to more than 90% in 2002. The number of teaching hospitals that integrated diagnostic hysteroscopy, polypectomy and myomectomy (procedures required for graduation) into their operative spectrum increased to 100%. CONCLUSION: This survey indicates a growing trend of the diffusion of diagnostic and "basic" therapeutic hysteroscopic procedures in The Netherlands. However, figures upon more advanced hysteroscopic surgery are less optimistic.

Diffusion of Innovation↗
PubMed2004

Constructing land-use maps of the Netherlands in 2030.

The National Environmental Assessment Agency of the RIVM in the Netherlands is obliged to report on future trends in the environment and nature every 4 years. The last report, Nature Outlook 2, evaluated the effects of four alternative socio-economic and demographic scenarios on nature and the landscape. Spatially detailed land-use maps are needed to assess effects on nature and landscape. The objective of the study presented here was how to create spatially detailed land-use maps of the Netherlands in 2030 using the Environment Explorer, a Cellular Automata-based land-use model to construct land-use maps from four scenarios. One of these is discussed in great detail to show how the maps were constructed from the various scenario elements, story lines and additional data and assumptions on national, regional and local land-use developments. It was the first time in the history of our outlooks that consistent, spatially detailed land-use maps of the Netherlands for 2030 were constructed from national economic and demographic scenarios. Each map represents a direct reflection of model input and assumptions. The maps do not show the most probable developments in the Netherlands but describe the possible change in land use if Dutch society were to develop according to one of the four scenarios. The large (societal) uncertainties are reflected in the total set of future land-use maps. The application of a land-use model such as the Environment Explorer ensures that all relevant aspects of a scenario, i.e. economic and demographic developments, zoning policies and urban growth, are integrated systematically into one consistent framework.

Agriculture↗
PubMed1982

The development of clinical tuberculosis following infection with tubercle bacilli. 1. A theoretical model for the development of clinical tuberculosis following infection, linking from data on the risk of tuberculous infection and the incidence of clinical tuberculosis in the Netherlands.

Information on the risk of tuberculous infection in the Netherlands has been linked with information on the incidence of tuberculosis, in an attempt to estimate the risks of developing the disease following infection or reinfection. It was postulated that: (a) those with a recent primary infection had a characteristic risk of developing progressive primary tuberculosis; (b) those with a distant (i.e. not recent) primary infection and a recent reinfection had a characteristic risk of developing exogenous tuberculosis; and (c) those with a distant primary infection but no recent reinfection had a characteristic risk of developing endogenous tuberculosis. The information on the risk of tuberculous infection was used to estimate the size of the population in each of these infection classes for different age-groups and calendar years in the Netherlands. Using multiple regression to link these population figures with the information on tuberculosis incidence in the same age group and calendar year, it was possible to estimate the above risks of developing tuberculosis. For Netherlands males aged 15-69 years during the period 1951-70 the three risks of developing pulmonary tuberculosis were estimated to be: (a) 5.06 per cent annually (for 5 years) following primary infection; (b) 1.91 per cent annually (for 5 years) following reinfection; (c) 0.0253 per cent annually, after the first 5 years following primary infection, in the absence of reinfection. The corresponding (and significantly different) estimated annual risks of development of pulmonary tuberculosis for females were 5.85, 1.10 and 0.0020 per cent respectively. From these risks, it may be estimated that the degree of protection conferred by a distant primary infection, against pulmonary tuberculosis arising from a recent reinfection, was 63 per cent for males and 81 per cent for females. The estimated relative proportions of cases of progressive primary, exogenous and endogenous tuberculosis varied considerably with age and calendar year. Progressive primary tuberculosis was dominant at the younger ages, exogenous and endogenous tuberculosis at older ages. At these older ages, the great majority of cases in the Netherlands in the early 1950s appeared to be exogenous in origin, but by 1970, with the decrease in the risk of infection, the exogenous contribution had dwindled substantially, especially among males.

Adolescent↗
PubMed2001

Seasonal changes in 24-h patterns of suicide rates: a study on train suicides in The Netherlands.

BACKGROUND: Annual patterns in suicide rates, peaking near the summer solstice, are well documented. It has been suggested that day length or total hours of sunshine has an impact on suicide rates. If these environmental factors are involved, we would expect changes in the daily pattern of suicide rates to occur over the year. To test this hypothesis, the 24-h patterns of suicide rate were investigated as a function of time of year. METHOD: Detailed information about the exact time of suicides in The Netherlands is only available for train suicides. Therefore, information concerning age, sex, time and place of occurrence of all verified train suicides over 15 years in The Netherlands (n=2830) was obtained from The Netherlands Railways archives. RESULTS: Daily patterns in train suicides show systematic variations of two kinds. First, independently of time of year, suicide rates at night drop to about 10% of their daytime values. Second, there are two daily peaks in the patterns which shift their timing over the year, with one peak occurring shortly after sunset, and the other one consistently occurring 9-10 h earlier. Both peaks shift with the 5.5-h shift in sunset time. LIMITATIONS: Train suicidal behaviour may not represent fatal suicidal behaviour in general. CONCLUSIONS: There are pronounced and systematic daily variations in train suicide rates in The Netherlands. One of these is related to clock time, the others are related to the light-dark cycle. The consistency of the patterns suggests a strong environmental influence on train suicidal behaviour. Research on 24-h patterns of suicide rates should control for time of year.

Adult↗
PubMed1999

The classical swine fever epidemic 1997-1998 in The Netherlands: descriptive epidemiology.

The objective of this paper is to describe the severe epidemic of classical swine fever (CSF) in The Netherlands in 1997-1998 under a policy of non-vaccination, intensive surveillance, pre-emptive slaughter and stamping out in an area which has one of the highest pig and herd densities in Europe. The primary outbreak was detected on 4 February 1997 on a mixed sow and finishing pig herd. A total of 429 outbreaks was observed during the epidemic, and approximately 700,000 pigs from these herds were slaughtered. Among these outbreaks were two artificial insemination centres, which resulted in a CSF-suspect declaration of 1680 pig herds (mainly located in the southern part of The Netherlands). The time between introduction of CSF virus (CSFV) into the country and diagnosis of CSF in the primary outbreak was estimated to be approximately 6 weeks. It is presumed that CSFV was spread from The Netherlands to Italy and Spain via shipment of infected piglets in the beginning of February 1997, before the establishment of a total stand-still of transportation. In June 1997, CSFV is presumed to be introduced into Belgium from The Netherlands. Pre-emptive slaughter of herds that had been in contact with infected herds or were located in close vicinity of infected herds, was carried out around the first two outbreaks. However, this policy was not further exercised till mid-April 1997, when pre-emptive slaughter became a standard operational procedure for the rest of the epidemic. In total, 1286 pig herds were pre-emptively slaughtered. (approximately 1.1 million pigs). A total of 44 outbreaks (10%) was detected via pre-emptive slaughter. When there were clinical signs, the observed symptoms in infected herds were mainly atypical: fever, apathy, ataxia or a combination of these signs. In 322 out of 429 outbreaks (75%), detection was bases on clinical signs observed: 32% was detected by the farmer, 25% by the veterinary practitioner, 10% of the outbreaks by tracing teams and 8% by screening teams of the veterinary authorities. In 76% of the outbreaks detected by clinical signs, the farmer reported to have seen clinical symptoms for less than 1 week before diagnosis, in 22% for 1-4 weeks before diagnosis, and in 4 herds (1%) the farmer reported to have seen clinical symptoms for more than 4 weeks before diagnosis. Transportation lorries played a major role in the transmission of CSFV before the primary outbreak was diagnosed. It is estimated that approximately 39 herds were already infected before the first measures of the eradication campaign came into force. After the first measures to stop the spread of CSFV had been implemented, the distribution of the most likely routes of transmission markedly changed. In most outbreaks, a neighbourhood infection was indicated. Basically, there were two reasons for this catastrophe. Firstly, there was the extent of the period between introduction of the virus in the region and detection of the first outbreak. As a result, CSFV had opportunities to spread from one herd to another during this period. Secondly, the measures initially taken did not prove sufficient in the swine- and herd-dense region involved.

Animal Husbandry↗
PubMed1998

Impact on human health of Salmonella spp. on pork in The Netherlands and the anticipated effects of some currently proposed control strategies.

The impact on human health of Salmonella spp. on pork in The Netherlands is described. Subsequently, the effects of some currently proposed control strategies in the Dutch pork production chain are evaluated and quantified with the aid of a simple mathematical model. The estimated average incidence of cases of salmonellosis in the Netherlands is about 450 cases per 100,000 person years at risk (pyar). Some special risk groups for which the risks could be quantified are (1) persons with underlying diseases, such as neoplasms or diabetes mellitus (1200 cases/100,000 pyar); (2) persons with achlorhydria or who excessively use antacids (1100 cases/100,000 pyar); (3) persons who have recently been treated with antibiotics that disturb the normal gut flora (1700 cases/100,000 pyar); (4) nurses (900 cases/100,000 pyar); (5) caterers (900 cases/100,000 pyar); (6) slaughterline personnel (1800 cases/100,000 pyar). Furthermore, it is estimated that 15% (5-25%) of all cases of salmonellosis in The Netherlands are associated with the consumption of pork. Currently, proposed control measures regarding Salmonella in pigs and on pork in The Netherlands are codes of good manufacturing practices (GMP) that, in fact, formalize recommendations that can be found in many handbooks about pig breeding and pig slaughtering. When evaluated by a mathematical model constructed for this purpose, the proposed GMP codes from farm to cutting/retail could, at best, reduce the current levels of Salmonella-positive pigs and pork by 50-60%. If pigs were bred according to the rather costly specific pathogen-free concept (SPF), the prevalence of contaminated carcasses and pork could in total be reduced by 95% or more. However, implementing GMP codes from the transport phase up to the cutting/retail phase coupled with a decontamination step at the end of the slaughterline would be just as effective as GMP in combination with breeding using the SPF-concept. It is therefore concluded that the most efficient and cost-effective way of reducing the 'Salmonella problem' entailed by the consumption of pork would be to decontaminate carcasses under the precondition that the entire production chain strictly adheres to GMP principles. Therefore, the EU should also allow for more possibilities regarding the decontamination of carcasses than is currently the case. It is also concluded that current EU regulations relying on hazard analysis of critical control points (HACCP)-inspired production in cutting plants will not be effective in reducing the prevalence of Salmonella spp. on pork. This is mainly because (1) there is currently an almost steady stream of Salmonella-positive carcasses that enter the cutting process; (2) when contaminated carcasses are being processed, further cross-contamination during working hours is unavoidable; (3) no steps in the cutting process are intentionally designed to effectively reduce the risks or consequences of cross contamination of cuts and retail-ready products.

Achlorhydria↗
PubMed2001

Integration of care in The Netherlands: the development of transmural care since 1994.

BACKGROUND: integration of primary and hospital services has been the subject of health policy in The Netherlands in the 1990s. A bottom-up facilitating approach was chosen to stimulate development of 'transmural care' between traditionally separate sectors. Transmural care has been defined as, care, attuned to the needs of the patient, provided on the basis of co-operation and co-ordination between general and specialised caregivers with shared overall responsibility and the specification of delegated responsibilities'. We conducted a national survey to determine the success of the bottom-up policy and the extent of the development of transmural care. METHODS: a written questionnaire was distributed among members of two national networks of transmural care executives and project coordinators, which are representative for hospitals and home care organisations in The Netherlands. A total of 271 facilities were included in the study representing 71% of hospitals and 63% of the home care organisations in The Netherlands. The questionnaire covered topics as; type of care provided, participants, population, goals and type of evaluation. RESULTS: all hospitals in The Netherlands provide one or more of the seven types of transmural care, however, there is a great variation in the number of facilities per organisation. Most facilities cater to one or more groups of chronically ill patients. Project coordinators experience difficulties finding adequate financing options for the facilities. Evidence on the effects of transmural care on quality and efficiency is lacking. CONCLUSION: the bottom-up approach towards the development of transmural care has been successful but needs to be followed by top-down measures to insure adequate evaluation and encourage wide-spread implementation.

Delivery of Health Care, Integrated↗
PubMed1997

Waiting for coronary revascularization: a comparison between New York State, The Netherlands and Sweden.

OBJECTIVE: To compare waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in New York State, the Netherlands and Sweden and to determine whether queuing adversely affects patients' health. METHODS: We reviewed the medical records of 4487 chronic stable angina patients who underwent PTCA or CABG in one of 15 New York State hospitals (n = 1021) or were referred for PTCA or CABG to one of ten hospitals in the Netherlands (n = 1980) or to one of seven hospitals in Sweden (n = 1486). We measured the median waiting time between coronary angiography and PTCA or CABG. RESULTS: The median waiting time for PTCA in New York was 13 days compared with 35 and 42 days, respectively, in the Netherlands and Sweden (P < 0.001). For CABG, New York patients waited 17 days, while Dutch and Swedish patients waited 72 and 59 days, respectively (P < 0.001). The Swedish and Dutch waiting list mortality rate was 0.8% for CABG candidates and 0.15% for PTCA candidates. CONCLUSIONS: There were large variations in waiting time for coronary revascularization among these three sites. Patients waiting for CABG were at greatest risk of experiencing an adverse event. In both the Netherlands and Sweden, the capacity to perform coronary revascularization has been expanded since this study began. Further international cooperation may identify other areas where quality of care can be improved.

Angina Pectoris↗
PubMed2001

Biological ageing research in the Netherlands.

After an introduction on the development of biological ageing research in the Netherlands during the past decades, 606 papers on aging published by Dutch institutes in the period 1991-2000, collected from PubMed, were analysed for their relevance to research into biological ageing. For the period 1996-2000, the total number of research papers on biological ageing amounted to 142, which accounts for 23% of all publications on ageing in that period. The number of publications per year did not change. On the basis of these papers and additional information provided by research groups a comprehensive overview of biological ageing research in the Netherlands is presented, together with an extensive literature list. Ageing of the central nervous system (CNS), of the endocrinological system and of the cardiovascular system are the topics most studied. It is concluded that general biological ageing research has not increased in the Netherlands over the last ten years, and that the infrastructure for basic biological ageing research in the Netherlands is weak.

Academies and Institutes↗
PubMed1997

Occurrence of retained lens fragments after phacoemulsification in The Netherlands.

PURPOSE: To determine the incidence of retained lens fragments after phacoemulsification in The Netherlands and to evaluate the effect of vitrectomy on this complication. SETTING: Eleven vitreoretinal centers in The Netherlands. METHODS: We performed a retrospective analysis of all patients with retained lens fragments (N = 70) who were referred for vitreoretinal surgery to 11 specialized centers. Seven patients (10%) were treated with medication alone, and 63 (90%) had pars plana vitrectomy. Minimum follow-up after vitrectomy was 3 months. RESULTS: The incidence of retained lens fragments in The Netherlands was calculated at 0.9/1000 cataract operations. Retained lens fragments occurred during the learning curve and with experienced surgeons. After medical or surgical treatment, visual acuity was 20/40 or better in 43 of 70 patients (61%). Uveitis disappeared in all cases. Retinal detachment occurred in 10 patients (14%). Attached retinal breaks were treated in an additional 5 patients. Corneal grafting was performed in 2 patients. Patients who had immediate vitrectomy did not have better functional results than patients in whom vitrectomy was delayed. The iris-fixated claw lens was implanted successfully when capsular support was insufficient. CONCLUSIONS: The introduction of phacoemulsification in The Netherlands is associated with an increase of patients with retained lens fragments. Retained lens fragments are complicated by an increased risk for retinal detachment and corneal decompensation. Vitrectomy resulted in a marked improvement of visual acuity and clearing of uveitis.

Aged↗
PubMed2000

Unmet needs, beliefs and treatment-seeking for infertility among migrant Ghanaian women in the Netherlands.

Studies on infertility in the Netherlands have little information on migrant Ghanaian women, even though Ghanaians are the third largest migrant group in Amsterdam. An exploratory study on the unmet needs, attitudes, and beliefs of migrant Ghanaian women with infertility problems living in the Netherlands, and the kinds of treatment they sought was undertaken in 1999. Qualitative data were collected from 12 women with primary or secondary infertility through narratives and 20 key informant interviews. The women described seeking treatment for infertility in Ghana, the Netherlands and other European countries, included use of infertility drugs, surgery, donor insemination and in vitro fertilisation. Illegal migrant women are not entitled to treatment paid by the national health system, and being of low income they cannot afford to pay directly for this or to obtain private health insurance. Herbalists and spiritual healers in both Amsterdam and Ghana were regularly consulted, especially for their willingness to address the social and spiritual aspects of infertility. To produce a pregnancy where male infertility was suspected, transfer of sexual rights to another man in the husband/partner's family, or a healer or priest, was a practical remedy that kept male infertility hidden. This study revealed difficulties experienced in clinical settings due to language barriers and cultural differences. Ghanaian women living in the Netherlands need much more information on the causes of infertility and their options.

Adoption↗
PubMed1995

Poliomyelitis in The Netherlands: a review of population immunity and exposure between the epidemics in 1978 and 1992.

An overview of serological and virological studies on poliomyelitis in the Netherlands between two epidemics in 1978 and 1992 is given. Three unvaccinated patients acquired poliomyelitis abroad. In the Netherlands vaccination coverage with quadruple DPT-IPV vaccine is very high. The strong immunogenicity of inactivated poliovirus vaccine was confirmed in a cohort of children, reflected in age-stratified antibody profiles of the population. Adults born in the pre vaccination era appeared in general protected, but 10-25% of persons born between 1930 and 1945 lacked neutralizing antibodies. Revaccination induced a booster type of antibody response in 75-90% of such persons, indicating immunological memory and protection. Virological studies on adopted children from other countries, patients with indications for viral examination, and river waters showed that the Netherlands was regularly exposed to polio virus (PV), without signs of indigenous transmission. Persons found to carry PV or their close contacts had travelled to a PV endemic country. Most of 557 isolates were vaccine-derived, only 8% were wild type viruses. Despite their presence, up to 1992 the well-known susceptibles for PV in the Netherlands were shielded by the herd immunity of the Dutch population.

Adult↗
PubMed1999

The duration and magnitude of influenza epidemics: a study of surveillance data from sentinel general practices in England, Wales and the Netherlands.

Weekly incidence data for influenza-like illness, routinely collected in sentinel general practices in England and Wales and in the Netherlands over 10 winter periods (week 37 in one year to week 20 in the next, 1987/1988-1996/1997) were examined in conjunction with matching virus isolate data to define epidemic periods of influenza in the two countries. We first defined the background rates of recording influenza-like illness which occurred at times when only sporadic or no isolations of virus were reported. The background rates were similar in the two networks with mean weekly incidence in England and Wales of 28.1 per 100,000 (all ages) and in the Netherlands 29.8. Epidemic periods defined as lying above the upper 95% confidence level of the background rate lasted on an average of about 10 weeks. Once epidemics were recognised, peak incidence was generally achieved within 4 weeks. The excess population (all ages) consulting general practitioners during influenza epidemic periods was calculated from the difference between the observed and background incidence rates, and expressed as a percentage of the total population. In the 10 periods surveyed, the percentage of the population consulting and diagnosed with influenza-like illness in England and Wales ranged from 0.4% in 1991/1992 to 1.7% in 1989/1990 and in the Netherlands from 0.5% in 1990/ 1991 to 2.1% in 1989/1990. The duration and epidemic periods were broadly similar in the two countries though the excess consulting population during the 10 epidemics studied averaged 0.85% in England and Wales compared with 1.39% in the Netherlands. There were substantial differences between the two countries in the impact of influenza in individual years, as measured in the consulting population even though the predominant virus (sub)types were similar.

Disease Outbreaks↗
PubMed2003

Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1).

BACKGROUND: To present actual data to estimate prevalence, incidence and mortality of known type 2 diabetes mellitus in all age categories in The Netherlands. METHODS: Prospective population-based study between 1998 and 2000 in The Netherlands. Baseline population of 155,774 patients, registered with 61 general practitioners participating in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC)-study. RESULTS: Age- and sex-adjusted prevalence of type 2 diabetes was 2.2% at baseline and 2.9% after 2 years of follow-up; for women and men it was 3.1 and 2.7% at follow-up, respectively. Patients aged >70 years account for almost 50% of all type 2 diabetes patients. Age- and sex-adjusted mean annual incidence per 10,000 over 3 years was 22.7 overall; for women 23.1 and for men 22.2. Incidence--even though high--decreases after the age of 70 years. The mortality rate was 47.9/1000 and standardised mortality ratio 1.40. Based on these results, the estimated total number of subjects known with type 2 diabetes was 466,000 for The Netherlands in 2000; the number of patients with newly diagnosed diabetes 36,000. CONCLUSIONS: Prevalence and incidence rates exceed all estimates regarding known type 2 diabetes for The Netherlands. Elderly patients, aged 70 years and over, account for 50% of the type 2 diabetic population. These results are important for health-care planning.

Adolescent↗
PubMed2002

The cost of atopic dermatitis in the Netherlands: an international comparison.

BACKGROUND: Only a few international studies have assessed the economic burden of atopic dermatitis (AD), and no costs-of-illness study for AD has been done for the Netherlands. OBJECTIVES: To estimate the incidence, prevalence and health-care costs of AD in the Netherlands and to put these in an international perspective. METHODS: We conducted a retrospective cohort study by using the data of an information system of general practitioners (GPs). To calculate the health-care costs at the primary care level we assessed medical resources utilization. We assessed the costs of patients with more severe AD from a retrospective study of patient files at the department of dermatology of a general hospital. We compared our results with costs-of-illness studies for other countries. RESULTS: The overall general population incidence and prevalence of AD were 0.8% and 2.3%, respectively. The incidence and prevalence were high among children until the age of 6 years, respectively, 3.1% and 11.3%, but decreased rapidly thereafter. The total mean health-care costs per patient were USD71. The most significant costs were due to visits to the GP (USD32) and medication, mostly corticosteroids (USD21). Young children were treated more often with emollients alone. Only 7.8% of patients were referred to a specialist. The mean costs for these patients were USD186. Costs-of-illness studies for Australia, Germany, the U.K., the U.S.A. and the Netherlands suggested that the costs associated with AD vary considerably across countries. Estimates of the costs-of-illness for AD ranged from USD71 in the Netherlands to USD2559 in Germany per patient due to variation in the study population (GP vs. hospital) and the number of cost components included. Studies that included costs due to the time spent on treatment had relatively high estimates. CONCLUSIONS: The prevalence and incidence of AD are high among young children. In general, the health-care costs for AD were low. Patients' out-of-pocket costs were relatively high.

Adolescent↗
PubMed2002

Fitness effects of Alternaria dauci on wild carrot in The Netherlands.

In a field experiment with a susceptible population of annual wild carrot (Daucus carota) from Iran, artificial inoculations with the fungal pathogen A. dauci led to a strong and very significant increase of the diseased leaf area. The pathogen caused a very significant decrease in fecundity and seed survival of the host. This considerable fitness reduction by A. dauci would suggest that introgression of disease resistance from cultivated (transgenic) carrot cultivars into wild carrot populations could strongly increase the fitness of wild carrot. In spite of the potential ability of A. dauci to lower the fitness of the host considerably, wild carrot is very common in The Netherlands. Disease levels of wild carrot were estimated in 26 natural populations in 1998. No A. dauci could be detected on the leaves, and only 0.4% of the seeds were contaminated with A. dauci, in spite of the conducive weather for A. dauci. Resistance tests showed that all 26 monitored populations were highly resistant to A. dauci strains from The Netherlands. It is probable that the strong potential fitness reduction by A. dauci led to a high selection pressure towards resistance in The Netherlands. In conclusion, our results suggest that transgenic resistance to A. dauci would not be beneficial to wild carrot populations in The Netherlands because they are already resistant to this pathogen.

Alternaria↗