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PubMed2006

The combined contraceptive vaginal ring (NuvaRing): first experience in daily clinical practice in The Netherlands.

OBJECTIVES: The combined contraceptive vaginal ring (NuvaRing) has been shown to be safe and effective, with high levels of user compliance, acceptance and satisfaction. However, the data collected from registration studies may differ from the clinical situation. The Dutch NuvaRing Experience Project was initiated to gain insight into NuvaRing use in daily clinical practice. METHODS: A total of 1,130 women, recruited by 257 general practitioners, participated in this observational study. Data on compliance, acceptance, satisfaction, and adverse events were collected during the first 3 months of ring use via an online questionnaire. RESULTS: The results of this study were almost identical to those of the international registration studies. The majority of women complied with the prescribed regimen and were (very) satisfied with NuvaRing, primarily because of the once-a-month administration, low hormonal dose, and ease of use. Only one pregnancy was recorded throughout the study period. The bleeding pattern was better than with the pill, and there were few estrogen-related adverse events. Only a small proportion of women discontinued because of local adverse events such as discomfort during intercourse and expulsion. Following study completion, 80% of women continued with NuvaRing. CONCLUSIONS: In The Netherlands, the first clinical experiences with NuvaRing in daily practice confirm that the contraceptive ring is a reliable, safe, and convenient method of contraception.

Adolescent↗
PubMed2006

A case of imported paracoccidioidomycosis: an awkward infection in The Netherlands.

Paracoccidioidomycosis is an important endemic mycosis in South America. In Europe the disease is very rare and only found as infections in travelers to Latin America. We report here the first case encountered in the Netherlands for which the appropriate diagnosis was not attained for several months. A Dutch 60-year-old man presented with a painful ulceration in the buccal mandibular vestibular mucosa of three months duration. While his medical history was uneventful, he had worked, until 8 years prior to his presentation, as a carpenter for 25 years in the jungles of Peru and Ecuador. An aberrant chest radiograph, CT-scan of the lungs and increased erythrocyte sedimentation rate were suggestive of sarcoidosis or a bronchiolitis obliterans organizing pneumonia. There was no improvement in the patient's symptoms despite the use of budesonide and prednisone medication, as well as tuberculosis prophylaxis with isoniazide and rifampicin, and local use of miconazole. Quite to the contrary, as an irritated, irregular hyperemic mucosa and gingiva with ulceration were noticed during this period of time. These precipitated an incisional biopsy through which a mixed inflammatory cellular infiltrate and large yeast cells were found on histopathologic examination. Based on the patient's travel history and the multiple budding yeastlike cells revealed in the biopsy tissue, the diagnosis of paracoccidioidomycosis was finally made. This was supported by the isolation of Paracoccidioides brasiliensis in culture. Antimycotic oral therapy with itraconazole was started and continued for 15 months. At two and five year follow-ups, the patient was asymptomatic. In Europe, it may be expected that diseases that are endemic in other areas will be seen more frequently in countries where the diseases are not routinely encountered. It is most likely that the use of corticosteroid medication, with its inherent immunosuppressive effect, resulted in the reactivation of an infection acquired many years before in Latin America. The etiologic agent then disseminated from the initial focal point to cause the ensuing oral mucous membrane lesions. The importance of the patient's prolonged residence in Latin America was overlooked. The very long latency of endemic mycoses emphasizes the need for a meticulous history which should include not only recent trips, but also past residence in foreign countries.

Antifungal Agents↗
PubMedDate not supplied

Fecundity of daughters born after short, intermediate, or long birth intervals. An analysis of family reconstitutions from The Netherlands, late 19th-early 20th century.

In an historical cohort study, we compared the reproductive performances of women born after short (< 14 completed months), intermediate (21-32 completed months), and long (> 39 completed months) birth intervals. Of the initial study base, comprising family reconstitutions of 1,425 women born between 1873 and 1902 in or around Rotterdam (The Netherlands) and married before age 45, a large portion (data of 1,001 women born between 1888 and 1902) was uninformative because of (unintended) selection on birth control behavior. Among the remaining 424 women, those born after very short birth intervals (less than 1 year) showed higher likelihood of childlessness and stillbirth in the offspring than those born after intermediate intervals (adjusted odds ratios (OR) and 95%-confidence intervals: 7.7 [1.8-33.0] and 3.3 [1.3-8.3], respectively). The latter association, however, nearly disappeared after restriction to women whose preceding sibling lived at least 1 year. Women born after modestly short intervals (12-13 months) exhibited longer interpregnancy intervals. So did women born after long birth intervals, but this might well be attributable to intergenerational transmission of reproductive behavior. These results indicate that fecundability is reduced in women born after short birth intervals.

Adult↗
PubMed2000

Socio-cultural plurality in obstetrics and gynaecology in The Netherlands: research note.

This article reports on an ongoing exploratory study of the quality of obstetrical and gynaecological care for an ethnic pluriform patient population in two non-academic city hospitals in the Netherlands. A bird's eye view is given of the study's background, goals and methodology, followed by a few preliminary results and by some concluding remarks about the need to pay more attention to cultural diversity in health care.

Cultural Diversity↗
PubMed2001

Season of birth and reproductive performance: an analysis of family reconstitutions of 800 women born in The Netherlands at the end of the 19th century.

BACKGROUND: Several studies have reported associations between season of birth and reproductive characteristics such as menarcheal age, fecundability, and twinning, but the results are inconsistent with respect to the location of high- and low-risk seasons. To assess whether this disagreement could be due to the use of populations from different geographic areas and time frames instead of different etiologic pathways, we investigated the season-of-birth dependency of a variety of reproductive outcomes within one time- and area-limited population. METHODS: In a historic follow-up study, the reconstituted families of 800 women born between 1873 and 1887 in or near Rotterdam, The Netherlands, were used to determine eight types of reproductive outcome: childlessness, interval to first pregnancy, pregnancy interval, stillbirth, neonatal death, postneonatal death, multiple birth, and gender of offspring. The relation of these outcomes with season of birth was modeled using cosinor functions with periods of 1 year or a half year. Data were analyzed by use of logistic regression or general estimation equations (GEE), dependent on whether outcomes could occur more than once per woman. RESULTS: Peaks in the model-based risks of reproductive failure were found within two small temporal ranges, January 1 to February 11 and July 1 to August 11 for all outcomes except gender. The picture did not change after controlling for known and possible risk factors, including age, offspring's birth cohort, and some social variables. CONCLUSIONS: This study reconfirms the idea that seasonal factors around conception or birth influence later reproductive characteristics. Observing the consistency of the location of high-risk seasons across a variety of outcomes, the explanation of season-of-birth dependency of different reproductive outcomes need not involve multiple etiological pathways.

Female↗
PubMed1998

Founder effect at PGL1 in hereditary head and neck paraganglioma families from the Netherlands.

PGL1, a gene responsible for hereditary paragangliomas of the head and neck, recently was mapped to a 2-cM interval on chromosome 11q22-q23, by linkage and haplotype-sharing analysis of a large multibranch Dutch family. We determined the disease-linked haplotype, as defined by 13 markers encompassing a large interval on 11q21-q23, in 10 additional families ascertained from the same geographical locale. Alleles were identical for six contiguous markers, spanning a genetic distance of 6 cM and containing PGL1. Despite this strong indication of a common ancestor, no kinships between the families could be demonstrated through genealogical surveys going back to 1800 a.d. We conclude that a single ancestral mutation is responsible for most, if not all, hereditary paragangliomas, in this region of The Netherlands, and that strong founder effects may exist at the PGL1 locus.

Chromosome Mapping↗
PubMed1999

High prevalence of mutations in the microtubule-associated protein tau in a population study of frontotemporal dementia in the Netherlands.

Mutations in microtubule-associated protein tau recently have been identified in familial cases of frontotemporal dementia (FTD). We report the frequency of tau mutations in a large population-based study of FTD carried out in the Netherlands from January 1994 to June 1998. Thirty-seven patients had >/=1 first-degree relative with dementia. A mutation in the tau gene was found in 17.8% of the group of patients with FTD and in 43% of patients with FTD who also had a positive family history of FTD. Three distinct missense mutations (G272V, P301L, R406W) accounted for 15.6% of the mutations. These three missense mutations, and a single amino acid deletion (DeltaK280) that was detected in one patient, strongly reduce the ability of tau to promote microtubule assembly. We also found an intronic mutation at position +33 after exon 9, which is likely to affect the alternative splicing of tau. Tau mutations are responsible for a large proportion of familial FTD cases; however, there are also families with FTD in which no mutations in tau have been found, which indicates locus and/or allelic heterogeneity. The different tau mutations may result in disturbances in the interactions of the protein tau with microtubules, resulting in hyperphosphorylation of tau protein, assembly into filaments, and subsequent cell death.

Dementia↗
PubMed2000

Hospital admissions for rotavirus infection in the Netherlands.

The development of a vaccine against rotavirus (RV) infection has necessitated the estimation of the number of hospitalizations for RV infection in the Netherlands. During 1998, pediatricians have reported all hospitalizations with RV infection and supplied information on the duration of admission, clinical picture, indication for admission, and treatment. Also, data from the National Disease Registry on hospitalizations for gastroenteritis (International Classification of Disease codes 006.6. 006.8, 009, and 558.9) and laboratory surveillance data for 1996-1998 were combined in a linear regression model to indirectly estimate the incidence and proportion of hospitalizations attributable to RV infection. The direct estimate of admissions for RV infection in children aged <5 years was 0.9 per 1000, and the indirect estimate was 2.7 per 1000 in 1998 (1996, 3.4; 1997, 1.6). The proportion of hospitalizations for gastroenteritis attributable to RV ranged from 32% in 1997 to 58% in 1996.

Child, Hospitalized↗
PubMed2000

Invasive group A streptococcal disease in the Netherlands: evidence for a protective role of anti-exotoxin A antibodies.

As part of a nationwide surveillance in The Netherlands during 1994-1997, 53 patients with invasive group A streptococcal (GAS) infections were evaluated for medical history, symptoms, and outcome. Patients' isolates were tested for the production of pyrogenic exotoxins A (SPE-A) and B (SPE-B). Acute-phase sera from all patients and convalescent sera from 12 patients were investigated for the presence of antibodies against SPE-A and SPE-B. Twenty-three patients developed toxic shock-like syndrome and 16 died. Absence of antibodies against SPE-A and/or SPE-B was a risk factor for developing invasive streptococcal disease. Toxic shock and mortality were associated with a lack of anti-SPE-A antibodies (P<.025). Anti-SPE-A antibodies were found in convalescent sera from all patients infected by speA-positive isolates. Virtually all invasive speA-positive streptococci expressed SPE-A protein in vitro. Thus antibodies against SPE-A appeared vital for mediating the outcome of invasive GAS disease in this population.

Adolescent↗
PubMed2000

Mutations at amino acid position 315 of the katG gene are associated with high-level resistance to isoniazid, other drug resistance, and successful transmission of Mycobacterium tuberculosis in the Netherlands.

The prevalence of mutations at amino acid (aa) position 315 in the katG gene of isoniazid (INH)-resistant Mycobacterium tuberculosis isolates in The Netherlands and the mutation's association with the level of INH resistance, multidrug resistance, and transmission were determined. Of 4288 M. tuberculosis isolates with available laboratory results, 295 (7%) exhibited INH resistance. Of 148 aa 315 mutants, 89% had MICs of 5-10 microg/mL, whereas 75% of the other 130 INH-resistant strains had MICs of 0.5-1 microg/mL. Of the aa 315 mutants, 33% exhibited monodrug resistance, compared with 69% of other INH-resistant strains (P<.0001). Multidrug resistance was found among 14% of the aa 315 mutants and 7% of the other INH-resistant strains (P>.05). The probability of being in an IS6110 DNA restriction fragment length polymorphism cluster was similar for aa 315 mutants and INH-susceptible strains, but the probability was reduced in other INH-resistant strains. Thus, aa 315 mutants lead to secondary cases of tuberculosis as often as INH-susceptible strains do.

Antitubercular Agents↗
PubMed2000

Outbreak of amebiasis in a family in The Netherlands.

Human-to-human transmission of Entamoeba histolytica is rare in industrialized countries. We describe an outbreak of amebiasis in a family in The Netherlands, demonstrating that even with Western standards of hygiene, persistent cyst passage may result in the transmission of E. histolytica to household contacts. If E. histolytica is isolated from a person living in an area of nonendemicity, it may be worthwhile to test all family members for cyst passage.

Adult↗
PubMed2001

Etiology of gastroenteritis in sentinel general practices in the netherlands.

Data from a general practice-based, case-control study on gastroenteritis and the pathogens related to this disease were used to study the association between specific pathogens and the infected patients' ages and symptoms. For comparison, the occurrence of these pathogens in control patients, stratified by age, also is presented. In children with gastroenteritis who were <5 years of age, rotavirus (in 21% of patients) and Norwalk-like virus (NLV; in 15%) were the most common pathogens. Among patients who were 5-14 years of age, Campylobacter species (in 16% of patients) and Giardia lamblia (in 10%) were the most common pathogens. In the older patients, Campylobacter species was also the most common pathogen (8% to 15% of patients). In addition, several symptoms in case patients were associated with specific pathogens. Blood in the stool was associated with infection with Campylobacter species. In patients with fever, Salmonella species, Campylobacter species, and rotavirus were detected relatively often. Vomiting was associated with NLV and rotavirus. This is the first study in The Netherlands and one of the first studies in the world that has investigated a broad range of pathogens recovered from an unselected population of patients who had consulted general practitioners because of gastroenteritis.

Adolescent↗
PubMed2001

Poliovirus circulation among schoolchildren during the early phase of the 1992-1993 poliomyelitis outbreak in The Netherlands.

During the 1992-1993 outbreak of poliomyelitis in The Netherlands, we examined 866 childrenat 7 schools for evidence of infection with the outbreak virus, poliovirus type 3(PV3), to determine the extent of the outbreak and the protection of the herd immunity. Seventy-seven children (8.9%) showed evidence of recent wild-type PV3 infection, as determined by virus isolation and/or poliovirus type-specific IgM assay. Most infected children lived in the same area as the index case patient, attended an orthodox-reformed (OR) primary school, and had not been vaccinated. At the OR school, as many as 22% of children immunized with inactive poliovirus vaccine were found to have evidence of recent infection, which is a significantly lower rate than that among unvaccinated children (59.5%). No evidence of vaccination was seen in 25.5%-43.1% of children at OR schools. Seroprevalence of antibodies against the 3 types of poliovirus suggested that no poliovirus circulation had occurred between the 1978 and 1992-1993 outbreaks.

Adolescent↗
PubMed2002

Measles epidemic in the Netherlands, 1999-2000.

In 1999-2000, a measles epidemic occurred in The Netherlands, with 3292 reported cases; 94% of the affected patients had not been vaccinated. Only 1 patient had received 2 doses of vaccine. Three patients died, and 16% had complications. For the unvaccinated population, the incidence per 1000 inhabitants 15 months to 14 years old increased from 83 (95% confidence interval [CI], 53-113), in municipalities with vaccine coverage rates < or =90%, to 200 (95% CI, 153-247), in municipalities with coverage rates >95%; for the vaccinated population, the incidence increased from 0.2 (95% CI, 0.1-0.4) to 1.4 (95% CI, 0.9-1.9). Unvaccinated individuals were 224 times (95% CI, 148-460 times) more likely to acquire measles than were vaccinated individuals; the relative risk increased with decreasing vaccine coverage. Herd immunity outside unvaccinated clusters was high enough to prevent further transmission. More case patients came from the vaccine-accepting population living among unvaccinated clusters than from individuals who declined vaccination and who lived among the vaccine-accepting population.

Adolescent↗
PubMed2002

Phylogenetic background and virulence profiles of fluoroquinolone-resistant clinical Escherichia coli isolates from the Netherlands.

Thirteen fluoroquinolone-resistant Escherichia coli (FQREC) isolates from hospitalized patients in the Netherlands were found to represent predominantly (low-virulence) phylogenetic groups A and B1 and to lack extraintestinal virulence traits. These FQREC resemble animal-source E. coli and presumably pose little threat to noncompromised hosts. Similar analysis of other FQREC is needed.

Anti-Infective Agents↗
PubMed2003

Evaluation of serological and virological tests in the diagnosis of clinical and subclinical measles virus infections during an outbreak of measles in The Netherlands.

We evaluated different approaches for diagnosing measles virus (MV) infection in unvaccinated children and in healthy contact persons (n=194) during a measles epidemic in The Netherlands. MV RNA was detected by reverse-transcriptase polymerase chain reaction in throat-swab specimens from 93% of the patients with clinical symptoms. MV RNA was detected from 5 days before until 12 days after the onset of symptoms. Most patients (88%) also secreted MV RNA in their urine until 5 weeks after the onset of symptoms. Oral fluid proved to be the most practical specimen for the simultaneous detection of MV-specific IgM antibody and viral RNA, which, together, confirmed 93% of measles cases. Viral RNA was also detected in oropharyngeal specimens from 3 healthy contact persons with serological proof of MV infection. The results of this study emphasize the feasibility of combined detection of viral RNA and MV-specific IgM antibodies in oropharyngeal specimens for the diagnosis of clinical and subclinical MV infection.

Adolescent↗
PubMed2004

Nontuberculous mycobacterial infection in children: a 2-year prospective surveillance study in the Netherlands.

We performed a prospective, 2-year nationwide study to assess incidence and disease characteristics of suspected infections with nontuberculous mycobacteria (NTM) in children, via the Netherlands Pediatric Surveillance Unit. Data for 61 children were reported (median age, 31 months; interquartile range, 22-50 months; female sex, 37 subjects); 2 subjects had an underlying disease. Most children (53 [87%] of 61) had cervical lymph node enlargement, with abscess in 25 (47%) and fistula in 11 (21%). The estimated annual incidence of NTM infection was 77 cases per 100,000 children. In 16 children, the diagnosis was based solely on the results of skin tests with mycobacterial antigens. Cultures were performed in 36 cases and yielded mycobacteria in 27 (75%); Mycobacterium avium was isolated from 18 cultures. Children with a culture positive for mycobacteria did not differ in presentation, complications, or treatment from those whose cultures showed no growth. Thirty children underwent surgery, and chemotherapy was the single treatment in 24 (39%) of the cases. The treatment of localized NTM infection in immunocompetent children by antimycobacterial drugs should be evaluated further.

Adolescent↗
PubMed2004

Avian influenza A virus (H7N7) epidemic in The Netherlands in 2003: course of the epidemic and effectiveness of control measures.

An epidemic of high-pathogenicity avian influenza (HPAI) A virus subtype H7N7 occurred in The Netherlands in 2003 that affected 255 flocks and led to the culling of 30 million birds. To evaluate the effectiveness of the control measures, we quantified between-flock transmission characteristics of the virus in 2 affected areas, using the reproduction ratio Rh. The control measures markedly reduced the transmission of HPAI virus: Rh before detection of the outbreak in the first infected flock was 6.5 (95% confidence interval [CI], 3.1-9.9) in one area and 3.1 in another area, and it decreased to 1.2 (95% CI, 0.6-1.9) after detection of the first outbreak in both areas. The observation that Rh remained >1 suggests that the containment of the epidemic was probably due to the reduction in the number of susceptible flocks by complete depopulation of the infected areas rather than to the reduction of the transmission by the other control measures.

Animals↗