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1.
J Clin Microbiol ; 39(2): 581-5, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11158110

ABSTRACT

Since January 1996, and over a 3-year time span, a significant spread of serotype 6B multidrug-resistant (MDR) pneumococci, susceptible to penicillin and resistant to erythromycin, clindamycin, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole, was noted in young carriers living in central and southern Greece. Using restriction fragment end labeling and penicillin binding protein (PBP) genotyping, we studied 41 serotype 6B penicillin-susceptible MDR pneumococci isolated during two independent studies in Greece. Forty (98%) of these 41 isolates were strongly related, representing a single lineage (genetic relatedness, > or = 91%). The Greek isolates were closely related (genetic relatedness, approximately 91%) to the penicillin-resistant MDR clone of serotype 6B that spread from Spain to Iceland in the late 1980s. Moreover, the Greek group of isolates was genetically distinct (genetic relatedness, < or = 83%) from other penicillin-susceptible or -resistant serotype 6B strains from various parts of the world. All serotype 6B penicillin-susceptible MDR isolates displayed a penicillin-susceptible PBP 1A-2B-2X genotype. Our findings suggest that the penicillin-susceptible MDR 6B clone that was found in Greece between the years 1996 and 1999 represents the ancestor of the pandemic penicillin-resistant MDR clone 6B.


Subject(s)
Bacterial Proteins , Hexosyltransferases , Peptidyl Transferases , Phylogeny , Pneumococcal Infections/epidemiology , Polymorphism, Genetic , Streptococcus pneumoniae/genetics , Carrier Proteins/genetics , Child , Drug Resistance, Multiple , Genotype , Greece/epidemiology , Humans , Molecular Epidemiology/methods , Muramoylpentapeptide Carboxypeptidase/genetics , Penicillin Resistance/genetics , Penicillin-Binding Proteins , Penicillins/therapeutic use , Polymorphism, Restriction Fragment Length , Serotyping , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/isolation & purification
2.
Ned Tijdschr Geneeskd ; 142(28): 1612-5, 1998 Jul 11.
Article in Dutch | MEDLINE | ID: mdl-9763843

ABSTRACT

OBJECTIVE: To assess the quantitative development of day surgery in the Netherlands. DESIGN: Descriptive. SETTING: St. Antonius Hospital, Nieuwegein, the Netherlands. METHOD: Numbers of admissions in the period 1984-1995 were obtained from Dutch data bases of the National Hospital Institution (NZi). From SIG Health Care Information numbers were obtained with regard to seven specified interventions in the years 1991 to 1995, i.e. breast tumour excision, inguinal hernia repair, varicose vein operation, laparoscopic sterilisation, knee arthroscopy, cataract operation and tonsillectomy. The increase if any of the number of interventions in day care was determined by placing the hospitals in the order of decreasing proportions of day care, and subsequently applying the proportions of the 5th and 10th hospitals, respectively, to the whole group. RESULTS: The number of day care admissions rose from 172,000 (9.9% of all admissions) to 649,000 (29.1%). Of all interventions studied, the percentage carried out in day care increased; the percentages varied greatly from one hospital to another. In 1995, the mean number of interventions in daytime was 115,000 (57% of all 201,000 interventions). The shift from interventions during hospitalization to day care would be 42,000 and 51,000 (21% and 25% respectively, of 201,000), respectively; operations performed in day care would then amount to 166,000 (83% of the total number of interventions) and 157,000 (78%). CONCLUSION: Of the interventions studied, the proportion carried out in day care increased to 57%. In view of the intra- and interhospital differences, a considerable increase of day care in the near future is possible.


Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , Day Care, Medical/statistics & numerical data , Adolescent , Adult , Ambulatory Surgical Procedures/classification , Ambulatory Surgical Procedures/trends , Day Care, Medical/trends , Forecasting , Humans , Netherlands
3.
Diabetes Care ; 19(5): 431-4, 1996 May.
Article in English | MEDLINE | ID: mdl-8732704

ABSTRACT

OBJECTIVE: To determine the number and duration of hospital admissions due to diabetes in children aged 0-19 years between 1980-1991. RESEARCH DESIGN AND METHODS: Secondary analysis of data collected by the SIG Health Care Information was based on the 9th revision of the International Classification of Diseases. The subjects were all children in The Netherlands, aged 0-19 years. The main outcome measures were number and duration of hospital admissions due to type I diabetes (ICD 9 code 250.0-250.9). RESULTS: The hospital admission rate due to diabetes decreased > 30%. This decrease was statistically significant in all age subgroups. The total number of days in hospital due to diabetes decreased dramatically: from 24,961 in 1980 to 11,305 in 1991. The average duration of hospital stay length due to diabetes decreased as well from 14.5 days in 1980 to 11.9 days in 1991. CONCLUSIONS: The hospital admission rate and the length of hospital stay for diabetes in children aged 0-19 years have decreased, in spite of an increasing incidence. The hospital admission rate may decrease still further if more children with newly diagnosed diabetes can be adequately managed by team management at home in the initial phase.


Subject(s)
Diabetes Mellitus, Type 1 , Hospitalization/trends , Adolescent , Adult , Age Factors , Child , Child, Preschool , Diabetic Coma/epidemiology , Diabetic Ketoacidosis/epidemiology , Female , Hospitalization/statistics & numerical data , Humans , Hypoglycemia/epidemiology , Infant , Insulin Coma/epidemiology , Length of Stay/statistics & numerical data , Length of Stay/trends , Male , Netherlands , Sex Characteristics
4.
Am J Epidemiol ; 142(12): 1300-5, 1995 Dec 15.
Article in English | MEDLINE | ID: mdl-7503050

ABSTRACT

The authors investigated the risk of developing dementia for persons aged 50-75 years who suffered from Parkinson's disease, epilepsy, or severe head trauma. They compared the risk in this patient group with the risk in a reference group in a follow-up study based on the linked databases of three Dutch nationwide morbidity registers over the years 1980-1989. The overall relative risk of developing dementia within 8 years in patients with Parkinson's disease who were initially free of dementia was 3.0 (95% confidence interval (CI) 2.9-3.1). Risk was especially increased in younger Parkinson's disease patients (relative risk (RR) = 13.2, 95% CI 6.2-28.6). For patients with epilepsy, the overall relative risk was 1.5 (95% CI 1.4-1.7). Severe head trauma was not associated with an increased risk of dementia (RR = 1.0, 95% CI 0.9-1.1). These findings suggest that Parkinson's disease is an important risk factor for dementia, with a particularly high risk in young patients with Parkinson's disease. Patients with epilepsy may bear a moderately increased risk of developing dementia. This study does not support earlier findings in retrospective case-control studies of an increased risk of dementia in head trauma patients.


Subject(s)
Craniocerebral Trauma/epidemiology , Dementia/epidemiology , Epilepsy/epidemiology , Parkinson Disease/epidemiology , Registries/statistics & numerical data , Age Distribution , Aged , Cohort Studies , Craniocerebral Trauma/complications , Dementia/etiology , Epilepsy/complications , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Parkinson Disease/complications , Risk Factors , Sex Distribution , Time Factors
5.
Eur J Med ; 2(4): 215-8, 1993 Apr.
Article in English | MEDLINE | ID: mdl-8261073

ABSTRACT

OBJECTIVE: To assess the impact of the diabetic foot on the hospitalization of patients with diabetes mellitus in The Netherlands. METHODS: Data on hospitalizations of patients with diabetes mellitus for the years 1988 and 1989 were obtained from the Dutch Information System on Hospital Care. Analysis of the data was performed if in the discharge summary a code number for chronic ulcer of the lower extremity, osteomyelitis or gangrene was reported. RESULTS: In 1988 20.4% of all hospitalized diabetics were reported to have foot problems. The men age of the study population was 71.3 +/- 12.1 years for 1988 and 71.2 +/- 11.9 for 1989. In patients who underwent (partial) limb amputation the M/F ratio was higher than in patients without amputation for all patient groups studied (p < 0.001). In 1988, 3707 and in 1989, 3790 patients were hospitalized for diabetic foot problems. The cumulative costs were calculated to be 38,556,960 ECU for 1988 and 37,720,020 ECU for 1989. The mean duration of hospitalization was 40.0 days in 1988 and 38.3 days in 1989. Patients with limb amputation stayed significantly longer in the hospital than patients without amputation (p < 0.001). Overall in-hospital mortality was 10%. Mortality was highest in patients staged Wagner 4 + 5. Mortality among patients staged Wagner 1 and 2 was higher than in patients with osteomyelitis (p < 0.001). Of all patients, approximately 10% were discharged to a rehabilitation centre or nursing home. CONCLUSION: Both the mean age of the patients hospitalized and the total amount of costs involved are higher than put forward previously in studies from the US Diabetic foot problems put a heavy burden on the health status of elderly diabetic patients. Financial resources should be reallocated in the direction of preventive health care.


Subject(s)
Diabetic Foot/therapy , Hospitalization/statistics & numerical data , Aged , Amputation, Surgical , Diabetic Foot/economics , Diabetic Foot/epidemiology , Female , Humans , Length of Stay , Male , Netherlands/epidemiology , Outcome Assessment, Health Care
6.
Osteoporos Int ; 2(6): 279-84, 1992 Nov.
Article in English | MEDLINE | ID: mdl-1421795

ABSTRACT

In this retrospective study the epidemiology of hip fractures in The Netherlands was evaluated. The number of hip fractures over the period 1972-1987 was collected from the Dutch Centre for Health Care Information (Stichting Informatiecentrum voor de Gezondheidszorg, SIG). The demographic data were collected from the Dutch Centre for Statistics (Centraal bureau voor de Statistiek, CBS). The age-adjusted incidence of hip fractures for both women and men 50 years of age and over, increased linearly over the period 1972-1987. There was also a linear rise in the age-adjusted incidence of hip fractures in women and men 65 years of age and over, but the rise in incidence was equal in both sexes. After the age of 50 years women and men showed an equal proportional increase in the age-specific incidence of hip fractures by 5-year age groups. This proportional increase was independent of the calendar year studied during the period 1972-1987. The increase over time in the age-adjusted incidence of hip fractures in inhabitants 50 years of age and over is the result of changes that act well before the age of 50 years, because the proportional increase in the age-specific incidence of these fractures after the age of 50 years did not change over the period studied. The cohort analysis showed that the age-specific incidence of hip fractures in more recently born birth cohorts is higher than that in birth cohorts born long ago. This observation agrees with the other observations.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Hip Fractures/epidemiology , Age Factors , Aged , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Retrospective Studies , Sex Factors
7.
Neth J Med ; 38(1-2): 51-8, 1991 Feb.
Article in English | MEDLINE | ID: mdl-2030811

ABSTRACT

The number of hip fractures in women 65 yr of age and over increased from 3416 in 1972 to 8075 in 1987. In men of the same age group the number of hip fractures increased from 1167 in 1972 to 2285 in 1987. This increase can only in part be explained by the increase in the proportion of aged people in the Dutch population. The age-adjusted incidence of hip fractures in The Netherlands rose linearly from 479/100,000 to 669/100,000 per year in women aged 65 yr and over during the period 1972-1987. In men of the same age group the age-adjusted incidence of hip fractures increased linearly from 198/100,000 to 308/100,000 per year over the period studied. The total number of hip fractures in the year 2010 has been estimated at 22,726. The mean duration of a hospital stay because of a hip fracture was 30 days in 1987. The annual need for hospital beds in 1987 for the treatment of hip fractures was calculated at 851. For the year 2010, the annual need for hospital beds, based on a 30-day hospital stay, has been estimated at 1866. Should the duration of a hospital admission due to a hip fracture be reduced to 20 days, then the annual need for hospital beds in 2010 would be 1244.


Subject(s)
Hip Fractures/epidemiology , Aged , Aging , Female , Hip Fractures/mortality , Hip Fractures/therapy , Humans , Incidence , Male , Netherlands/epidemiology , Retrospective Studies , Sex Factors
8.
Eur J Clin Pharmacol ; 40(4): 367-71, 1991.
Article in English | MEDLINE | ID: mdl-1675606

ABSTRACT

In 1981 generalized anaphylaxis was registered on 166 occasions in Dutch general and academic hospitals. Clinical details of 120 of those patients revealed that in 107 anaphylaxis was either probable (n = 90) or possible (n = 17), whereas in 13 cases some other reaction than anaphylaxis had occurred. The series of confirmed cases contained 46 men and 61 women, with mean ages of 47 y and 48 y, respectively. There was a complete recovery in 102 patients and two patients died. Hypotension was present in 79 cases (74%), dyspnoea in 34 cases (32%) and a skin reaction, mainly urticaria, erythema or angioedema, was mentioned in 62 cases (58%). Most cases of anaphylaxis were drug-induced (76%), the main causes being the analgesic glafenine and contrast media. Glafenine was mentioned as the cause in 36% of all admissions for drug-induced anaphylaxis. Only 3.7% of cases had been reported to the voluntary reporting scheme of the Netherlands Centre for Monitoring of Adverse Reactions to Drugs. On the basis of reimbursement data, the risk of developing severe anaphylaxis to glafenine was estimated at 11.7-19.3-fold relative to indomethacin, and 13.4-20.2-fold relative to oral penicillins.


Subject(s)
Anaphylaxis/chemically induced , Glafenine/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Anaphylaxis/epidemiology , Child , Child, Preschool , Female , Hospitalization , Humans , Male , Middle Aged , Netherlands , Risk Factors
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