[Health Council recommendation on the 'Contours of the basic package']. / Gezondheidsraadadvies 'Contouren van net basispakket'.

As part of the planned reform of the health insurance system, the Minister of Health, Welfare and Sport has requested the Health Council to 'formulate an opinion with regard to the workable, scientifically-based criteria for identifying which health-care services should be included in a basic package'. The Committee on Contours of the Basic Health Benefit Package has now designated two sets of criteria distinguishing a 'solidarity package' from compulsory insurance. The individual 'burden of disease' combined with 'cost-effectiveness' forms a good basis upon which to define a basic package that, in accordance with the principle of solidarity (rich with poor, young with old, and healthy with sick), will be accessible to all. These criteria have, in the meantime, been applied in a number of situations. For a compulsory package, additional criteria are required: the costs of treatment, nursing or care; the extent to which the disorder that is to be prevented or treated may afflict other people; the preventive nature of services; and the impact that the use of services has on the efficiency of health care as a whole. The two sets of criteria may result in a single basic package, but a 'solidarity package' and a 'compulsory package' need not necessarily coincide. Considerations such as actuarial feasibility may have a bearing on the governmental decisions in this matter. In order to apply the criteria to different services, it is necessary to have a 'national assessment framework' that supports rational decisions. This framework will need to accommodate procedures for defining the package, since application of the criteria will always require a qualified approach.

[Centenary of the Health Council of the Netherlands. I. Introduction]. / Honderd jaar Gezondheidsraad. I. Inleiding.

The Health Council of the Netherlands [Dutch name: Gezondheidsraad] is an independent, statutory advisory body whose task is to inform the Dutch government on the current level of knowledge with respect to public health issues. Its work covers the entire terrain of curative and preventive healthcare, environmental protection, nutrition, occupational hygiene and environmental hygiene. The Health Council has existed in one form or another since 1 August 1902. Its present form was established by the 1956 Health Act, which was amended in 1997. To perform its task, the Health Council brings together multidisciplinary committees of leading experts--nominated in a personal capacity--on specific topics both at the government's request and on its own initiative. About thirty committees are operative at any one time. The Health Council has published more than 2000 advisory reports during its 100 years of existence.

The identification of new health care technologies by the Health Council of The Netherlands.

The article gives a global overview of the 14 years of signposting experience of the Health Council of the Netherlands. The Council signals new health care technologies and emerging health care problems in briefs, comprehensive reports, and bulletins. Its main purpose is to provide the government with timely information to support rational policy decision making.

[Brain death criteria; guidelines by the Public Health Council]. / Hersendoodcriteria; richtlijnen van de Gezondheidsraad.

The Committee on brain death criteria of the Health Council of the Netherlands has formulated guidelines for diagnosing brain death according to prevailing medical opinion. The guidelines are based on the relevant scientific literature and consultation of the professional groups involved and take into consideration that various views on death, or brain death, are existent in the community. The Committee has attempted to phrase the guidelines in clear and specific terms, in order to minimize interpretational differences. It endorses the most stringent definition of brain death, as given in the Organ Donation Act, the so-called 'whole brain death' concept. It must be established that the potential donor has irreparable and complete loss of brain and brain stem function. Three diagnostic phases are needed. In one of these an isoelectric electroencephalogram is required. This does not preclude that certain neurons in certain areas may still be active, but these phenomena are no indication of higher brain function or its intermediary or supportive functions. If electroencephalography cannot be performed, or if the apnoea test is not possible, cerebral arterial angiography is required. In children, the investigations must be repeated. A written codicil by the donor will be respected, but it is unlikely that organs or tissues are removed against the will of the family.

[Prenatal study of trisomy 21: triple test more efficient than age criterion]. / Prenataal onderzoek op trisomie 21: tripletest efficiënter dan leeftijdscriterium.

OBJECTIVE: To compare the results of selection of gravidae for trisomy 21 testing on the basis of age or of the triple test. DESIGN: Theoretical evaluation. METHOD: Demographic statistical data for the years 1980, 1985, 1990 and 1994 and the age-specific risk were used to calculate the expected number of children to be born with trisomy 21. Also calculated were the size of the risk groups, the number of children with trisomy 21 to be detected early, the iatrogenic loss of pregnancy and the number of invasive tests to be performed in order to detect one child with trisomy 21 with either selection method. RESULTS: Shifting of pregnancy to women with a mean older age results in a increase of the risk group as determined by age. It will also result in an increase of the number of iatrogenic losses of pregnancy. Selection of the risk group by the triple test will not result in these increases. The risk group, as determined by the triple test, includes about 60 per cent of the women pregnant of a child with trisomy 21; that determined by age 23 to 30 per cent. The number of invasive tests to be performed for the detection of one child with trisomy 21 is significantly smaller in case of selection by the triple test. CONCLUSION: By application of the triple test less pregnant women have to be further examined and more cases of trisomy 21 are detected, than by application of the age criterium.

[Costs and benefits of vaccination against Haemophilus influenzae type b]. / De kosten en baten van vaccinatie tegen Haemophilus influenzae type b.

In the Netherlands, Haemophilus influenzae type b (Hib) causes invasive disease in hundreds of children every year; meningitis is the most frequent and most severe infection. Children from the age of 6 months can be protected against Hib-diseases by conjugated vaccines. The financial consequences of the introduction of such vaccine into the state vaccination programme are considered in a cost-effectiveness analysis. Some elements in the analysis are still uncertain, such as the price and the schedule and method of administration of the vaccine. Presumably, the costs and benefits will be in balance, if one vaccine dose will cost about 7 US $+ and if the administration can be combined with the present programme of vaccinations against diphtheria, whooping cough, poliomyelitis and tetanus.

[Terminal kidney insufficiency in children in the years 1979 through 1986 in The Netherlands]. / Terminale nierinsufficiëntie op de kinderleeftijd in de jaren 1979 tot en met 1986 in Nederland.

During the period 1979-1986, 167 children with terminal renal failure were treated in 4 dialysis centres for children: 124 of them were treated by haemodialysis, 43 by continuous ambulatory peritoneal dialysis (CAPD). The frequency of CAPD increased during the last few years. This method is suitable for small children. The number of transplantations should be increased. Present facilities cannot deal with the numbers of new patients with terminal renal failure.

Heat transport in the canine left ventricular wall.

The rate of rise of local myocardial temperature (dT/dt) evoked by left coronary artery main stem occlusion has been proposed in the literature as a measure of local metabolic heat production, assuming heat loss due to diffusion to be negligible. In a previous study (ten Velden, G. H. M., G. Elzinga, and N. Westerhof. Circ. Res. 50: 63-73, 1982), we showed that this assumption was not valid. With this information in mind, in an attempt to study local metabolism, we compared, in anesthetized dogs, the dT/dt with the temperature distribution over the left ventricular wall. We found the value of dT/dt to be reproducible in time and to reproducibly depend on location. Negative values as well as positive values were measured; values even higher than the maximal possible temperature slope, calculated from the energy equivalent of left ventricular oxygen consumption and the specific heat of cardiac tissue, were found. Transmural distribution of the dT/dt showed positive values epicardially and negative values endocardially, while, as previously shown, a parabola-like shape of the transmyocardial temperature distribution existed. Our findings demonstrate that dT/dt by left coronary main stem occlusion cannot be used as a measure of local myocardial heat production.

Left ventricular energetics. Heat loss and temperature distribution of canine myocardium.

The sum of total left ventricular heat loss and left ventricular mean total external power was compared with the product of oxygen consumption and its energy equivalent. Myocardial blood flow, measured with 15 +/- 3 micrometers radioactive microspheres, was multiplied by the transcoronary arteriovenous temperature difference and by oxygen content difference to obtain coronary heat loss and oxygen consumption, respectively. Since only part of the heat is carried away by the coronary system a thermodilution technique was used to obtain the ratio between the heat removed by the coronary system and the external heat loss. A correction was made for the endothermic reactions of hemoglobin deoxygenation and carbon dioxide reactions with blood. Left ventricular oxygen consumption corresponded to 2.26 +/- 0.66 W/100 g, and for the sum of total left, ventricular heat loss and external power, 2.09 +/- 0.51 W/100 g was found (n = 14). In a second series, the measured transmyocardial temperature distribution was compared with the calculated temperature distribution, assuming that heat production in the myocardium is uniform and that heat is lost by coronary flow and diffusion. When thoracic and luminal myocardial surface temperatures were about equal, blood flow was found to be about the same in the various layers of the heart, whereas myocardial temperature was found to be highest near the middle of the wall (0.36 +/ 0.07 degrees C warmer than luminal temperature (n = 6). When thoracic surface temperature was increased or decreased (by + 1.56 +/- 0.99 degrees and -1.10 +/- 0.59 degrees C, respectively), consistent changes were seen for the temperature distribution in the myocardium, but not for the local flow (endo/epi ratio: 1.06 +/- 0.29 and 0.96 +/- 0.21, respectively). These data suggest that myocardial blood flow is independent of tissue temperature.