Home treatment and reimbursement in The Netherlands.

In The Netherlands home care is one of the most rapidly growing fields in health. It is thought to provide a cheaper alternative to hospitalization and improved quality of life for the patient. However, there is evidence that home care may result in better care but does not reduce the burden on hospital services. Studies have shown that outpatient parenteral antibiotic therapy (OPAT) is more cost-effective, resulting in an improved quality of life. The new home-treatment technology requires careful evaluation, under set guidelines, to ensure safety and effectiveness.

The HIV epidemic and its effect on the tuberculosis situation in The Netherlands.

To determine the influence of the HIV (human immunodeficiency virus) epidemic on the tuberculosis situation in the Netherlands, we made a retrospective analysis of all reported tuberculosis cases from 1984 through 1990. We studied the course of the tuberculosis incidence in the Netherlands among the group at highest risk for HIV infection (Dutch males, 25-49 years of age, in Amsterdam). This was compared with the course among same-age Dutch males in areas with lower risk for HIV infection and among other-age Dutch males in Amsterdam. The tuberculosis incidence among Dutch males aged 25-49 years in Amsterdam increased from 16.1 in 1984 to 34.7 per 100,000 in 1990 (chi 2 for trend, P < 0.01). The incidences among Dutch males in other places of residence in this age group and among other-age Dutch males in Amsterdam remained stable or decreased during the same period. As this increase could not be ascribed to tuberculosis among other risk groups, it appears to be related to the HIV epidemic among male homosexuals. Our results indicate that, even in a country where the prevalence of tuberculous infection is low, an increase of tuberculosis among certain subgroups can be observed as the result of the HIV epidemic.

[An outbreak of mostly extrapulmonary tuberculosis in a family practice]. / Een explosie van voornamelijk extrapulmonale tuberculose in een artsenpraktijk.

An outbreak of mainly extrapulmonary tuberculosis (TB) in a group of about 550 patients with rheumatoid arthritis (RA) is described. These patients had been attending the practice of a former general practitioner who treated cases of rheumatoid arthritis with phenylbutazone and steroids. The number of diagnosed TB cases was 55. Six cases had a contagious lung localisation. The possible sources of the outbreak were analysed. Both a visit on a same day as a sputum positive patient (chi 2-trend: 20.4; p < 0.001) and the administration of steroids (odds ratio (OR): 36.2; 95% confidence interval (CI): 8.8-313) were independent risk factors. There also appeared to be a relationship between TB and RA (OR: 4.4; 95%-BI: 2.2-9.1). Exogenous re(infection) and endogenous reactivation are possible causes of this outbreak.

[Sexually transmissible disorders in allochtonous population groups; a pilot study]. / Seksueel overdraagbare aandoeningen bij allochtone bevolkingsgroepen; een oriënterend onderzoek.

In the registration of sexually transmitted diseases (STD) carried out by the nursing staff in the STD clinics the share of the immigrant populations of Turkish, Moroccan, Surinam and Antilles origin was investigated for the period 1986-89. In the total population of STD patients the immigrants appear to be overrepresented. Their share has increased from one-eight to one-fifth of the total number of STD cases. The STD rates (number of cases per 1000) for the Turkish and Moroccan populations are high, even after adjusting for population size and age. High STD rates are most apparent among males, especially among Turkish males. In comparison with the Dutch population more gonorrhoea is found among immigrants, in particular penicillinase producing Neisseria gonorrhoeae (PPNG). Turkish males (and prostitutes) contributed much to this relatively high prevalence. Further research is to be initiated in order to obtain better insight into the occurrence of STD among immigrant populations in The Netherlands, especially in connection with a potentially increased risk of infection with Human Immunodeficiency Virus (HIV).

[Prognosis concerning HIV-infection and AIDS epidemic in The Netherlands based on mathematical analysis]. / Prognose aangaande HIV-infectie en AIDS-epidemie in Nederland op basis van wiskundige analyse.

In the Netherlands by the 1st of January 1990 1074 AIDS patients have been reported to the Department of the Chief Medical Officer. In the last few years the proportion of intravenous drug users increased and the proportion of homo/bisexual men decreased. After adjustment for the effect of delay in reporting the total number of AIDS patients by 1st January 1990 is estimated to be 1173. It appears that the reporting delay outside Amsterdam is longer than in this city. The time required for doubling of the half-yearly incidence of new AIDS patients (doubling time, dt) increased from 9 months in the beginning of the epidemic to 34 months. It is expected on the assumption of constant dt that 1120 new AIDS patients will be diagnosed in 1990 and 1991 together. The present growth among the homo/bisexual men (dt 34 months) is smaller than the one among the intravenous drug users (dt 23 months). The growth in Amsterdam (dt 36 months) is less than that in the rest of the Netherlands (dt 32 months). Based on the course of the AIDS epidemic the number of HIV infected (including the AIDS patients) is estimated as 9,000-12,000 by the 1st of January 1990.

[Reported patients with infectious diseases in 1989]. / Aangegeven patiënten met infectieziekten in 1989.

The number of cases of infectious diseases notified in 1989 in accordance with the Infectious Diseases Control and Disease Cause Act are given. Of each A, B and C disease the numbers ar mentioned separately. The most significant changes as compared with the previous years are discussed.

[Meningococcal disease in the winter season 1988-1989]. / Meningokokkenziekte in het winterseizoen 1988-1989.

We describe the 304 cases of meningococcal disease notified from week 45 of 1988 and up to week 21 of 1989, and compare these data with those for 1966, the year of the last epidemic in The Netherlands. During the epidemic the interval between the first day of illness and the moment of reporting shortened.

[Reported patients with infectious diseases in 1988]. / Aangegeven patiënten met infectieziekten in 1988.

The number of cases of infectious diseases notified in 1988 in accordance with the Infectious Diseases Control and Disease Cause Act is given. Of each A, B and C disease the numbers are mentioned separately. The most significant changes as compared with the previous years are discussed.

The lateralization percentage as a measure of nasal flow asymmetry in active anterior rhinomanometry.

A new parameter is introduced in active anterior rhinomanometry: the lateralization percentage, calculated as (right flow--left flow)/(right flow + left flow) x 100%. The flow was measured at 15 mm H2O pressure difference after induced shrinkage of the nasal mucosa. Two groups of subjects were studied. One group consisting of 28 male and 40 female volunteers was used to establish normal values in both sexes for flow, absolute flow difference and lateralization percentage. The second group consisting of 20 men who were to undergo submucous septal reconstruction for nasal obstruction was used to test the detection of abnormal cases when applying the normal values derived from the control group. It appeared that the absolute flow difference is a less effective measure than either the total flow or the lateralization percentage. Optimum detection (75-85% of the abnormal cases) was achieved by applying a criterion combining total flow and lateralization percentage.