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PubMed2002

[Centenary of the Health Council of the Netherlands. VI. Coordination mechanisms and the authority of the Health Council of the Netherlands].

What do scientific advisory boards such as the Health Council of the Netherlands get their authority from? How does the Council ensure that its advice is incorporated into policy and into the practices at which the advice is directed? A frequently heard answer to this question is: by describing 'the state of knowledge' as optimally as possible. However, case studies on advisory work by the Health Council have shown that this explanation is too simplistic. It is more likely that the explanation lies in the use of 'co-ordination tools'--such as problem definition, the committee process and a specific use of language--that enable the Council to both separate and bridge science and policy. The authority of the Council is based on the hybrid nature of its work.

Advisory Committees↗

PubMed2003

[The tuberculin skin test in the Netherlands: new policies for an old test; guideline from the Netherlands Tuberculosis Control Policy Committee].

The primary function of tuberculin skintesting is to demonstrate latent tuberculosis infection. The Netherlands Tuberculosis Control Policy Committee revised the guideline for the use and interpretation of the test because of new insights and changes of the epidemiological situation. Tuberculin testing should target persons who are likely to benefit from treatment of latent tuberculosis infection, such as contacts of tuberculosis-source cases, persons with increased occupational risk of tuberculosis exposure and persons with an increased risk of breaking down from infection to active disease as a result of depressed cellular immunity. The contribution of the tuberculin skintest to the diagnosis of active tuberculosis is limited. Different cut-off values for a positive test result are recommended in order to obtain optimum positive and negative predictive values in different target groups. In screening programmes, if the initial test result is 3-9 mm, follow-up tests are only indicated after exclusion of boosting by the initial two-step method. In contact investigations and persons with immune disorders, a history of Bacillus Calmette Guérin (BCG) vaccination should not longer be regarded a contraindication for tuberculin testing.

Health Policy↗

PubMed1994

Risk assessment of carcinogenic chemicals in The Netherlands. Health Council of The Netherlands: Committee on the Evaluation of the Carcinogenicity of Chemical Substances.

The Health Council of The Netherlands advises the Dutch government on scientific issues concerning health and environmental protection. In 1978 a committee of the Council established mechanistic criteria for quantitative risk assessment of carcinogenic substances. For this purpose it adopted the multistage model of carcinogenesis. Based on this model two categories of carcinogens were distinguished. The first category includes complete carcinogens and tumor initiators; these agents induce irreversible modification of DNA and act by a stochastic mechanism. The second category includes promoters and other substances acting as cocarcinogens; these agents act by nonstochastic mechanisms. Stochastic action implies that there is no threshold for the contribution to the carcinogenic effect, whereas nonstochastic action implies a threshold dose. Recently, reevaluation of the method for carcinogenic risk assessment was considered due because of remarkable scientific progress since 1978, such as the identification of cellular oncogenes and tumor suppressor genes, and the partial clarification of mechanisms at the cellular and/or molecular level by which tumor promoters stimulate tumor development. The present paper discusses the Dutch method for carcinogenic risk assessment in the light of the recent scientific developments. It concludes that this method for risk assessment is still a valid and appropriate one.

Animals↗

PubMed1998

[Optimization of the antibiotics policy in the Netherlands. II. SWAB guidelines for the antimicrobial therapy of pneumonia in patients at home and as nosocomial infections. The Netherlands Antibiotic Policy Foundation].

The Netherlands Antibiotic Policy Foundation issued guidelines for empirical antimicrobial therapy of adult pneumonia patients in hospitals. A distinction is made between pneumonia contracted at home or in hospital because of the differences in micro-organisms and resistance patterns. These two categories are subdivided further with an empirical antibiotic treatment being chosen on the basis of the causative agents to be expected. For instance, pneumonia contracted at home is mostly caused by Streptococcus pneumoniae, to be treated with benzylpenicillin or amoxicillin. With regard to nosocomial pneumonia, treatment varies according to whether a pneumonia has or has not been contracted in the intensive care unit. Combating development of resistance is alloted an important place. Emphasis is laid on 'streamlining' the therapy, i.e. its adjustment (including choosing an antibiotic with the narrowest possible spectrum) once the causative agent is known.

Adult↗

PubMed1997

[Psychiatric morbidity among adults in The Netherlands: the NEMESIS-Study. I. Objectives, design and methods. Netherlands Mental Health Survey and Incidence Study].

OBJECTIVE: To determine prevalence, incidence and course of psychiatric disorders in non-institutionalised Dutch adults. DESIGN: Prospective and cross-sectional. SETTING: Trimbos Institute, Utrecht, the Netherlands. METHOD: A multistage, stratified random sampling procedure was used to obtain a sample of 7076 adults (18-64 years). Respondents were interviewed throughout 1996 in their homes. The main diagnostic instrument was the 'Composite international diagnostic interview' (CIDI), designed to assess lifetime prevalence of mental disorders according to Diagnostic and statistical manual of mental disorders, 3rd revised edition (DSM-III-R). The diagnostic categories were: affective disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, and substance use disorders (dependence and abuse). The sample was weighted towards national census data on sex, age, marital status and urbanicity. RESULTS: The results of the first measurement (1996) will be described in the next article (1997:2353-60). The response rate was 64.2%. There were no indications that the psychiatric morbidity of non-respondents differed from respondents. The same respondents will be interviewed again after 12 (1997) and after 36 months (1999).

Adolescent↗

PubMed1988