The automatic external defibrillator in the Netherlands; an advisory report from the Health Council of the Netherlands

The introduction of the automatic external defibrillator could become an important improvement in the treatment of sudden cardiac arrest in the Netherlands, if the legal regulations for the treatment of sudden cardiac death in the Individual Healthcare Professions Act are modified. The time gained in the recovery of the cardial function is considerable. The use of this device by patrolling police teams and its installation at places where a lot of people congregate would seem to be particularly promising. However, whether the presence of an automatic external defibrillator in the home situation would provide any benefits remains questionable.     

'Pharmacologic interventions in drug addiction': an advisory report from the Health Council of the Netherlands

Addiction is a relapsing brain disease with a tendency towards chronicity. Biological, psychological and socio-cultural factors play a role in the onset and course of this disease. The Health Council of the Netherlands has issued a report on pharmacotherapeutic interventions. The treatment of addiction should be regarded as a medical intervention. A growing number of effective pharmacotherapies are becoming available for the treatment of heroin addiction, although not all of those are available in the Netherlands. Currently, no effective pharmacotherapies are available for the treatment of cocaine addiction. In polydrug addicts, pharmacotherapeutic interventions should be directed at the various separate addictions. In the majority of cases pharmacotherapy is part of an integrated treatment approach in which supportive psychosocial interventions are also important. The long-term continuation of treatment is usually indicated. The Health Council recommends that addiction physicians be put in charge of the multidisciplinary treatment. Medical schools should pay attention to the practical aspects of the treatment and management of addicts. The organisation and workforce of addiction treatment services should comply with the demands that are placed upon healthcare services. Public information campaigns about addiction and the treatment options for addicts can contribute to the destigmatisation of this patient category.     

The benefit of population screening for breast cancer; an advisory report from the Health Council of the Netherlands

A recent Cochrane review does not nullify the evidence supporting the practice of mammographic population screening for breast cancer for women aged 50 years and over. Thus concludes the Health Council of the Netherlands in an advisory report to the Dutch Government. A central feature of the Cochrane review is the conclusion that breast-cancer mortality is an unreliable outcome that is biased in favour of screening. The Health Council finds this conclusion too extreme and does not support the view that breast-cancer mortality must be replaced by overall mortality as an outcome. The Health Council does agree with the view that the use of disease-specific mortality as the only endpoint renders cancer-screening trials subject to bias. Therefore, careful attention should be paid to total cancer mortality, other important causes of death, and overall mortality.     

Scientific research in trauma care; an advisory report from the Health Research Council of the Netherlands

Within the medical sciences, traumatology is a relatively under-researched field. The Health Research Council of the Netherlands [Dutch: Raad voor Gezondheidsonderzoek; RGO] has issued an advisory report to the Minister of Health, Welfare and Sport aimed at reducing this shortfall in the coming years. The advisory report recommends that a specific budget is set apart for traumatology research. The assessment and selection of research submissions must have a strong subject-specific component. Innovative areas within the subject need to be chosen, for which the RGO has formulated recommendations. With this administrative breakthrough in the area of funding provision, the opportunity for research groups to carry out structured research has been created. If these recommendations are followed, then the subject specialists will face the challenge of taking the next step.     

Eye problems due to contact lenses; an advisory report from the Health Council of the Netherlands

In a recent report, the Committee on Health Risks of Contact Lenses from the Health Council of the Netherlands evaluated the health risks of contact lens wear in the Netherlands. Contact lens-related eye disease appears to be common, with an incidence of approximately 80,000 persons per year, who suffer from self-limiting or mild conditions. Such conditions are multifactorial, caused for example by chronic hypoxia, tear-film dysfunction or inadequate fit of the lens. They can range from ocular irritation to giant papillary conjunctivitis, a common cause of permanent lens intolerance. A very serious complication of contact lens wear is infectious keratitis, caused by bacteria or fungi. This is most common in users of permanent-wear soft lenses (20 per 10,000 persons per year) and can lead to a severe loss of vision. Therefore, the Committee has recommended that permanent-wear lenses should not be used. Moreover, lens fitting and follow-up of contact lens wearers should be a prerequisite for optometrists and ophthalmologists. However, the Dutch government has not taken action with respect to this last recommendation.     

Health Council of the Netherlands advisory report 'Vaccination against pertussis'--time for a new vaccine

An advisory report on vaccination against pertussis by the National Vaccination Programme Review Committee of the Health Council of the Netherlands makes recommendations on improving pertussis vaccination in the Netherlands. Since 1996, between 4000 and 8000 cases of pertussis have been reported each year, mainly in young children who have already been vaccinated. The main cause of this increase, apart from decreasing immunity in older children and adults, seems to be diminished vaccine effectiveness due to the occurrence of non-vaccine related strains of the pertussis bacterium in the Netherlands. The cellular vaccine used in the Netherlands contains low levels of the major antigens pertussis toxin and pertactin. The Health Council recommends the fastest possible transition to the use of an acellular combination vaccine. Such a vaccine will be effective and will have considerably fewer side effects than the one currently in use. The Committee recommends that research is done into the sources of pertussis infections in young infants.     

'Treatment of drug-addicted detainees': and advisory report by the Health Council of the Netherlands

The Minister of Health, Welfare and Sport and the Minister of Justice requested advice from the Health Council of the Netherlands, on options for the treatment of detainees addicted to drugs. It is estimated that 15,000 to 23,000 people per year with addiction problems are detained. On the basis of the Custodial Institutions Act detainees have the right to adequate medical, psychological and psychiatric care, including treatment for drug addiction. The legal possibilities for using compulsion in the treatment of addicted persons in detention are very limited. A consensus needs to be reached on methadone medication; professional groups must reach this consensus. As well as abstinence, Addiction Support Sections should aim to achieve harm reduction, for example, by means of stabilisation with a maintenance dose of methadone. The success of interventions among addicted detainees is largely dependent on both the introduction of pressure in the area of follow-up care and the continuity of care. Bearing in mind the frequent psychiatric comorbidity, more psychiatric care should be available within the penitentiary setting. The Penal Care Facility for Addicts [Dutch acronym: SOV] is a new sanction option in the Penal Code with which drug-addicted repeat offenders can be involuntarily admitted to a drug addiction treatment centre for a maximum of 2 years. There is not enough scientific evidence to support the effectiveness of the SOV approach. The compulsory placement of an addict in the SOV could reduce the addict's motivation to do something about his addiction problem. SOV is a harsh sanction that should only be used once lighter sanctions (based on pressure by means of special conditions) have been shown to be ineffective for the persons concerned.     

Brain injury in boxers and soccer players; an advisory report from the National Health Council of the Netherlands

The National Health Council of the Netherlands has released a report entitled 'Brain damage in boxers and soccer players'. It examines epidemiology and prevention of cerebral damage from professional and amateur sports, focusing particularly on soccer and boxing. The connection between cerebral injuries and acute and chronic sports injuries is well established. However, proper diagnosis and therapy may be difficult in acute head trauma and during the chronic stage. It makes proposals for a simple cognitive screening test for acute injuries (soccer-related in particular) and more extensive testing for the detection and follow-up of chronic cerebral injuries (boxing-related in particular). Neuropsychological testing may be an important additional diagnostic tool. Professional boxing should be banned if the measures suggested fail to prevent chronic cognitive dysfunction. A dedicated knowledge centre for soccer and boxing would enhance the epidemiology and knowledge of brain injuries, and could help to develop more evidence-based guidelines in the future.     

'Knowledge Infrastructure for Public Health': an advisory report from the Advisory Council on Health Research

Social, scientific and technological developments are forcing health care systems to shift the focus from disease to health and from cure to prevention. The Advisory Council on Health Research (RGO) has published an advisory report about the knowledge infrastructure serving the needs of public health in the Netherlands. The Council's concept of public health also includes aspects such as policy and health management. The Council concludes that more research is needed on the following determinants of health: environmental issues, social factors, unhealthy behaviour and genetic factors. Intervention research must focus on health protection, health promotion and disease prevention. The public health infrastructure can be improved by amalgamating research groups, establishing departments of public health at every academic medical centre, and linking service, education and research.     

Repetitive strain injury (RSI); a report from the Health Council of the Netherlands

The Health Council of the Netherlands has published its advisory report on Repetitive Strain Injury (RSI). The report provides clear information on the state of this syndrome, including the definition of the problem, the epidemiology, various hypothetical pathophysiological mechanisms, occupational and personal risk factors, and possible methods of treatment. The council states that with regard to the last aspect, too few data are available to draw any conclusion as to the most promising therapy. Nevertheless, patients should get consistent advice from their GP or company doctor. The council emphasises that encouraging physical exercise and eliminating any possible causative strain should be part of an integrated approach, embracing work-related psychosocial and personal issues. Of particular interest is the council's advice to prevent RSI by improving the physical condition and by selective training of muscle function. The report recommends that more research be carried out in order to provide insight into the effectiveness of the treatment of RSI.     

Possibilities and limitations of genetic research; an advisory report from the Advisory Council on Health Research

The Raad voor Gezondheidsonderzoek [Advisory Council on Health Research] has issued a report entitled 'New applications of genetic information in health care: which knowledge is needed?' The report is limited to areas where research is likely to have consequences within the relatively short time-span of a few years. These include genetics in diagnostics and screening, pharmacogenetics, and certain inherited diseases in adult age. Complex diseases such as multifactorial ones are not addressed. The report provides a useful overview of the prospects and problems in genetic research and how it will be applied in the years to come. Societal consequences of genetic research are also discussed. To enhance the understanding of complex diseases, epidemiological studies with long-term follow-up that combine genetic data with other data are essential. At the same time, potential privacy risks should be acknowledged and scientists should take extreme care in collecting, handling and analysing such data. The Netherlands Federation of Societies for Medical Research has produced guidelines which researchers should follow when carrying out their research.     

Report of the Health Council on the use of benzodiazepines. The Netherlands Health Council]

The Netherlands Health Council has issued a report on the appropriate use of benzodiazepines, detailing current knowledge on mode of action, indications for use, adverse effects and the prescribed volume in the Netherlands. About 3% of the adult population are chronic users of benzodiazepines. Chronic use is complicated by the risk of falling; the relative risk of hip fractures in chronic benzodiazepine users in about 1.7. Chronic use should be discouraged. However, most chronic users are fragile elderly people for whom a good night's sleep implies temporary escape from a sorry existence with somatic or psychic symptoms. Such circumstances should be kept in mind when treating individual patients.     

'Ageing with ambition'; a recommendation from the Health Council of The Netherlands

The Health Council of the Netherlands, at the request of the policy committee for the elderly of the Dutch parliament, has deliberated over the intermediate- and long-term developments in the field of 'care and ageing'. In a comprehensive report, the overall conclusion is that there is sufficient room for the ambition to stimulate the health, independence and welfare of the elderly. The effects of biological ageing and the connections that exist between ageing, life span, illness and wellbeing are addressed. The number of people with illnesses and functional disorders will inevitably increase with ageing of the population. Nevertheless, numerous opportunities will arise to achieve health benefits and increase the quality of life. A range of measures is proposed in the field of prevention and treatment. An innovative policy on the elderly, political courage and social solidarity will be necessary in order to achieve 'ageing with ambition'. However, as pointed out in the report, health care is not merely an expense but also an important service industry that provides employment to a large number of people.     

Report from the Health Council of the Netherlands on disputed memories

The Health Council of the Netherlands recently has published an advisory report to the Minister of Health, Welfare and Sport on 'Disputed Memories'. The committee, which was established to formulate the report, has answered questions about the accessibility of memories of traumatic events, about the circumstances that might make memories accessible again, and about the possibility of recalling memories of events that were never experienced. The role of psychotherapy in retrieving traumatic memories is discussed extensively, leading to specific recommendations. In contacts with patients and law enforcement agency therapists are expected to refrain from judgments about the historical truth of recovered memories.     

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.     

Recommendations for calcium and vitamin D in the report 'Nutritional standards' of the Netherlands Health Council

The Health Council of the Netherlands has issued a report on the recommended use of calcium, vitamin D and a number of other vitamins. The recommendations for calcium and vitamin D have been adjusted (upward) in view of recent evidence that these nutrients affect the occurrence of osteoporosis and bone fractures in all stages of life.