Safe motherhood : severe maternal morbidity in the Netherlands. The LEMMoN study

This thesis describes the results of the LEMMoN study, a nationwide prospective cohort study into severe maternal morbidity in the Netherlands in which all hospitals in the Netherlands participated. The main objectives of the study were to assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Cases of severe maternal morbidity were collected during a two-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n=371,021). Special attention was paid to the ethnic background. Substandard care was assessed in selected cases during audit meetings. Severe maternal morbidity was reported in 2552 cases, overall incidence being 7.1 per 1000 deliveries. Incidences of ICU admission, uterine rupture, eclampsia and major obstetric haemorrhage were 0.24%, 0.06%, 0.06% and 0.45% per 1000, respectively. Non-Western immigrant women had a 1.3 fold increased risk of severe maternal morbidity as compared with Western women. Jehovah__s witnesses had a 3.1-fold increased risk. Overall case fatality rate was 1 in 53. Substandard care was found in 80% of assessed cases during clinical audit. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge.ZonMW Matty Brand FoundationUBL - phd migration 201

Veel teelten op zand kunnen niet aan de nitraatnorm voldoen

De oppervlakte- en grondwaterkwaliteit op de zandgronden in het zuidoosten van Nederland voldoen niet aan de normen van de Nitraatrichtlijn. De Nederlandse Overheid heeft met de nieuwe mestwetgeving stikstofgebruiksnormen per gewas opgesteld. Uit onderzoek op een proefbedrijf in Noord-Limburg blijkt dat met het toepassen van de gebruiksnormen op het proefbedrijf de waterkwaliteitsnormen niet gehaald worden bji de gangbare open teelten. Verdere aanscherping van de normen leidt tot verlies aan opbrengst en een onvoldoende verlaging van de uitspoeling. Andere maatregelen zijn nodig, zoals inzet van grote groenbemesters als stikstofvanggewas, het afvoeren van gewasresten, de aanleg van zuiveringsmoerassen, beter bodembeheer en nieuwe teeltsystemen los van de grond. Veel van deze maatregelen zijn echter nog niet rijp voor uitvoering of economisch rendabel voor ondernemers. Met verdere ontwikkeling van technische oplossingen hebben genoemde maatregelen wel de potentie om de waterkwaliteitsnormen te halen of er tenminste in de buurt te kome

Incidence and Predictors of Maternal Cardiovascular Mortality and Severe Morbidity in the Netherlands: A Prospective Cohort Study

Objective: To assess incidence and possible risk factors of severe maternal morbidity and mortality from cardiovascular disease in the Netherlands. Design: A prospective population based cohort study. Setting: All 98 maternity units in the Netherlands. Population: All women delivering in the Netherlands between August 2004 and August 2006 (n = 371,021) Methods: Cases of severe maternal morbidity and mortality from cardiovascular disease were prospectively collected during a two-year period in the Netherlands. Women with cardiovascular complications during pregnancy or postpartum who were admitted to the ward, intensive care or coronary care unit were included. Cardiovascular morbidity was defined as cardiomyopathy, valvular disease, ischaemic heart disease, arrhythmias or aortic dissection. All women delivering in the same period served as a reference cohort. Main outcome measures: Incidence, case fatality rates and possible risk factors. Results: Incidence of severe maternal morbidity due to cardiovascular disease was 2.3 per 10,000 deliveries (84/358,874). Maternal mortality rate from cardiovascular disease was 3.0 per 100,000 deliveries (11/358,874). Case fatality rate in women with severe maternal morbidity due to cardiovascular disease was 13% (11/84). Case fatality rate was highes

Nutriënten Waterproof : Nitraatnorm op zand verdraagt geen intensieve landbouw

Van 2005 tot en met 2008 zijn twee bedrijfssystemen getest op proefbedrijf Vredepeel. Door handhaving of verbetering van de bodemkwaliteit blijft het productievermogen van de bodem intact en is de benutting van nutriënten wellicht hoger. Met een integrale aanpak zijn bodemkwaliteit en ‑gezondheid, vruchtwisseling en bemesting beter op elkaar af te stemmen en kunnen mogelijk rendabele productiesystemen worden ontworpen die voldoen aan de milieucriteria. Ook het goed inspelen op stikstofmineralisatie c.q. benutten van alle stikstof uit andere bronnen dan meststoffen hoort daarbij

Base-stock policies for lost-sales models: Aggregation and asymptotics

This paper considers the optimization of the base-stock level for the classical periodic review lost-sales inventory system. The optimal policy for this system is not fully understood and computationally expensive to obtain. Base-stock policies for this system are asymptotically optimal as lost-sales costs approach infinity, easy to implement and prevalent in practice. Unfortunately, the state space needed to evaluate a base-stock policy exactly grows exponentially in both the lead time and the base-stock level. We show that the dynamics of this system can be aggregated into a one-dimensional state space description that grows linearly in the base-stock level only by taking a non-traditional view of the dynamics. We provide asymptotics for the transition probabilities within this single dimensional state space and show that these asymptotics have good convergence properties that are independent of the lead time under mild conditions on the demand distribution. Furthermore, we show that these asymptotics satisfy a certain ow conservation property. These results lead to a new and computationally efficient heuristic to set base-stock levels in lost-sales systems. In a numerical study we demonstrate that this approach performs better than existing heuristics with an average gap with the best base-stock policy of 0.01% across a large test-bed

Trends in direct oral anticoagulant (DOAC) use:Health benefits and patient preference

In 2012, the Dutch Health Council published a report addressing barriers for an early and broad introduction of direct oral anticoagulants (DOACs). The report raised concerns about the lack of an antidote, adherence, lack of monitoring in the case of overdose and the increased budget impact at DOAC introduction. In the past decade, international studies have shown that DOACs can provide healthcare benefits for a large number of patients. This has led to an increase in the prescription of DOACs, as they are an effective and user-friendly alternative to vitamin K antagonists (VKAs). Unlike VKAs, DOACs do not need monitoring of the international normalized ratio due to more predictable pharmacokinetics. However, the number of prescriptions of DOACs in the Netherlands is still lagging, compared to other European countries. This article highlights the potential health gains in the Netherlands if the use of DOACs were to increase, based on current international experience