There has been a tradition of preventive home visiting to the elderly by Public Health Nurses for quite a time. There is no agreement as to the effect of these visits; until now no study has been performed on this topic in the Netherlands. Studies from other countries suggest a positive effect: viz. a reduction in mortality and hospital admissions. Recommendations for a replication study in the Netherlands are made.
The revised Netherlands guideline 'Sexually transmitted diseases and neonatal herpes' recommends shortening of the follow-up period from 6 to 3 months for HIV-testing after a risky contact and a period of 6 months in case of post-exposure prophylaxis. The newly adopted follow-up period has a precedent in Sweden, where, based on the same scientific arguments, the follow-up period has been reduced to 3 months. There is little scientific information on which to base the optimal duration of the follow-up period. Therefore, two different periods are used in the Netherlands: 3 months for medical practice in the field of sexually transmitted diseases and 6 months for occupational exposure of health care workers and for blood products.
A recent study from a research group from Quebec showed a strong decrease in the number of births affected by a neural tube defect since folic acid fortification was introduced in Canada. The prevalence decreased from 1.58 neural tube defects per 1000 births before the introduction of folic acid fortification to 0.86 per 1000 births in the period of complete fortification. Although folic acid fortification of staple food is probably the most effective way to decrease the incidence of neural tube defects, more knowledge about possible health risks should be obtained before fortification is introduced. More research is needed to determine which population groups are at risk of possible negative effects of folic acid fortification and at which level of fortification. Until then, it is important to generate more attention and publicity in order to increase awareness and knowledge concerning folic acid and to promote its use before and after conception.
Vitamin-D deficiency is common in immobile elderly and non-Western immigrants and has been related to muscle weakness in these populations. When serum calcidiol concentrations are below 50 nmol/l, parathyroid hormone concentrations increase, causing bone resorption. Bone mineral density and proximal muscle strength increase as the serum concentration ofcalcidiol increases. Vitamin-D supplementation is reported to reduce the incidence of fractures in nursing home residents. Dutch guidelines recommend vitamin-D supplementation for nursing home residents and for those who are house-bound. Fortification of milk and other foods with vitamin D in the United States and Sweden has led to a better nutritional state with respect to vitamin D than in the Netherlands. Therefore the dairy industry should be allowed to add vitamin D to dairy products to prevent fractures.
Comment On: Ned Tijdschr Geneeskd. 2006 May 27;150(21):118116768282
Two recent randomized clinical trials from Denmark and Canada show that postoperative radiotherapy of breast cancer patients in whom the findings revealed a high risk of dying from the disease not only causes improvement of the locoregional tumour control but also prolongs survival. However, this does not establish definitely which patients belong to this 'high risk category'. Results of retrospective studies from Leiden suggest that selective withholding of postoperative radiotherapy in the Netherlands is justified for large groups of breast cancer patients. Both clinically manifest parasternal recurrences and axillary recurrences are rare among these patients. The condition is, however, that the axillary dissection is radical and performed properly.
Comment On: Ned Tijdschr Geneeskd. 1999 Jan 9;143(2):71-310086106