Green knowledge exchange Turkey-The Netherlands : priority issues identified for cooperation in the field of biodiversity protection and conservation : interviews with experts from Governmental and Non-Governmental Organisations based in Turkey and based in The Netherlands

As a consequence of its geographical location Turkey is very rich in biodiversity; its flora is richest, both in terms of overall plant diversity and level of endemism compared to Europe, North Africa, or countries in the Middle East. This report gives an overview of important biodiversity issues in Turkey and priorities for cooperation selected by Turkish and Dutch parties. The project aimed to facilitate the set up of a long-term cooperation between Turkey and The Netherlands in a structural ‘Green Knowledge Exchange’ between officials and experts of the two countries. Reports of interviews with (non)governmental organizations (Netherlands and Turkey) form the backbone of this publication. It also provides a SWOT analysis and comparison of the information obtained from Turkish side and the information provided by organisations based in The Netherlands

Immunological and Physiological Differences Between Layer- and Broiler Chickens after Concurrent Intratracheal Administration of Lipopolysaccharide and Human Serum Albumin

Layers and broilers were concurrently intratracheally challenged with 0.5 mg Lipopolysaccharide (LPS) and 0.1 mg Human Serum Albumin (HuSA) at 3 weeks of age. Specific total and isotype-specific (IgM, IgG, IgA) Antibody (Ab) responses to HuSA during 3 weeks following immunization, cellular in vitro mitogen responses to Concanavalin A (Con A) and specific cellular responses in vitro to different dosages of HuSA, blood serotonin (5-HT) levels, plasma Corticosterone (CORT) levels at 6 weeks of age and ex vivo nitric oxide (NO) production in the presence of LPS, respectively, were measured in all birds. Higher in vitro cellular responses to HuSA, but not Con A, were found in the broilers than in the layers. Also higher total, IgM and IgG antibody responses to HuSA were found in the broilers. Higher ex vivo NO production was found in the layers. A heavier spleen weight was found in the broilers, but relative spleen weight was higher in the layers. The broilers grew much heavier and also maintained a higher growth during the first 24 and 48 h after i.t. challenge with LPS and HuSA. No breed effect was found for body temperature responses after i.t. challenge. Blood 5-HT levels and plasma CORT levels were significantly higher in the layers. Number and type of significant correlations between 5-HT levels, cachectin response to LPS, antibody levels and cellular immunity differed between breeds. Our data suggest comparable immune responses to i.t. HuSA challenge in broilers and layers of similar age and confirm the earlier reported higher humoral immune response in broilers. On the other hand, the cachectin response to LPS differed between broilers and layers. Our results do not confirm the earlier reported higher cellular immune response of layers. Different significant relationships between physiological parameters in broilers and layers were found. Our results suggest that selection for enhanced growth does not necessarily affect specific immune competence of poultr

The management of cervical intra-epithelial neoplasia (CIN): Extensiveness and costs in The Netherlands

In order to provide greater insight into both the extensiveness and the medical costs of the diagnosis and treatment of screen-detected cervical intra-epithelial neoplasia (CIN) in general medical practice in The Netherlands, data from national registries and gynaecology departments were retrieved, and experts were interviewed. Of the 5060 women diagnosed with CIN in 1988, more than 50% were treated in hospital with conisation or hysterectomy, which on average took 5.5 days stay per admission. The assessed average duration of the total pre- and post-treatment period is 4.6 years. The average total medical costs in women with detected CIN III are Dfl 3700 per woman. The diagnosis of CIN I and II involves more medical procedures and time than CIN III, but fewer women have conisation or hysterectomy, resulting in lower total medical costs (Dfl 2572). The overall extent and costs of the management of CIN should be accounted for when balancing the benefits, unfavourable effects and costs of cervical cancer screening

A cost-effectiveness study of ICT training among the visually impaired in the Netherlands

Background: Due to the ageing population, the number of visually impaired people in the Netherlands will increase. To ensure the future availability of services in rehabilitative eye care, we aim to assess the cost-effectiveness of information and communication technology (ICT) training among visually impaired adults from a societal perspective, using primary data from two large rehabilitative eye care providers in the Netherlands. Methods: Participants were asked to fill in a questionnaire, which used six different instruments at three different time points: pre training, post training and three months post training. We investigated whether the participants' quality of life and well-being improved after the training and whether this improvement persisted three months post training. Economic evaluation was conducted by comparing costs and outcomes before and after training. Quality of life and well-being were derived from the EQ-5D and ICECAP-O, respectively. Costs for productivity losses and medical consumption were obtained from the questionnaires. Information regarding the costs of training sessions was provided by the providers. Results: Thirty-eight participants filled in all three questionnaires. The mean age at baseline was 63 years (SD = 16). The effect of ICT training on ICT skills and participants' well-being was positive and persisted three months after the last training session. Assuming these effects remain constant for 10 years, this would result in an incremental cost-effectiveness ratio (ICER) of € 11,000 per quality-adjusted life-year (QALY) and € 8000 per year of well-being gained, when only the costs of ICT training are considered. When the total costs of medical consumption are included, the ICER increases to € 17,000 per QALY gained and € 12,000 per year of well-being gained. Furthermore, when the willingness-to-pay threshold is € 20,000 per year of well-being, the probability that ICT training will be cost-effective is 75% (91% when including only the costs of ICT training). Conclusion: Our study suggests that ICT training among the visually impaired is cost-effective when the effects of ICT training on well-being persist for several years. However, further research involving a larger sample and incorporating long-term effects should be conducted

Towards a new approach for estimating indirect costs of disease

__Abstract__ Many researchers in the field of evaluation of health care doubt the usefulness of estimates of indirect costs of disease in setting priorities in health care. This paper attempts to meet part of the criticism on the concept of indirect costs, which are defined as the value of production lost to society due to disease. Thus far in cost of illness studies and cost-effectiveness analyses the potential indirect costs of disease were calculated. In the following a first step will be taken towards a new method for estimating indirect costs which are expected to be effectuated in reality: the friction cost method. This method explicitly takes into account short and long run processes in the economy which reduce the production losses substantially as compared with the potential losses. According to this method production losses will be confined to the period needed to replace a sick worker: the so called friction period. The length of this period and the resulting indirect costs depend on the situation on the labour market. Some preliminary results are presented for the indirect costs of the incidence of cardiovascular disease in the Netherlands for 1988, both for the friction costs and the potential costs. The proposed methodology for estimating indirect costs is promising, but needs further development. The consequences of illness in people without a paid job need to be incorporated in the analysis. Also the relation between internal labour reserves and costs of disease should be further investigated. Next to this, more refined labour market assumptions, allowing for diverging situations on different segments of the labour market are necessary

Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy

Contains fulltext : 47628.pdf (publisher's version ) (Closed access)BACKGROUND AND PURPOSE: An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. SUBJECTS: One hundred thirteen primary care physical therapists treated a total of 500 patients. METHODS: The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. RESULTS: Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. DISCUSSION AND CONCLUSION: The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved

Indirect costs of disease; an international comparison

Results of economic evaluations are often strongly influenced by estimates of indirect costs. International comparability of these estimates may contribute to rational decision-making in health care policy. Hence, estimates should be international comparable. Comparability of these results between countries may be hampered due to variation in methodology, data sources, valuation of production losses, and social security arrangements. Furthermore differences in epidemiology, demography and economic environment may cause variation in the level and the distribution by diagnosis of indirect costs. In this study indirect costs of disease for the Netherlands are compared with estimates for Sweden and the United States. We found large differences: both in the share of indirect costs in GDP as in the constituting elements, absence from work, disability and mortality. The level of indirect costs due to absence from work and the distribution according to diagnosis are quite similar for the two European countries. The costs of disability are particularly high for the Netherlands. Comparison of disability costs between the three countries is hampered due to lack of quantitative information on the influence of social insurance arrangements on the level of indirect costs and the distribution by diagnosis. The large number of deaths at young age in the U.S. is responsible for the higher mortality costs compared to the two European countries