Two experiments were made. In experiment 1, dairy cows in early lactation (2 to 4 weeks) and dairy cows in late lactation (34 to 36 weeks) were given aflatoxin B, (AFB t ) at a level of 34 to 39 fig/day by feeding them contaminated compound food. The aflatoxin M r content (AFMj) of raw milk was determined four times during the experimental period of 14 days. The milk yield was measured daily. The carry-over rate of aflatoxin was proportionately 0-062 and 0-018 for cows in early and late lactation respectively. This difference was not only due to milk production level but possibly also associated to AFB, liver metabolism. In experiment 2, eight high (40 kg milk per day) and eight low (16 kg milk per day) milk yielding cows, carry-over of AFB 1 from compound food into AFM, in milk was measured at different levels ofAFB 7 intake ranging from 7 to 57 fig/day. Independent of AFBj-intake, high-producing dairy cows had a higher carry-over rate than low producing animals (proportionately 0-038 v. 0-025). Carry-over ofAFB 1 to AFM, was linearly correlated with milk yield. Variations in the level of AFM 1 in milk of individual cows were not due to variations in milk yield. The relationship between AFB 2 intake per day and AFM^content in milk per kg could be described by the formula: AFMj (ng/kg milk) = 119 AFB, intake (fig per cow per day) + 1-9. This means that in order to produce milk with less than 0-05 fig AFM, per kg milk the average daily individual intake in a herd should be limited to 40 fig AFB 7 per day.As dairy cows in their early to mid lactation period consume large quantities of compound food, a maximum level of AFB 3 in dairy foods has to be set at an acceptable daily intake (ADI) value to guarantee that AFM 1 levels in milk do not exceed tolerable levels.

BackgroundThe prevalence of obesity is growing worldwide. Obesity guidelines recommend increasing the level of weight-related care for persons with elevated levels of weight-related health risk (WRHR). However, there seems to be a discrepancy between need for and use of weight-related care. The primary aim of this study is to examine predisposing factors that may influence readiness to lose weight and intention to use weight-related care in an overweight population.MethodsA population-based, cross-sectional survey was conducted. Data were collected using an online self-administered questionnaire sent to a population-representative sample of 1,500 Dutch adults on the Health Care Consumer Panel (n = 861 responded). Data were used from individuals (n = 445) with a mildly, moderately or severely elevated level of WRHR. WRHR status was based on self-reported data on Body Mass Index, risk assessment for diabetes mellitus type 2 (DM2) and cardiovascular disease (CVD), or co-morbidities.Results55.1% of persons with increased WRHR were ready to lose weight (n = 245). Depending on level of WRHR; educational level, marital status, individuals with an accurate perception of their weight and better perceptions and expectations of dietitians were significantly related to readiness to lose weight. Most of them preferred individual weight-loss methods (82.0% of n = 245). 11% (n = 26 of n = 245) intended to use weight-related care. Weight-related care seeking was higher for those with moderate or severe WRHR. Expectations and trust in dietitians did not seem to influence care seeking.ConclusionsMany Dutch adults who are medically in need of weight-related care are ready to lose weight. Most intend to lose weight individually, and only a few intend to use weight-related care. Therefore, obesity prevention initiatives should focus on monitoring weight change and weight-loss plans, and timely referral to obesity management. However, many people are not ready to lose weight. For this group, strategies for behaviour change may depend on WRHR, perceptions of weight and dietitians, educational level and marital status. Obesity prevention initiatives should focus on increasing the awareness of the seriousness of their condition and offering individually appropriate weight management programmes.

Dietetic treatment in primary care lowers BMI in overweight patients. Patients' change in BMI was rather similar between dietitians. Greater BMI reductions were observed in those with a high initial BMI and those treated for at least 6 months. Future research is necessary to study the long-term effects of weight loss after treatment by primary healthcare dietitians, especially because many patients drop out of treatment prematurely.

BackgroundGeneral practitioners (GPs) can play an important role in both the prevention and management of overweight and obesity. Current general practice guidelines in the Netherlands allow room for GPs to execute their own weight management policy.ObjectiveTo examine GPs’ current weight management policy and the factors associated with this policy.Methods800 Dutch GPs were asked to complete a questionnaire in December 2012. The questionnaire items were based on the Dutch Obesity Standard for GPs. The data were analyzed by means of descriptive statistics and multiple linear regression analyses in 2013.ResultsIn total, 307 GPs (39.0%) responded. Most respondents (82.9%) considered weight management as part of their responsibility for providing care. GPs aged <48 years discussed weight less frequent. Next, weight is less frequently discussed with patients without weight-related comorbidities or with moderately overweight patients compared to obese patients. On average, 47.7% of the GPs reported to refer obese patients to a weight management professional, preferably a dietitian (98.3%). GPs with a BMI ≥ 25 kg/m2 were less likely to refer obese patients. In addition, GPs who had frequent contact with a dietitian were more likely to refer obese patients.ConclusionsIn the context of General Practice and preventive medicine, GPs’ discussion of weight and the variety of obesity-determinants with their moderately overweight patients deserves more attention, especially from younger GPs. Strengthening interdisciplinary collaboration between GPs and dietitians could increase the referral percentage for dietary treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/2052-9538-1-2) contains supplementary material, which is available to authorized users.

Introduction: In the Netherlands, bundled payments were introduced as part of a strategy to redesign chronic care delivery. Under this strategy new entities of health care providers in primary care are negotiating with health insurers about the price for a bundle of services for several chronic conditions. This study evaluates the level of involvement of primary health care dietitians in these entities and the experienced advantages and disadvantages.