Dutch Situation Research Articles

Shifting the imbalance: Intentional reuse of Dutch sewage effluent in sub-surface irrigation

Worldwide, agricultural irrigation currently accounts for 69% of freshwater withdrawal. Countries with a temperate climate, such as the Netherlands, experience periodic freshwater shortages in agriculture. The pressure on available freshwater will increase due to climate change and a growing demand for freshwater by e.g. industrial activities. Possible alternative water resources are considered in order to meet the current and future water demand. In this study we explore where, and how much, sewage treatment plant (STP) effluent can directly be reused in agricultural sub-surface irrigation (SSI) during an average and a dry season scenario, for all active (335) Dutch STPs. SSI systems may have a higher water demand as part of the STP effluent is transported with groundwater flow, although aboveground irrigation has a loss of water due to interception. Furthermore, such aboveground irrigation systems provide direct contact of crops with irrigation water. SSI systems provide a soil barrier which may function as a filter and buffer zone. In the Dutch situation, direct intentional reuse of STP effluent can fulfill up to 25% of croplands SSI water demand present within a five-kilometer transport buffer from the STPs during an average season and 17% during a dry season. Hereto, respectively, 78% and 84% of the total available Dutch STP effluent would be used. Thus, the intentional direct STP effluent reuse in agricultural SSI has the potential to satisfy a significant amount of the agricultural water demand at a national scale, presuming responsible reuse: safe applications for humans and environment and no limiting effects on water availability for other actors.

No differences in cost-effectiveness and short-term functional outcomes between cemented and uncemented total knee arthroplasty

BackgroundThere is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), however cost has not been addressed as profoundly. Therefore, the current study primarily aimed to compare costs and cost-effectiveness 1 year after cemented or uncemented TKA. A secondary objective was to compare short-term functional outcomes between both groups.MethodsA posthoc prospective observational multicenter cohort study of 60 cemented and 50 uncemented Low Contact Stress (LCS) knee systems. Outcome was evaluated using the EuroQol5D-3 L (EQ5D) index, in order to calculate quality adjusted life years (QALYs). Total costs were calculated considering direct costs within the hospital setting (inpatient cost) as well as direct and indirect costs outside the hospital. Cost-effectiveness (total costs per QALY), Oxford Knee Score (OKS) and Numeric Rating Scale (NRS) were compared between cemented and uncemented cases at 1 year after surgery. HealthBASKET project, a micro-costing approach, represents the Dutch costs and situation and was used to calculate hospital stay. (In) direct costs outside the healthcare (medical cost and productivity cost) were determined using two validated questionnaires.ResultsMedian costs per QALY were similar between cemented and uncemented TKA patients (€16,269 and €17,727 respectively; p = 0.50). Median OKS (44 and 42; p = 0.79), EQ5D (0.88 and 0.90; p = 0.82) and NRS for pain (1.0 and 1.0; p = 0.48) and satisfaction (9.0 and 9.0; p = 0.15) were also comparable between both groups.ConclusionFor this type of knee implant (LCS), inpatient hospital costs and costs after hospitalization were comparable between groups.

Waarom Nederland in 1848 geen revolutie kende

Abstract Why the Netherlands did not witness a revolution in 1848 In 1848, a wave of democratic revolutions struck most of Europe, but not the Netherlands. Historians have provided only partial explanations from a range of perspectives, such as socio-economic, socio-political, and institutional. We argue that none of these are fully tenable or satisfactory by comparing the Dutch situation with countries that did experience revolutions in 1848. Also, we add a cultural perspective by studying the role of the Dutch consensus culture. After tracing its roots, we identify its key characteristics and use these as a prism to interpret several governmental sources, brochures, and newspaper articles. On this basis, we argue that it is likely that the consensus culture strongly contributed to the stability of Dutch society during the European revolutionary months of 1848. Without wanting to present this perspective as the definitive explanation, we claim that (political) culture as such deserves more attention in studies to the Netherlands during 1848.

COVID-19: Clinical Challenges in Dutch Geriatric Psychiatry

The COVID-19 pandemic has changed everyday life tremendously in a short period of time. After a brief timeline of the Dutch situation and our management strategy to adapt geriatric mental health care, we present a case-series to illustrate the specific challenges for geriatric psychiatrists.

Cost-effectiveness analysis of a gender-neutral human papillomavirus vaccination program in the Netherlands

BackgroundVaccinating girls against human papillomavirus (HPV) infection is a highly effective and cost-effective intervention to provide protection against HPV-induced cancers. Since vaccination coverage rates among girls is modest in the Netherlands, additional strategies should be implemented to improve the protection against HPV-related cancer. Here we assessed the benefits and cost-effectiveness of gender-neutral vaccination. MethodsWe designed a static Markov model with a lifelong time horizon to simulate a cohort of 100,000 12-year-old Dutch boys. The model compares health and economic effects of HPV vaccination taking the current female vaccination coverage into consideration. HPV prevalence in boys was corrected for the predicted herd effects of the female programme in 2017. We extracted transition probabilities from peer-reviewed literature and previously constructed models. The robustness of the model was tested with multiple sensitivity analyses. ResultsVaccinating 30% of 100,000 12-year-old boys prevents 18, 13 and 25 cases of anal, penile, and oropharyngeal cancers in men, respectively. A total of 205 quality-adjusted life-years (QALYs) are saved by preventing cancer-related morbidity and mortality. Assuming a vaccine price of €50 per dose, the incremental cost-effectiveness ratio (ICER) is €17,907 per QALY. In addition, due to vaccine-induced herd effects, we estimated that 110 cases of cancer in females would be additionally prevented and 246 QALYs would be gained in the female cohort, bringing the total to 166 cancers prevented and 451 QALYs gained. Taking these additional benefits of boys’ vaccination into account, the overall ICER was estimated at €7310 per QALY gained. The model outcomes are most sensitive to variation in vaccine price, herd immunity from females and vaccine efficacy. ConclusionsVaccination of boys, additional to girls, will prevent a relevant number of cancers in both boys and girls. Based on the current Dutch situation vaccination of HPV in boys is likely cost-effective.GSK Study identifier: HO-18-19169. A graphical abstract and supplementary data to this article can be found online at https://doi.org/10.1016/j.vaccine.2020.05.031.

Dutch nurses and the Great War: on caregiving and gender

ABSTRACT In 1910 female nurses were allowed to work in Dutch military hospitals. However, it proved difficult to find them. The blame was partly directed at nurses themselves: they didn’t have the right background and didn’t fit into military, male discipline. The nurses themselves blamed the Dutch Red Cross who had failed in its mobilizing task. The typical Dutch situation – neutrality resulting in a lack of urgency to create a strong military nursing corpse – thus gave rise to discussions on femininity and professionalism in military nursing. The war also provoked criticism of militaristic use of female care and again neutrality was at the bottom of this. Dutch nurses working in warzones could write more easily about the horrors they witnessed, leading to questions about the role of wartime medicine. During the interwar period the peace movement made medical care one of its targets. This pacifist protest was shared by some female nurses. They too described women as ‘mothers’ and ‘givers of life’, just like (male) soldiers and officers who stood up for female war nurses, but with opposite intentions. Instead of being ‘disciplined’ and ‘chaste’, they sought the right preconditions to be able to do their job properly, thus leading to critique on – for example – the uncomfortable nurses’ uniforms. Though the critique attracted some attention, it did not last, partly because of another war coming. In this war finally ‘real’ female war nurses went to work. Although disagreeing with the critique itself, as far as their uniform concerned, they were happy to benefit from the pacifist-feminist critique.

Life cycle assessment and nutrient balance for five different treatment methods for poultry litter

• Thermal conversion has the lowest environmental impact of the five treatment methods. • Major environmental impact categories are climate change and particulate matter formation. • In Dutch situation low impact due to production of renewable, carbon-neutral electricity.

Introduction to the geothermal play and reservoir geology of the Netherlands

Abstract The Netherlands has ample geothermal resources. During the last decade, development of these resources has picked up fast. In 2007 one geothermal system had been realised; to date (1 January 2019), 24 have been. Total geothermal heat production in 2018 was 3.7 PJ from 18 geothermal systems. The geothermal sources are located in the same reservoirs/aquifers in which the oil and gas accumulations are hosted: Cenozoic, Upper Jurassic – Lower Cretaceous, Triassic and Rotliegend reservoirs. Additionally, the yet unproven hydrocarbon play in the Lower Carboniferous (Dinantian) Limestones delivered geothermal heat in two geothermal systems. This is in contrast to the Upper Cretaceous and Upper Carboniferous with no producing geothermal systems but producing hydrocarbon fields. Similar to hydrocarbon development, developing the geothermal source relies on fluid flow through the reservoir. For geothermal application a transmissivity of 10 Dm is presently thought to be a minimum value for a standard doublet system. Regional mapping of the geothermal plays, with subsequent resource mapping, by TNO discloses the areas with favourable transmissivity within play areas for geothermal development. The website www.ThermoGis.nl provides the tool to evaluate the geothermal plays on a sub-regional scale. The Dutch geothermal source and resource portfolio can be classified using geothermal play classification of, for example, Moeck (2014). An appropriate adjective for play classification for the Dutch situation would be the predominant permeability type: matrix, karst, fracture or fault permeability. The Dutch geothermal play is a matrix-permeability dominated ‘Hot Sedimentary Aquifer’, ‘Hydrothermal’ or ‘Intra-cratonic Conductive’ play. The Dutch ‘Hot Sedimentary Aquifer’ play is subdivided according to the lithostratigraphical annotation of the reservoir. The main geothermal plays are the Delft Sandstone and Slochteren Sandstone plays.

Economic Impact of Reducing Inappropriate Inhaled Corticosteroids Use in Patients With Chronic Obstructive Pulmonary Disease: ISPOR's Guidance on Budget Impact in Practice

ObjectivesTo assess the budget impact of restricting inappropriate inhaled corticosteroids (ICS) use according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)-guidelines indication for ICS use in the chronic obstructive pulmonary disease (COPD)-population, taking The Netherlands as a reference case. MethodsA budget impact model was developed and closely aligned with the International Society for Pharmacoeconomics and Outcomes Research best-practice guidelines. The model estimates the impact of pharmacologic COPD maintenance treatments on clinical events (exacerbations and pneumonias) and associated healthcare utilization and costs. The current treatment mix included all maintenance treatments including long-acting muscarinic antagonists (LAMA), long-acting β2-agonists (LABA), LABA/ICS, LABA/LAMA, and triple therapy (LABA/LAMA/ICS). We modeled a situation where 25% of patients would use ICS-containing treatments and compared this to the current Dutch situation with 60% ICS use. A 5-year time horizon with a Dutch healthcare payer's perspective was used. In sensitivity analyses, a range of values for absolute ICS reduction (20%-40%), relative risks of exacerbations and pneumonia events, and other input parameters were explored. ResultsOver a period of 5 years, the new treatment mix with Global Initiative for Chronic Obstructive Lung Disease guideline recommended ICS, and LABA/LAMA use resulted in potential avoidance of 17 405 exacerbations and 11 984 pneumonias and accompanied savings of €84 million in the base-case scenario. Savings were consistent in various sensitivity analyses, indicating cost savings between €30 and €200 million. ConclusionReducing inappropriate ICS use and increasing use of LABA/LAMA in COPD patients could result in a reduction of exacerbations and pneumonias, corresponding with a reduction in total costs for COPD in The Netherlands.

Foundations for measuring IT-outsourcing success and failure

We implemented five easy-to-complete questionnaires in Excel, which could serve as early warning signals for practitioners interested in the odds of their IT-outsourcing deals and could serve to redirect their course when still possible. The questionnaires are based on our earlier published longitudinal, observational study on 30 representative ITO-deals in the Netherlands, of which we know whether they failed or not. Our questionnaires predicted their outcome correctly. To help redirect the course of a dubious deal, we developed a questionnaire estimating the odds in relation to boosting strongly significant critical success determinants. Another questionnaire guides practitioners how to further improve on less critical factors. There are no specific reasons that limit our results to the Dutch situation, which makes it promising, therefore, to apply the Excel as an aid in improving ITO deals in other contexts.

A nationwide retrospective observational study of population newborn screening for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency in the Netherlands.

To evaluate the Dutch newborn screening (NBS) for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency since 2007, a nationwide retrospective, observational study was performed of clinical, laboratory and epidemiological parameters of patients with MCAD deficiency born between 2007 and 2015. Severe MCAD deficiency was defined by ACADM genotypes associated with clinical ascertainment, or variant ACADM genotypes with a residual MCAD enzyme activity <10%. Mild MCAD deficiency was defined by variant ACADM genotypes with a residual MCAD enzyme activity ≥10%. The prevalence of MCAD deficiency was 1/8300 (95% CI: 1/7300-1/9600). Sensitivity of the Dutch NBS was 99% and specificity ~100%, with a positive predictive value of 86%. Thirteen newborns with MCAD deficiency suffered from neonatal symptoms, three of them died. Of the 189 identified neonates, 24% had mild MCAD deficiency. The acylcarnitine ratio octanoylcarnitine (C8)/decanoylcarnitine (C10) was superior to C8 in discriminating between mild and severe cases and more stable in the first days of life. NBS for MCAD deficiency has a high sensitivity, specificity, and positive predictive value. In the absence of a golden standard to confirm the diagnosis, the combination of acylcarnitine (ratios), molecular and enzymatic studies allows risk stratification. To improve evaluation of NBS protocols and clinical guidelines, additional use of acylcarnitine ratios and multivariate pattern-recognition software may be reappraised in the Dutch situation. Prospective recording of NBS and follow-up data is warranted covering the entire health care chain of preventive and curative medicine.

Should women with a BRCA1/2 mutation aged 60 and older be offered intensified breast cancer screening? – A cost-effectiveness analysis

ObjectivesThis study aimed to investigate the cost-effectiveness of intensified breast cancer (BC) screening for women with a BRCA1/2 mutation aged 60–74. Simulated strategies were: (0) annual mammography as reference, (1) alternating annual mammography and MRI for women with dense breasts only; (2) addition of annual MRI for women with dense breasts only; (3) addition of annual MRI for all women. Materials and methodsA validated micro-simulation model of invasive BC was updated and validated for interval BC rates and tumor size distribution. Incremental cost-effectiveness ratios (ICER) of all three intensified strategies were compared to the next best strategy and stratified for BRCA1 and BRCA2. Discount rates for costs and life years gained (LYG) were 1.5% and 4% for the Dutch situation; 3% and 3% for international comparison. A threshold of €20,000 per LYG was applied. ResultsAll intensified strategies showed more detected BCs and LYG, reduced BC deaths, and increased false positives. The Dutch discounted ICER of intensified strategy 1 compared to annual mammography was €38,000 per LYG in BRCA1 mutation carriers and €18,000 per LYG in BRCA2 mutation carriers. Further intensified strategies showed an ICER above the threshold when compared to this strategy. With international discount rate, the ICERs of all intensified strategies were above the threshold. ConclusionOf the three alternative strategies, only alternating annual MRI and mammography for BRCA2 mutation carriers and dense breasts aged 60–75 is cost-effective compared to annual mammography. For BRCA1 mutation carriers, none of the alternative strategies is cost-effective compared to the next best strategy.

Hospice and Palliative Care volunteering in the Netherlands. Practices of Being There

Hospice and Palliative Care (HPC) volunteering is not easily comparable through European countries. Comparison of practices in different countries helps to acknowlegde, protect and improve the core of this unique source in palliative care. To this end this contribution describes volunteering practices at the end of life in The Netherlands. It presents quantitative characteristics about numbers of volunteers, type of hospices and hours worked and a qualitative description of the volunteering work guided by the concept of ‘ Being There’. Some reflections on education of volunteers is added. The satisfaction of relatives with services is discussed and some thoughts on quality assurance of volunteering are shared. All information and data in this publication is retrieved from several ‘grey’ documents like mission statements, year reports or registration fact sheets. All describe the Dutch situation of HPC volunteering and are written in the Dutch language. Palliat Med Pract 2018; 12, 4: 193–197

De blik naar buiten: bestuurlijke verbouwingen in het buitenland

In this special issue, recent public sector reforms in South Africa, Denmark, Belgium, Mexico, Singapore and Denmark are analysed. Reforms in the public sector are by and large explained as a chronological development from traditional bureaucracy, via New Public Management to New Public Governance. This is also the way the many administrative reforms in the Dutch public sector are often explained.The articles give insight in the administrative developments in these countries and their background. They also offer the opportunity to make comparisons with administrative developments in the Netherlands, and to draw lessons. The analyses show that the dominant explanation of reforms in the public sector (from traditional bureaucracy, to New Public Management to New Public Governance) is helpful in making sense of administrative developments, but they put this explanation into perspective too.For the Dutch situation yet another insight came to light. We often complain that the Dutch processes are cumbersome, take long and involve many -if not all- stakeholders. A close reading of the contributions from abroad must inevitably change this pejorative view on our national sport: the cumbersome process provides valuable checks and balances, that will help to fight the drawbacks and risks that we have seen in the international cases.

Estimating the impact of clinical mastitis in dairy cows on greenhouse gas emissions using a dynamic stochastic simulation model: a case study

The increasing attention for global warming is likely to contribute to the introduction of policies or other incentives to reduce greenhouse gas (GHG) emissions related to livestock production, including dairy. The dairy sector is an important contributor to GHG emissions. Clinical mastitis (CM), an intramammary infection, results in reduced milk production and fertility, increases culling and mortality of cows and, therefore, has a negative impact on the efficiency (output/input) of milk production. This may increase GHG emissions per unit of product. Our objective was to estimate the impact of CM in dairy cows on GHG emissions of milk production for the Dutch situation. A dynamic stochastic simulation model was developed to simulate the dynamics and losses of CM for individual lactations. Cows receive a parity (1 to 5+), a milk production and a calving interval (CI). Based on the parity, cows have a risk of CM, with a maximum of three cases in a lactation. Pathogens causing CM were classified as gram-positive bacteria, gram-negative bacteria, or other. Based on the parity and pathogen combinations, cows had a reduced milk production, discarded milk, prolonged CI and a risk of removal (culling and mortality) that reduce productivity of dairy cows and therefore increase GHG emissions per unit of product. Using life cycle assessment, emissions of GHGs were estimated from cradle to farm gate for processes along the milk production chain that are affected by CM. Processes included were feed production, enteric fermentation, and manure management. Emissions of GHGs were expressed as kg CO2 equivalents per ton of fat-and-protein-corrected milk (kg CO2e/t FPCM). Emissions of cows with CM increased on average by 57.5 (6.2%) kg CO2e/t FPCM compared with cows without CM. This increase was caused by removal (39%), discarded milk (38%), reduced milk production (17%) and prolonged CI (6%). The GHG emissions increased by 48 kg CO2e/t FPCM for cows with one case of CM, by 69 kg CO2e/t FPCM for cows with two cases of CM and by 92 kg CO2e/t FPCM for cows with three cases of CM compared with cows without CM. Preventing CM can be an effective strategy for farmers to reduce GHG emissions and can contribute to sustainable development of the dairy sector, because this also can improve the income of farmers and the welfare of cows. The impact of CM on GHG emissions, however, will vary between farms due to environmental conditions and management practices.

How do we measure up?

AbstractResearch into the pedagogies employed by CLIL teachers has been limited to date and, as such, has been identified as a key area in need of further investigation (Pérez-Cañado, 2012;Dalton-Puffer &amp; Smit, 2013). This review uses an elaborated 4Cs Analysis Framework (adapted fromCoyle, Hood, &amp; Marsh, 2010;Coyle, 2015a,2015b) as a basis for analysis of studies of pedagogies implemented by CLIL subject teachers internationally and in Dutch classrooms. This allows us to place the Dutch situation in an international context and to identify avenues for future research and development. The following questions guided the review: (1) What appear to be the most prominent international trends with regard to the implementation of the 4Cs in CLIL subject pedagogies?; and, (2) To what extent do Dutch CLIL subject pedagogies appear to reflect these international trends? Findings about pedagogies reported in the reviewed studies suggest that, in general, studies from the Netherlands stand out compared to international studies in several respects. Specifically, there is evidence of a relatively strong pedagogic focus in the Netherlands on developing students’ intercultural competence. The Dutch studies also stand out, however, for not addressing the role that the L1 can play in CLIL pedagogy. Furthermore, a main finding is that both the Dutch and the international studies reviewed provide little insight into aspects of CLIL pedagogy related to subject-specific culture and into ways in which content and language areintegrated.

Quality standard for Person-centred and Integrated Care for Older adults

Background: Current healthcare systems are challenged to cope with changing demands of the growing population of older adults, while maintaining quality of care at lower costs. Between 2008 and 2016, the Dutch National Care for the Elderly Program was organized by the ‘Netherlands Organization for Health Research and Development’ ZonMw and financially supported by the Dutch ministry of Health. Aim of the program was to contribute to a solution to these challenges. One of the projects was Embrace1, a person-centered and integrated care service for community-living older adults. Aims of this service are to improve quality of care by reducing the fragmentation in health services, to improve patient outcomes, and to increase sustainability of the healthcare system. Embrace combines two globally recognized models, the Chronic Care Model and a population health management model. Both models were translated to the Dutch situation and specified for older adults. Embrace has been implemented in the Netherlands since 2012. Short- and long-term evaluations, using mixed methods, showed positive results regarding patient outcomes, quality of care, and costs. Before final closing of the national programme, the program committee, with support from the Dutch Care institute and the Dutch ministry of Health, decided to develop a ‘Quality standard Person-centred and Integrated Care for older adults’ based on the characteristics and positive results of Embrace. Aim of this quality standard is to support the transformation in the Dutch health system towards person-centred and integrated care by reaching consensus on values and standards of care for older adults, creating clarity for older adults and professionals, and providing tools for administrative accountability. This network discussion is part of the preparation phase before the actual development of the quality standard. Aim of this phase is to explore the support, scope, and potential bottlenecks for the new standard with future owners of this standard. These owners may include older adults’ representatives, professional organizations and funders for care and welfare. Aims and Objectives: Aim of this network discussion is to use the available expertise among participants of this conference to further explore the support, scope, and potential bottlenecks for the new standard. We have the intention to invite Dutch participants and share the results of the explorations until then, and ask for feedback. Format: The meeting is planned at the end of the six months preparation phase starting January 2018. The preliminary results will be shared with participants, and their reflections and advises will be collected and discussed. Target audience: Dutch experts on person-centred and integrated care. Take away: Results will be included in the final report for the committee of the Dutch National Care for the Elderly Program. Reference: 1- Spoorenberg SLW, Uittenbroek RJ, Middel B, Kremer HPH, Reijneveld SA, Wynia K. Embrace, a model for integrated elderly care: study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care. BMC Geriatr. 2013;13:62.

Overheidsfinanciering voor geloofsgemeenschappen in de Straatsburgse jurisprudentie

Extensive analysis of the impact of the ECHR on religion and state model thinking in the Council of Europe when it comes to restricting foreign funding for national religious organisations. The Turkish situation is used, distilling principles from the applicable case law of the ECtHR with which to analyse the Dutch situation - coming to conclusion that while the Turkish case was born of the wish to limit 'state religion', its application to the Dutch situation allows reason to allow the foreign funding of 'state religion' to be sustained.

Wie is verantwoordelijk voor het levensbeschouwelijk onderwijs op school?

While the Dutch state sets formal aims and requirements for all major school subjects, it remains neutral in view of religious and worldview education. This paper critically assesses this neutral position of the Dutch state and argues that the state should take more responsibility for the aim and content of religious and worldview education in school. To do this, this paper offers a description of the current position of religious and worldview education in the Dutch educational system and also shows that this position is no longer in accordance with the present-day Dutch religious landscape. By comparing the Dutch situation with the position of religious and worldview education in the educational systems of Denmark, England, Russia and Sweden this paper makes a nuanced plea for more state interference with religious and worldview education in school, while the paper at the same time warns for the danger of politicizing religious and worldview education or of ignoring the basic right of parents to opt for religious or worldview education for their children in conformity with their own convictions.

Comparison of Three Modelling Approaches for Predicting Deoxynivalenol Contamination in Winter Wheat

Forecasting models for mycotoxins in cereal grains during cultivation are useful for pre-harvest and post-harvest mycotoxin management. Some of such models for deoxynivalenol (DON) in wheat, using two different modelling techniques, have been published. This study aimed to compare and cross-validate three different modelling approaches for predicting DON in winter wheat using data from the Netherlands as a case study. To this end, a published empirical model was updated with a new mixed effect logistic regression method. A mechanistic model for wheat in Italy was adapted to the Dutch situation. A new Bayesian network model was developed to predict DON in wheat. In developing the three models, the same dataset was used, including agronomic and weather data, as well as DON concentrations of individual samples in the Netherlands over the years 2001–2013 (625 records). Similar data from 2015 and 2016 (86 records) were used for external independent validation. The results showed that all three modelling approaches provided good accuracy in predicting DON in wheat in the Netherlands. The empirical model showed the highest accuracy (88%). However, this model is highly location and data-dependent, and can only be run if all of the input data are available. The mechanistic model provided 80% accuracy. This model is easier to implement in new areas given similar mycotoxin-producing fungal populations. The Bayesian network model provided 86% accuracy. Compared with the other two models, this model is easier to implement when input data are incomplete. In future research, the three modelling approaches could be integrated to even better support decision-making in mycotoxin management.