• Toward optimisation of water use efficiency in dryland pastures using carbon isotope discrimination as a tool to select plant species mixtures.

      Pronger, J; Campbell, D I; Clearwater, M J; Mudge, P L; Rutledge, S; Wall, A M; Schipper, L A (2019-05-15)
      Pastoral agriculture is important for supplying global demand for animal products but pasture productivity is often water limited. Increased plant diversity has been shown to increase water use efficiency (ω) and productivity under water limitation but the optimal mix of species varies spatially, dependent on climate, soil type, and plant water requirements. Consequently, a cost-effective method to screen for high ω plant species and mixes in situ at farm scale is needed. Using carbon isotope discrimination (∆
    • Monitoring of pork liver and meat products on the Dutch market for the presence of HEV RNA.

      Boxman, Ingeborg L A; Jansen, Claudia C C; Hägele, Geke; Zwartkruis-Nahuis, Ans; Tijsma, Aloys S L; Vennema, Harry (2019-05-02)
      The aim of the present study was to assess pork liver and meat products present on the Dutch market for the presence of hepatitis E virus (HEV) RNA. HEV RNA was detected in 27.3% of 521 products sampled from Dutch retail stores in 2016. 12.7% of livers were positive for HEV RNA (n = 79), 70.7% of liverwurst (n = 99), 68.9% of liver pate (n = 90), but in none of the pork chops (n = 98), fresh sausages (n = 103) or wild boar meat (n = 52). The highest level of HEV RNA contamination was observed in a liver (reaching up to 1 × 10
    • Analytical approaches for characterizing and quantifying engineered nanoparticles in biological matrices from an (eco)toxicological perspective: old challenges, new methods and techniques.

      Abdolahpur Monikh, Fazel; Chupani, Latifeh; Vijver, Martina G; Vancová, Marie; Peijnenburg, Willie J G M (2019-04-10)
      To promote the safer by design strategy and assess environmental risks of engineered nanoparticles (ENPs), it is essential to understand the fate of ENPs within organisms. This understanding in living organisms is limited by challenges in characterizing and quantifying ENPs in biological media. Relevant literature in this area is scattered across research from the past decade or so, and it consists mostly of medically oriented studies. This review first introduces those modern techniques and methods that can be used to extract, characterize, and quantify ENPs in biological matrices for (eco)toxicological purposes. It then summarizes recent research developments within those areas most relevant to the context and field that are the subject of this review paper. These comprise numerous in-situ techniques and some ex-situ techniques. The former group includes techniques allowing to observe specimens in their natural hydrated state (e.g., scanning electron microscopy working in cryo mode and high-pressure freezing) and microscopy equipped with elemental microanalysis (e.g., energy-dispersive X-ray spectroscopy); two-photon laser and coherent anti-Stokes Raman scattering microscopy; absorption-edge synchrotron X-ray computed microtomography; and laser ablation-inductively coupled plasma mass spectrometry (LA-ICP-MS). The latter group includes asymmetric flow field flow fractionation coupled with ICP-MS and single particle-ICP-MS. Our review found that most of the evidence gathered for ENPs actually focused on a few metal-based ENPs and carbon nanotube and points to total mass concentration but no other particles properties, such as size and number. Based on the obtained knowledge, we developed and presented a decision scheme and analytical toolbox to help orient scientists toward selecting appropriate ways for investigating the (eco)toxicity of ENPs that are consistent with their properties.
    • Predictors of stunting with particular focus on complementary feeding practices: A cross-sectional study in the northern province of Rwanda.

      Uwiringiyimana, Vestine; Ocké, Marga C; Amer, Sherif; Veldkamp, Antonie (2019-04-01)
      The aim of this study was to review the factors associated with stunting in the northern province of Rwanda by assessing anthropometric status, dietary intake, and overall complementary feeding practices. This was a cross-sectional study with 138 children 5 to 30 mo of age. A structured questionnaire was used to collect information on sociodemographic characteristics of each mother and child and breastfeeding and complementary feeding practices. Anthropometric status was assessed using height-for-age z-scores for children and body mass index for caregivers. Dietary intakes were estimated using a 24-h recall. Multiple linear and logistic regression models were performed to study the predictors of height-for-age z scores and stunting. There was a 42% stunting prevalence. Prevalence of continued breastfeeding and exclusive breastfeeding were 92% and 50%, respectively. Most children (62%) fell into the low dietary diversity score group. The nutrient intake from complementary foods was below recommendations. The odds of stunting were higher in children >12 mo of age (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.08-1.29). Exclusive breastfeeding (OR, 0.22; 95% CI, 0.10-0.48) and deworming tablet use in the previous 6 mo (OR, 0.25; 95% CI, 0.07-0.80) decreased significantly the odds of stunting in children. Also, the body mass index of the caretaker (β = 0.08 kg/m Interventions focusing on optimal nutrition during the complementary feeding stage, exclusive breastfeeding, and the use of deworming tablets have the potential to substantially reduce stunting in children in the northern province of Rwanda.
    • Test sensitivity of a commercial serine protease digestion kit for the detection of Trichinella spiralis and Trichinella pseudospiralis larvae in pig muscle.

      Franssen, F; Johne, A; van der Giessen, J; Nöckler, K; Mayer-Scholl, A (2019-04-01)
      The reference method for Trichinella detection at meat inspection is the magnetic stirrer method (MSM) utilising HCl-pepsin for pooled sample digestion. Due to availability and quality issues with pepsin, alternative digestion methods are being offered, such as the Priocheck Trichinella AAD kit (T-AAD), based on serine endopeptidase digestion. In this study the T-AAD kit was compared to the reference method. Minced pork samples were spiked with T. spiralis muscle larvae (ML) with- and without capsule or T. pseudospiralis ML, and analysed with both tests. Test results of individually spiked test samples were analysed by generalised linear modelling. The T-AAD test kit was comparable to the reference method for the qualitative detection of T. spiralis in pigs, but not quantitatively. Overall, 94% of spiked T. spiralis were recovered using MSM against 75.2% when using T-AAD (p < 0.0001). Using the MSM 80.0% of spiked T. pseudospiralis were recovered against 20% with the T-AAD (p < 0.0001). Based on our experience with the T-AAD kit, we strongly recommend validating the method on site prior to introduction into routine diagnostic laboratories, but this will not alleviate the poor test sensitivity of the T-AAD for the detection of T. pseudospiralis.
    • A DFT/TDDFT study on the mechanisms of direct and indirect photodegradation of tetrabromobisphenol A in water.

      Wang, Se; Wang, Zhuang; Hao, Ce; Peijnenburg, Willie J G M (2019-04-01)
      Tetrabromobisphenol A (TBBPA) is the most widely used commercial brominated flame retardant. However, the mechanisms underlying the photodegradation of TBBPA remain unclear. Here we use density functional theory and time-dependent density functional theory to examine the photodegradation of the two species of TBBPA in water: TBBPA (neutral form) and TBBPA
    • Optimizing molecular surveillance of mumps genotype G viruses.

      Bodewes, Rogier; van Rooijen, Kristel; Cremer, Jeroen; Veldhuijzen, Irene K; van Binnendijk, Rob (2019-04-01)
      Mumps viruses continue to cause sporadic cases and outbreaks in countries with a high vaccination coverage for mumps. Molecular surveillance of mumps viruses can be supportive to elucidate the origin and transmission routes of mumps virus in case of an outbreak. Currently, molecular surveillance is worldwide primarily focused on sequencing of the small hydrophobic (SH) gene. However, few studies have already shown that additional genes or regions contribute to the resolution of the sequence data in such a way that mumps cases that seem to be linked to the same source on basis of the SH sequence, appear to be linked to another source or chain of transmission. Notably, this sequence information was recently extracted from the hemagglutinin-neuraminidase (HN) and fusion (F) genes (total 3364 nucleotides), or from the sum of the three non-coding regions (NCRs; total 1954 nt) between the nucleocapsid protein, phosphoprotein, matrix protein and F protein, but also from the complete genome. Here, sequence data from NCRs were compared with that of the HN and F gene, using mumps genotype G viruses detected in the Netherlands between 2010 and 2018. Results of this study indicate that NCRs sequence data provided similar or slightly better sequence resolution compared to the HN and F genes for most viruses. For molecular surveillance of currently circulating mumps genotype G viruses is sequencing of SH in combination with NCRs currently a useful approach.
    • The antimicrobial resistome in relation to antimicrobial use and biosecurity in pig farming, a metagenome-wide association study in nine European countries.

      Van Gompel, Liese; Luiken, Roosmarijn E C; Sarrazin, Steven; Munk, Patrick; Knudsen, Berith E; Hansen, Rasmus B; Bossers, Alex; Aarestrup, Frank M; Dewulf, Jeroen; Wagenaar, Jaap A; Mevius, Dik J; Schmitt, Heike; Heederik, Dick J J; Dorado-García, Alejandro; Smit, Lidwien A M (2019-04-01)
      Previous studies in food-producing animals have shown associations between antimicrobial use (AMU) and resistance (AMR) in specifically isolated bacterial species. Multi-country data are scarce and only describe between-country differences. Here we investigate associations between the pig faecal mobile resistome and characteristics at the farm-level across Europe. A cross-sectional study was conducted among 176 conventional pig farms from nine European countries. Twenty-five faecal samples from fattening pigs were pooled per farm and acquired resistomes were determined using shotgun metagenomics and the Resfinder reference database, i.e. the full collection of horizontally acquired AMR genes (ARGs). Normalized fragments resistance genes per kilobase reference per million bacterial fragments (FPKM) were calculated. Specific farm-level data (AMU, biosecurity) were collected. Random-effects meta-analyses were performed by country, relating farm-level data to relative ARG abundances (FPKM). Total AMU during fattening was positively associated with total ARG (total FPKM). Positive associations were particularly observed between widely used macrolides and tetracyclines, and ARGs corresponding to the respective antimicrobial classes. Significant AMU-ARG associations were not found for β-lactams and only few colistin ARGs were found, despite high use of these antimicrobial classes in younger pigs. Increased internal biosecurity was directly related to higher abundances of ARGs mainly encoding macrolide resistance. These effects of biosecurity were independent of AMU in mutually adjusted models. Using resistome data in association studies is unprecedented and adds accuracy and new insights to previously observed AMU-AMR associations. Major components of the pig resistome are positively and independently associated with on-farm AMU and biosecurity conditions.
    • Health Policy Performance in 16 Caribbean States, 2010-2015.

      Verstraeten, Soraya P A; van Oers, Hans A M; Mackenbach, Johan P (2019-04-01)
      To determine whether Caribbean states vary in health policy performance in 11 different areas; to explore the association with sociodemographic, economical, and governance determinants; and to estimate the potential health gains of "best-practice" health policies. We selected 50 indicators that included data on mortality (latest available, 2010-2015), intermediate outcomes, and policy implementation to calculate a state's health policy performance score. We related this score to country characteristics and calculated the potential number of avoidable deaths if the age-specific mortality rates of best-performer Martinique applied in all states. We found large differences in health policy performance among Caribbean states. Martinique, Cuba, and Guadeloupe had the highest performance scores, and Guyana, Belize, and Suriname the lowest. Political affiliation, religious fractionalization, corruption, national income, and population density were associated with health policy performance. If the mortality rates of Martinique applied to all Caribbean states, an overall mortality reduction of 12% would be achieved. Differences in health outcomes between Caribbean states are partly attributable to variations in health policy implementation. Our results suggest that many deaths can be prevented if Caribbean governments adopt best-practice policies.
    • Evaluating progress towards triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B in the Netherlands.

      Visser, Maartje; van der Ploeg, Catharina P B; Smit, Colette; Hukkelhoven, Chantal W P M; Abbink, Frithjofna; van Benthem, Birgit H B; Op de Coul, Eline L M (2019-03-29)
      In 2014 the World Health Organisation (WHO) established validation criteria for elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. Additionally, the WHO set targets to eliminate hepatitis, including hepatitis B (HBV). We evaluated to what extent the Netherlands has achieved the combined WHO criteria for EMTCT of HIV, syphilis and HBV. Data of HIV, syphilis and HBV infections among pregnant women and children (born in the Netherlands with congenital infection) for 2009-2015, and data required to validate the WHO criteria were collected from multiple sources: the antenatal screening registry, the HIV monitoring foundation database, the Perinatal Registry of the Netherlands, the national reference laboratory for congenital syphilis, and national HBV notification data. Screening coverage among pregnant women was > 99% for all years, and prevalence of HIV, syphilis and HBV was very low. In 2015, prevalence of HIV, syphilis and HBV was 0.06, 0.06 and 0.29%, respectively. No infections among children born in the Netherlands were reported in 2015 for all three diseases, and in previous years only sporadic cases were observed In 2015, treatment of HIV positive pregnant women was 100% and HBV vaccination of children from HBV positive mothers was > 99%. For syphilis, comprehensive data was lacking to validate WHO criteria. In the Netherlands, prevalence of maternal HIV, syphilis and HBV is low and congenital infections are extremely rare. All minimum WHO criteria for validation of EMTCT are met for HIV and HBV, but for syphilis more data are needed to prove elimination.
    • Harmonized methodology to assess chronic dietary exposure to residues from compounds used as pesticide and veterinary drug.

      Arcella, Davide; Boobis, Alan; Cressey, Peter; Erdely, Holly; Fattori, Vittorio; Leblanc, Jean-Charles; Lipp, Markus; Reuss, Rainer; Scheid, Stefan; Tritscher, Angelika; Van der Velde-Koerts, Trijntje; Verger, Philippe (2019-03-28)
      Risk assessments for pesticide and veterinary drug residues in food are performed respectively by the Joint FAO/WHO Expert Meeting on Pesticide Residues (JMPR) and the Joint FAO/WHO Expert Committee on Food Additives (JECFA). The models used by the two Committees to assess chronic dietary exposure are based on different data and assumptions which may be confusing, particularly for risk managers, when the same compound is used to treat plants and animals. This publication details the results of combined chronic dietary exposure assessments for eight compounds used both as pesticide and veterinary drugs. It compares the results from models in use by JMPR and JECFA with those from national estimates performed by 17 countries. Results show that the JECFA model is better reflecting less than lifetime dietary exposure by considering consumption of children and high consumers. The JMPR model is a suitable model for estimating average chronic (lifetime) exposure to residues present in widely and regularly consumed staple commodities. However, it is suitable neither for estimating children's exposure nor more generally for assessing less than lifetime dietary exposure. In order to select the appropriate exposure model related to the occurrence of adverse effects i.e. effects occurring over less-than-lifetime or effects occurring only over lifetime, this paper proposes criteria to match the toxicological profile of the compound and the appropriate exposure scenarios. These approaches will continue to be harmonized to ensure the most scientifically sound basis for the risk assessment for pesticides and veterinary drug residues and consequently for other chemicals in food.
    • Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems.

      Buitenweg, David C; Bongers, Ilja L; van de Mheen, Dike; van Oers, Hans Am; van Nieuwenhuizen, Chijs (2019-03-28)
      Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language-based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants' previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability.
    • A Stepwise Approach to a National Hepatitis C Screening Strategy in Malaysia to Meet the WHO 2030 Targets: Proposed Strategy, Coverage, and Costs.

      Hiebert, Lindsey; Hecht, Robert; Soe-Lin, Shan; Mohamed, Rosmawati; Shabaruddin, Fatiha H; Syed Mansor, Syed Mukhtar; Dahlui, Maznah; Azzeri, Amirah; McDonald, Scott A (2019-03-25)
      In Malaysia, more than 330 000 individuals are estimated to be chronically infected with hepatitis C virus (HCV), but less than 2% have been treated to date. To estimate the required coverage and costs of a national screening strategy to inform the launch of an HCV elimination program. We designed an HCV screening strategy based on a "stepwise" approach. This approach relied on targeting of people who inject drugs in the early years, with delayed onset of widespread general population screening. Annual coverage requirements and associated costs were estimated to ensure that the World Health Organization elimination treatment targets were met. In total, 6 million individuals would have to be screened between 2018 and 2030. Targeting of people who inject drugs in the early years would limit annual screening coverage to less than 1 million individuals from 2018 to 2026. General population screening would have to be launched by 2026. Total costs were estimated at MYR 222 million ($58 million). Proportional to coverage targets, 60% of program costs would fall from 2026 to 2030.
    • When are Adverse Outcome Pathways and Associated Assays "Fit for Purpose" for Regulatory Decision-Making and Management of Chemicals?

      Coady, Katie; Browne, Patience; Embry, Michelle; Hill, Thomas; Leinala, Eeva; Steeger, Thomas; Maślankiewicz, Lidka; Hutchinson, Tom (2019-03-25)
      There have been increasing demands for chemical hazard and risk assessments in recent years. Chemical companies have expanded internal product stewardship initiatives, and jurisdictions have increased the regulatory requirements for the manufacture and sale of chemicals. There has also been a shift in chemical toxicity evaluations within the same timeframe with new methodologies being developed to improve chemical safety assessments for both human health and the environment. With increased needs for chemical assessments coupled with more diverse data streams from new technologies, regulators and others tasked with chemical management activities are faced with increasing workloads and more diverse types of data to consider. The Adverse Outcome Pathway (AOP) framework can be applied in different scenarios to integrate data and guide chemical assessment and management activities. In this paper, scenarios of how AOPs can be used to guide chemical management decisions during research and development, chemical registration, and subsequent regulatory activities like prioritization and risk assessment are considered. Furthermore, specific criteria (e.g. the type and level of AOP complexity, confidence in the AOP, as well as external review and assay validation) are proposed to examine whether AOPs and associated tools are fit for purpose when applied in different contexts. Certain toxicity pathways are recommended as priority areas for AOP research and development, and the continued use of AOPs and defined approaches in regulatory activities are recommended. Furthermore, a call for increased outreach, education and enhanced use of AOP databases are proposed to increase their utility in chemicals management. This article is protected by copyright. All rights reserved.
    • Genospecies of Borrelia burgdorferi sensu lato detected in 16 mammal species and questing ticks from northern Europe.

      Mysterud, Atle; Stigum, Vetle M; Jaarsma, Ryanne I; Sprong, Hein (2019-03-25)
      Lyme borreliosis is the most common vector-borne zoonosis in the northern hemisphere, and the pathogens causing Lyme borreliosis have distinct, incompletely described transmission cycles involving multiple host groups. The mammal community in Fennoscandia differs from continental Europe, and we have limited data on potential competent and incompetent hosts of the different genospecies of Borrelia burgdorferi sensu lato (sl) at the northern distribution ranges where Lyme borreliosis is emerging. We used qPCR to determine presence of B. burgdorferi sl in tissue samples (ear) from 16 mammalian species and questing ticks from Norway, and we sequenced the 5S-23 S rDNA intergenic spacer region to determine genospecies from 1449 qPCR-positive isolates obtaining 423 sequences. All infections coming from small rodents and shrews were linked to the genospecies B. afzelii, while B. burgdorferi sensu stricto (ss) was only found in red squirrels (Sciurus vulgaris). Red squirrels were also infected with B. afzelii and B. garinii. There was no evidence of B. burgdorferi sl infection in moose (Alces alces), red deer (Cervus elaphus) or roe deer (Capreolus capreolus), confirming the role of cervids as incompetent hosts. In infected questing ticks in the two western counties, B. afzelii (67% and 75%) dominated over B. garinii (27% and 21%) and with only a few recorded B. burgdorferi ss and B. valaisiana. B. burgdorferi ss were more common in adult ticks than in nymphs, consistent with a reservoir in squirrels. Our study identifies potential competent hosts for the different genospecies, which is key to understand transmission cycles at high latitudes of Europe.
    • Prediction and validation of immunogenic domains of pneumococcal proteins recognized by human CD4 T-cells.

      van de Garde, Martijn D B; van Westen, Els; Poelen, Martien C M; Rots, Nynke Y; van Els, Cécile A C M (2019-03-25)
      CD4
    • GloPID-R report on Chikungunya, O'nyong-nyong and Mayaro virus, part I: Biological diagnostics.

      Pezzi, L; Reusken, C B; Weaver, S C; Drexler, J F; Busch, M; LaBeaud, A D; Diamond, M S; Vasilakis, N; Drebot, M A; Siqueira, A M; Ribeiro, G S; Kohl, A; Lecuit, M; Ng, L F P; Gallian, P; de Lamballerie, X; Boyer, S; Brasil, P; Diallo, M; Failloux, A B; Jaenisch, T; Lourenço-de-Oliveira, R; Neyts, J; Rios, M; Rodriguez-Morales, A J; Rosa-Freitas, M G; Sall, A; Simmons, G; Simon, F; Vega Rua, A (2019-03-21)
      The GloPID-R (Global Research Collaboration for Infectious Disease Preparedness) Chikungunya (CHIKV), O'nyong-nyong (ONNV) and Mayaro virus (MAYV) Working Group is investigating the natural history, epidemiology and medical management of infection by these viruses, to identify knowledge gaps and to propose recommendations for direct future investigations and rectification measures. Here, we present the first report dedicated to diagnostic aspects of CHIKV, ONNV and MAYV. Regarding diagnosis of the disease at the acute phase, molecular assays previously described for the three viruses require further evaluation, standardized protocols and the availability of international standards representing the genetic diversity of the viruses. Detection of specific IgM would benefit from further investigations to clarify the extent of cross-reactivity among the three viruses, the sensitivity of the assays, and the possible interfering role of cryoglobulinaemia. Implementation of reference panels and external quality assessments for both molecular and serological assays is necessary. Regarding sero-epidemiological studies, there is no reported high-throughput assay that can distinguish among these different viruses in areas of potential co-circulation. New specific tools and/or improved standardized protocols are needed to enable large-scale epidemiological studies of public health relevance to be performed. Considering the high risk of future CHIKV, MAYV and ONNV outbreaks, the Working Group recommends that a major investigation should be initiated to fill the existing diagnostic gaps.
    • Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment.

      Luyten, Jeroen; Kessels, Roselinde; Atkins, Katherine E; Jit, Mark; van Hoek, Albert Jan (2019-03-20)
      Vaccination programs generate direct protection, herd protection and, occasionally, side effects, distributed over different age groups. This study elicits the general public's view on how to balance these outcomes in funding decisions for vaccines. We performed an optimal design discrete choice experiment with partial profiles in a representative sample (N = 1499) of the population in the United Kingdom in November 2016. Using a panel mixed logit model, we quantified, for four different types of infectious disease, the importance of a person's age during disease, how disease was prevented-via direct vaccine protection or herd protection-and whether the vaccine induced side effects. Our study shows clear patterns in how the public values vaccination programs. These diverge from the assumptions made in public health and cost-effectiveness models that inform decision-making. We found that side effects and infections in newborns and children were of primary importance to the perceived value of a vaccination program. Averting side effects was, in any age group, weighted three times as important as preventing an identical natural infection in a child whereas the latter was weighted six times as important as preventing the same infection in elderly aged 65-75 years. These findings were independent of the length or severity of the disease, and were robust across respondents' backgrounds. We summarize these patterns in a set of preference weights that can be incorporated into future models. Although the normative significance of these weights remains a matter open for debate, our study can, hopefully, contribute to the evaluation of vaccination programs beyond cost-effectiveness.
    • External validation of prognostic models for preeclampsia in a Dutch multicenter prospective cohort.

      Lamain-de Ruiter, Marije; Kwee, Anneke; Naaktgeboren, Christiana A; Louhanepessy, Rebecca D; De Groot, Inge; Evers, Inge M; Groenendaal, Floris; Hering, Yolanda R; Huisjes, Anjoke J M; Kirpestein, Cornel; Monincx, Wilma M; Schielen, Peter C J I; Van 't Zelfde, Annewil; Van Oirschot, Charlotte M; Vankan-Buitelaar, Simone A; Vonk, Mariska A A W; Wiegers, Therese A; Zwart, Joost J; Moons, Karel G M; Franx, Arie; Koster, Maria P H (2019-03-20)
      To perform an external validation of all published prognostic models for first-trimester prediction of the risk of developing preeclampsia (PE). Women <14 weeks of pregnancy were recruited in the Netherlands. All systematically identified prognostic models for PE that contained predictors commonly available were eligible for external validation. 3,736 women were included; 87 (2.3%) developed PE. Calibration was poor due to overestimation. Discrimination of 9 models for LO-PE ranged from 0.58 to 0.71 and of 9 models for all PE from 0.55 to 0.75. Only a few easily applicable prognostic models for all PE showed discrimination above 0.70, which is considered an acceptable performance.