• Dairy Product Intake and Risk of Type 2 Diabetes in EPIC-InterAct: A Mendelian Randomization Study.

      Vissers, Linda E T; Sluijs, Ivonne; van der Schouw, Yvonne T; Forouhi, Nita G; Imamura, Fumiaki; Burgess, Stephen; Barricarte, Aurelio; Boeing, Heiner; Bonet, Catalina; Chirlaque, Maria-Dolores; Fagherazzi, Guy; Franks, Paul W; Freisling, Heinz; Gunter, Marc J; Quirós, J Ramón; Ibsen, Daniel B; Kaaks, Rudolf; Key, Timothy; Khaw, Kay T; Kühn, Tilman; Mokoroa, Olatz; Nilsson, Peter M; Overvad, Kim; Pala, Valeria; Palli, Domenico; Panico, Salvatore; Sacerdote, Carlotta; Spijkerman, Annemieke M W; Tjonneland, Anne; Tumino, Rosario; Rodríguez-Barranco, Miguel; Rolandsson, Olov; Riboli, Elio; Sharp, Stephen J; Langenberg, Claudia; Wareham, Nicholas J (2019-02-06)
      To estimate the causal association between intake of dairy products and incident type 2 diabetes. The analysis included 21,820 European individuals (9,686 diabetes cases) of the EPIC-InterAct case-cohort study. Participants were genotyped, and rs4988235 (LCT-12910C>T), a SNP for lactase persistence (LP) which enables digestion of dairy sugar, i.e., lactose, was imputed. Baseline dietary intakes were assessed with diet questionnaires. We investigated the associations between imputed SNP dosage for rs4988235 and intake of dairy products and other foods through linear regression. Mendelian randomization (MR) estimates for the milk-diabetes relationship were obtained through a two-stage least squares regression. Each additional LP allele was associated with a higher intake of milk (β 17.1 g/day, 95% CI 10.6-23.6) and milk beverages (β 2.8 g/day, 95% CI 1.0-4.5) but not with intake of other dairy products. Other dietary intakes associated with rs4988235 included fruits (β -7.0 g/day, 95% CI -12.4 to -1.7 per additional LP allele), nonalcoholic beverages (β -18.0 g/day, 95% CI -34.4 to -1.6), and wine (β -4.8 g/day, 95% CI -9.1 to -0.6). In instrumental variable analysis, LP-associated milk intake was not associated with diabetes (hazard ratio 0.99 rs4988235 was associated with milk intake but not with intake of other dairy products. This MR study does not suggest that milk intake is associated with diabetes, which is consistent with previous observational and genetic associations. LP may be associated with intake of other foods as well, but owing to the modest associations we consider it unlikely that this has caused the observed null result.
    • Data on child complementary feeding practices, nutrient intake and stunting in Musanze District, Rwanda.

      Uwiringiyimana, Vestine; Ocké, Marga C; Amer, Sherif; Veldkamp, Antonie (2018-12)
      Stunting prevalence in Rwanda is still a major public health issue, and data on stunting is needed to plan relevant interventions. This data, collected in 2015, presents complementary feeding practices, nutrient intake and its association with stunting in infants and young children in Musanze District in Rwanda. A household questionnaire and a 24-h recall questionnaire were used to collect the data. In total 145 children aged 5-30 months participated in the study together with their caregivers. The anthropometric status of children was calculated using WHO Anthro software [1] according to the WHO growth standards [2]. The complementary feeding practices together with households' characteristics are reported per child stunting status. The nutrient intake and food group consumption are presented per age group of children. Also, the percentage contribution of each food groups to energy and nutrient intake in children is reported. The data also shows the association between zinc intake and age groups of children. Using multiple linear regression, a sensitivity analysis was done with height-for-age z-score as the dependent variable and exclusive breastfeeding, deworming table use, BMI of caregiver, dietary zinc intake as independent variables. The original linear regression model and a detailed methodology and analyses conducted are presented in Uwiringiyimana et al. [3].
    • Decreased, but still sufficient, iodine intake of children and adults in the Netherlands.

      Verkaik-Kloosterman, Janneke; Buurma-Rethans, Elly J M; Dekkers, Arnold L M; van Rossum, Caroline T M (2017-04)
      Sufficient I intake is important for the synthesis of thyroid hormones, which play an important role in normal growth and development. Our aim was to estimate habitual I intake for the Dutch population and the risk of inadequate or excessive intakes. Further, we aimed to provide an insight into the dietary sources of I and the association with socio-demographic factors. Data from the Dutch National Food Consumption Survey 2007-2010 (n 3819; 7-69 years), and from the Dutch food and supplement composition tables were used to estimate habitual I intake with a calculation model. Contribution of food groups to I intake were computed and multiple linear regression was used to examine associations of intakes with socio-demographic factors. A total of ≤2 % of the population had an intake below the estimated average requirement or above the upper level. The main sources of I were bread containing iodised salt (39 %), dairy products (14 %) and non-alcoholic drinks (6 %). I intake (natural sources only, excluding iodised salt and supplements) was positively associated with (parental) education, which could at least partly be attributed to a higher consumption of dairy products. Among children, the consumption of bread, often containing iodised bakery salt, was positively associated with parental education. The I intake of the Dutch population (7-69 years) seems adequate, although it has decreased since the period before 2008. With the current effort to reduce salt intake and changing dietary patterns (i.e. less bread, more organic foods) it is important to keep a close track on the I status, important sources and potential risk groups.
    • Deer presence rather than abundance determines the population density of the sheep tick, Ixodes ricinus, in Dutch forests.

      Hofmeester, Tim R; Sprong, Hein; Jansen, Patrick A; Prins, Herbert H T; van Wieren, Sipke E (2017-09-19)
      Understanding which factors drive population densities of disease vectors is an important step in assessing disease risk. We tested the hypothesis that the density of ticks from the Ixodes ricinus complex, which are important vectors for tick-borne diseases, is determined by the density of deer, as adults of these ticks mainly feed on deer.
    • Delta-aanpak water factor bij reductie medicijnresten

      Venhuis B; Elk B van; Moermond CTA (2017-11)
    • Deriving Global OH Abundance and Atmospheric Lifetimes for Long-Lived Gases: A Search for CH 3 CCl 3 Alternatives

      Liang, Qing; Chipperfield, Martyn P.; Fleming, Eric L.; Abraham, N. Luke; Braesicke, Peter; Burkholder, James B.; Daniel, John S.; Dhomse, Sandip; Fraser, Paul J.; Hardiman, Steven C.; Jackman, Charles H.; Kinnison, Douglas E.; Krummel, Paul B.; Montzka, Stephen A.; Morgenstern, Olaf; McCulloch, Archie; Mühle, Jens; Newman, Paul A.; Orkin, Vladimir L.; Pitari, Giovanni; Prinn, Ronald G.; Rigby, Matthew; Rozanov, Eugene; Stenke, Andrea; Tummon, Fiona; Velders, Guus J. M.; Visioni, Daniele; Weiss, Ray F.; Atmospheric Chemistry and Dynamics Laboratory; NASA Goddard Space Flight Center; Greenbelt Maryland USA; National Centre for Earth Observation, School of Earth and Environment; University of Leeds; Leeds UK; Atmospheric Chemistry and Dynamics Laboratory; NASA Goddard Space Flight Center; Greenbelt Maryland USA; National Centre for Atmospheric Science; Leeds UK; Karlsruhe Institute of Technology; Karlsruhe Germany; Chemical Sciences Division; NOAA Earth System Research Laboratory; Boulder Colorado USA; Chemical Sciences Division; NOAA Earth System Research Laboratory; Boulder Colorado USA; National Centre for Earth Observation, School of Earth and Environment; University of Leeds; Leeds UK; Climate Science Centre; CSIRO Oceans and Atmosphere; Aspendale Vic Australia; Met Office Hadley Centre; Exeter UK; Atmospheric Chemistry and Dynamics Laboratory; NASA Goddard Space Flight Center; Greenbelt Maryland USA; National Center for Atmospheric Research; Boulder Colorado USA; Climate Science Centre; CSIRO Oceans and Atmosphere; Aspendale Vic Australia; Global Monitoring Division; NOAA Earth System Research Laboratory; Boulder Colorado USA; National Institute of Water and Atmospheric Research; Wellington New Zealand; School of Chemistry; University of Bristol; Bristol UK; Scripps Institution of Oceanography; University of California, San Diego; La Jolla California USA; Atmospheric Chemistry and Dynamics Laboratory; NASA Goddard Space Flight Center; Greenbelt Maryland USA; National Institute of Standards and Technology; Gaithersburg Maryland USA; Department of Physical and Chemical Sciences; Università dell'Aquila; L'Aquila Italy; Massachusetts Institute of Technology; Cambridge Massachusetts USA; School of Chemistry; University of Bristol; Bristol UK; Institute for Atmospheric and Climate Science; ETH Zurich; Zurich Switzerland; Institute for Atmospheric and Climate Science; ETH Zurich; Zurich Switzerland; Institute for Atmospheric and Climate Science; ETH Zurich; Zurich Switzerland; National Institute for Public Health and the Environment; Bilthoven Netherlands; Department of Physical and Chemical Sciences; Università dell'Aquila; L'Aquila Italy; Scripps Institution of Oceanography; University of California, San Diego; La Jolla California USA (2017-11-16)
    • Design and validation of an ontology-driven animal-free testing strategy for developmental neurotoxicity testing.

      Hessel, Ellen V S; Staal, Yvonne C M; Piersma, Aldert H (2018-03-12)
      Developmental neurotoxicity entails one of the most complex areas in toxicology. Animal studies provide only limited information as to human relevance. A multitude of alternative models have been developed over the years, providing insights into mechanisms of action. We give an overview of fundamental processes in neural tube formation, brain development and neural specification, aiming at illustrating complexity rather than comprehensiveness. We also give a flavor of the wealth of alternative methods in this area. Given the impressive progress in mechanistic knowledge of human biology and toxicology, the time is right for a conceptual approach for designing testing strategies that cover the integral mechanistic landscape of developmental neurotoxicity. The ontology approach provides a framework for defining this landscape, upon which an integral in silico model for predicting toxicity can be built. It subsequently directs the selection of in vitro assays for rate-limiting events in the biological network, to feed parameter tuning in the model, leading to prediction of the toxicological outcome. Validation of such models requires primary attention to coverage of the biological domain, rather than classical predictive value of individual tests. Proofs of concept for such an approach are already available. The challenge is in mining modern biology, toxicology and chemical information to feed intelligent designs, which will define testing strategies for neurodevelopmental toxicity testing.
    • The design of a Social Cost-Benefit Analysis of preventive interventions for toxoplasmosis: An example of the One Health approach.

      Suijkerbuijk, A W M; van Gils, P F; Bonačić Marinović, A A; Feenstra, T L; Kortbeek, L M; Mangen, M-J J; Opsteegh, M; de Wit, G A; van der Giessen, J W B (2018-02)
      Toxoplasma gondii infections cause a large disease burden in the Netherlands, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. Infections in humans occur via exposure to oocysts in the environment and after eating undercooked meat containing tissue cysts, leading to asymptomatic or mild symptoms, but potentially leading to the development of ocular toxoplasmosis. Infection in pregnant women can lead to stillbirth and disorders in newborns. At present, prevention is only targeted at pregnant women. Cat vaccination, freezing of meat destined for undercooked consumption and enhancing biosecurity in pig husbandries are possible interventions to prevent toxoplasmosis. As these interventions bear costs for sectors in society that differ from those profiting from the benefits, we perform a social cost-benefit analysis (SCBA). In an SCBA, costs and benefits of societal domains affected by the interventions are identified, making explicit which stakeholder pays and who benefits. Using an epidemiological model, we consider transmission of T. gondii after vaccination of all owned cats or cats at livestock farms. To identify relevant high-risk meat products that will be eaten undercooked, a quantitative microbial risk assessment model developed to attribute predicted T. gondii infections to specific meat products will be used. In addition, we evaluate serological monitoring of pigs at slaughter followed by an audit and tailor made advice for farmers in case positive results were found. The benefits will be modelled stochastically as reduction in DALYs and monetized in Euro's following reference prices for DALYs. If the balance of total costs and benefits is positive, this will lend support to implementation of these preventive interventions at the societal level. Ultimately, the SCBA will provide guidance to policy makers on the most optimal intervention measures to reduce the disease burden of T. gondii in the Netherlands.
    • Designing Surveillance of Healthcare-Associated Infections in the Era of Automation and Reporting Mandates.

      van Mourik, Maaike S M; Perencevich, Eli N; Gastmeier, Petra; Bonten, Marc J M (2018-03-05)
      Surveillance and feedback of infection rates to clinicians and other stakeholders is a cornerstone of healthcare-associated infection (HAI) prevention programs. In addition, HAIs are increasingly included in public reporting and payment mandates. Conventional manual surveillance methods are resource intensive and lack standardization. Developments in information technology have propelled a movement toward the use of standardized and semiautomated methods.When developing automated surveillance systems, several strategies can be chosen with regard to the degree of automation and standardization and the definitions used. Yet, the advantages of highly standardized surveillance may come at the price of decreased clinical relevance and limited preventability. The choice among (automated) surveillance approaches, therefore, should be guided by the intended aim and scale of surveillance (eg, research, in-hospital quality improvement, national surveillance, or pay-for-performance mandates), as this choice dictates subsequent methods, important performance characteristics, and suitability of the data generated for the different applications.
    • Detection and dissemination of Toxoplasma gondii in experimentally infected calves, a single test does not tell the whole story.

      Burrells, Alison; Taroda, Alessandra; Opsteegh, Marieke; Schares, Gereon; Benavides, Julio; Dam-Deisz, Cecile; Bartley, Paul M; Chianini, Francesca; Villena, Isabella; van der Giessen, Joke; Innes, Elisabeth A; Katzer, Frank (2018-01-18)
      Although the detection of Toxoplasma gondii in bovine tissues is rare, beef might be an important source of human infection. The use of molecular techniques, such as magnetic capture qPCR (MC-qPCR), in combination with the gold standard method for isolating the parasite (mouse bioassay), may increase the sensitivity of T. gondii detection in infected cattle. The risk of transmission of the parasite to humans from undercooked/raw beef is not fully known and further knowledge about the predilection sites of T. gondii within cattle is needed. In the current study, six Holstein Friesian calves (Bos taurus) were experimentally infected with 106 T. gondii oocysts of the M4 strain and, following euthanasia (42 dpi), pooled tissues were tested for presence of the parasite by mouse bioassay and MC-qPCR.
    • Detection of Anaplasma phagocytophilum, Candidatus Neoehrlichia sp., Coxiella burnetii and Rickettsia spp. in questing ticks from a recreational park, Portugal.

      Santos, Ana Sofia; de Bruin, Arnout; Veloso, Ana Raquel; Marques, Cátia; Pereira da Fonseca, Isabel; de Sousa, Rita; Sprong, Hein; Santos-Silva, Maria Margarida (2018-09)
      Tick-borne agents with medical relevance have been recorded in Portugal but little is known about their occurrence in urban outdoor leisure areas. This study aimed to investigate ticks and tick-borne agents in three public parks of Lisbon's metropolitan area. A total of 234 questing ticks belonging to eight species were found in Parque Florestal de Monsanto (PFM). Ixodes ventalloi represented 40% of collections. Mitochondrial genes confirmed Ixodes morphological identification, evidencing the intraspecific variability of I. ricinus and particularly I. frontalis populations. Regarding tick-borne agents, Rickettsia massiliae DNA were found in 21 (9.0%) ticks, Coxiella burnetii in 15 (6.4%), Anaplasma phagocytophilum in five (2.1%), an agent closely related to Candidatus Neoehrlichia mikurensis in two (0.9%), Rickettsia sibirica mongolitimonae and Rickettsia monacensis each in one (0.4%). Active enzootic cycles were suggested for these agents by the detection of positives in different time periods. Five tick species were founded with C. burnetii, including I. ventalloi which seems to be a new association record. This tick was also the only species found positive for A. phagocytophilum and the Candidatus Neoehrlichia mikurensis-like agent. Two A. phagocytophilum variants were detected in PFM, one of them representing a potentially new ecotype already found in I. ventalloi from another Portuguese area. To the authors´ knowledge, this is also the first report of such a Candidatus Neoehrlichia mikurensis-like microorganism. These data show an interesting diversity of ticks and tick-borne agents with potential public health relevance in PFM, an urban recreational area commonly frequented by humans and their pets.
    • Detection of Incident Anal High-Risk Hpv-Dna in Msm: Incidence or Reactivation?

      Twisk, Denise E; van der Sande, Marianne A B; van Eeden, Arne; Heideman, Daniëlle A M; van der Klis, Fiona R M; de Vries, Henry J C; Schim van der Loeff, Maarten F (2018-05-16)
      We aimed to assess whether sexual exposure may explain all incident anal HPV detections among men who have sex with men (MSM).
    • Detection of opsonizing antibodies directed against a recently circulating Bordetella pertussis strain in paired plasma samples from symptomatic and recovered pertussis patients.

      Hovingh, Elise S; Kuipers, Betsy; Bonačić Marinović, Axel A; Jan Hamstra, Hendrik; Hijdra, Danielle; Mughini Gras, Lapo; van Twillert, Inonge; Jongerius, Ilse; van Els, Cecile A C M; Pinelli, Elena (2018-08-13)
      Correlates of protection (CoPs) against the highly contagious respiratory disease whooping cough, caused by Bordetella pertussis, remain elusive. Characterizing the antibody response to this pathogen is essential towards identifying potential CoPs. Here, we evaluate levels, avidity and functionality of B. pertussis-specific-antibodies from paired plasma samples derived from symptomatic and recovered pertussis patients, as well as controls. Natural infection is expected to induce protective immunity. IgG levels and avidity to nine B. pertussis antigens were determined using a novel multiplex panel. Furthermore, opsonophagocytosis of a B. pertussis clinical isolate by neutrophils was measured. Findings indicate that following infection, B. pertussis-specific antibody levels of (ex-) pertussis patients waned, while the avidity of antibodies directed against the majority of studied antigens increased. Opsonophagocytosis indices decreased upon recovery, but remained higher than controls. Random forest analysis of all the data revealed that 28% of the opsonophagocytosis index variances could be explained by filamentous hemagglutinin- followed by pertussis toxin-specific antibodies. We propose to further explore which other B. pertussis-specific antibodies can better predict opsonophagocytosis. Moreover, other B. pertussis-specific antibody functions as well as the possible integration of these functions in combination with other immune cell properties should be evaluated towards the identification of CoPs against pertussis.
    • Detection of titanium particles in human liver and spleen and possible health implications.

      Heringa, M B; Peters, R J B; Bleys, R L A W; van der Lee, M K; Tromp, P C; van Kesteren, P C E; van Eijkeren, J C H; Undas, A K; Oomen, A G; Bouwmeester, H (2018-04-11)
      Titanium dioxide (TiO2) is produced at high volumes and applied in many consumer and food products. Recent toxicokinetic modelling indicated the potential of TiO2 to accumulate in human liver and spleen upon daily oral exposure, which is not routinely investigated in chronic animal studies. A health risk from nanosized TiO2 particle consumption could not be excluded then.
    • Determinants of diet and physical activity (DEDIPAC): a summary of findings.

      Brug, Johannes; van der Ploeg, Hidde P; Loyen, Anne; Ahrens, Wolfgang; Allais, Oliver; Andersen, Lene F; Cardon, Greet; Capranica, Laura; Chastin, Sebastien; De Bourdeaudhuij, Ilse; De Craemer, Marieke; Donnelly, Alan; Ekelund, Ulf; Finglas, Paul; Flechtner-Mors, Marion; Hebestreit, Antje; Kubiak, Thomas; Lanza, Massimo; Lien, Nanna; MacDonncha, Ciaran; Mazzocchi, Mario; Monsivais, Pablo; Murphy, Marie; Nicolaou, Mary; Nöthlings, Ute; O'Gorman, Donal J; Renner, Britta; Roos, Gun; van den Berg, Matthijs; Schulze, Matthias B; Steinacker, Jürgen M; Stronks, Karien; Volkert, Dorothee; Lakerveld, Jeroen (2017-11-03)
      The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013-2016, was the first action taken by the 'Healthy Diet for a Healthy Life' European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in late 2016. In this paper we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favour of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC's work on nutrition, physical activity, and sedentary behaviour policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonisation of pan-European surveillance.
    • Determinants of first-time utilization of long-term care services in the Netherlands: an observational record linkage study.

      Slobbe, Laurentius C J; Wong, Albert; Verheij, Robert A; van Oers, Hans A M; Polder, Johan J (2017-09-05)
      Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.
    • Determinants of frequent and infrequent STI testing and STI diagnosis related to test frequency among men who have sex with men in the eastern part of the Netherlands: a 6-year retrospective study.

      Kampman, Carolina J G; Heijne, Janneke C M; Kistemaker-Koedijk, Petronella H M; Koedijk, Femke D H; Visser, Maartje; Hautvast, Jeannine L A (2018-05-31)
      Men who have sex with men (MSM) remain vulnerable to sexually transmitted infections (STIs) and are advised to be tested at least twice a year. The aim of this study was to assess the determinants of test frequency and their associations with an STI diagnosis.
    • Determinants of Human Papillomavirus Vaccination Intention Among Female Sex Workers in Amsterdam, the Netherlands

      Marra, Elske; van Dam, Laura; Kroone, Niki; Craanen, Marianne; Zimet, Gregory D.; Heijman, Titia; Hogewoning, Arjan A.; Sonder, Gerard J.B.; de Vries, Henry J.C.; Alberts, Catharina J.; Paulussen, Theo G.W.M.; Schim van der Loeff, Maarten F. (2017-12)
    • Developing a policy game intervention to enhance collaboration in public health policymaking in three European countries.

      Spitters, H P E M; van Oers, J A M; Sandu, P; Lau, C J; Quanjel, M; Dulf, D; Chereches, R; van de Goor, L A M (2017)
      One of the key elements to enhance the uptake of evidence in public health policies is stimulating cross-sector collaboration. An intervention stimulating collaboration is a policy game. The aim of this study was to describe the design and methods of the development process of the policy game ‘In2Action’ within a real-life setting of public health policymaking networks in the Netherlands, Denmark and Romania.