• Haem iron intake and risk of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

      Ward, Heather A; Whitman, Julia; Muller, David C; Johansson, Mattias; Jakszyn, Paula; Weiderpass, Elisabete; Palli, Domenico; Fanidi, Anouar; Vermeulen, Roel; Tjønneland, Anne; Hansen, Louise; Dahm, Christina C; Overvad, Kim; Severi, Gianluca; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Kaaks, Rudolf; Fortner, Renee; Boeing, Heiner; Trichopoulou, Antonia; La Vecchia, Carlo; Kotanidou, Anastasia; Berrino, Franco; Krogh, Vittorio; Tumino, Rosario; Ricceri, Fulvio; Panico, Salvatore; Bueno-de-Mesquita, H Bas; Peeters, Petra H; Nøst, Therese Haugdahl; Sandanger, Torkjel M; Quirós, Jose Ramón; Agudo, Antonio; Rodríguez-Barranco, Miguel; Larrañaga, Nerea; Huerta, Jose Maria; Ardanaz, Eva; Drake, Isabel; Brunnström, Hans; Johansson, Mikael; Grankvist, Kjell; Travis, Ruth C; Freisling, Heinz; Stepien, Magdalena; Merritt, Melissa A; Riboli, Elio; Cross, Amanda J (2018-10-18)
      Epidemiological studies suggest that haem iron, which is found predominantly in red meat and increases endogenous formation of carcinogenic N-nitroso compounds, may be positively associated with lung cancer. The objective was to examine the relationship between haem iron intake and lung cancer risk using detailed smoking history data and serum cotinine to control for potential confounding.
    • Haemophilus is overrepresented in the nasopharynx of infants hospitalized with RSV infection and associated with increased viral load and enhanced mucosal CXCL8 responses.

      Ederveen, Thomas H A; Ferwerda, Gerben; Ahout, Inge M; Vissers, Marloes; de Groot, Ronald; Boekhorst, Jos; Timmerman, Harro M; Huynen, Martijn A; van Hijum, Sacha A F T; de Jonge, Marien I (2018-01-11)
      While almost all infants are infected with respiratory syncytial virus (RSV) before the age of 2 years, only a small percentage develops severe disease. Previous studies suggest that the nasopharyngeal microbiome affects disease development. We therefore studied the effect of the nasopharyngeal microbiome on viral load and mucosal cytokine responses, two important factors influencing the pathophysiology of RSV disease. To determine the relation between (i) the microbiome of the upper respiratory tract, (ii) viral load, and (iii) host mucosal inflammation during an RSV infection, nasopharyngeal microbiota profiles of RSV infected infants (< 6 months) with different levels of disease severity and age-matched healthy controls were determined by 16S rRNA marker gene sequencing. The viral load was measured using qPCR. Nasopharyngeal CCL5, CXCL10, MMP9, IL6, and CXCL8 levels were determined with ELISA.
    • 'Happy the man, who, studying nature's laws, Thro' known effects can trace the secret cause.' Do we have enough pieces to solve the pyrazinamide puzzle?

      Anthony, R M; den Hertog, A L; van Soolingen, D (2018-03-08)
      A low pH was assumed to be required for the activity of pyrazinoic acid (the active form of pyrazinamide) against Mycobacterium tuberculosis, but recently activity has been demonstrated at neutral pH. Renewed interest in pyrazinamide has led to an increasing number of potential targets and the suspicion that pyrazinamide is a 'dirty drug'. However, it is our opinion that the recent demonstration that pyrazinoic acid is active against PanD provides an alternative explanation for the secret of pyrazinamide's unusual activity. In this article we propose that PanD is the primary target of pyrazinoic acid but expression of pyrazinoic acid susceptibility requires an intact stress response. As the mycobacterial stress response requires the interaction of a number of genes, disruption of any could result in an inability to enter the susceptible phenotype. We believe this model can explain most of the recent observations of the seemingly diverse spectrum of activity of pyrazinamide.
    • Harmonization of PCR-based detection of intestinal pathogens: experiences from the Dutch external quality assessment scheme on molecular diagnosis of protozoa in stool samples.

      Schuurs, Theo A; Koelewijn, Rob; Brienen, Eric A T; Kortbeek, Titia; Mank, Theo G; Mulder, Bert; Stelma, Foekje F; van Lieshout, Lisette; van Hellemond, Jaap J (2018-02-16)
      Real-time PCR methods are increasingly used in routine patient care settings not only to determine the presence or absence of pathogens in patient materials, but also to obtain semiquantitative results to estimate the pathogen load. However, it is so far unknown how well these methods are harmonized among different laboratories.
    • Harvesting the wisdom of the crowd: using online ratings to explore care experiences in regions.

      Hendrikx, Roy J P; Spreeuwenberg, Marieke D; Drewes, Hanneke W; Struijs, Jeroen N; Ruwaard, Dirk; Baan, Caroline A (2018-10-20)
      Regional population health management (PHM) initiatives need an understanding of regional patient experiences to improve their services. Websites that gather patient ratings have become common and could be a helpful tool in this effort. Therefore, this study explores whether unsolicited online ratings can provide insight into (differences in) patient's experiences at a (regional) population level.
    • Head skeleton malformations in zebrafish (Danio rerio) to assess adverse effects of mixtures of compounds.

      Staal, Yvonne C M; Meijer, Jeroen; van der Kris, Remco J C; de Bruijn, Annamaria C; Boersma, Anke Y; Gremmer, Eric R; Zwart, Edwin P; Beekhof, Piet K; Slob, Wout; van der Ven, Leo T M (2018-10-04)
      The EU-EuroMix project adopted the strategy of the European Food Safety Authority (EFSA) for cumulative risk assessment, which limits the number of chemicals to consider in a mixture to those that induce a specific toxicological phenotype. These so-called cumulative assessment groups (CAGs) are refined at several levels, including the target organ and specific phenotype. Here, we explore the zebrafish embryo as a test model for quantitative evaluation in one such CAG, skeletal malformations, through exposure to test compounds 0-120 hpf and alcian blue cartilage staining at 120 hpf, focusing on the head skeleton. Reference compounds cyproconazole, flusilazole, metam, and thiram induced distinctive phenotypes in the head skeleton between the triazoles and dithiocarbamates. Of many evaluated parameters, the Meckel's-palatoquadrate (M-PQ) angle was selected for further assessment, based on the best combination of a small confidence interval, an intermediate maximal effect size and a gentle slope of the dose-response curve with cyproconazole and metam. Additional test compounds included in the CAG skeletal malformations database were tested for M-PQ effects, and this set was supplemented with compounds associated with craniofacial malformations or cleft palate to accommodate otherwise organized databases. This additional set included hexaconazole, all-trans-retinoic acid, AM580, CD3254, maneb, pyrimethanil, imidacloprid, pirimiphos-methyl, 2,4-dinitrophenol, 5-fluorouracil, 17alpha-ethynylestradiol (EE2), ethanol, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), PCB 126, methylmercury, boric acid, and MEHP. Most of these compounds produced a dose-response for M-PQ effects. Application of the assay in mixture testing was provided by combined exposure to cyproconazole and TCDD through the isobole method, supporting that in this case the combined effect can be modeled through concentration addition.
    • Health and Economic Impact of a Tender-Based, Sex-Neutral Human Papillomavirus 16/18 Vaccination Program in the Netherlands.

      Qendri, Venetia; Bogaards, Johannes A; Berkhof, Johannes (2017-07-15)
      Uptake of human papillomavirus (HPV) vaccine among girls in the Dutch immunization program has plateaued at around 60%. Vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases, especially since tender negotiations and reduced dosing schemes have driven down the cost of vaccination.
    • Health assessments for health governance—concepts and methodologies

      Fehr, Rainer; Alexanderson, Kristina; Favaretti, Carlo; de Jong, Judith; La Torre, Giuseppe; Lim, Tek-Ang; Martin-Olmedo, Piedad; Mekel, Odile C L; Michelsen, Kai; Rosenkötter, Nicole; Verschuuren, Marieke; de Waure, Chiara; Zeegers Paget, Dineke (2017-08)
    • Health impact assessment of a skin sensitizer: Analysis of potential policy measures aimed at reducing geraniol concentrations in personal care products and household cleaning products.

      Jongeneel, W P; Delmaar, J E; Bokkers, B G H (2018-09)
      A methodology to assess the health impact of skin sensitizers is introduced, which consists of the comparison of the probabilistic aggregated exposure with a probabilistic (individual) human sensitization or elicitation induction dose. The health impact of potential policy measures aimed at reducing the concentration of a fragrance allergen, geraniol, in consumer products is analysed in a simulated population derived from multiple product use surveys. Our analysis shows that current dermal exposure to geraniol from personal care and household cleaning products lead to new cases of contact allergy and induce clinical symptoms for those already sensitized. We estimate that this exposure results yearly in 34 new cases of geraniol contact allergy per million consumers in Western and Northern Europe, mainly due to exposure to household cleaning products. About twice as many consumers (60 per million) are projected to suffer from clinical symptoms due to re-exposure to geraniol. Policy measures restricting geraniol concentrations to <0.01% will noticeably reduce new cases of sensitization and decrease the number of people with clinical symptoms as well as the frequency of occurrence of these clinical symptoms. The estimated numbers should be interpreted with caution and provide only a rough indication of the health impact.
    • Health literacy among older adults is associated with their 10-years' cognitive functioning and decline - the Doetinchem Cohort Study.

      Geboers, Bas; Uiters, Ellen; Reijneveld, Sijmen A; Jansen, Carel J M; Almansa, Josué; Nooyens, Astrid C J; Verschuren, W M Monique; de Winter, Andrea F; Picavet, H Susan J (2018-03-20)
      Many older adults have low levels of health literacy which affects their ability to participate optimally in healthcare. It is unclear how cognitive decline contributes to health literacy. To study this, longitudinal data are needed. The aim of this study was therefore to assess the associations of cognitive functioning and 10-years' cognitive decline with health literacy in older adults.
    • Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts.

      Woudstra, Anke J; Timmermans, Daniëlle R M; Uiters, Ellen; Dekker, Evelien; Smets, Ellen M A; Fransen, Mirjam P (2017-12-20)
      The process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework.
    • The health of Antillean migrants in the Netherlands: a comparison with the health of non-migrants in both the countries of origin and destination.

      Verstraeten, Soraya P A; van den Brink, Carolien L; Mackenbach, Johan P; van Oers, Hans A M (2018-04-09)
      This article examines risk factor and health differences between Antillean migrants in the Netherlands and Antillean and Dutch non-migrants, and relates these findings to four commonly used explanations for migrant health disparities.
    • Health Risks Awareness of Electronic Waste Workers in the Informal Sector in Nigeria.

      Ohajinwa, Chimere M; Van Bodegom, Peter M; Vijver, Martina G; Peijnenburg, Willie J G M (2017-08-13)
      Insight into the health risk awareness levels of e-waste workers is important as it may offer opportunities for better e-waste recycling management strategies to reduce the health effects of informal e-waste recycling. Therefore, this study assessed the knowledge, attitude, and practices associated with occupational health risk awareness of e-waste workers compared with a control group (butchers) in the informal sector in Nigeria. A cross-sectional study was used to assess health risk awareness of 279 e-waste workers (repairers and dismantlers) and 221 butchers from the informal sector in three locations in Nigeria in 2015. A questionnaire was used to obtain information on socio-demographic backgrounds, occupational history, knowledge, attitude, and work practices. The data was analysed using Analysis of Variance. The three job designations had significantly different knowledge, attitude, and practice mean scores (p = 0.000), with butchers consistently having the highest mean scores. Only 43% of e-waste workers could mention one or more Personal Protective Equipment needed for their job compared with 70% of the butchers. The health risk awareness level of the e-waste workers was significantly lower compared with their counterparts in the same informal sector. A positive correlation existed between the workers' knowledge and their attitude and practice. Therefore, increasing the workers' knowledge may decrease risky practices.
    • Health status in Europe: comparison of 24 urban areas to the corresponding 10 countries (EURO-URHIS 2).

      Koster, E M; de Gelder, R; Di Nardo, F; Williams, G; Harrison, A; van Buren, L P; Lyshol, H; Patterson, L; Birt, C A; Higgerson, J; Achterberg, P W; Verma, A; van Ameijden, E J C (2017-05-01)
      : In Europe, over 70% of the population live in urban areas (UAs). Most international comparative health research is done using national level data, as reliable and comparable urban data are often unavailable or difficult to access. This study aims to investigate whether population health is different in UAs compared with their corresponding countries. : Routinely available health-related data were collected by the EURO-URHIS 2 project, for 10 European countries and for 24 UAs within those countries. National and UA level data for 11 health indicators were compared through the calculation of relative difference, and geographical patterns within Europe were investigated using the Mann Whitney U test. Linear regression modelling was used to adjust for population density, gross domestic product and urbanicity. : In general, the urban population in Eastern Europe is less healthy than the Western European urban population. However, people in Eastern Europe have significantly better broad health outcomes in UAs as compared with the corresponding country as a whole, whereas people in Western Europe have generally worse broader health outcomes in UAs. : For most European countries and UAs that were investigated, the national level health status data does not correspond with the health status at UA level. In order to identify health problems in UAs and to provide information for local health policy, health monitoring and international benchmarking should also be conducted at the local level.
    • Healthcare costs attributable to congenital cytomegalovirus infection.

      Korndewal, Marjolein J; Weltevrede, Marlies; van den Akker-van Marle, M Elske; Oudesluys-Murphy, Anne Marie; de Melker, Hester E; Vossen, Ann C T M (2018-01-23)
      Congenital cytomegalovirus infection (cCMV) can cause symptoms at birth as well as long-term impairment. This study estimates cCMV-related healthcare costs in the Netherlands in early childhood.
    • Healthcare utilisation and expenditure of overweight and non-overweight children.

      Wijga, Alet H; Mohnen, Sigrid M; Vonk, Judith M; Uiters, Ellen (2018-06-11)
      Quantification of the burden of overweight on the healthcare system is becoming increasingly urgent for health policy, but accurate estimates are hard to obtain.
    • Healthcare-associated pneumonia in acute care hospitals in European Union/European Economic Area countries: an analysis of data from a point prevalence survey, 2011 to 2012.

      Walter, Jan; Haller, Sebastian; Quinten, Chantal; Kärki, Tommi; Zacher, Benedikt; Eckmanns, Tim; Abu Sin, Muna; Plachouras, Diamantis; Kinross, Pete; Suetens, Carl (2018)
      An aim of the ECDC point prevalence survey (PPS) in European Union/European Economic Area acute care hospitals was to acquire standardised healthcare-associated infections (HAI) data. We analysed one of the most common HAIs in the ECDC PPS, healthcare-associated pneumonia (HAP). Standardised HAI case definitions were provided and countries were advised to recruit nationally representative subsets of hospitals. We calculated 95% confidence intervals (CIs) around prevalence estimates and adjusted for clustering at hospital level. Of 231,459 patients in the survey, 2,902 (1.3%; 95% CI: 1.2-1.3) fulfilled the case definition for a HAP. HAPs were most frequent in intensive care units (8.1%; 95% CI: 7.4-8.9) and among patients intubated on the day of the survey (15%; 95% CI: 14-17; n = 737 with HAP). The most frequently reported microorganism was Pseudomonas aeruginosa (17% of 1,403 isolates), followed by Staphylococcus aureus (12%) and Klebsiella spp. (12%). Antimicrobial resistance was common among isolated microorganisms. The most frequently prescribed antimicrobial group was penicillins, including combinations with beta-lactamase inhibitors. HAPs occur regularly among intubated and non-intubated patients, with marked differences between medical specialities. HAPs remain a priority for preventive interventions, including surveillance. Our data provide a reference for future prevalence of HAPs at various settings.
    • Healthy diets with reduced environmental impact? – The greenhouse gas emissions of various diets adhering to the Dutch food based dietary guidelines

      van de Kamp, Mirjam E.; van Dooren, Corné; Hollander, Anne; Geurts, Marjolein; Brink, Elizabeth J.; van Rossum, Caroline; Biesbroek, Sander; de Valk, Elias; Toxopeus, Ido B.; Temme, Elisabeth H.M. (2017-06)
    • Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017.

      Ndumbi, Patricia; Freidl, Gudrun S; Williams, Christopher J; Mårdh, Otilia; Varela, Carmen; Avellón, Ana; Friesema, Ingrid; Vennema, Harry; Beebeejaun, Kazim; Ngui, Siew Lin; Edelstein, Michael; Smith-Palmer, Alison; Murphy, Niamh; Dean, Jonathan; Faber, Mirko; Wenzel, Jürgen; Kontio, Mia; Müller, Luise; Midgley, Sofie Elisabeth; Sundqvist, Lena; Ederth, Josefine Lundberg; Roque-Afonso, Anne-Marie; Couturier, Elisabeth; Klamer, Sofieke; Rebolledo, Javiera; Suin, Vanessa; Aberle, Stephan W; Schmid, Daniela; De Sousa, Rita; Augusto, Gonçalo Figueiredo; Alfonsi, Valeria; Del Manso, Martina; Ciccaglione, Anna Rita; Mellou, Kassiani; Hadjichristodoulou, Christos; Donachie, Alastair; Borg, Maria-Louise; Sočan, Maja; Poljak, Mario; Severi, Ettore (2018)
      Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.