• Laboratory management of Crimean-Congo haemorrhagic fever virus infections: perspectives from two European networks.

      Bartolini, Barbara; Gruber, Cesare Em; Koopmans, Marion; Avšič, Tatjana; Bino, Sylvia; Christova, Iva; Grunow, Roland; Hewson, Roger; Korukluoglu, Gulay; Lemos, Cinthia Menel; Mirazimi, Ali; Papa, Anna; Sanchez-Seco, Maria Paz; Sauer, Aisha V; Zeller, Hervè; Nisii, Carla; Capobianchi, Maria Rosaria; Ippolito, Giuseppe; Reusken, Chantal B; Di Caro, Antonino (2019-01-01)
      BackgroundCrimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging infectious disease threat in the European Union. Since 2000, the incidence and geographic range of confirmed CCHF cases have markedly increased, following changes in the distribution of its main vector,
    • Laboratory methods for case finding in human psittacosis outbreaks: a systematic review.

      Nieuwenhuizen, Annelies A; Dijkstra, Frederika; Notermans, Daan W; van der Hoek, Wim (2018-08-30)
      Psittacosis outbreak investigations require rapid identification of cases in order to trace possible sources and perform public health risk assessments. In recent outbreaks in the Netherlands, such investigations were hampered by the non-specificity of laboratory testing methods to identify human Chlamydia psittaci infections.
    • Land use regression modelling estimating nitrogen oxides exposure in industrial south Durban, South Africa.

      Muttoo, Sheena; Ramsay, Lisa; Brunekreef, Bert; Beelen, Rob; Meliefste, Kees; Naidoo, Rajen N (2018-01-01)
      The South Durban (SD) area of Durban, South Africa, has a history of air pollution issues due to the juxtaposition of low-income communities with industrial areas. This study used measurements of oxides of nitrogen (NOx) to develop a land use regression (LUR) model to explain the spatial variation of air pollution concentrations in this area.
    • Large-scale genomic analysis shows association between homoplastic genetic variation in Mycobacterium tuberculosis genes and meningeal or pulmonary tuberculosis.

      Ruesen, Carolien; Chaidir, Lidya; van Laarhoven, Arjan; Dian, Sofiati; Ganiem, Ahmad Rizal; Nebenzahl-Guimaraes, Hanna; Huynen, Martijn A; Alisjahbana, Bachti; Dutilh, Bas E; van Crevel, Reinout (2018)
      Meningitis is the most severe manifestation of tuberculosis. It is largely unknown why some people develop pulmonary TB (PTB) and others TB meningitis (TBM); we examined if the genetic background of infecting M. tuberculosis strains may be relevant.
    • Latent tuberculosis infection in foreign-born communities: Import vs. transmission in The Netherlands derived through mathematical modelling.

      Korthals Altes, Hester; Kloet, Serieke; Cobelens, Frank; Bootsma, Martin (2018)
      While tuberculosis (TB) represents a significant disease burden worldwide, low-incidence countries strive to reach the WHO target of pre-elimination by 2035. Screening for TB in immigrants is an important component of the strategy to reduce the TB burden in low-incidence settings. An important option is the screening and preventive treatment of latent TB infection (LTBI). Whether this policy is worthwhile depends on the extent of transmission within the country, and introduction of new cases through import. Mathematical transmission models of TB have been used to identify key parameters in the epidemiology of TB and estimate transmission rates. An important application has also been to investigate the consequences of policy scenarios. Here, we formulate a mathematical model for TB transmission within the Netherlands to estimate the size of the pool of latent infections, and to determine the share of importation-either through immigration or travel- versus transmission within the Netherlands. We take into account importation of infections due to immigration, and travel to the country of origin, focusing on the three ethnicities most represented among foreign-born TB cases (after exclusion of those overrepresented among asylum seekers): Moroccans, Turkish and Indonesians. We fit a system of ordinary differential equations to the data from the Netherlands Tuberculosis Registry on (extra-)pulmonary TB cases from 1995-2013. We estimate that about 27% of Moroccans, 25% of Indonesians, and 16% of Turkish, are latently infected. Furthermore, we find that for all three foreign-born communities, immigration is the most important source of LTBI, but the extent of within-country transmission is much lower (about half) for the Turkish and Indonesian communities than for the Moroccan. This would imply that contact investigation would have a greater yield in the latter community than in the former. Travel remains a minor factor contributing LTBI, suggesting that targeting returning travelers might be less effective at preventing LTBI than immigrants upon entry in the country.
    • De LCI in 2016: van A(viaire influenza) tot Z(ika).

      Haverkate M; Jacobi A; Oomen T; SwaanC (2017-10)
    • LCIA framework and cross-cutting issues guidance within the UNEP-SETAC Life Cycle Initiative

      Verones, Francesca; Bare, Jane; Bulle, Cécile; Frischknecht, Rolf; Hauschild, Michael; Hellweg, Stefanie; Henderson, Andrew; Jolliet, Olivier; Laurent, Alexis; Liao, Xun; Lindner, Jan Paul; Maia de Souza, Danielle; Michelsen, Ottar; Patouillard, Laure; Pfister, Stephan; Posthuma, Leo; Prado, Valentina; Ridoutt, Brad; Rosenbaum, Ralph K.; Sala, Serenella; Ugaya, Cassia; Vieira, Marisa; Fantke, Peter (2017-09)
    • Learning from games: stakeholders' experiences involved in local health policy.

      Spitters, H P E M; van de Goor, L A M; Lau, C Juel; Sandu, P; Eklund Karlsson, L; Jansen, J; van Oers, J A M (2018-03-01)
      Since public health problems are complex and the related policies need to address a wide range of sectors, cross-sectoral collaboration is beneficial. One intervention focusing on stimulating collaboration is a 'policy game'. The focus on specific problems facilitates relationships between the stakeholders and stimulates cross-sectoral policymaking. The present study explores stakeholders' learning experiences with respect to the collaboration process in public health policymaking. This was achieved via their game participation, carried out in real-life stakeholder networks in the Netherlands, Denmark and Romania. The policy game (In2Action) was developed and implemented as a 1-day role-play. The data consisted of: (i) observations and evaluation notes during the game and (ii) participant questionnaire after the game. All three countries showed similar results in learning experience during the collaboration processes in local policymaking. Specific learning experiences were related to: (i) the stakeholder network, (ii) interaction and (iii) relationships. The game also increased participant's understanding of group dynamics and need for a coordinator in policymaking. This exploratory study shows that the game provides participants with learning experiences during the collaboration process in policymaking. Experiencing what is needed to establish cross-sectoral collaboration is a first step towards enhancing knowledge exchange and more effective public health policies.
    • Legionella-uitbraak in Amsterdam: koeltoren als bron

      Hoek, J A R van den; IJzerman, E P F; Coutinho, Roel A (2006-08-19)
      During the period 6-28 July 2006, 30 confirmed cases of Legionella infection were identified in Amsterdam, 2 of which were fatal. All had a positive urinary antigen test, by which Legionella pneumophila serogroup I could be demonstrated. Consultations between the parties involved in the control of infectious diseases started on July 7th, as soon as it became clear that there was an outbreak. On July 10th it was established that relatively many of these patients lived in the eastern part of the city centre. After a study of the prevailing winds during the past 3 weeks, the search for installations containing water was started. A cooling tower in the town centre was closed on July 11th by way of precaution. During the following week, this tower was proven to be the source of the outbreak.
    • Legionellapreventie: betere naleving Waterleidingwet nodig

      Versteegh, A.; Brandsema, P.; Aa, M. van der; Dik, H. (Dekker en Nordemann, Rotterdam, 2007-11-01)
      Ongeveer 20 procent van de zorginstellingen en zwembaden heeft in 2005 te maken gehad met een legionellabesmetting in de leidingwaterinstallatie. Dit gold ook voor 5 procent van de hotels en campings. Vooral in zorginstellingen kan Legionella in de waterleidingen gevaarlijk zijn, omdat de mensen hier vaak een zwakkere gezondheid hebben. Circa 90% van de instellingen leeft niet alle wettelijk voorgeschreven preventiemaatregelen volledig na. Bij hercontrole is echter een groot deel van de problemen opgelost. Dit toont de effectiviteit en het belang van de controles: eenmaal op de hoogte van de risico’s zijn de eigenaren meestal bereid de nodige aanpassingen te doen. Het aantal collectieve leidingwaterinstallaties met Legionella nam tussen 2000 en 2006 niet duidelijk af. Een betere naleving van de legionellapreventie regelgeving en installatievoorschriften leidt naar verwachting wél tot minder Legionella in leidingwaterinstallaties. Tussen 2000 en 2006 steeg het aantal gemelde patiënten met legionellose. Een betrouwbare schatting van het aantal patiënten dat gerelateerd is aan een collectieve leidingwaterinstallatie als besmettingsbron is echter niet mogelijk.
    • Let's talk about sex: A qualitative study exploring the experiences of HIV nurses when discussing sexual risk behaviours with HIV-positive men who have sex with men.

      de Munnik, S; den Daas, C; Ammerlaan, H S M; Kok, G; Raethke, M S; Vervoort, S C J M (2017-11)
      Despite prevention efforts, the incidence of sexually transmitted infection among HIV-positive men who have sex with men remains high, which is indicative of unchanged sexual risk behaviour. Discussing sexual risk behaviour has been shown to help prevent sexually transmitted infections among HIV-positive men who have sex with men.
    • A lifelong study of a pack Rhodesian ridgeback dogs reveals subclinical and clinical tick-borne Anaplasma phagocytophilum infections with possible reinfection or persistence.

      Hovius, Emil; de Bruin, Arnout; Schouls, Leo; Hovius, Joppe; Dekker, Niels; Sprong, Hein (2018-04-12)
      Various tick-borne infections often occur without specific clinical signs and are therefore notoriously hard to diagnose separately in veterinary practice. Longitudinal studies over multiple tick seasons performing clinical, serological and molecular investigations in parallel, may elucidate the relationship between infection and disease. In this regard, six related Rhodesian Ridgeback dogs living as a pack became subject of lifetime studies due to ongoing tick infestations and recurring clinical problems. Blood samples for diagnostic tests were obtained throughout the years 2000 to 2009.
    • Lifespan analysis of brain development, gene expression and behavioral phenotypes in the Ts1Cje, Ts65Dn and Dp(16)1/Yey mouse models of Down syndrome.

      Aziz, Nadine M; Guedj, Faycal; Pennings, Jeroen L A; Olmos-Serrano, Jose Luis; Siegel, Ashley; Haydar, Tarik F; Bianchi, Diana W (2018-04-30)
      Down syndrome (DS) results from triplication of human chromosome 21. Neuropathological hallmarks of DS include atypical central nervous system development that manifests prenatally and extends throughout life. As a result, individuals with DS exhibit cognitive and motor deficits and have delays in achieving developmental milestones. To determine whether different mouse models of DS recapitulate the human prenatal and postnatal phenotypes, here we directly compared brain histogenesis, gene expression, and behavior over the lifespan of three cytogenetically distinct mouse models of DS: Ts1Cje, Ts65Dn and Dp(16)1/Yey. Histological data indicated that Ts65Dn mice were the most consistently affected with respect to somatic growth, neurogenesis, and brain morphogenesis. Embryonic and adult gene expression results showed that Ts1Cje and Ts65Dn brains had considerably more differentially expressed (DEX) genes compared to Dp(16)1/Yey mice, despite the larger number of triplicated genes in the latter model. In addition, DEX genes showed little overlap in identity and chromosomal distribution in the three models, leading to dissimilarities in affected functional pathways. Perinatal and adult behavioral testing also highlighted differences among the models in their abilities to achieve various developmental milestones and perform hippocampal- and motor-based tasks. Interestingly, Dp(16)1/Yey mice showed no abnormalities in prenatal brain phenotypes, yet they manifested behavioral deficits starting at postnatal day 15 that continued through adulthood. In contrast, Ts1Cje mice showed mildly abnormal embryonic brain phenotypes, but only select behavioral deficits as neonates and adults. Altogether, our data showed widespread and unexpected fundamental differences in behavioral, gene expression, and brain development phenotypes between these three mouse models. Our findings illustrate unique limitations of each model when studying aspects of brain development and function in DS. This work helps to inform model selection in future studies investigating how observed neurodevelopmental abnormalities arise, how they contribute to cognitive impairment, and when testing therapeutic molecules to ameliorate the intellectual disability associated with DS.
    • Lifestyle Interventions Are Cost-Effective in People With Different Levels of Diabetes Risk: Results from a modeling study.

      Jacobs-van der Bruggen, Monique A M; Bos, Griët; Bemelmans, Wanda J; Hoogenveen, Rudolf T; Vijgen, Sylvia M; Baan, Caroline A (2007-01-01)
      OBJECTIVE: In the current study we explore the long-term health benefits and cost-effectiveness of both a community-based lifestyle program for the general population (community intervention) and an intensive lifestyle intervention for obese adults, implemented in a health care setting (health care intervention). RESEARCH DESIGN AND METHODS: Short-term intervention effects on BMI and physical activity were estimated from the international literature. The National Institute for Public Health and the Environment Chronic Diseases Model was used to project lifetime health effects and effects on health care costs for minimum and maximum estimates of short-term intervention effects. Cost-effectiveness was evaluated from a health care perspective and included intervention costs and related and unrelated medical costs. Effects and costs were discounted at 1.5 and 4.0% annually. RESULTS: One new case of diabetes per 20 years was prevented for every 7-30 participants in the health care intervention and for every 300-1,500 adults in the community intervention. Intervention costs needed to prevent one new case of diabetes (per 20 years) were lower for the community intervention (euro2,000-9,000) than for the health care intervention (euro5,000-21,000). The cost-effectiveness ratios were euro3,100-3,900 per quality-adjusted life-year (QALY) for the community intervention and euro3,900-5,500 per QALY for the health care intervention. CONCLUSIONS: Health care interventions for high-risk groups and community-based lifestyle interventions targeted to the general population (low risk) are both cost-effective ways of curbing the growing burden of diabetes.
    • Lifetime and baseline alcohol intakes and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition study.

      Naudin, Sabine; Li, Kuanrong; Jaouen, Tristan; Assi, Nada; Kyrø, Cecilie; Tjønneland, Anne; Overvad, Kim; Boutron-Ruault, Marie-Christine; Rebours, Vinciane; Védié, Anne-Laure; Boeing, Heiner; Kaaks, Rudolf; Katzke, Verena; Bamia, Christina; Naska, Androniki; Trichopoulou, Antonia; Berrino, Franco; Tagliabue, Giovanna; Palli, Domenico; Panico, Salvatore; Tumino, Rosario; Sacerdote, Carlotta; Peeters, Petra H; Bueno-de-Mesquita, Bas; Weiderpass Vainio, Elisabete; Gram, Inger Torhild; Skeie, Guri; Chirlaque, Maria-Dolores; Rodríguez-Barranco, Miguel; Barricarte, Aurelio; Quirós, Jose Ramón; Dorronsoro, Miren; Johansson, Ingegerd; Sund, Malin; Sternby, Hanna; Bradbury, Kathryn E; Wareham, Nick; Riboli, Elio; Gunter, Marc; Brennan, Paul; Duell, Eric J; Ferrari, Pietro (2018-03-09)
      Recent evidence suggested a weak relationship between alcohol consumption and pancreatic cancer (PC) risk. In this study, the association between lifetime and baseline alcohol intakes and the risk of PC was evaluated, including the type of alcoholic beverages and potential interaction with smoking. Within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, 1,283 incident PC (57% women) were diagnosed from 476,106 cancer-free participants, followed up for 14 years. Amounts of lifetime and baseline alcohol were estimated through lifestyle and dietary questionnaires, respectively. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and their 95% confidence interval (CI). Alcohol intake was positively associated with PC risk in men. Associations were mainly driven by extreme alcohol levels, with HRs comparing heavy drinkers (>60 g/day) to the reference category (0.1-4.9 g/day) equal to 1.77 (95% CI: 1.06, 2.95) and 1.63 (95% CI: 1.16, 2.29) for lifetime and baseline alcohol, respectively. Baseline alcohol intakes from beer (>40 g/day) and spirits/liquors (>10 g/day) showed HRs equal to 1.58 (95% CI: 1.07, 2.34) and 1.41 (95% CI: 1.03, 1.94), respectively, compared to the reference category (0.1-2.9 g/day). In women, HR estimates did not reach statistically significance. The alcohol and PC risk association was not modified by smoking status. Findings from a large prospective study suggest that baseline and lifetime alcohol intakes were positively associated with PC risk, with more apparent risk estimates for beer and spirits/liquors than wine intake. This article is protected by copyright. All rights reserved.
    • Limited influence of hospital wastewater on the microbiome and resistome of wastewater in a community sewerage system.

      Buelow, Elena; Bayjanov, Jumamurat R; Majoor, Eline; Willems, Rob J L; Bonten, Marc J M; Schmitt, Heike; van Schaik, Willem (2018-05-14)
      Effluents from wastewater treatment plants (WWTPs) have been proposed to act as point sources of antibiotic-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs) in the environment. Hospital sewage may contribute to the spread of ARB and ARGs as it contains the feces and urine of hospitalized patients, who are more frequently colonized with multi-drug resistant bacteria than the general population. However, whether hospital sewage noticeably contributes to the quantity and diversity of ARGs in the general sewerage system has not yet been determined.Here, we employed culture-independent techniques, namely 16S rRNA gene sequencing and nanolitre-scale quantitative PCRs, to assess the role of hospital effluent as a point source of ARGs in the sewerage system, through comparing microbiota composition and levels of ARGs in hospital sewage with WWTP influent with and without hospital sewage.Compared to other sites, hospital sewage was richest in human-associated bacteria and contained the highest relative levels of ARGs. Yet, the relative abundance of ARGs was comparable in the influent of WWTPs with and without hospital sewage, suggesting that hospitals do not contribute importantly to the quantity and diversity of ARGs in the investigated sewerage system.
    • Limited salt consumption reduces the incidence of chronic kidney disease: a modeling study.

      Hendriksen, Marieke A H; Over, Eelco A B; Navis, Gerjan; Joles, Jaap A; Hoorn, Ewout J; Gansevoort, Ron T; Boshuizen, Hendriek C (2018-01-09)
      In addition to blood pressure and cardiovascular disease, high-salt intake has been associated with renal diseases. The aim of this study is to estimate the potential health impact of salt reduction on chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in the Netherlands.
    • Livestock-associated risk factors for pneumonia in an area of intensive animal farming in the Netherlands.

      Freidl, Gudrun S; Spruijt, Ineke T; Borlée, Floor; Smit, Lidwien A M; van Gageldonk-Lafeber, Arianne B; Heederik, Dick J J; Yzermans, Joris; van Dijk, Christel E; Maassen, Catharina B M; van der Hoek, Wim (2017)
      Previous research conducted in 2009 found a significant positive association between pneumonia in humans and living close to goat and poultry farms. However, as this result might have been affected by a large goat-related Q fever epidemic, the aim of the current study was to re-evaluate this association, now that the Q-fever epidemic had ended. In 2014/15, 2,494 adults (aged 20-72 years) living in a livestock-dense area in the Netherlands participated in a medical examination and completed a questionnaire on respiratory health, lifestyle and other items. We retrieved additional information for 2,426/2,494 (97%) participants from electronic medical records (EMR) from general practitioners. The outcome was self-reported, physician-diagnosed pneumonia or pneumonia recorded in the EMR in the previous three years. Livestock license data was used to determine exposure to livestock. We quantified associations between livestock exposures and pneumonia using odds ratios adjusted for participant characteristics and comorbidities (aOR). The three-year cumulative frequency of pneumonia was 186/2,426 (7.7%). Residents within 2,000m of a farm with at least 50 goats had an increased risk of pneumonia, which increased the closer they lived to the farm (2,000m aOR 1.9, 95% CI 1.4-2.6; 500m aOR 4.4, 95% CI 2.0-9.8). We found no significant associations between exposure to other farm animals and pneumonia. However, when conducting sensitivity analyses using pneumonia outcome based on EMR only, we found a weak but statistically significant association with presence of a poultry farm within 1,000m (aOR: 1.7, 95% CI 1.1-2.7). Living close to goat and poultry farms still constitute risk factors for pneumonia. Individuals with pneumonia were not more often seropositive for Coxiella burnetii, indicating that results are not explained by Q fever. We strongly recommend identification of pneumonia causes by the use of molecular diagnostics and investigating the role of non-infectious agents such as particulate matter or endotoxins.
    • Living Close to Natural Outdoor Environments in Four European Cities: Adults' Contact with the Environments and Physical Activity.

      Triguero-Mas, Margarita; Donaire-Gonzalez, David; Seto, Edmund; Valentín, Antònia; Smith, Graham; Martínez, David; Carrasco-Turigas, Glòria; Masterson, Daniel; van den Berg, Magdalena; Ambròs, Albert; Martínez-Íñiguez, Tania; Dedele, Audrius; Hurst, Gemma; Ellis, Naomi; Grazulevicius, Tomas; Voorsmit, Martin; Cirach, Marta; Cirac-Claveras, Judith; Swart, Wim; Clasquin, Eddy; Maas, Jolanda; Wendel-Vos, Wanda; Jerrett, Michael; Gražulevičienė, Regina; Kruize, Hanneke; Gidlow, Christopher J; Nieuwenhuijsen, Mark J (2017-09-30)
      This study investigated whether residential availability of natural outdoor environments (NOE) was associated with contact with NOE, overall physical activity and physical activity in NOE, in four different European cities using objective measures. A nested cross-sectional study was conducted in Barcelona (Spain); Stoke-on-Trent (United Kingdom); Doetinchem (The Netherlands); and Kaunas (Lithuania). Smartphones were used to collect information on the location and physical activity (overall and NOE) of around 100 residents of each city over seven days. We used Geographic Information Systems (GIS) to determine residential NOE availability (presence/absence of NOE within 300 m buffer from residence), contact with NOE (time spent in NOE), overall PA (total physical activity), NOE PA (total physical activity in NOE). Potential effect modifiers were investigated. Participants spent around 40 min in NOE and 80 min doing overall PA daily, of which 11% was in NOE. Having residential NOE availability was consistently linked with higher NOE contact during weekdays, but not to overall PA. Having residential NOE availability was related to NOE PA, especially for our Barcelona participants, people that lived in a city with low NOE availability.