• European seroepidemiology network 2: Standardisation of assays for seroepidemiology of varicella zoster virus.

      Ory, Fernando de; Echevarría, José Manuel; Kafatos, George; Anastassopoulou, Cleo; Andrews, Nick; Backhouse, Josephine; Berbers, Guy A M; Bruckova, Blazena; Cohen, Daniel I; Melker, Hester E de; Davidkin, Irja; Gabutti, Giovanni; Hesketh, Louise M; Johansen, Kari; Jokinen, Sari; Jones, Lindsay; Linde, Anika; Miller, Elisabeth; Mossong, Joël; Nardone, Anthony; Rota, Maria Cristina; Sauerbrei, Andreas; Schneider, François; Smetana, Zahava; Tischer, Annedore; Tsakris, Athanassios; Vranckx, Robert (2006-06-01)
      BACKGROUND: The aim of the European Sero-Epidemiology Network (ESEN2) is to harmonise the serological surveillance of vaccine-preventable diseases in Europe. OBJECTIVE: To allow comparison of antibody prevalence in different countries by standardising results into common units. STUDY DESIGN: For varicella zoster virus (VZV), a reference laboratory established a panel of 148 samples, characterised by indirect enzyme-immunoassay (ELISA), indirect immunofluorescence, and complement fixation test. Fifty-seven samples were also studied by the fluorescence antibody to membrane antigen test. The geometric mean of the antibody activity (GMAA) obtained from four ELISA determinations was used to characterise each sample of the panel as positive (GMAA: >100 mIU/ml), equivocal (GMAA: 50-100 mIU/ml) or negative (GMAA: <50 mIU/ml) for antibody to VZV (anti-VZV). Thirteen laboratories, using five different ELISA tests, tested the panel. RESULTS: Agreement with the reference laboratory was above 85% in all cases, and the R(2) values obtained from regression analysis of the quantitative results were always higher than 0.87. Finally, the regression equations could be used to convert national values into a common unitage. CONCLUSION: This study confirmed that results for anti-VZV obtained by different ELISA methods can be converted into common units, enabling the comparison of the seroprevalence profiles obtained in the participant countries.
    • Evaluating a Dutch cardiology primary care plus intervention on the Triple Aim outcomes: study design of a practice-based quantitative and qualitative research.

      Quanjel, Tessa C C; Spreeuwenberg, Marieke D; Struijs, Jeroen N; Baan, Caroline A; Ruwaard, Dirk (2017-09-06)
      In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. This study focuses on a cardiology primary care plus intervention. Primary care plus (PC+) is a new health-care delivery model focused on substitution of specialist care in the hospital setting with specialist care in the primary care setting. The intervention consists of a cardiology PC+ centre in which cardiologists, supported by other health-care professionals, provide consultations in a primary care setting. The PC+ centre aims to improve the health of the population and quality of care as experienced by patients, and reduce the number of referrals to hospital-based outpatient specialist care in order to reduce health-care costs. These aims reflect the Triple Aim principle. Hence, the objectives of the study are to evaluate the cardiology PC+ centre in terms of the Triple Aim outcomes and to evaluate the process of the introduction of PC+.
    • Evaluating the evidence for non-monotonic dose-response relationships: A systematic literature review and (re-)analysis of in vivo toxicity data in the area of food safety.

      Varret, C; Beronius, A; Bodin, L; Bokkers, B G H; Boon, P E; Burger, M; De Wit-Bos, L; Fischer, A; Hanberg, A; Litens-Karlsson, S; Slob, W; Wolterink, G; Zilliacus, J; Beausoleil, C; Rousselle, C (2018-01-15)
      This study aims to evaluate the evidence for the existence of non-monotonic dose-responses (NMDRs) of substances in the area of food safety. This review was performed following the systematic review methodology with the aim to identify in vivo studies published between January 2002 and February 2015 containing evidence for potential NMDRs. Inclusion and reliability criteria were defined and used to select relevant and reliable studies. A set of six checkpoints was developed to establish the likelihood that the data retrieved contained evidence for NMDR. In this review, 49 in vivo studies were identified as relevant and reliable, of which 42 were used for dose-response analysis. These studies contained 179 in vivo dose-response datasets with at least five dose groups (and a control group) as fewer doses cannot provide evidence for NMDR. These datasets were extracted and analyzed using the PROAST software package. The resulting dose-response relationships were evaluated for possible evidence of NMDRs by applying the six checkpoints. In total, 10 out of the 179 in vivo datasets fulfilled all six checkpoints. While these datasets could be considered as providing evidence for NMDR, replicated studies would still be needed to check if the results can be reproduced to rule out that the non-monotonicity was caused by incidental anomalies in that specific study. This approach, combining a systematic review with a set of checkpoints, is new and appears useful for future evaluations of the dose response datasets regarding evidence of non-monotonicity.
    • Evaluation and enumeration of online test providers for sexually transmitted infections, specifically chlamydia, in the Netherlands.

      den Daas, Chantal; Sukel, Bob; Bos, Hanna; van den Broek, Ingrid (2019-01-22)
      Online testing for STIs might complement regular care provided by general practitioners or STI clinics. Two types of online testing can be distinguished, self-testing and self-sampling (sending sample to a laboratory for diagnosis). Online testing can occur without consultation with a healthcare professional, therefore information given by providers is essential for informed decision-making. We aimed to enumerate online test providers in the Netherlands focusing on chlamydia tests, to evaluate information using quality indicators and to gain insight on the proportion of online testing in the STI testing arena. We performed a systematic internet search to identify online STI test providers. Twenty quality indicators were evaluated on their websites; indicator scores were weighted by level of importance (expert opinion). High scoring providers were recommended, on the condition that the sensitivity and specificity of the test were above 95% and providers included a follow-up procedure in case of a positive result. Finally, providers were contacted to inquire about the number of sold tests, positivity rates and demographic characteristics of testers. Five out of 12 identified self-sample test providers could be recommended, versus zero out of eight self-test providers. Self-sample test providers gave complete and correct information on more indicators (67%) compared with self-test providers (38%). In 2015, an estimated 30 000-40 000 self-sample tests were purchased, and 12 000-25 000 self-tests, which is roughly 10%-15% of the total number of STI tests. This evaluation shows that some online self-sample test providers could be put forward as way of STI testing complementing regular testing options. None of the self-test providers were recommended. Regularly evaluating online test providers is advised to improve quality of the information on the websites. Finally, self-testing might not be suited for all populations as most information is provided in written format only.
    • Evaluation of a culture dependent algorithm and a molecular algorithm for identification of Shigella spp., Escherichia coli, and enteroinvasive E. coli (EIEC).

      van den Beld, Maaike J C; de Boer, Richard F; Reubsaet, Frans A G; Rossen, John W A; Zhou, Kai; Kuiling, Sjoerd; Friedrich, Alexander W; Kooistra-Smid, Mirjam A M D (2018-07-18)
      Identification of Shigella spp., Escherichia coli and enteroinvasive E. coli is challenging, because of their close relatedness. Distinction is vital, as infections with Shigella spp. are under surveillance of health authorities, in contrast to EIEC infections. In this study, a culture dependent identification algorithm and a molecular identification algorithm were evaluated. Discrepancies between the two algorithms and original identification were assessed using Whole Genome Sequencing (WGS). After discrepancy analysis, with the molecular algorithm, 100% of the evaluated isolates were identified in concordance with original identification. However, the resolution for certain serotypes was lower than previously described methods and lower than the culture dependent algorithm. Although, the resolution of the culture dependent algorithm is high, 100% of non-invasive E. coli, S. sonnei, S. dysenteriae, 93% of S. boydii and EIEC and 85% of S. flexneri were identified in concordance with the original identification. Discrepancy analysis using WGS was able to confirm one of the used algorithms in four discrepant results. However, it failed to clarify three other discrepant results as it added yet another identification. Both proposed algorithms performed well for the identification of Shigella spp and EIEC, and are applicable in low-resource settings in contrast to earlier described methods that require WGS for daily diagnostics. Evaluation of the algorithms showed that both algorithms are capable of identifying Shigella species and EIEC isolates. The molecular algorithm is more applicable in clinical diagnostics for fast and accurate screening, while the culture dependent algorithm is more suitable for reference laboratories to identify Shigella spp. and EIEC up to serotype level.
    • Evaluation of a procedure to assess the adverse effects of illicit drugs.

      Amsterdam, J G C van; Best, W; Opperhuizen, A; Wolff, F A de (2004-02-01)
      The assessment procedure of new synthetic illicit drugs that are not documented in the UN treaty on psychotropic drugs was evaluated using a modified Electre model. Drugs were evaluated by an expert panel via the open Delphi approach, where the written score was discussed on 16 items, covering medical, health, legal, and criminalistic issues of the drugs. After this face-to-face discussion the drugs were scored again. Taking the assessment of ketamine as an example, it appeared that each expert used its own scale to score, and that policymakers do not score deviant from experts trained in the medical-biological field. Of the five drugs evaluated by the panel, p-methoxy-metamphetamine (PMMA), gamma-hydroxybutyric acid (GHB), and 4-methylthio-amphetamine (MTA) were assessed as more adverse than ketamine and psilocine and psilocybine-containing mushrooms. Whereas some experts slightly adjusted during the assessment procedure their opinion on ketamine and PMMA, the opinion on mushrooms was not affected by the discussion held between the two scoring rounds. All experts rank the five drugs in a similar way on the adverse effect scale i.e., concordance scale of the Electre model, indicating unanimity in the expert panel with respect to the risk classification of these abused drugs.
    • Evaluation of Bacterial Contamination as an Indicator of Viral Contamination in a Sedimentary Aquifer in Uruguay.

      Gamazo, P; Victoria, M; Schijven, J F; Alvareda, E; Tort, L F L; Ramos, J; Burutaran, L; Olivera, M; Lizasoain, A; Sapriza, G; Castells, M; Colina, R (2018-03-21)
      In Uruguay, groundwater is frequently used for agricultural activities, as well as for human consumption in urban and rural areas. As in many countries worldwide, drinking water microbiological quality is evaluated only according to bacteriological standards and virological analyses are not mentioned in the legislation. In this work, the incidence of human viral (Rotavirus A, Norovirus GII, and human Adenovirus) and bacterial (total and thermotolerant coliform and Pseudomonas aeruginosa) contamination in groundwater in the Salto district, Uruguay, as well as the possible correlation between these groups of microorganisms, was studied. From a total of 134 groundwater samples, 42 (32.1%) were positive for Rotavirus, only 1 (0.7%) for both Rotavirus and Adenovirus, and 96 (72.6%) samples were positive for bacterial indicators. Results also show that Rotavirus presence was not associated with changes in chemical composition of the aquifer water. Bacteriological indicators were not adequate to predict the presence of viruses in individual groundwater samples (well scale), but a deeper spatial-temporal analysis showed that they are promising candidates to assess the viral contamination degree at aquifer scale, since from the number of wells with bacterial contamination the number of wells with viral contamination could be estimated.
    • Evaluation of Carbapenems for Treatment of Multi- and Extensively Drug-Resistant .

      van Rijn, Sander P; Zuur, Marlanka A; Anthony, Richard; Wilffert, Bob; van Altena, Richard; Akkerman, Onno W; de Lange, Wiel C M; van der Werf, Tjip S; Kosterink, Jos G W; Alffenaar, Jan-Willem C (2019-02-01)
      Multi- and extensively drug-resistant tuberculosis (M/XDR-TB) has become an increasing threat not only in countries where the TB burden is high but also in affluent regions, due to increased international travel and globalization. Carbapenems are earmarked as potentially active drugs for the treatment of
    • Evaluation of data from the literature on the transport and survival of Escherichia coli and thermotolerant coliforms in aquifers under saturated conditions.

      Foppen, J W A; Schijven, J F (2006-02-01)
      Escherichia coli and thermotolerant coliforms are of major importance as indicators of fecal contamination of water. Due to its negative surface charge and relatively low die-off or inactivation rate coefficient, E. coli is able to travel long distances underground and is therefore also a useful indicator of fecal contamination of groundwater. In this review, the major processes known to determine the underground transport of E. coli (attachment, straining and inactivation) are evaluated. The single collector contact efficiency (SCCE), eta0, one of two parameters commonly used to assess the importance of attachment, can be quantified for E. coli using classical colloid filtration theory. The sticking efficiency, alpha, the second parameter frequently used in determining attachment, varies widely (from 0.003 to almost 1) and mainly depends on charge differences between the surface of the collector and E. coli. Straining can be quantified from geometrical considerations; it is proposed to employ a so-called straining correction parameter, alpha(str). Sticking efficiencies determined from field experiments were lower than those determined under laboratory conditions. We hypothesize that this is due to preferential flow mechanisms, E. coli population heterogeneity, and/or the presence of organic and inorganic compounds in wastewater possibly affecting bacterial attachment characteristics. Of equal importance is the inactivation or die-off of E. coli that is affected by factors like type of bacterial strain, temperature, predation, antagonism, light, soil type, pH, toxic substances, and dissolved oxygen. Modeling transport of E. coli can be separated into three steps: (1) attachment rate coefficients and straining rate coefficients can be calculated from Darcy flow velocity fields or pore water flow velocity fields, calculated SCCE fields, realistic sticking efficiency values and straining correction parameters, (2) together with the inactivation rate coefficient, total rate coefficient fields can be generated, and (3) used as input for modeling the transport of E. coli in existing contaminant transport codes. Areas of future research are manifold and include the effects of typical wastewater characteristics, including high concentrations of organic compounds, on the transport of E. coli and thermotolerant coliforms, and the upscaling of experiments to represent typical field conditions, possibly including preferential flow mechanisms and the aspect of population heterogeneity of E. coli.
    • Evaluation of the Dutch neonatal screening for congenital adrenal hyperplasia.

      van der Linde, Annelieke A A; Schönbeck, Yvonne; van der Kamp, Hetty J; van den Akker, Erica L T; van Albada, Mirjam E; Boelen, Anita; Finken, Martijn J J; Hannema, Sabine E; Hoorweg-Nijman, Gera; Odink, Roelof J; Schielen, Peter C J I; Straetemans, Saartje; van Trotsenburg, Paul S; Claahsen-van der Grinten, Hedi L; Verkerk, Paul H (2019-02-02)
      In 2002, a nationwide screening for congenital adrenal hyperplasia (CAH) was introduced in the Netherlands. The aim of our study is to evaluate the validity of the neonatal screening for CAH and to assess how many newborns with salt-wasting (SW) CAH have already been clinically diagnosed before the screening result was known. Retrospective, descriptive study. The following data of patients with positive screening results since implementation of the screening programme were collected (1 January 2002 up until 31 December 2013): gestational age, sex, diagnosis, clinical presentation and contribution of screening to the diagnosis. In the evaluated period, 2 235 931 newborns were screened. 479 children had an abnormal screening result, 133 children were diagnosed with CAH (114 SW, 14 simple virilizing (SV)), five non-classic CAH. During this period, no patients with SW CAH were missed by neonatal screening (sensitivity was 100%). After exclusion of 17 cases with missing information on diagnosis, specificity was 99.98% and positive predictive value was 24.7%. Most false positives (30%) were attributable to prematurity. Of patients with SW CAH, 68% (71/104) patients were detected by neonatal screening and 33 (33/104) were clinically diagnosed. Of girls with SW CAH, 38% (14/37) were detected by neonatal screening and 62% (23/37) were clinically diagnosed. The Dutch neonatal screening has an excellent sensitivity and high specificity. Both boys and girls can benefit from neonatal screening.
    • Evaluation of the impact of a hygiene warning label on the packaging of poultry

      Antonise-Kamp, Laura; Friesema, Ingrid H.M.; van der Vossen-Wijmenga, Wieke P.; Beaujean, Desirée J.M.A. (2018-10)
    • An Evaluation of the Loss-on-Ignition Method for Determining the Soil Organic Matter Content of Calcareous Soils

      Hoogsteen, M.J.J.; Lantinga, E.A.; Bakker, E.J.; Tittonell, P.A.; National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Farming Systems Ecology Group, Wageningen University and Research Centre, Wageningen, The Netherlands; Mathematical and Statistical methods, Wageningen University and Research Centre, Wageningen, The Netherlands; Farming Systems Ecology Group, Wageningen University and Research Centre, Wageningen, The Netherlands (2018-05-21)
    • Evaluation of the medical devices benchmark materials in the controlled human patch testing and in the RhE in vitro skin irritation protocol.

      Kandárová, Helena; Bendova, Hana; Letasiova, Silvia; Coleman, Kelly P; De Jong, Wim H; Jírova, Dagmar (2018-02-17)
      Several irritants were used in the in vitro irritation medical device round robin. The objective of this study was to verify their irritation potential using the human patch test (HPT), an in vitro assay, and in vivo data. The irritants were lactic acid (LA), heptanoic acid (HA), sodium dodecyl sulfate (SDS), Genapol® X-80 (GP), and Y-4 polymer. Dilute saline and sesame seed oil (SSO) solutions of each were evaluated using a 4 and 18 h HPT and the EpiDerm™ SIT-MD RhE assay; results were then compared to existing rabbit skin irritation test data. Results from the 4 h HPT were negative in most cases except for GP and SDS, while the 18 h HPT also identified some LA, HA, and GP samples as irritants. EpiDerm™ SIT-MD correctly identified all irritants except GP in SSO due to limited solubility. Data from cutaneous rabbit irritation tests were negative, while all intracutaneous results were strongly or weakly positive except for the most dilute GP solutions. These findings indicate that EpiDerm™ SIT-MD results correlate with those from the rabbit intracutaneous test and confirm that RhE assays are suitable replacements for animals in evaluating the tissue irritation potential of medical devices.
    • Evaluation of the Process of Implementing an Outdoor School Ground Smoking Ban at Secondary Schools.

      Rozema, Andrea D; Mathijssen, Jolanda J P; van Oers, Hans A M; Jansen, Maria W J (2018-11)
      Although outdoor smoking bans at school are becoming important, it remains unclear whether successful implementation is feasible and what conditions promote it. Therefore, this study evaluates the implementation process by identifying important factors.
    • Evaluation of the Recipe Function in Popular Dietary Smartphone Applications, with Emphasize on Features Relevant for Nutrition Assessment in Large-Scale Studies.

      Zhang, Liangzi; Nawijn, Eline; Boshuizen, Hendriek; Ocké, Marga (2019-01-19)
      Nutrient estimations from mixed dishes require detailed information collection and should account for nutrient loss during cooking. This study aims to make an inventory of recipe creating features in popular food diary apps from a research perspective and to evaluate their nutrient calculation. A total of 12 out of 57 screened popular dietary assessment apps included a recipe function and were scored based on a pre-defined criteria list. Energy and nutrient content of three recipes calculated by the apps were compared with a reference procedure, which takes nutrient retention due to cooking into account. The quality of the recipe function varies across selected apps with a mean score of 3.0 (out of 5). More relevant differences (larger than 5% of the Daily Reference Intake) between apps and the reference were observed in micronutrients (49%) than in energy and macronutrients (20%). The primary source of these differences lies in the variation in food composition databases underlying each app. Applying retention factors decreased the micronutrient contents from 0% for calcium in all recipes to more than 45% for vitamins B6, B12, and folate in one recipe. Overall, recipe features and their ability to capture true nutrient intake are limited in current apps.
    • An evaluation of the TREC assay with regard to the integration of SCID screening into the Dutch newborn screening program.

      Blom, Maartje; Pico-Knijnenburg, Ingrid; Sijne-van Veen, Marja; Boelen, Anita; Bredius, Robbert G M; van der Burg, Mirjam; Schielen, Peter C J I (2017-07)
      Newborn screening of severe combined immunodeficiency through the detection of T-cell receptor excision circles will provide the opportunity of treating before the occurrence of life-threatening infections. With the EnLite Neonatal TREC assay (PerkinElmer) and end-point PCR, 39 samples (3.0%) of 1295 heel prick cards of the Dutch newborn screening program required a retest after initial analysis. After retest, 21 samples (1.62%) gave TREC levels below cut-off. A significant reduction in TREC levels was observed in heel prick cards stored for three months (n=33) and one year (n=33). Preterm newborns (n=155) showed significantly lower TREC levels and a higher retest-rate than full-term newborns. Peripheral blood spots of 22 confirmed SCID patients and 17 primary immunodeficiency patients showed undetectable or low TREC-levels. These findings suggest that the EnLite Neonatal TREC assay is a suitable method for SCID-screening in the Netherlands, thereby providing guidance in the decisions concerning implementation into the Dutch program.
    • Evaluation of tuberculosis screening of immigrants in the Netherlands.

      van de Berg, Sarah; Erkens, Connie; van Rest, Job; van den Hof, Susan; Kamphorst, Margreet; Keizer, Sytze; de Vries, Gerard (2017-10)
    • Evidence Synthesis in Harm Assessment of Medicines Using the Example of Rosiglitazone and Myocardial Infarction.

      Rietbergen, Charlotte; Stefansdottir, Gudrun; Leufkens, Hubert G; Knol, Mirjam J; De Bruin, Marie L; Klugkist, Irene (2017)
      The current system of harm assessment of medicines has been criticized for relying on intuitive expert judgment. There is a call for more quantitative approaches and transparency in decision-making. Illustrated with the case of cardiovascular safety concerns for rosiglitazone, we aimed to explore a structured procedure for the collection, quality assessment, and statistical modeling of safety data from observational and randomized studies. We distinguished five stages in the synthesis process. In Stage I, the general research question, population and outcome, and general inclusion and exclusion criteria are defined and a systematic search is performed. Stage II focusses on the identification of sub-questions examined in the included studies and the classification of the studies into the different categories of sub-questions. In Stage III, the quality of the identified studies is assessed. Coding and data extraction are performed in Stage IV. Finally, meta-analyses on the study results per sub-question are performed in Stage V. A Pubmed search identified 30 randomized and 14 observational studies meeting our search criteria. From these studies, we identified 4 higher level sub-questions and 4 lower level sub-questions. We were able to categorize 29 individual treatment comparisons into one or more of the sub-question categories, and selected study duration as an important covariate. We extracted covariate, outcome, and sample size information at the treatment arm level of the studies. We extracted absolute numbers of myocardial infarctions from the randomized study, and adjusted risk estimates with 95% confidence intervals from the observational studies. Overall, few events were observed in the randomized studies that were frequently of relatively short duration. The large observational studies provided more information since these were often of longer duration. A Bayesian random effects meta-analysis on these data showed no significant increase in risk of rosiglitazone for any of the sub-questions. The proposed procedure can be of additional value for drug safety assessment because it provides a stepwise approach that guides the decision-making in increasing process transparency. The procedure allows for the inclusion of results from both randomized an observational studies, which is especially relevant for this type of research.
    • Evolution of aerosol optical thickness over Europe during the August 2003 heat wave as seen from CHIMERE model simulations and POLDER data

      Hodzic, A; Vautard, R; Chepfer, H; Goloub, P; Menut, L; Chazette, P; Deuzé, J L; Apituley, A; Couvert, P (2006-05-30)
      This study describes the atmospheric aerosol load encountered during the large-scale pollution episode that occurred in August 2003, by means of the aerosol optical thicknesses (AOTs) measured at 865 nm by the Polarization and Directionality of the Earth's Reflectances (POLDER) sensor and the simulation by the CHIMERE chemistry-transport model. During this period many processes (stagnation, photochemistry, forest fires) led to unusually high particle concentrations and optical thicknesses. The observed/simulated AOT comparison helps understanding the ability of the model to reproduce most of the gross AOT features observed in satellite data, with a general agreement within a factor 2 and correlations in the 0.4–0.6 range. However some important aerosol features are missed when using regular anthropogenic sources. Additional simulations including emissions and high-altitude transport of smoke from wildfires that occurred in Portugal indicate that these processes could dominate the AOT signal in some areas. Our results also highlight the difficulties of comparing simulated and POLDER-derived AOTs due to large uncertainties in both cases. Observed AOT values are significantly lower than the simulated ones (30–50%). Their comparison with the ground-based Sun photometer Aerosol Robotic Network (AERONET) measurements suggests, for the European sites considered here, an underestimation of POLDER-derived aerosol levels with a factor between 1 and 2. AERONET AOTs compare better with simulations (no particular bias) than POLDER AOTs.