• 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.
    • Evaluation of the taxonomic and functional variation of freshwater plankton communities induced by trace amounts of the antibiotic ciprofloxacin.

      Lu, Tao; Zhu, Youchao; Ke, Mingjing; Peijnenburg, W J G M; Zhang, Meng; Wang, Tingzhang; Chen, Jun; Qian, Haifeng (2019-02-27)
      Ciprofloxacin (CIP), one of the most frequently detected antibiotics in water systems, has become an aquatic contaminant because of improper disposal and excretion by humans and animals. It is still unknown how trace amounts of CIP affect the aquatic microbial community diversity and function. We therefore investigated the effects of CIP on the structure and function of freshwater microbial communities via 16S/18S rRNA gene sequencing and metatranscriptomic analyses. CIP treatment (7 μg/L) did not significantly alter the physical and chemical condition of the water body as well as the composition of the main species in the community, but slightly increased the relative abundance of cyanobacteria and decreased the relative abundance of eukaryotes. Metatranscriptomic results showed that bacteria enhanced their phosphorus transport and photosynthesis after CIP exposure. The replication, transcription, translation and cell proliferation were all suppressed in eukaryotes, while the bacteria were not affected in any of these aspects. This interesting phenomenon was the exact opposite to both the antibacterial property of CIP and its safety for eukaryotes. We hypothesize that reciprocal and antagonistic interactions in the microcosm both contribute to this result: cyanobacteria may enhance their tolerance to CIP through benefiting from cross-feeding and some secreted substances that withstand bacterial CIP stress would also affect eukaryotic growth. The present study thus indicates that a detailed assessment of the aquatic ecotoxicity of CIP is essential, as the effects of CIP are much more complicated in microbial communities than in monocultures. CIP will continue to be an environmental contaminant due to its wide usage and production and more attention should be given to the negative effects of antibiotics as well as other bioactive pollutants on aquatic environments.
    • 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.
    • Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017.

      Vestergaard, Lasse S; Nielsen, Jens; Krause, Tyra G; Espenhain, Laura; Tersago, Katrien; Bustos Sierra, Natalia; Denissov, Gleb; Innos, Kaire; Virtanen, Mikko J; Fouillet, Anne; et al. (2017-04-06)
      Since December 2016, excess all-cause mortality was observed in many European countries, especially among people aged ≥ 65 years. We estimated all-cause and influenza-attributable mortality in 19 European countries/regions. Excess mortality was primarily explained by circulation of influenza virus A(H3N2). Cold weather snaps contributed in some countries. The pattern was similar to the last major influenza A(H3N2) season in 2014/15 in Europe, although starting earlier in line with the early influenza season start.
    • Experiences of carriers of multidrug-resistant organisms: a systematic review

      Rump, B; Timen, A; Verweij, M; Hulscher, M (2018-12-03)
    • Expert Views on Their Role as Policy Advisor: Pilot Study for the Cases of Electromagnetic Fields, Particulate Matter, and Antimicrobial Resistance.

      Spruijt, Pita; Knol, Anne B; Petersen, Arthur C; Lebret, Erik (2018-10-31)
      This perspective presents empirical data to demonstrate the existence of different expert views on scientific policy advice on complex environmental health issues. These views are partly research-field specific. According to scientific literature, experts differ in the way they provide policy advice on complex issues such as electromagnetic fields (EMF), particulate matter (PM), and antimicrobial resistance (AMR). Where some experts feel their primary task is to carry out fundamental research, others actively engage in the policy dialogue. Although the literature provides ideas about expert roles, there exists little empirical underpinning. Our aim is to gather empirical evidence about expert roles. The results of an international study indicated that experts on EMF, PM, and AMR differ in the way they view their role in the policy dialogue. For example, experts differed in their views on the need for precaution and their motivation to initiate stakeholder cooperation. Besides, most experts thought that their views on the risks of EMF/PM/AMR did not differ from those of colleagues. Great dissensus was found in views on the best ways of managing risks and uncertainties. In conclusion, the theoretical ideal-typical roles from the literature can be identified to a certain extent.
    • Explaining sex differences in chronic musculoskeletal pain in a general population.

      Wijnhoven, Hanneke A H; Vet, Henrica C W de; Picavet, H Susan J (2006-09-01)
      Many studies report a female predominance in the prevalence of chronic musculoskeletal pain (CMP) but the mechanisms explaining these sex differences are poorly understood. Data from a random postal questionnaire survey in the Dutch general population were used to examine whether sex differences in the prevalences of CMP are due to sex differences in the distribution of known potential risk factors for CMP (exposure model) and/or to the different importance of risk factors for CMP (i.e. show different strength of association) in men and women (vulnerability model). In the present analyses, 909 men and 1178 women aged 25-65 were included. CMP was defined as pain lasting longer than 3 months and was assessed for 10 anatomical locations (neck, shoulder, higher back, elbow, wrist/hand, lower back, hip, knee, ankle, foot). Sex differences in CMP could not be explained by a different distribution of age, educational level, smoking status, overweight, physical activity, and pain catastrophizing. Having no paid job was associated with CMP, explaining part of the sex differences, but its role seems complex. Risk factors with a sex-specific association were: overweight (all pain locations) and older age (lower extremities)--both having only an effect among women--and pain catastrophizing (upper extremities), which was stronger associated with CMP among men than among women. In conclusion, sex differences in prevalence of CMP may partly be explained by sex differences in vulnerability to risk factors for CMP. Future research towards sex-specific identification of risk factors for CMP is warranted. Eventually this may lead to sex-specific prevention and management of CMP.
    • An exploration of socio-economic and food characteristics of high trans fatty acid consumers in the Dutch and UK national surveys after voluntary product reformulation.

      Rippin, H L; Hutchinson, J; Ocke, M; Jewell, J; Breda, J J; Cade, J E (2017)
      Trans fatty acids (TFA) increase the risk of mortality and chronic diseases. TFA intakes have fallen since reformulation, but may still be high in certain, vulnerable, groups. This paper investigates socio-economic and food consumption characteristics of high TFA consumers after voluntary reformulation in the Netherlands and UK. Post-reformulation data of adults aged 19-64 was analysed in two national surveys: the Dutch National Food Consumption Survey (DNFCS) collected 2007-2010 using 2*24hr recalls (N = 1933) and the UK National Diet and Nutrition Survey (NDNS) years 3&4 collected 2010/11 and 2011/12 using 4-day food diaries (N = 848). The socio-economic and food consumption characteristics of the top 10% and remaining 90% TFA consumers were compared. Means of continuous data were compared using t-tests and categorical data means using chi-squared tests. Multivariate logistic regression models indicated which socio-demographic variables were associated with high TFA consumption. In the Dutch analyses, women and those born outside the Netherlands were more likely to be top 10% TFA consumers than men and Dutch-born. In the UK unadjusted analyses there was no significant trend in socio-economic characteristics between high and lower TFA consumers, but there were regional differences in the multivariate logistic regression analyses. In the Netherlands, high TFA consumers were more likely to be consumers of cakes, buns & pastries; cream; and fried potato than the remaining 90%. Whereas in the UK, high TFA consumers were more likely to be consumers of lamb; cheese; and dairy desserts and lower crisps and savoury snack consumers. Some socio-demographic differences between high and lower TFA consumers were evident post-reformulation. High TFA consumers in the Dutch 2007-10 survey appeared more likely to obtain TFA from artificial sources than those in the UK survey. Further analyses using more up-to-date food composition databases may be needed.
    • Exploring causality of the association between smoking and Parkinson's disease.

      Gallo, Valentina; Vineis, Paolo; Cancellieri, Mariagrazia; Chiodini, Paolo; Barker, Roger A; Brayne, Carol; Pearce, Neil; Vermeulen, Roel; Panico, Salvatore; Bueno-de-Mesquita, Bas; et al. (2018-11-20)
      The aim of this paper is to investigate the causality of the inverse association between cigarette smoking and Parkinson's disease (PD). The main suggested alternatives include a delaying effect of smoking, reverse causality or an unmeasured confounding related to a low-risk-taking personality trait. A total of 715 incident PD cases were ascertained in a cohort of 220 494 individuals from NeuroEPIC4PD, a prospective European population-based cohort study including 13 centres in eight countries. Smoking habits were recorded at recruitment. We analysed smoking status, duration, and intensity and exposure to passive smoking in relation to PD onset. Former smokers had a 20% decreased risk and current smokers a halved risk of developing PD compared with never smokers. Strong dose-response relationships with smoking intensity and duration were found. Hazard ratios (HRs) for smoking <20 years were 0.84 [95% confidence interval (CI) 0.67-1.07], 20-29 years 0.73 (95% CI 0.56-0.96) and >30 years 0.54 (95% CI 0.43-0.36) compared with never smokers. The proportional hazard assumption was verified, showing no change of risk over time, arguing against a delaying effect. Reverse causality was disproved by the consistency of dose-response relationships among former and current smokers. The inverse association between passive smoking and PD, HR 0.70 (95% CI 0.49-0.99) ruled out the effect of unmeasured confounding. These results are highly suggestive of a true causal link between smoking and PD, although it is not clear which is the chemical compound in cigarette smoking responsible for the biological effect.
    • Exploring solutions for healthy, safe, and sustainable fatty acids (EPA and DHA) consumption in The Netherlands

      Hollander, A.; De Jonge, R.; Biesbroek, S.; Hoekstra, J.; Zijp, M. C. (2018-07-20)
    • Exploring the effect of previous inactivated influenza vaccination on seasonal influenza vaccine effectiveness against medically-attended influenza: results of the European I-MOVE multicentre test-negative case-control study, 2011/12-2016/17.

      Valenciano, Marta; Kissling, E; Larrauri, Amparo; Nunes, Baltasar; Pitigoi, Daniela; O Donnell, Joan; Reuss, Annicka; Horváth, Judit Krisztina; Paradowska-Stankiewicz, Iwona; Rizzo, Caterina; et al. (2018-04-16)
      Results of previous influenza vaccination effects on current season influenza vaccine effectiveness (VE) are inconsistent.
    • Exploring the Role of Farm Animals in Providing Care at Care Farms.

      Hassink, Jan; De Bruin, Simone R; Berget, Bente; Elings, Marjolein (2017-06-02)
      We explore the role of farm animals in providing care to different types of participants at care farms (e.g., youngsters with behavioural problems, people with severe mental problems and people with dementia). Care farms provide alternative and promising settings where people can interact with animals compared to a therapeutic healthcare setting. We performed a literature review, conducted focus group meetings and carried out secondary data-analysis of qualitative studies involving care farmers and different types of participants. We found that farm animals are important to many participants and have a large number of potential benefits. They can (i) provide meaningful day occupation; (ii) generate valued relationships; (iii) help people master tasks; (iv) provide opportunities for reciprocity; (v) can distract people from them problems; (vi) provide relaxation; (vii) facilitate customized care; (viii) facilitate relationships with other people; (ix) stimulate healthy behavior; (x) contribute to a welcoming environment; (xi) make it possible to experience basic elements of life; and (xii) provide opportunities for reflection and feedback. This shows the multi-facetted importance of interacting with animals on care farms. In this study the types of activities with animals and their value to different types of participants varied. Farm animals are an important element of the care farm environment that can address the care needs of different types of participants.
    • Exploring uptake and biodistribution of polystyrene (nano)particles in zebrafish embryos at different developmental stages.

      van Pomeren, M; Brun, N R; Peijnenburg, W J G M; Vijver, M G (2017-09)
      In ecotoxicology, it is continuously questioned whether (nano)particle exposure results in particle uptake and subsequent biodistribution or if particles adsorb to the epithelial layer only. To contribute to answering this question, we investigated different uptake routes in zebrafish embryos and how they affect particle uptake into organs and within whole organisms. This is addressed by exposing three different life stages of the zebrafish embryo in order to cover the following exposure routes: via chorion and dermal exposure; dermal exposure; oral and dermal exposure. How different nanoparticle sizes affect uptake routes was assessed by using polystyrene particles of 25, 50, 250 and 700nm. In our experimental study, we showed that particle uptake in biota is restricted to oral exposure, whereas the dermal route resulted in adsorption to the epidermis and gills only. Ingestion followed by biodistribution was observed for the tested particles of 25 and 50nm. The particles spread through the body and eventually accumulated in specific organs and tissues such as the eyes. Particles larger than 50nm were predominantly adsorbed onto the intestinal tract and outer epidermis of zebrafish embryos. Embryos exposed to particles via both epidermis and intestine showed highest uptake and eventually accumulated particles in the eye, whereas uptake of particles via the chorion and epidermis resulted in marginal uptake. Organ uptake and internal distribution should be monitored more closely to provide more in depth information of the toxicity of particles.
    • Exposure to bacterial products lipopolysaccharide and flagellin and hepatocellular carcinoma: a nested case-control study.

      Fedirko, Veronika; Tran, Hao Quang; Gewirtz, Andrew T; Stepien, Magdalena; Trichopoulou, Antonia; Aleksandrova, Krasimira; Olsen, Anja; Tjønneland, Anne; Overvad, Kim; Carbonnel, Franck; et al. (2017-04-04)
      Leakage of bacterial products across the gut barrier may play a role in liver diseases which often precede the development of liver cancer. However, human studies, particularly from prospective settings, are lacking.
    • Exposure to Coxiella burnetii and risk of non-Hodgkin lymphoma: a retrospective population-based analysis in the Netherlands.

      van Roeden, Sonja E; van Houwelingen, Fedor; Donkers, Chiel M J; Hogewoning, Sander J; de Lange, Marit M A; van der Hoek, Wim; Kampschreur, Linda M; Bonten, Marc J M; Hoepelman, Andy I M; Bleeker-Rovers, Chantal P; et al. (2018-04-09)
      An association between Coxiella burnetii and non-Hodgkin lymphoma has been suggested. After a large Q fever epidemic in the Netherlands (2007-10), we postulated that the incidence of non-Hodgkin lymphoma would be increased during and after the epidemic in areas with a high endemicity of Q fever compared with those with low endemicity.