Dutch food bank recipients have poorer dietary intakes than the general and low-socioeconomic status Dutch adult population.

PURPOSE: Food-assistance program users are a specific group of nutritional concern, as they are often food insufficient and have poorer diet quality compared to non-food-assistance program users. The aim of our study was to assess dietary intake of Dutch food bank recipients (n = 167) and to compare this with dietary intake of a representative sample of the general population (Dutch National Food Consumption Survey (DNFCS-all): n = 1933), including a low-socioeconomic status (SES) sample (DNFCS-low SES: n = 312), using data from the DNFCS 2007-2010. METHODS: In this cross-sectional study, 12 food banks throughout The Netherlands participated. Food bank recipients' characteristics were assessed with a self-administered questionnaire. Dietary intake data were collected through three 24-h recalls. Habitual dietary intake (mean, percentiles, and 95% CI) was estimated for all samples. Differences between samples were determined by comparing the 95% CIs. RESULTS: Mean age of the study population (62.9% female) was 48.6 years (SD:10.1). Mean energy intake was 1986 (95% CI 1830-2089) kcal. The majority of the Dutch food bank recipients had lower intakes than dietary reference intakes for dietary fiber, fruit, vegetables, and fish (range 86.6-99.3%), and a higher intake for saturated fat [88.1% (95% CI 84.1-98.9)]. Furthermore, mean intakes of energy, fiber, fruit, and vegetables were significantly lower in Dutch food bank recipients than in the DNFCS-all and the DNFCS-low-SES [e.g., daily mean fruit intake (g) food bank recipients 62.8 (95% CI 45.5-76.5), DNFCS-all 105.8 (95% CI 105.4-117.9), and DNFCS-low-SES 85.1 (95% CI 78.7-100.2)]. Fish intake was significantly lower compared with the DNFCS-all, but not compared with the DNFCS-low-SES. CONCLUSIONS: Dutch food bank recipients, who largely rely on the content of food parcels, are not able to meet the nutritional guidelines for a healthy diet, and their dietary intake is poorer than the general as well as the low-SES sample of the Dutch adult population. More research is needed on how to improve the dietary intake of this vulnerable population subgroup, by, e.g., revising the content of the food parcels, and to develop effective intervention activities.

Evaluation of food and nutrient intake assessment using concentration biomarkers in European adolescents from the Healthy Lifestyle in Europe by Nutrition in Adolescence study.

Accurate food and nutrient intake assessment is essential for investigating diet-disease relationships. In the present study, food and nutrient intake assessment among European adolescents using 24 h recalls (mean of two recalls) and a FFQ (separately and the combination of both) were evaluated using concentration biomarkers. Biomarkers included were vitamin C, ß-carotene, DHA+EPA, vitamin B12 (cobalamin and holo-transcobalamin) and folate (erythrocyte folate and plasma folate). For the evaluation of the food intake assessment 390 adolescents were included, while 697 were included for the nutrient intake assessment evaluation. Spearman rank and Pearson correlations, and validity coefficients, which are correlations between intake estimated and habitual true intake, were calculated. Correlations were higher between frequency of food consumption (from the FFQ) and concentration biomarkers than between mean food intake (from the recalls) and concentration biomarkers, especially for DHA+EPA (r 0·35 v. r 0·27). Most correlations were higher among girls than boys. For boys, the highest validity coefficients were found for frequency of fruit consumption (0·88) and for DHA+EPA biomarker (0·71). In girls, the highest validity coefficients were found for fruit consumption frequency (0·76), vegetable consumption frequency (0·74), mean fruit intake (0·90) and DHA+EPA biomarker (0·69). After exclusion of underreporters, correlations slightly improved. Correlations between usual food intakes, adjusted for food consumption frequency, and concentration biomarkers were higher than correlations between mean food intakes and concentration biomarkers. In conclusion, two non-consecutive 24 h recalls in combination with a FFQ seem to be appropriate to rank subjects according to their usual food intake.

Identifying persons at risk for PTSD after trauma with TSQ in the Netherlands.

In The Netherlands about 80% of the population experience a traumatic event while about 14% develop post traumatic stress disorder (PTSD). Considering this high prevalence the prevention or early treatment of posttraumatic stress is important from a health as well as cost-benefit perspective. The aim of this study was to examine whether we could identify subjects at risk of developing PTSD. We included 100 Dutch victims of different civil traumas that contacted the Victim Support Foundation. The trauma screening questionnaire (TSQ), was used as a screening tool. The results show that a cut-off score of 7 on the TSQ correctly identified most subjects with PTSD. We found a moderate positive correlation between PTSD and the severity of complaints. We also found a significant relationship between the TSQ and depression symptoms. This study indicates that the Dutch version of the TSQ is a useful instrument for identifying future cases of PTSD.

Seasonal patterns in time series of pertussis.

To gain insight into pertussis disease dynamics, we studied age-specific long-term periodicity and seasonality of pertussis in The Netherlands. Hierarchical time-series models were used to analyse the monthly reported pertussis incidence in January 1996-June 2006 by age group. The incidence of pertussis showed a slightly increasing long-term trend with highest incidence rates seen in 1996, 1999, 2001 and 2004. For all age groups the annual peak incidence was found in August, except for the 13-18 years age group where the peak occurred in November. Monthly trends in adults showed high correlation with trends in age groups 0-4 years (0.94) and 5-12 years (0.92). We found no evidence for a relationship between annual rises in pertussis and the opening of schools. Concurrent annual fluctuations of pertussis incidence in adults and infants suggest frequent transmission within and between these age groups. Studying trends offers insight into transmission dynamics and may facilitate decisions on future vaccination strategies.

Time lag between immigration and tuberculosis rates in immigrants in the Netherlands: a time-series analysis.

SETTING AND OBJECTIVE: In low-incidence countries, most tuberculosis (TB) cases are foreign-born. We explored the temporal relationship between immigration and TB in first-generation immigrants between 1995 and 2012 to assess whether immigration can be a predictor for TB in immigrants from high-incidence countries. DESIGN: We obtained monthly data on immigrant TB cases and immigration for the three countries of origin most frequently represented among TB cases in the Netherlands: Morocco, Somalia and Turkey. The best-fit seasonal autoregressive integrated moving average (SARIMA) model to the immigration time-series was used to prewhiten the TB time series. The cross-correlation function (CCF) was then computed on the residual time series to detect time lags between immigration and TB rates. RESULTS: We identified a 17-month lag between Somali immigration and Somali immigrant TB cases, but no time lag for immigrants from Morocco and Turkey. CONCLUSION: The absence of a lag in the Moroccan and Turkish population may be attributed to the relatively low TB prevalence in the countries of origin and an increased likelihood of reactivation TB in an ageing immigrant population. Understanding the time lag between Somali immigration and TB disease would benefit from a closer epidemiological analysis of cohorts of Somali cases diagnosed within the first years after entry.

STAN S21 fetal heart monitor for fetal surveillance during labor: an observational study in 637 patients.

OBJECTIVE: To assess the value of the STAN fetal heart monitor for intrapartum fetal monitoring using cardiotocography (CTG) and fetal electrocardiography (ECG). DESIGN: Prospective observational study. MATERIAL AND METHODS: Between August 2000 and November 2002, 637 high-risk labors were monitored using a STAN S21 fetal heart monitor, providing CTG plus automatic ST analysis of the fetal ECG. Guidelines with recommendations about when to intervene were available. During the study period labor-ward personnel were systematically instructed about the (patho)-physiology of asphyxia and CTG and ST changes during labor. RESULTS: Four hundred and forty-nine recordings were available for analysis of outcome in relation to ST changes. In 61 cases, ST changes requiring intervention occurred > 10 min before birth. In 35 (57%) of these cases, umbilical artery blood pH at delivery was < 7.15. Eighteen (4.0%) neonates were born with metabolic acidosis (umbilical artery pH < 7.05 and extracellular base deficit > 12 mmol/l). Significant ST changes (18-31 min before birth) were present in all five cases with pH < 7.00 and in six of the 13 cases with pH of 7.00-7.04 (false-negative rate 1.6%). Neonatal follow-up showed no adverse outcome. One hundred and ninety-two fetal blood samples (121 in the first stage and 71 in the second stage of labor) were taken from 142 women. Fetal scalp blood pH was < 7.15 in ten samples, 7.15-7.19 in 11 samples, 7.20-7.24 in 30 samples and > or =7.25 in 141 samples. ST changes occurred in eight (80%), six (55%), nine (30%) and 15 (11%) of these cases, respectively. In 188 (29.5%) women, outcome could not be analyzed in relation to ST changes because of inadequate recording (time between end of recording and delivery > 20 min or poor signal quality) or the absence of umbilical cord gases. In this group, four (2.1%) neonates with metabolic acidosis were born. In three of these cases the fetal ECG signal was of was poor quality and in one case the recording had ended 60 min before birth. CONCLUSION: ST changes were present in all five cases with severe metabolic acidosis (umbilical artery pH < 7.00). ST changes occurred in 46% of cases with mild metabolic acidosis. CTG plus ST analysis was more specific in detecting fetal acidemia than CTG alone.

Optimization of a monitoring network for sulfur dioxide.

In this study, we develop and apply a methodology to reduce an existing monitoring network to find an optimal configuration of a smaller network. We use a criterion based on locally weighted regression with two different weight functions. The methodology is applied to the Dutch national SO2 network and offers the possibility to include different politically relevant options in the model by weight criteria. Because full enumeration of all monitoring networks is impossible, a combinatorial search algorithm is applied to find a (sub)optimal solution. If different (optimal) monitoring networks result from different criteria, then the best can be selected.

Similar seasonal peak in clustered and unique extra-pulmonary tuberculosis notifications: winter crowding hypothesis ruled out?

BACKGROUND: The incidence of extra-pulmonary tuberculosis (EPTB) in the Netherlands shows a seasonal trend, with a peak in spring and a trough in autumn. Possible causes of this peak are winter crowding and a seasonal decrease in immune competence in spring. A third explanation may be a reporting bias. OBJECTIVE: To investigate the role of winter crowding by a time-series analysis of notification data. DNA fingerprinting clustering status can differentiate between recent and remote infections. Seasonality in clustered cases would reflect enhanced transmission in winter and/or seasonally lowered immunity, while seasonality in unique cases would only reflect seasonally lowered immunity. METHODS: We fitted (seasonal) auto-regressive moving average models to culture-positive TB notifications in the Netherlands (1993-2008) to assess seasonality. We then used seasonal trend Loess decompositions to derive the seasonal pattern, and compared the heights of the seasonal peaks. RESULTS: Clustered and unique EPTB notifications showed a seasonal trend that was absent in clustered and unique PTB notifications. The seasonal peak in clustered EPTB cases was not significantly higher than in unique EPTB cases. CONCLUSIONS: The similar timing and height of the seasonal peak of clustered and unique EPTB cases suggests that winter crowding is unlikely to cause the seasonal trend in notifications.

Gaussian Quadrature is an efficient method for the back-transformation in estimating the usual intake distribution when assessing dietary exposure.

In dietary exposure assessment, statistical methods exist for estimating the usual intake distribution from daily intake data. These methods transform the dietary intake data to normal observations, eliminate the within-person variance, and then back-transform the data to the original scale. We propose Gaussian Quadrature (GQ), a numerical integration method, as an efficient way of back-transformation. We compare GQ with six published methods. One method uses a log-transformation, while the other methods, including GQ, use a Box-Cox transformation. This study shows that, for various parameter choices, the methods with a Box-Cox transformation estimate the theoretical usual intake distributions quite well, although one method, a Taylor approximation, is less accurate. Two applications--on folate intake and fruit consumption--confirmed these results. In one extreme case, some methods, including GQ, could not be applied for low percentiles. We solved this problem by modifying GQ. One method is based on the assumption that the daily intakes are log-normally distributed. Even if this condition is not fulfilled, the log-transformation performs well as long as the within-individual variance is small compared to the mean. We conclude that the modified GQ is an efficient, fast and accurate method for estimating the usual intake distribution.

Comparing four methods to estimate usual intake distributions.

BACKGROUND/OBJECTIVES: The aim of this paper was to compare methods to estimate usual intake distributions of nutrients and foods. As 'true' usual intake distributions are not known in practice, the comparison was carried out through a simulation study, as well as empirically, by application to data from the European Food Consumption Validation (EFCOVAL) Study in which two 24-h dietary recalls (24-HDRs) and food frequency data were collected. The methods being compared were the Iowa State University Method (ISU), National Cancer Institute Method (NCI), Multiple Source Method (MSM) and Statistical Program for Age-adjusted Dietary Assessment (SPADE). SUBJECTS/METHODS: Simulation data were constructed with varying numbers of subjects (n), different values for the Box-Cox transformation parameter (λ(BC)) and different values for the ratio of the within- and between-person variance (r(var)). All data were analyzed with the four different methods and the estimated usual mean intake and selected percentiles were obtained. Moreover, the 2-day within-person mean was estimated as an additional 'method'. These five methods were compared in terms of the mean bias, which was calculated as the mean of the differences between the estimated value and the known true value. The application of data from the EFCOVAL Project included calculations of nutrients (that is, protein, potassium, protein density) and foods (that is, vegetables, fruit and fish). RESULTS: Overall, the mean bias of the ISU, NCI, MSM and SPADE Methods was small. However, for all methods, the mean bias and the variation of the bias increased with smaller sample size, higher variance ratios and with more pronounced departures from normality. Serious mean bias (especially in the 95th percentile) was seen using the NCI Method when r(var) = 9, λ(BC) = 0 and n = 1000. The ISU Method and MSM showed a somewhat higher s.d. of the bias compared with NCI and SPADE Methods, indicating a larger method uncertainty. Furthermore, whereas the ISU, NCI and SPADE Methods produced unimodal density functions by definition, MSM produced distributions with 'peaks', when sample size was small, because of the fact that the population's usual intake distribution was based on estimated individual usual intakes. The application to the EFCOVAL data showed that all estimates of the percentiles and mean were within 5% of each other for the three nutrients analyzed. For vegetables, fruit and fish, the differences were larger than that for nutrients, but overall the sample mean was estimated reasonably. CONCLUSIONS: The four methods that were compared seem to provide good estimates of the usual intake distribution of nutrients. Nevertheless, care needs to be taken when a nutrient has a high within-person variation or has a highly skewed distribution, and when the sample size is small. As the methods offer different features, practical reasons may exist to prefer one method over the other.

[External migration in 1985]. / Buitenlandse migratie in 1985.

PIP: International migration concerning the Netherlands in 1985 is reviewed using data from the national population register. The concepts used in the definition of migrants are explained. (SUMMARY IN ENG)^ieng

[Continued increase of immigration in 1986]. / Verdere stijging van de immigratie in 1986.

Immigration to the Netherlands in 1986 is reviewed using data from official sources. "In 1986, 87 thousand persons immigrated into the Netherlands, a 10% rise compared with 1985. Emigration numbered 55 thousand persons, just under 1% down on the preceding year." Information is provided on changes in country of origin of immigrants as compared with 1985. (SUMMARY IN ENG)

[Intra-municipal changes of residence and internal migration in 1985]. / Binnengemeentelijke verhuizingen en binnenlandse migratie in 1985.

PIP: The methodology used in compiling official Dutch statistics on residential mobility and internal migration is described. The data for 1985 are then presented and compared to the 1984 data. Separate consideration is given to intra-municipal moves, moves within provinces, and moves between provinces. (SUMMARY IN ENG)^ieng

[Less immigrants and more emigrants in 1988]. / Minder immigranten en meer emigranten in 1988.

PIP: International migration to and from the Netherlands in 1988 is examined and compared to 1987 migration patterns. Findings indicate an increase in Turkish and Moroccan migration to the Netherlands and an increase of Dutch nationals migrating to other European countries. (SUMMARY IN ENG)^ieng

A rationale for the appropriate amount of inoculum in ready biodegradability tests.

Several screening methods at the so-called ready biodegradability level are suitable to test poorly soluble substances. Typical for these tests is that mineralization is evaluated from monitoring oxygen uptake or carbon dioxide production. Unfortunately, they suffer from a rather low precision in the calculated percentage of mineralization caused by subtracting a too high inoculum control measurement from the response in the test system. Criteria for blank oxygen consumption, due to the metabolic activity of the inoculum, are proposed from which maximum amounts of activated sludge or secondary effluent per litre test medium can be derived to be used as an appropriate inoculum. Both for current and future standardized tests the precision of the method can be kept within acceptable margins. Inoculum material was sampled from 40 communal biological waste water treatment plants. From endogenous respiration rates it was derived that the concentration of secondary effluent in the Closed Bottle Test can be increased up to 50 mL/L but that in respirometry tests inoculated with activated sludge the appropriate concentration is 10 mg/L dry matter or below, depending of the design of the test system.

A double-blind clinical evaluation of different dose intervals with fluspirilene (IMAP).

The possibility of a biweekly dose of fluspirilene, without deterioration of the clinical picture, was investigated in a group of 34 chronic schizophrenic patients. There were no significant clinical difference between the patients receiving fluspirilene every week and the patients receiving it every two weeks. Therefore it is possible to give fluspirilene in individually adjusted doses with a dose interval of 14 days in stabilized patients.

A quantitative evaluation of monitoring networks for region-specific nitrate reduction policies.

Modern environmental policy implementation in many developed countries is increasingly regionally oriented. Regional governments have undertaken measures designed for the specific needs of the region but, so far, the resulting change in environmental quality has hardly been monitored. This study develops a method for the quantitative evaluation of region-specific environmental policy. Two forms of monitoring are distinguished: monitoring of performance of policy measures and monitoring of environmental quality. This study investigates two regions in the Netherlands where region-specific policy has been implemented. Performance monitoring focused on reduction of nitrate leaching to groundwater. Leaching reductions were calculated with simple models or rules of thumb. Quality monitoring focused on nitrate concentrations under grassland and other land use. An analysis of variance showed significant differences between different soil units. Stratified kriging was applied for spatial interpolation, showing within-unit variability. The current monitoring network could be improved by using a more regular type of grid.