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1.
BMC Ophthalmol ; 19(1): 175, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395046

RESUMO

BACKGROUND: To assess the relationship between different indications for trans pars plana vitrectomies (PPV's) and the intraocular pressure (IOP), and the effect of multiple PPV's on the IOP. We also examined whether there were differences in the number of IOP-lowering medications or surgeries before and after PPV. METHODS: A retrospective study including all patients that underwent at least one PPV in the period from 2001 till 2014 at our clinic. Medical records of all patients were reviewed and clinically relevant data were entered in a database. Generalized estimating equations models for repeated measurements were used to examine the effect of the number of PPV's on the IOP and on the risk of undergoing glaucoma surgery, for each of the indications for PPV. RESULTS: Of 1072 PPV's 447 eyes fulfilled the inclusion criteria. The IOP increased with 3.0 mmHg after a PPV with indication retinal detachment (p < 0.001), but remained stable after PPV for epiretinal membrane (p = 0.555), macular hole (p = 0.695), and vitreous hemorrhage (p = 0.787). At the end of the follow-up period the number of IOP-lowering medications was significantly higher compared to baseline, except in the macular hole group (p = 0.103). Also, the number of eyes that underwent glaucoma surgery was significantly higher compared to the fellow (not-operated) eyes (p < 0.001). There was a significant association between the number of PPV's and the final IOP for the indication retinal detachment (p = 0.009), and between the number of PPV's and glaucoma surgery (odds ratio [95% confidence interval]: 2.60 [1.62-4.15]). CONCLUSIONS: The IOP rises significantly after PPV with indication retinal detachment. This association was not found for other indications for PPV. Also, the risk of IOP-lowering surgeries was higher after PPV, but not different between the PPV indications. The IOP should be monitored carefully after PPV, since there may be a higher risk of secondary glaucoma.


Assuntos
Previsões , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias/epidemiologia , Doenças Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Países Baixos/epidemiologia , Reoperação/tendências , Doenças Retinianas/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Acuidade Visual
2.
Ned Tijdschr Tandheelkd ; 126(7-8): 399-407, 2019 Jul.
Artigo em Holandês | MEDLINE | ID: mdl-31309939

RESUMO

This second in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 5-year-olds. The study was conducted among 5-year-olds living in Alphen aan den Rijn, Gouda, Breda or Den Bosch and consisted of completing a questionnaire and undergoing a clinical oral examination. 76% of the 5-year-olds had a caries-free deciduous dentition. This percentage represented an increase compared to previous research. No change was seen in children with caries experience. In 2017, there were still differences in oral health among the socio-economic groups, in favour of the highest socio-economic group. Conclusion: the oral health of the 5-year-olds seems to be moving in the right direction, but there is still a social gradient and there is still room for improvement. For risk groups, interventions to keep the teeth intact should be aimed primarily at improving behaviour and oral health self-care to prevent caries.


Assuntos
Cárie Dentária , Criança , Índice CPO , Cárie Dentária/epidemiologia , Feminino , Humanos , Incidência , Masculino , Países Baixos/epidemiologia , Saúde Bucal
3.
BMC Public Health ; 19(Suppl 2): 538, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159760

RESUMO

BACKGROUND: Relatively little is known about how total sedentary time is accumulated in different domains and if correlates of sedentary time differ across domains. Time use surveys present a unique opportunity to study sedentary time in more detail. This study aimed to use the 2006 Dutch time use survey to 1) describe the (sedentary) time use of Dutch adults, and 2) explore socio-demographic and health-related correlates of total (non-occupational) and domain-specific sedentary time. METHODS: The Dutch time use survey randomly selected participants from a population-representative research sample of Dutch households. Participants reported daily activities on seven consecutive days using a time use diary and socio-demographic and health-related characteristics during telephone interviews. All reported activities were coded for activity domain (i.e. education; household; leisure; occupation; sleep; transport; voluntary work) and activity intensity (i.e. sedentary; light intensity physical activity; moderate-to-vigorous intensity physical activity). As occupational activities were not specified in sufficient detail, the intensity of these activities was unknown. We described the time spent in different domains and intensities, and assessed the socio-demographic and health-related correlates of high levels of total (non-occupational), household, leisure, and transport sedentary time using logistic regression analyses. RESULTS: The final dataset consisted of 1614 adult (18+) participants. On average, participants spent 8.0 h (61.1%) of their daily waking non-occupational time on sedentary activities. More than 87% of leisure time was spent sedentary. Men, participants aged 18-34 and 65+ years, full-time employed participants and obese participants had higher levels of total non-occupational sedentary time. The correlates of household, leisure and transport sedentary time differed by domain. CONCLUSIONS: This study reports high levels of total non-occupational sitting time of Dutch adults. The large proportion of sedentary leisure activities might indicate the potential of strategies aiming to reduce leisure sedentary time. The difference in correlates across sedentary behaviour domains demonstrates the importance of targeting these domains differently in interventions and policies.


Assuntos
Actigrafia/estatística & dados numéricos , Comportamento Sedentário , Fatores de Tempo , Adolescente , Adulto , Emprego/estatística & dados numéricos , Exercício , Características da Família , Feminino , Humanos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Obesidade/epidemiologia , Ocupações , Prevalência , Sono , Inquéritos e Questionários , Estudos de Tempo e Movimento , Adulto Jovem
4.
Accid Anal Prev ; 129: 334-341, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31200121

RESUMO

In the Netherlands, cyclists have to share the bicycle path with light moped riders. These riders are allowed to ride 25 km/h and do not have to wear a helmet (Dutch regulation). Due to several trends such as traffic congestion and the introduction of the scooter model, light mopeds have become more popular, both among older and younger people. This has led to an increased traffic density on bicycle paths as well as concerns about the safety of cyclists. In response to these concerns, several Dutch cities would like to ban light moped riders (LMRs) from the bicycle path and let them ride on the carriageway. However, it is uncertain what the consequences would be for the safety of light moped riders. Moreover, it is not clear to what extent the shared use of bicycle paths leads to serious crashes between cyclists and LMRs. Therefore, an in-depth crash investigation study was carried out to gain more insight into the factors and circumstances that influence the occurrence and consequences of light moped crashes on bicycle paths. A dedicated team for in-depth road crash investigation collected and analyzed detailed information on 36 light moped crashes that occurred on an urban bicycle path. This resulted in a description of the course of events for every crash that was analyzed, including a list of factors that contributed to the occurrence of the crash and possible injuries. Crashes with a similar course of events and a comparable combination of contributory factors were grouped into (sub)types of light moped crashes. Six types of crashes were identified. Based on the contributory crash factors of the identified crash types, remedial measures can be developed to prevent similar crashes from occurring in the future. Moving the LMR to the carriageway is only advisable on 30 km/h roads. Alternative measures to improve the safety of both cyclists and light moped riders include: 1) removing obstacles such as poles from the bicycle path, 2) following guidelines on the minimum width of bicycle paths given traffic volumes, 3) improving sight distances at intersections, 4) traffic light control without conflicts between traffic flows, and 5) introducing a helmet law for light moped riders and their passengers.


Assuntos
Acidentes de Trânsito/prevenção & controle , Motocicletas/estatística & dados numéricos , Acidentes de Trânsito/classificação , Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Ciclismo/estatística & dados numéricos , Cidades , Planejamento Ambiental , Humanos , Escala de Gravidade do Ferimento , Motocicletas/legislação & jurisprudência , Países Baixos/epidemiologia , Medição de Risco , Ferimentos e Lesões/epidemiologia
5.
BMC Infect Dis ; 19(1): 377, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046688

RESUMO

BACKGROUND: Climate change is expected to increase the chance of extreme rainfall events in the Northern Hemisphere and herewith, there is an increased chance of urban pluvial flooding. Urban pluvial flooding often consists of street flooding and/or flooding of combined sewerage systems, leading to contamination of the floodwater with several gastrointestinal and/or respiratory pathogens. An increase in flooding events therefore pose a health risk to those exposed to urban floodwater. We studied the association between exposure to pluvial floodwater and acute gastroenteritis (AGE) and acute respiratory infection (ARI). METHODS: We performed a retrospective, cross-sectional survey during the summer of 2015 in 60 locations in the Netherlands with reported flooding. Two weeks after the flooding, questionnaires were sent to households in these locations, collecting data on self-reported AGE and ARI and information on floodwater exposure in the previous 2 weeks. Multivariable generalized estimating equations (GEE) regression models, accounting for the clustered data structure, were used to identify risk factors for AGE and ARI. RESULTS: In total, 699 households with 1,656 participants (response rate 21%) returned the questionnaire. Contact with floodwater was significantly associated with AGE (aOR 4.2, 95%CI 2.1-8.4) and ARI (aOR 3.3, 95%CI 2.0-5.4). Risk factors for AGE were skin contact with floodwater (aOR 4.0, 95%CI 1.8-9.0), performing post-flooding cleaning operations (aOR 8.6, 95%CI 3.5-20.9) and cycling through floodwater (aOR 2.3, 95%CI 1.0-5.0). Skin contact with floodwater (aOR 3.6, 95%CI 1.9-6.9) and performing post-flooding cleaning operations (aOR 5.5, 95%CI 3.0-10.3) were identified as risk factors for ARI. CONCLUSIONS: Results suggest an association between direct exposure to pluvial floodwater and AGE and ARI. As it is predicted that the frequency of pluvial flooding events will increase in the future, there is a need for flood-proof solutions in urban development and increased awareness among stakeholders and the public about the potential health risks. Future prospective studies are recommended to confirm our results.


Assuntos
Inundações , Gastroenteropatias/diagnóstico , Infecções Respiratórias/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Gastroenteropatias/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Razão de Chances , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Autorrelato , Inquéritos e Questionários , Adulto Jovem
6.
BMC Infect Dis ; 19(1): 470, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138148

RESUMO

BACKGROUND: This paper outlines the methodology, study population and response rate of a third large Dutch population-based cross-sectional serosurvey carried-out in 2016/2017, primarily aiming to obtain insight into age-specific seroprevalence of vaccine-preventable diseases to evaluate the National Immunization Programme (NIP). In addition, Caribbean Netherlands (CN) was included, which enables additional research into tropical pathogens. METHODS: A two-stage cluster sampling technique was used to draw a sample of Dutch residents (0-89 years) (NS), including an oversampling of non-Western migrants, persons living in low vaccination coverage (LVC) areas, and an extra sample of persons born in Suriname, Aruba and the former Dutch Antilles (SAN). A separate sample was drawn for each Caribbean island. At the consultation hours, questionnaires, blood samples, oro- and nasopharyngeal swabs, faeces, - and only in the Netherlands (NL) saliva and a diary about contact patterns - were obtained from participants. Vaccination- and medical history was retrieved, and in CN anthropometric measurements were taken. RESULTS: In total, blood samples and questionnaires were collected from 9415 persons: 5745 (14.4%) in the NS (including the non-Western migrants), 1354 (19.8%) in LVC areas, 501 (6.9%) SAN, and 1815 (23.4%) in CN. CONCLUSIONS: This study will give insight into protection of the population against infectious diseases included in the NIP. Research based on this large biobank will contribute to public health (policy) in NL and CN, e.g., regarding outbreak management and emerging pathogens. Further, we will be able to extend our knowledge on infectious diseases and its changing dynamics by linking serological data to results from additional materials collected, environmental- and pharmacological data.


Assuntos
Bancos de Espécimes Biológicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bancos de Espécimes Biológicos/estatística & dados numéricos , Países Baixos Caribenhos/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Soroepidemiológicos , Inquéritos e Questionários , Migrantes , Vacinação/estatística & dados numéricos , Cobertura Vacinal
7.
BMC Cancer ; 19(1): 420, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060544

RESUMO

BACKGROUND: At present, palliative systemic chemotherapy is the standard treatment in the Netherlands for gastric cancer patients with peritoneal dissemination. In contrast to lymphatic and haematogenous dissemination, peritoneal dissemination may be regarded as locoregional spread of disease. Administering cytotoxic drugs directly into the peritoneal cavity has an advantage over systemic chemotherapy since high concentrations can be delivered directly into the peritoneal cavity with limited systemic toxicity. The combination of a radical gastrectomy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promising results in patients with gastric cancer in Asia. However, the results obtained in Asian patients cannot be extrapolated to Western patients. The aim of this study is to compare the overall survival between patients with gastric cancer with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with palliative systemic chemotherapy, and those treated with gastrectomy, CRS and HIPEC after neoadjuvant systemic chemotherapy. METHODS: In this multicentre randomised controlled two-armed phase III trial, 106 patients will be randomised (1:1) between palliative systemic chemotherapy only (standard treatment) and gastrectomy, CRS and HIPEC (experimental treatment) after 3-4 cycles of systemic chemotherapy.Patients with gastric cancer are eligible for inclusion if (1) the primary cT3-cT4 gastric tumour including regional lymph nodes is considered to be resectable, (2) limited peritoneal dissemination (Peritoneal Cancer Index < 7) and/or tumour positive peritoneal cytology are confirmed by laparoscopy or laparotomy, and (3) systemic chemotherapy was given (prior to inclusion) without disease progression. DISCUSSION: The PERISCOPE II study will determine whether gastric cancer patients with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with systemic chemotherapy, gastrectomy, CRS and HIPEC have a survival benefit over patients treated with palliative systemic chemotherapy only. TRIAL REGISTRATION: clinicaltrials.gov NCT03348150 ; registration date November 2017; first enrolment November 2017; expected end date December 2022; trial status: Ongoing.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Hipertermia Induzida/métodos , Cuidados Paliativos/métodos , Neoplasias Peritoneais/terapia , Neoplasias Gástricas/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimioterapia Adjuvante/economia , Quimioterapia Adjuvante/métodos , Ensaios Clínicos Fase III como Assunto , Análise Custo-Benefício , Procedimentos Cirúrgicos de Citorredução/economia , Intervalo Livre de Doença , Feminino , Gastrectomia/economia , Gastrectomia/métodos , Humanos , Hipertermia Induzida/economia , Estimativa de Kaplan-Meier , Masculino , Estudos Multicêntricos como Assunto , Países Baixos/epidemiologia , Cuidados Paliativos/economia , Neoplasias Peritoneais/economia , Neoplasias Peritoneais/secundário , Peritônio/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/economia , Neoplasias Gástricas/patologia
8.
BMJ ; 365: l1652, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088823

RESUMO

OBJECTIVE: To investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population. DESIGN: Retrospective, nationwide cohort study. SETTING: Specialised tertiary gender clinic in Amsterdam, the Netherlands. PARTICIPANTS: 2260 adult trans women (male sex assigned at birth, female gender identity) and 1229 adult trans men (female sex assigned at birth, male gender identity) who received gender affirming hormone treatment. MAIN OUTCOME MEASURES: Incidence and characteristics (eg, histology, hormone receptor status) of breast cancer in transgender people. RESULTS: The total person time in this cohort was 33 991 years for trans women and 14 883 years for trans men. In the 2260 trans women in the cohort, 15 cases of invasive breast cancer were identified (median duration of hormone treatment 18 years, range 7-37 years). This was 46-fold higher than in cisgender men (standardised incidence ratio 46.7, 95% confidence interval 27.2 to 75.4) but lower than in cisgender women (0.3, 0.2 to 0.4). Most tumours were of ductal origin and oestrogen and progesterone receptor positive, and 8.3% were human epidermal growth factor 2 (HER2) positive. In 1229 trans men, four cases of invasive breast cancer were identified (median duration of hormone treatment 15 years, range 2-17 years). This was lower than expected compared with cisgender women (standardised incidence ratio 0.2, 95% confidence interval 0.1 to 0.5). CONCLUSIONS: This study showed an increased risk of breast cancer in trans women compared with cisgender men, and a lower risk in trans men compared with cisgender women. In trans women, the risk of breast cancer increased during a relatively short duration of hormone treatment and the characteristics of the breast cancer resembled a more female pattern. These results suggest that breast cancer screening guidelines for cisgender people are sufficient for transgender people using hormone treatment.


Assuntos
Neoplasias da Mama/epidemiologia , Estrogênios/efeitos adversos , Transexualismo/tratamento farmacológico , Adulto , Antagonistas de Androgênios/uso terapêutico , Neoplasias da Mama Masculina/epidemiologia , Estrogênios/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Países Baixos/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Testosterona/uso terapêutico , Adulto Jovem
9.
BMC Public Health ; 19(1): 612, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113424

RESUMO

BACKGROUND: Evidence has not been conclusive on whether adolescent overweight is associated with mental health, possibly caused by indirect, yet untested associations. Therefore, the purpose of this study was to examine the association between overweight or obesity and mental health problems among adolescents, and to determine whether victimization plays a mediating role in these associations. METHODS: Self-reported data on mental health and victimization and objectively measured Body Mass Index data were used, using three cohorts (2010-2011 until 2012-2013) and an interval between the measurement waves of two years later. We performed a multi-level mediation analysis with a two-level structure to incorporate the clustering of the measurements within individuals. The study population consisted of 13,740 secondary school students, 13-14 years old at the first measurement moment, in Amsterdam, the Netherlands. RESULTS: Compared to their normal-weight peers, adolescents with overweight or obesity reported psychosocial problems and suicidal thoughts more often. Victimization was a significant mediator in the relationship between having overweight, and psychosocial problems (indirect effect OR: 2.3; 95% CI 1.5, 3.7 and direct effect OR: 1.4; 95% CI 1.2, 1.7) or suicidal thoughts (indirect effect OR: 2.1; 95% CI 1.4, 3.2 and direct effect OR: 1.3; 95% CI 1.1, 1.5). The associations between obesity, and psychosocial problems (indirect OR: 6.2; 95% CI 2.8, 14.7 and direct effect OR: 1.4; 95% CI 1.0, 2.0), or suicidal thoughts (indirect OR: 4.5; 95% CI 2.3, 9.1 and direct effect OR: 1.5; 95% CI 1.1, 2.0) were even stronger. CONCLUSIONS: Overweight and obesity were significantly associated with mental health problems in adolescents, and victimization played a mediating role in this association. Victimization and mental health should be integrated into prevention programs that address healthy weight development. Moreover, overweight should be given more attention in programs to prevent victimization and promote adolescent mental health.


Assuntos
Bullying/psicologia , Vítimas de Crime/psicologia , Transtornos Mentais/epidemiologia , Obesidade Pediátrica/psicologia , Adolescente , Estudos de Coortes , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Grupo Associado , Autorrelato , Ideação Suicida
10.
Vet Microbiol ; 232: 58-64, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31030845

RESUMO

This study was conducted to assess: (1) a change in between-herd prevalence of extended-spectrum and AmpC ß-lactamase-producing Escherichia coli (ESBL/AmpC-EC) between 2011 and 2013, the period during which the antimicrobial policy in animal husbandry in the Netherlands changed significantly, and (2) the prevalence of ESBL/AmpC-EC in individual calves, young stock, and dairy cows in the Netherlands. In 196 randomly selected conventional dairy herds, faecal samples were collected from calves (maximum n = 15), and randomly selected young stock (n = 5) and dairy cows (n = 15). Additionally, fresh faecal samples were collected from five different places on the floors where the dairy cows were housed. Samples were screened for E. coli with non-wild type susceptibility for cefotaxime and isolates were phenotypically confirmed as ESBL/AmpC-producing by disc diffusion, using cefotaxime and ceftazidime with and without clavulanic acid, and cefoxitin. Samples containing ESBL/AmpC-EC were examined semi-quantitatively. In 59.6% of the dairy herds one or more samples tested positive for ESBL/AmpC-EC. The between-herd prevalence based on floor samples in 2013 (18.0%) was significantly lower than the prevalence in 2011 based on comparable samples (32.7%). The individual animal prevalence of ESBL/AmpC-EC, with a minimum shedding level of 103 cfu/g of faeces, was 19.3% in calves, 0.9% in young stock, and 0.8% in dairy cows. Although ESBL/AmpC-EC was found in the majority of dairy herds, the herd prevalence declined significantly between 2011 and 2013. Calves were found to have both, a much higher individual animal prevalence and a higher level of shedding than young stock and cows.


Assuntos
Proteínas de Bactérias/biossíntese , Doenças dos Bovinos/microbiologia , Infecções por Escherichia coli/veterinária , Escherichia coli/enzimologia , beta-Lactamases/biossíntese , Animais , Antibacterianos/farmacologia , Bovinos , Doenças dos Bovinos/epidemiologia , Cefotaxima/farmacologia , Cefoxitina/farmacologia , Ácido Clavulânico/farmacologia , Indústria de Laticínios , Farmacorresistência Bacteriana Múltipla , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/epidemiologia , Fezes/microbiologia , Feminino , Países Baixos/epidemiologia , Prevalência
11.
Plast Reconstr Surg ; 143(5): 1298-1306, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033810

RESUMO

BACKGROUND: The Dutch Breast Implant Registry (DBIR) was established in April of 2015 and currently contains information on 38,000 implants in 18,000 women. As a clinical registry, it evaluates the quality of breast implant surgery, including adverse events such as breast implant-associated (BIA) anaplastic large cell lymphoma (ALCL). To examine the efficacy of the DBIR, the capture rate of BIA-ALCL was compared to the registration of BIA-ALCL in the Dutch Nationwide Network and Registry of Histo- and Cytopathology (PALGA) as a gold standard, in combination with matching these databases to obtain complementary information. METHODS: All BIA-ALCL patients diagnosed and registered in The Netherlands in 2016 and 2017 were identified separately in the PALGA and DBIR databases. In addition, both databases were matched using indirect key identifiers. Pathologic information from the PALGA and clinical and device characteristics from the DBIR were obtained for all patients. RESULTS: Matching of both databases gave a capture rate of BIA-ALCL in the DBIR of 100 percent (n = 6) in 2016 and 70 percent (n = 7) in 2017. In total, 17 patients were identified in the PALGA, of which 14 patients were also identified in the DBIR; three patients were not registered; and 10 patients were registered false-positive. Of all confirmed patients, symptoms, staging results, treatment, and implant information were registered. CONCLUSIONS: Currently, the DBIR contains 2 full registration years and captures most of the BIA-ALCL patients despite overestimation. Therefore, pathology confirmation remains essential. By matching these databases, complementary clinical and implant information could be retrieved, establishing the DBIR as an essential postmarketing surveillance system for health risk assessments.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/epidemiologia , Vigilância de Produtos Comercializados/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Implante Mamário/instrumentação , Feminino , Humanos , Linfoma Anaplásico de Células Grandes/etiologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vigilância de Produtos Comercializados/métodos , Medição de Risco
12.
J Cancer Res Clin Oncol ; 145(6): 1485-1493, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020418

RESUMO

PURPOSE: Propensity trimming, hierarchical modelling and instrumental variable (IV) analysis are statistical techniques dealing with confounding, cluster-related variation or confounding by severity. This study aimed to explain (dis)advantages of these techniques in estimating the effect of breast-conserving therapy (BCT) and mastectomy on 10-year distant metastasis-free survival (DMFS). METHODS: All women diagnosed in 2005 with primary T1-2N0-1 breast cancer treated with BCT or mastectomy were selected from the Netherlands Cancer Registry. We used multivariable Cox regression to correct for confounding. Propensity trimming was used to create a more homogeneous population for which the treatment choice was not self-evident. Hospital of surgery was used as hierarchical level to handle hospital-related variation, and as IV to deal with unmeasured confounding. RESULTS: Multivariable Cox regression showed higher 10-year DMFS for BCT than mastectomy [HR 0.70 (95% CI 0.60-82)]. Propensity trimming on the 10-90th and the 20-80th percentile of the propensity score distribution and hierarchical modelling showed similar HRs. IV analysis showed no significant difference between BCT and mastectomy. CONCLUSION: Unmeasured confounding is very difficult to eliminate in observational research. We cannot conclude that BCT or mastectomy has a causal relationship with 10-year DMFS. It is crucial to critically evaluate all model's assumptions, and to be careful in drawing firm conclusions.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Mastectomia Segmentar/mortalidade , Mastectomia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Fatores de Confusão (Epidemiologia) , Feminino , Humanos , Mastectomia/estatística & dados numéricos , Mastectomia Segmentar/estatística & dados numéricos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Observacionais como Assunto , Pontuação de Propensão , Modelos de Riscos Proporcionais , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
BMC Infect Dis ; 19(1): 324, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987580

RESUMO

BACKGROUND: After antibiotic treatment of Lyme borreliosis, a subset of patients report persistent symptoms, also referred to as post-treatment Lyme disease syndrome. The reported prevalence of persistent symptoms varies considerably, and its pathophysiology is under debate. The LymeProspect study has been designed to investigate the prevalence, severity, and a wide range of hypotheses on the etiology of persistent symptoms among patients treated for Lyme borreliosis in the Netherlands. METHODS: LymeProspect is a prospective, observational cohort study among adults with proven or probable Lyme borreliosis, either erythema migrans or disseminated manifestations, included at the start of antibiotic treatment. During one year of follow-up, participants are subjected to questionnaires every three months and blood is collected repeatedly during the first three months. The primary outcome is the prevalence of persistent symptoms after treatment, assessed by questionnaires online focusing on fatigue (CIS, subscale fatigue severity), pain (SF-36, subscale pain) and neurocognitive dysfunction (CFQ). Potential microbiological, immunological, genetic, epidemiological and cognitive-behavioral determinants for persistent symptoms are secondary outcome measures. Control cohorts include patients with long-lasting symptoms and unconfirmed Lyme disease, population controls, and subjects having reported a tick bite not followed by Lyme borreliosis. DISCUSSION: This article describes the background and design of the LymeProspect study protocol. This study is characterized by a prospective, explorative and multifaceted design. The results of this study will provide insights into the prevalence and determinants of persistent symptoms after treatment for Lyme borreliosis, and may provide a rationale for preventive and treatment recommendations. TRIAL REGISTRATION: NTR4998 (Netherlands Trial Register). Date of registration: 13 February 2015.


Assuntos
Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Adulto , Idoso , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/complicações , Protocolos Clínicos , Estudos de Coortes , Eritema Migrans Crônico/tratamento farmacológico , Eritema Migrans Crônico/epidemiologia , Eritema Migrans Crônico/etiologia , Fadiga/etiologia , Humanos , Doença de Lyme/etiologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Carrapatos
14.
Mil Med Res ; 6(1): 9, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30929640

RESUMO

BACKGROUND: This study examines the relationship between coping strategies and symptoms of anxiety or depression among Dutch servicemembers deployed to Afghanistan. METHODS: Coping strategies were assessed in 33 battlefield casualties (BCs) and the control group (CTRLs) of 33 uninjured servicemembers from the same combat units using the Cognitive Emotion Regulation Questionnaire. A factor analysis was performed, and two clusters of coping strategies were derived, namely, adaptive and maladaptive coping. Symptoms of anxiety and depression were evaluated using the depression and anxiety subscales of the Symptom Checklist-90-Revised. Correlations between coping and symptoms of anxiety and between coping and symptoms of depression were calculated, and a logistic regression was performed. RESULTS: A moderate correlation was observed between maladaptive coping and symptoms of anxiety in the BC group (r = 0.42) and among the CTRLs (r = 0.56). A moderate correlation was observed between maladaptive coping and symptoms of depression in both groups (r = 0.55). The statistical analysis for the total sample (BCs and CTRLs) demonstrated no association between coping and symptoms of anxiety or depression. CONCLUSIONS: A correlation but no association was observed between maladaptive coping and mental health disorders in deployed Dutch servicemembers. Further research should focus on constructing cluster profiles of coping strategies and associating them with mental health outcomes and reintegration into society.


Assuntos
Adaptação Psicológica , Militares/psicologia , Adulto , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Militares/estatística & dados numéricos , Países Baixos/epidemiologia , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Guerra/psicologia , Guerra/estatística & dados numéricos
15.
Artigo em Inglês | MEDLINE | ID: mdl-31018480

RESUMO

In an effort to better quantify the impact of adulthood socioeconomic circumstances on prediabetes and type 2 diabetes (T2DM), we set out to examine the relative importance of four adulthood socioeconomic indicators. Using cross-sectional data from The Maastricht Study on 2011 middle-aged older men and women, our findings indicate that low educational level (OR = 1.81, 95% CI = 1.24-2.64), low occupational level (OR = 1.42, 95% CI = 0.98-2.05), and material deprivation (OR = 1.78, 95% CI = 1.33-2.38) were independently associated with T2DM. Low income (OR = 1.28, 95% CI = 0.88-1.87) was the strongest, albeit not significant, SEP (socioeconomic position) correlate of prediabetes. This association confirms SEP as a multifaceted concept and indicates the need to measure SEP accordingly. In order to tackle the social gradient in prediabetes and T2DM, one should, therefore, address multiple SEP indicators and their possible pathways.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Exposição Materna , Ocupações , Fatores Socioeconômicos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estado Pré-Diabético/epidemiologia , Fatores de Risco
16.
Lett Appl Microbiol ; 69(1): 35-40, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30958895

RESUMO

With wild rodents and insectivores being present around humans and their living, working and food production environments, it is important to gain knowledge of the zoonotic pathogens present in these animals. The enteropathogen Clostridium difficile, an opportunistic anaerobic bacteria, can be carried by both animals and humans, and is distributed globally. It is known that there is genetic overlap between human and animal sources of C. difficile. In this study, the aim was to assess the presence of C. difficile in rodents and insectivores trapped on and around pig and cattle farms in the Netherlands. In total 347 rodents and insectivores (10 different species) were trapped and 39·2% tested positive for presence of C. difficile. For all positive samples the ribotype (RT) was determined, and in total there were 13 different RTs found (in descending order of frequency: 057, 010, 029, 005, 073, 078, 015, 035, 454, 014, 058, 062, 087). Six of the RTs isolated from rodents and insectivores are known to be associated with human C. difficile infection; RT005, RT010, RT014, RT015, RT078 and RT087. The presence of rodents and insectivores in and around food production buildings (e.g. farms) could contribute to the spread of C. difficile in the human environment. In order to enable on-farm management for pathogen control, it is essential to comprehend the role of wild rodents and insectivores that could potentially affect the ecology of disease agents on farms. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows that rodents and insectivores in and around food production buildings (e.g. farms) can carry Clostridium difficile ribotypes associated with human C. difficile infection (CDI). C. difficile spores in rodent and insectivore droppings are able to survive in the environment for prolonged periods, leading to host-to-host exposure and transmission. Therefore we can state that rodent and insectivore presence on farms is a risk for zoonotic pathogen transmission of C. difficile.


Assuntos
Infecções por Clostridium/epidemiologia , Infecções por Clostridium/veterinária , Clostridium difficile/isolamento & purificação , Insetívoros/microbiologia , Roedores/microbiologia , Animais , Bovinos , Infecções por Clostridium/microbiologia , Fazendas , Humanos , Camundongos , Países Baixos/epidemiologia , Ratos , Ribotipagem , Suínos , Doenças dos Suínos/microbiologia
17.
BJOG ; 126(10): 1252-1257, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30946519

RESUMO

OBJECTIVE: To assess intrapartum/neonatal mortality and morbidity risk in infants born at 37 weeks of gestation compared with infants born at 39-41 weeks of gestation. DESIGN: Nationwide cohort study. SETTING: The Netherlands. POPULATION: A total of 755 198 women delivering at term of a singleton without congenital malformations during 2010-14. METHODS: We used data from the national perinatal registry (PERINED). Analysis was performed with logistic regression and stratification for the way labour started and type of care. MAIN OUTCOME MEASURES: Intrapartum or neonatal mortality up to 28 days and adverse neonatal outcome (neonatal mortality, 5-minute Apgar <7, and/or neonatal intensive care unit admission). RESULTS: At 37 weeks of gestation intrapartum/neonatal mortality was 1.10‰ compared with 0.59‰ at 39-41 weeks (P < 0.0001). Adjusted odds ratio (aOR) for 37 weeks compared with 39-41 weeks was 1.84 (95% CI) 1.39-2.44). Adverse neonatal outcome at 37 weeks was 21.4‰ compared with 12.04‰ at 39-41 weeks (P < 0.0001) with an aOR 1.63 (95% CI 1.53-1.74). Spontaneous start of labour at 37 weeks of gestation was significantly associated with increased intrapartum/neonatal mortality with an aOR of 2.20 (95% CI 1.56-3.10), in both primary (midwifery-led) care and specialist care. Neither induction of labour nor planned caesarean section showed increased intrapartum/neonatal mortality risk. CONCLUSIONS: Birth at 37 weeks of gestation is independently associated with a higher frequency of clinically relevant adverse perinatal outcomes than birth at 39-41 weeks. In particular, spontaneous start of labour at 37 weeks of gestation doubles the risk for intrapartum/neonatal mortality. Extra fetal monitoring is warranted. TWEETABLE ABSTRACT: Birth at 37 weeks of gestation gives markedly higher intrapartum/neonatal mortality risk than at 39-41 weeks, especially with spontaneous start of labour.


Assuntos
Parto Obstétrico/mortalidade , Mortalidade Infantil/tendências , Assistência Perinatal/estatística & dados numéricos , Nascimento a Termo , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Trabalho de Parto , Países Baixos/epidemiologia , Razão de Chances , Gravidez , Resultado da Gravidez , Prova de Trabalho de Parto
18.
Prev Vet Med ; 166: 21-27, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935502

RESUMO

In the late summer of 2011, a sudden rise in incidence of fever, drop in milk production and diarrhoea was observed in dairy cows in the eastern region of the Netherlands and in north-western Germany. In the autumn of 2011, a novel orthobunyavirus was identified by metagenomic analyses in samples from acutely diseased cows on a farm near the German city of Schmallenberg, and was thereafter named Schmallenberg virus (SBV). Due to the novelty of the virus, there was an immediate need for knowledge regarding the epidemiological characteristics of SBV-infections to inform surveillance and control strategies. A rapid assessment of the spread and impact of an emerging disease supports decision-makers on allocation of resources. This paper reviews the disease mitigation activities during and after the SBV epidemic in the Netherlands, to illustrate the phases in surveillance when a new (vector-borne) pathogen emerges in a country or region. Immediate and short-term disease mitigation activities that were initiated after SBV was identified are discussed in detail, as well as ways to enhance future surveillance (e.g. by syndromic surveillance) and preparedness for similar disease outbreaks. By doing so, lessons learnt from the SBV epidemic will also improve surveillance for other emerging diseases in cattle.


Assuntos
Infecções por Bunyaviridae/veterinária , Doenças dos Bovinos/epidemiologia , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças/veterinária , Vigilância de Evento Sentinela/veterinária , Animais , Infecções por Bunyaviridae/epidemiologia , Infecções por Bunyaviridae/prevenção & controle , Infecções por Bunyaviridae/virologia , Bovinos , Doenças dos Bovinos/prevenção & controle , Doenças dos Bovinos/virologia , Surtos de Doenças/prevenção & controle , Feminino , Países Baixos/epidemiologia , Orthobunyavirus/fisiologia , Vigilância da População/métodos
19.
BMC Public Health ; 19(1): 353, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30922277

RESUMO

BACKGROUND: In 2014 the World Health Organisation (WHO) established validation criteria for elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. Additionally, the WHO set targets to eliminate hepatitis, including hepatitis B (HBV). We evaluated to what extent the Netherlands has achieved the combined WHO criteria for EMTCT of HIV, syphilis and HBV. METHODS: Data of HIV, syphilis and HBV infections among pregnant women and children (born in the Netherlands with congenital infection) for 2009-2015, and data required to validate the WHO criteria were collected from multiple sources: the antenatal screening registry, the HIV monitoring foundation database, the Perinatal Registry of the Netherlands, the national reference laboratory for congenital syphilis, and national HBV notification data. RESULTS: Screening coverage among pregnant women was > 99% for all years, and prevalence of HIV, syphilis and HBV was very low. In 2015, prevalence of HIV, syphilis and HBV was 0.06, 0.06 and 0.29%, respectively. No infections among children born in the Netherlands were reported in 2015 for all three diseases, and in previous years only sporadic cases were observed In 2015, treatment of HIV positive pregnant women was 100% and HBV vaccination of children from HBV positive mothers was > 99%. For syphilis, comprehensive data was lacking to validate WHO criteria. CONCLUSIONS: In the Netherlands, prevalence of maternal HIV, syphilis and HBV is low and congenital infections are extremely rare. All minimum WHO criteria for validation of EMTCT are met for HIV and HBV, but for syphilis more data are needed to prove elimination.


Assuntos
Erradicação de Doenças , Infecções por HIV/prevenção & controle , Hepatite B/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Sífilis/prevenção & controle , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Hepatite B/epidemiologia , Hepatite B/transmissão , Humanos , Recém-Nascido , Países Baixos/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Diagnóstico Pré-Natal/estatística & dados numéricos , Prevalência , Sífilis/epidemiologia , Sífilis/transmissão , Organização Mundial da Saúde
20.
Eur Psychiatry ; 58: 63-69, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836316

RESUMO

BACKGROUND: Little is known about the association between trauma and intellectual disability in SMI patients. AIM: To establish the prevalence of trauma and its association with intellectual functioning in SMI outpatients. METHODS: A cross-sectional study was conducted in two mental health trusts in the Netherlands. We used the Trauma Screening Questionnaire (TSQ) to screen for trauma and PTSD, and the Screener for Intelligence and Learning disabilities (SCIL) for suspected MID/BIF. Chi-square and t-tests were used to test differences in outcome over patient characteristics. Post-hoc analysis was used to investigate gender differences between patients with and without MID/BIF on trauma and sexual trauma. RESULTS: Any trauma was found in 86% of 570 patients and 42% were suspected for PTSD. The SCIL suggested that 40% had Borderline Intellectual Functioning (BIF), half of whom were suspected of having Mild Intellectual Disability (MID). These patients had more traumatic experiences (1.89 in BIF, 1.75 in MID, against 1.41 in SCIL-negative patients). Female MID/BIF patients (61%) had experienced significantly more sexual abuse than male MID/BIF patients (23%). CONCLUSIONS: Significantly more SMI outpatients who screened positive for MID/BIF reported having experienced traumatic events than those who screened negative. Rates of all trauma categories were significantly higher in the screen-positive group, who were also more likely to have PTSD. Sexual abuse occurred more in all females but the SCIL positive women are even more often victim. Clinical practice has to pay more attention to all of these issues, especially when they occur together in a single patient.


Assuntos
Deficiência Intelectual/epidemiologia , Pessoas Mentalmente Doentes/estatística & dados numéricos , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Inteligência , Transtornos de Aprendizagem/epidemiologia , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Prevalência , Adulto Jovem
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