Performance of a bedside test for tetanus immunity: results of a cross-sectional study among three EDs in the Netherlands in 2012-2013.

INTRODUCTION: Despite sustained high vaccination coverage and a national guideline by the Health Council (HC-guideline) on tetanus postexposure prophylaxis (T-PEP), tetanus sporadically occurs in the Netherlands. This study aims to assess the added value of a bedside test for tetanus immunity (Tetanos Quick Stick (TQS); Ingen BioSciences Group, France), in the context of routine T-PEP in two adult cohorts: those born before introduction of tetanus toxoid vaccination in the National Immunization Programme (NIP) in 1957 (pre-NIP-cohort; n=196) and those born after (NIP-cohort; n=405). METHODS: Adults included at the time of visiting one of three participating EDs received T-PEP as per routine recommendations. Subsequently, a nurse performed the TQS and filled in a questionnaire. We compared the indication for T-PEP based on TQS results with those based on the HC-guideline and with actually administration of T-PEP, stratified by cohort. RESULTS: Among the pre-NIP and NIP-cohort, 16% and 9%, respectively, received T-PEP, while this was not indicated based on the HC-guideline. Furthermore, 8% and 7%, respectively, did not get T-PEP, although it was indicated by the guideline. Comparing the indication derived from the HC-guideline with TQS result found that 22% (pre-NIP-cohort) and 8% (NIP-cohort) were not eligible for T-PEP according to the HC-guideline but had a negative TQS. Conversely, 36% (pre-NIP-cohort) and 73% (NIP-cohort) were eligible for T-PEP according to the HC-guideline but had positive TQS, indicating sufficient tetanus protection. CONCLUSION: Use of the TQS would allow better targeting of T-PEP. Furthermore, stricter adherence to the HC-guideline can prevent overimmunisation and decrease the risk of tetanus.

Use of PCR for detection of faecal HAV as a screening tool in an outbreak of hepatitis A in daycare centres.

Using polymerase chain reaction (PCR) to detect faecal hepatitis A virus (HAV) can be a useful tool for investigating HAV outbreaks, especially in low-endemic countries. We describe the use of faecal HAV PCR as a non-invasive tool for screening. Two Dutch children visiting different daycare centres were diagnosed with hepatitis A in 2011. A systematic contact investigation was started in the daycare centres and relevant contacts were screened. The faecal HAV PCR test was used to screen the children. The employees were screened with a serum IgM. The faecal HAV PCR test proved to be an appropriate tool for screening. The screening of a total of 135 children and employees in the daycare centres resulted in evidence of eight asymptomatic infections and transmission to three related daycare centres. Control measures were taken including immunization. Compared to an epidemiological investigation without screening, 144 extra contacts were vaccinated based on the screening results. This most likely led to improved prevention of expansion of the outbreak.

An outbreak of severe respiratory tract infection caused by human metapneumovirus in a residential care facility for elderly in Utrecht, the Netherlands, January to March 2010.

Recognition of infections with human metapneumovirus (HMPV) among institutionalised elderly is rising. When HMPV was found to be the causative agent of an outbreak of pneumonia in a residential care facility for elderly in the Netherlands, an elaborate outbreak investigation was set up, including active surveillance for new cases. From clinical cases, defined by fever (> 38°C) and symptoms of respiratory tract infections, respiratory samples for analyses of viral pathogens by real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) and blood samples for determination of HMPV-specific IgM and IgG antibody titres were taken. Five staff members and 18 residents fulfilled the clinical case definition. Of those, five residents tested positive for HMPV by rRT-PCR. The combination of rRTPCR and serology identified nine confirmed cases, six probable cases, six possible cases and ruled out two persons as cases. Among residents, the outbreak of HMPV had an attack rate, ranging from 5% for laboratory- confirmed cases, to 13% for clinical cases. This outbreak investigation shows that HMPV is a potential serious pathogen for institutionalised elderly.

[Zika virus and sexual transmission; when and for how long does one need to use a condom?] / Zikavirus en seksuele transmissie.

- More evidence has become available concerning the sexual transmission of Zika virus and viral shedding in semen, which has led to the expansion of international guidelines for prevention of sexual transmission; Dutch guidelines have not been altered.- Internationally, the use of condoms during sex or sexual abstinence is advised for the duration of the pregnancy. Furthermore, when actively trying to conceive one should use a condom for six months.- In the Dutch guidelines, men who have visited a Zika virus epidemic area are advised to use a condom for 2 months upon return, irrespective of their partner possibly being pregnant or their wish to conceive.- Based on reports to the World Health Organisation and patient reports, the serial interval between disease onsets of both sexual partners is 4-44 days (median: 15).- Zika virus RNA is often no longer detectable in semen 2-3 months after disease onset.- International guidelines are based on the maximum detection period of Zika virus RNA and on virus isolation. Dutch prevention guidelines, on the other hand, are based on the longest serial interval known for sexual transmission (44 days).- Detection of Zika virus RNA in semen does not give a definitive answer on contagiousness. Currently, following the Dutch prevention advice is the best option in order to prevent sexual transmission.

[Outbreak of Campylobacter fetus infection after consumption of unpasteurized sheep's milk cheeses: how to trace the source?] / Een uitbraak met Campylobacter fetus na het eten van rauwmelkse schapenkaas.

Campylobacter fetus is a species of gram-negative bacteria whose primary reservoir is the gastrointestinal tracts of cattle and sheep. Human infections are rare, though often invasive and sometimes fatal. In this paper, we studied an outbreak of six patients with a C. fetus infection and outlined their disease histories. In each case we were able to identify factors that led to a reduced resistance, including pre-existing illnesses and old age. Because of the unusually high number of patients that presented in a time period of only five months, the Community Health Services were commissioned to identify the source of infection. Using whole genome sequencing, we showed that 5 out of 6 patients belonged to the same cluster. This One Health approach resulted in the conclusion that the infection originated from unpasteurized sheep's milk processed into unripened cheese. Finally, various measures were put into place to prevent any further outbreaks.

Regional differences in cardiovascular risk factor profile cannot fully explain differences in cardiovascular morbidity in the Netherlands: a comparison of two urban areas.

BACKGROUND: Our objective was to investigate whether a region in the south of the Netherlands (Heerlen/Kerkrade) had a high burden of cardiovascular disease in comparison with a nearby region (Maastricht) and the average Dutch population, respectively. We also wanted to determine if there are interregional differences in cardiovascular risk factor profile. DESIGN: Cross-sectional study. METHODS: Data from a nationwide registry (CBS) were used to analyse cardiovascular mortality in the two regions and the average in the Netherlands. Data from a primary care morbidity registration network (RNH) were used to compare cardiovascular morbidity and cardiovascular risk factors in both regions. A standardisation procedure was carried out for age and sex. Data were analysed using logistic regression analyses. RESULTS: The overall cardiovascular mortality rate was higher in the Heerlen/Kerkrade region (7.8 per thousand) compared with Maastricht (6.1 per thousand, OR=1.3, 95% CI 1.2-1.5) and the average in the Netherlands (5.7 per thousand). Similarly, most cardiovascular morbidity rates for Heerlen/Kerkrade were more elevated compared with the RNH overall and with Maastricht. Prevalence rates of risk factors such as diabetes mellitus (7.2%, OR=1.5, 95% CI 1.3-1.7) and overweight (10.8%, OR= 2.0, 95% CI 1.8-2.2) were significantly higher in the Heerlen/Kerkrade region compared with Maastricht. There were no differences with regard to hypertension (15.2%, OR=1.0, 95% CI 0.9-1.1). CONCLUSION: Heerlen/Kerkrade is indeed a region with a high burden of cardiovascular disease. Differences in morbidity between Heerlen/Kerkrade and Maastricht cannot be fully explained by differences in cardiovascular risk factor profile.

[Health care needs and wish to be admitted of subjects with positive indications; a comparison with residents of homes for the aged]. / De hulpbehoefte en opnamewens van positief geïndiceerden; een vergelijking met verzorgingshuisbewoners.

The care needs, utilization of care and the wish to be admitted on a short or long term basis of 135 applicants to homes for the aged are presented and their interrelations considered. The care needs of the applicants to and 207 residents of homes for the aged are compared. With an increasing number of housekeeping disabilities, depressive complaints, memory disorders and, as expected, the use of formal and informal care increased. The care needs of the applicants were at least as large as those of the residents. They had (nearly) as much housekeeping and ADL disabilities and even more feelings of loneliness and depressive complaints. Yet, for those applicants with few housekeeping disabilities the necessity of admission to a home for the aged can be questioned. That is, the wish to be admitted on short term was strongly associated with depressive complaints and feelings of loneliness. Provided that these mental problems can be handled effectively, (more) home care may be an alternative for them.

[Validation: its effect in residents and staff in a home for the aged]. / Validation: effecten bij bewoners en personeel in een verzorgingshuis.

In a quasi-experimental study the effectiveness of the method Validation is evaluated. This approach for disoriented institutionalized old people was developed by Naomi Feil in the U.S.A. This study evaluated the effect of Validation on the behaviour of institutionalized 'old-old' suffering from dementia and of those who deliver care to them. The study group included 19 demented residents of a home for the aged and 29 nurses, of whom 15 nurses had followed the basic course in Validation. The other 14 nurses were selected as members of the control group. The behaviour of the residents was measured with the BPS (a scale for Mental and Social Problems). This measurement was performed by the nurses of the two groups on three different points of time (before the course, immediately after the course and 4 months after the course). At the same time the nurses evaluated their own behaviour by a questionnaire developed by Verpoort. Differences between pre- and post-testscores showed some improvement in behaviour of residents and staff. However, contamination, social desirability and enthusiasm of the researcher and the staff may have influenced the results. It is concluded that Validation contributes to an improvement of the attitude and job satisfaction of nurses too. This benefits the residents.

[Nursing home admission; a study among elderly applicants]. / Verpleeghuisopname; een onderzoek bij op te nemen ouderen.

This article describes the care needs, social network, housing conditions, utilization of care and diagnoses of 157 elderly applicants to nursing homes in Maastricht. The study was conducted during the period of February 1987 to July 1988. Possible differences in these characteristics in relation to the goal of the admission (rehabilitation versus continuous support) and in relation to prior living arrangements (home versus hospital) were investigated. In addition, the question to what extent substitution of care is possible is discussed. Within the group of nursing home applicants, a fairly clear distinction could be made between a number of subgroups, although care needs, social network (with the exception of the number of visits paid), and demographic characteristics showed no differences in relation to admission goals and prior living arrangements. The distinction was based particularly on the nature of the disorders (psychogeriatric versus somatic and chronic versus more or less acute), which was reflected not only in the main diagnosis itself, but also in differences in housing conditions, numbers of visits paid to others, and utilization of care prior to admission. Under the proposed policies for substitution, about a quarter of the applicants would be eligible for substitution. However, the major care needs, and the levels of formal and informal care prior to admission, as well as the shortage of alternative services, would seem to indicate that the actual possibilities for substitution are more limited.

[The course of nursing home admission. A follow-up study in chronic and rehabilitation patients]. / Het verloop van verpleeghuisopnamen. Een follow-up onderzoek bij chronische en reactiveringspatiënten.

This article describes the course of the nursing home stays of 157 newly admitted patients (55 years and older) using the Behaviour Rating Scale for Elderly Patients ('Beoordelingsschaal Oudere Patiënten'). The follow-up period lasted maximally one year. Differences in the course in relation to the objective of the admission (rehabilitation versus continuous support) and possible factors which impeded or advanced the discharge of the rehabilitation patients, were investigated. For that purpose, information on diagnoses, prognosis, treatment goals and their achievement, and disability according to SIVIS (SIG Nursing Home Information System) was also obtained from the physicians in charge at the nursing home. The course of the nursing home stay appeared to differ for chronic and rehabilitation patients. In addition to physical disability and depressive behavior, the chronic patients, from the time of admission onwards, had more behavioural problems than the rehabilitation patients. Moreover, their dependency, physical and mental disability and inactivity increased in different degree during the stay. For two thirds of the rehabilitation patients, the stay did not end in discharge from the nursing home. For this group, the dependency, depressive behaviour, and to a lesser extent, aggressiveness increased during the stay. The outcome of rehabilitation appeared to be related to the extent of behavioural problems, to the level of disability, and to the medical condition on admission. The least disabled and the 'medically least complex' patients could usually be discharged with an improved level of functioning, which seemed to justify the nursing home stay. The absence of other services impeded discharge in a few cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effectiveness of validation. A literature study]. / De effectiviteit van validation. Eeen literatuuronderzoek.

This review-article reports on literature on the effectiveness of validation; and approach used for disoriented elderly. Literature has been searched for by means of several (computerized) indexes and references. By contacting Feil, who developed validation, unpublished articles and reports became available. This search resulted in 13 effect-studies, of which 7 are unpublished, 2 descriptive reports, and 1 research-proposal. The effect-studies have varying designs with different methodological restrictions causing bias. The analysis showed that the quality and therefore the evidential value of the effect-studies is limited. The better the study, the less validation appeared to be effective. It is concluded that the hypothesis, that validation has positive effects on disoriented elderly and their caregivers, has no or minimal scientific basis. Before validation is implemented more and more in Dutch health care, scientific research addressing its effects is indicated.

Factors associated with differential utilization of professional care among elderly people: residents of old people's homes compared to elderly people living at home.

To investigate factors that explain differential utilization of professional care among elderly people a study was performed in Maastricht, the Netherlands. For that purpose 657 interviews with elderly people were held. In this article a comparison is made between elderly people living at home, with or without professional home care, and residents of old people's homes. Besides the functional status, as measured by limitations in household activities and activities of daily living, the composition of the household of the elderly person is recognized as a major discriminating factor between the three groups. The role of depressive complaints in care utilization is less prominent than expected from an earlier study. A bivariate analysis clearly showed the frequency of mental problems and the poorly developed social network among elderly persons using professional care. Implications for caregiving and policy planning are discussed.

The functional status and utilization of care of elderly people living at home.

A postal questionnaire was used to obtain information on the functional status of and the utilization of care by elderly people living at home. The aim of the questionnaire was to enable the investigators to select elderly people for a further interview to identify the factors that lead to a demand for professional care. The questionnaire provided relevant information as to the prevalence of physical limitations in elderly people and their use of professional and informal care. The information obtained was reliable and valid as is shown by comparison with information given in subsequent interviews. It appears that the prevalence of limitations was of the same size as that found in other studies, both national and international. The more limitations, the higher the proportion of professional care utilization. The factors "use of informal care" and "not living alone" were inversely related to the utilization of professional care. The amount of informal care provided was very high among elderly people with handicaps. Rather than being a substitute, it seems that informal care is a condition for professional home care to be successful. The postal questionnaire appeared to be an efficient means of investigating the functional status of and utilization of care by elderly people living at home. As such it could be used for planning and allocation of home care.

A scale for the functional status of the elderly living at home.

Many scales have been developed to describe the functional status of geriatric patients. These scales are of limited use for describing the functional status of elderly people living at home, because of their poor capacity for differentiation. This article reports the results of a postal questionnaire among elderly people living at home. The findings will be analysed to see whether the inventory on performance of household and daily living activities describes the functional status of elderly people in a useful manner. A combined scale was constructed, which has satisfactory Guttman coefficients when applied to elderly people living at home. In addition, the scale is informative for those providing home care with regard to the elderly person's quantitative and qualitative needs for assistance. As such, it could be an instrument to be applied in community nursing. The applicability of the scale to institutionalized elderly people remains to be investigated.

Why do elderly people seek professional home care? Methodologies compared.

In order to investigate which characteristics, besides physical limitations, of elderly people living at home contribute to the utilization of professional home care, a study was conducted in which 450 elderly people aged 55 and over, 123 with and 327 without professional home care, were interviewed. To obtain a selection for the interviews, a postal questionnaire, containing questions on functional status and care utilization, sent out to a random sample of the elderly people (55+) living at home (n = 2451), preceded the actual interviews. The oral interviews yielded the same information, plus an inventory of aspects of the mental status, the social network, the socio-economic status and the housing condition. Analysis was performed in three ways: bivariate analysis, logistic regression analysis and discriminant analysis. The bivariate analysis revealed that users of professional care were older, more often female and more often not married. Their social network was less extensive, as they received less informal care and lived alone more often. Besides they had more mental and financial problems. From the regression analysis it appeared that, in addition to the functional status, the amount of informal care and the household composition contributed to the utilization of professional home care. For the other characteristics inventoried, no independent association with the utilization of professional care could be established. With hindsight, it appeared that in this study long interviews hardly had additional value over postal questionnaires, in which the contribution of functional status and informal care to professional care was already discovered.