Effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +): a stepped wedge study protocol.

BACKGROUND: People with mental illness have a reduced life expectancy compared to the general population. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is often referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings. Our study assesses the effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +). METHODS: An open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal, the Netherlands. The wards are divided into three clusters based on geographical region. These clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI + . MULTI + can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate the difference in the mean QRISK3 score of patients receiving MULTI + compared to patients receiving TAU. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors. Findings will be analysed using mixed model analyses. DISCUSSION: The MULTI + study is the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors in routine inpatient mental health care. A limitation of this study is the risk of missing data due to the large-scale, real-world setting of this study. Furthermore, implementation monitoring and external events that may influence outcomes could be difficult to account for. Strengths of this study are the focus on effectiveness as well as implementation and the inclusion of both patient and health care professionals' perspectives. Effectiveness studies in routine clinical care can advance our knowledge on lifestyle interventions in real-world settings. TRIAL REGISTRATION: ClinicalTrials.gov registration. Identifier: NCT04922749 . Retrospectively registered 3th of June 2021.

Inactivation rates of Cronobacter spp. and selected other bacterial strains in powdered infant formulae stored at different temperatures.

The aim of this study was to determine the survival of two strains of Cronobacter (Enterobacter sakazakii) and six other bacterial strains inoculated into dry powdered infant formula (PIF) stored for 22 weeks at several temperatures between 7 and 42 degrees C. The experimental setup involved a relatively high initial concentration of bacteria, around 10(4) CFU/g of powder, and enumeration of survivors with a minimum detection level of 100 CFU/g. For all strains tested, it was found that the number of bacterial cells decreased faster with increasing temperature. Cronobacter spp. cells generally survived better at high temperatures (37 and 42 degrees C) than the other bacteria, while such a difference in survival was not apparent at other temperatures. To describe the effect of temperature on survival, both the Weibull distribution model and the log-linear model were tested. At 22 degrees C, decline rates of 0.011 and 0.008 log units per day were found for Cronobacter sakazakii ATCC 29544 and Cronobacter strain MC10, respectively. Assuming a linear relationship between log-transformed D-values and temperature, z-values estimated for C. sakazakii ATCC 29544 and Cronobacter MC10 were 13.3 and 23.5 degrees C, respectively. Such differences found in resistance among Cronobacter spp. would be relevant to consider when establishing quantitative risk assessments on consumer risks related to PIF.

A new protocol for the detection of Enterobacter sakazakii applied to environmental samples.

Enterobacter sakazakii is a motile, peritrichous, gram-negative rod that was previously known as a yellow pigmented Enterobacter cloacae. It is documented as a rare cause of outbreaks and sporadic cases of life-threatening neonatal meningitis, necrotizing enterocolitis, and sepsis. E. sakazakii has been isolated from milk powder-based formulas, and there is thus a need to investigate whether and where E. sakazakii occurs in these manufacturing environments. For this purpose, a simple detection method was developed based on two features of E. sakazakii: its yellow pigmented colonies when grown on tryptone soy agar and its constitutive alpha-glucosidase, which is detected in a 4-h colorimetric assay. Using this screening method, E. sakazakii strains were isolated from three individual factories from 18 of 152 environmental samples, such as scrapings from dust, vacuum cleaner bags, and spilled product near equipment. The method is useful for routine screening of environmental samples for the presence of E. sakazakii.

Standardisation of microbiological methods. The Salmonella example.

The results of studies carried out under the leadership of Prof. Kampelmacher to elaborate a reliable Salmonella isolation method are highlighted. The strategy which was successfully followed is summarised in a table. This strategy can also be applied in attempts at standardisation of other microbiological methods.

[Studies on the persistence of Clostridium botulinum on a cattle farm (author's transl)]. / Onderzoek naar de persistentie van Clostridium botulinum op een rundveebedrijf.

In the winter of 1978-1979, the presence of Clostridium botulinum was studied on a cattle farm, on which botulism caused by feeding the animals contaminated brewers' grains occurred in 1977. Cl. botulinum type B, the cause of mortality among cattle at the time, was detected in grass silage prepared in 1978. This organism was not detectable in a grass silage pit dating from 1977 and made prior to the outbreak of botulism. Investigations showed that proteolytic types of C. botulinum having grass as the substrate may produce large amounts of toxin. The production of toxin in grass silage pits may, however, be prevented by a low pH in conjunction with low water activity. The present study showed that the faeces of cattle were also contaminated with Cl. botulinum type B. The degree of infection ran parallel with the degree of contamination of silage feeding in these cases.

[Studies on the possibility of producing broilers free from Salmonella (author's transl)]. / Een onderzoek naar mogelijkheden voor de produktie van Salmonella-vrije slachtkuikens.

The results of the present study show that the only method by which broilers could be reared free from Salmonella would be to adopt a number of radical measures at the same time. These measures include the production of Salmonella-free one-day chicks, decontaminating the feed, thorough cleansing and decontamination of the houses and preventing the introduction of Salmonella from the environment. Adopting separate measures was found to have a very slight effect.

[Epidemiological studies on Salmonella in a particular area ('Walcheren Project'). V. Studies on the possibility of fattening pigs free from Salmonella (author's transl)]. / Epidemiologisch Salmonella-onderzoek in een bepaald gebied ('Project Walcheren'). V. Onderzoek naar de mogelijkheid varkens onder praktijkomstandigheden Salmonella-vrij te mesten.

Four trials were made to study the possibility of fattening pigs free from Salmonella under field conditions. One pig-sty on a Salmonella-contaminated farm was used in these studies. Previous studies had shown that Salmonella-free fattening pigs could be produced under experimental conditions. A number of hygienic measures were adopted on the farm, such as the purchase of Salmonella-free piglets, the use of correctly pelleted feed, thorough cleaning and disinfecting of the pig-sty, and the prevention of all infections originating from the environment. Notwithstanding all these measures, completely Salmonella-free pigs could not be obtained. In three out of four experiments, even a mass infection with Salmonella even became apparent among the pigs. During the experiments a number of possible routes of infection were detected. The presence of these possible routes of infection was due to the fact that the measures referred to were not carried out accurately. This suggests that it will be very difficult to satisfy the requirements of strict hygiene under field conditions. Further experimental studies will have to show whether this is usually the case. During the third and fourth trial, studies were not confined to the farm, but also extended to the period of slaughter. From these investigations it became apparent that transport to as well as the period of waiting in the slaughter-house also provide several opportunities for contamination of the pigs, in spite of extensive cleaning and disinfection of both cattle-truck and lairages.

Plasma concentrations, plasma protein binding and residues of sulfamonomethoxine in pigs, horses and cattle.

The protein binding, the plasma half-life and the residue depletion of sulfamonomethoxine (SMM) after intramuscular administration were investigated in pigs, horses and cattle. Protein binding was weakly concentration-dependent. The bound fraction in plasma in the therapeutic range amounted to approximately 45, 40 and 50% for pigs, horses and cattle respectively, and the plasma half-lives were approximately 5.1, 5.7 and 3.1 hours respectively. SMM levels were less than 1 mug/g in muscle tissue after 36, 20 and 12 hours in pigs, horses and cattle respectively. In the kidney SMM levels were not less than 1 mug/g until 48, 60 (extrapolated) and 36 (extrapolated) hours respectively. In pigs and horses SMM residues in the injection site were extremely variable. In cattle, SMM disappearance from the injection site was more regular. SMM concentrations in pig, horse and cattle liver remained more or less constant in the latter part of the period investigated.

[Epidemiological studies on Salmonella in a particular area ('Walcheren Project'). IV. The incidence of Salmonella in the sewage system, in faeces of man and pets as well as in shops, kitchens and lavatories in the village of Aagtekerke (author's transl)]. / Epidemiologisch Salmonella-onderzoek in een bepaald gebied ('Project Walcheren'). IV. Het voorkomen van Salmonella in het rioolstelsel, in faeces van mensen en huisdieren, in winkels en in keukens en toiletten in het dorp Aagtekerke.

As part of the epidemiological investigations on Salmonella on the island of Walcheren, the contamination of sewage water in the village of Aagtekerke was studied over a prolonged period. These studies showed that this sewage water was frequently contaminated by large numbers of Salmonella. In the present study, efforts were made to find an answer to the question of the origins of this contamination. For this purpose, the incidence of Salmonella in the sewage system, in faeces of man and pets as well as in shops, kitchens and lavatories in the village of Aagtekerke was studied for a period of three weeks in June 1977. In addition to the findings in the sewage system (including the inlet water and effluents of the sewage works) which were positive for Salmonella, this organism was only isolated from a few faecal samples of human and animal origin. Serotyping showed that the strains isolated from human faeces were similar to those found to be present in the sewage system. This fact, in conjunction with the results of the bacterial counts. suggests that the sewage system was only contaminated by the small number of carriers. The reduction of contamination observed in the sewage system during the period of investigation could be evidence of the fact that Salmonella organisms cannot survive by themselves in an environment of this type, at least not at the temperatures recorded on collecting samples from the sewage water. Growth of organisms under more favourable conditions cannot be ruled out. An inquiry on dietary habits and kitchen hygiene of the local population showed that contamination within households. Origination with the food, is a real possibility.

[Epidemiological studies on salmonella in a particular area ("Walcheren Project"). III. The incidence of salmonella in man, insects, gulls as well as foods scrapings from butcher's blocks, effluents of sewage treatment plants and drains from butcher's shops (author's transl)]. / Epidemiologisch salmonella-onderzoek in een bepaald gebied ("Project Walcheren"). III. Het voorkomen van salmonella bij mens, insecten, meeuwen en in levensmiddelen, hakblokafkrabsels, effluenten van rioolwaterzuiveringsinstallaties en rioolafvoeren van slagerijen

In continuation of previous studies, various materials (meat and meat products, insects, gull droppings, scrapings from butcher's blocks, effluents of sewage treatment plants, drains from butcher's shops and faeces of patients) were examined again at the same time for the presence of Salmonella in a relatively small are (Walcheren) over a period of three months. As was also the case in previous studies, S. typhi murium (27.5 per cent), S. panama (22.2 per cent) and S. brandenburg (9.2 per cent) were the three serotypes most frequently isolated. The three most frequently isolated phage types of S. typhi murium were II 505 (62.1 per cent), II 502 (5.3 per cent) and I 650 (4.2 per cent). The serotypes and phage types were present in nearly all the materials studied which again emphasizes the fact that there are contamination cycles of Salmonella. These studies showed that the route of contamination divides in the butcher's shop. Salmonella ogranisms carried with the meat frome the slaughter-house find their way into the drains on the one hand, and, by meat and meat products, to consumers on the other. Moreover, the high degree of contamination of effluents is not in accordance with the small number of cases of salmonellosis.

[Quantitative studies for the presence of Salmonellae in deep frozen broiler chickens (author's transl)]. / Onderzoekingen over het kwantitatief voorkomen van Salmonellae bij diepvrieskuikens

When poultry carcasses were examined immediately prior to deep freezing those which were contaminated with salmonellae were generally found to contain about 17/100 g skin. In two instances more than 1400 salmonellae/100 g skin were found to be present. After deep freezing and thawing a 5 fold reduction had occurred in the numbers of salmonellae present. A high positive correlation was found between the number of Salmonella organisms on the skin and that in the thaw water.

[Contamination of broiler chickens by Salmonella during processing in a number of poultry-processing plants (author's transl)]. / Salmonella-contaminatie van slachtkuikens tijdens het slachtproces in enkele pluimveeslachterijen

The mechanism of cross examination with Salmonella during processing was studied. For this purpose, various flocks were examined for the presence of Salmonella at various points in the slaughter-line during processing. The results show that not all Salmonella organisms present on the skin are killed during scalding at 55 degrees C. Contamination with Salmonella shows a marked increase during plucking. This increase is due, among other things, to the ways of processing. Evisceration did not cause a considerable change in contamination with Salmonella. It is apparent from the results that chillers may be used in a variety of ways, which has a markedly different effect on contamination. The studies show that the effect of a spinchiller is closely associated with that of processing on the whole slaughter line.

[Reduction of the number of tetracycline-resistant strains of Salmonella in the Netherlands (author's transl)]. / Afname van het aantal tetracycline-resistente Salmonella stammen in Nederland.

Since 1974, tetracycline resistance in salmonellae of human and porcine origin has decreased nation-wide in the Netherlands. This decrease had coincided with the ban on incorporation of tetracycline in animal feeds for growth-promotion.

Effects of preculturing conditions on lag time and specific growth rate of Enterobacter sakazakii in reconstituted powdered infant formula.

Enterobacter sakazakii can be present, although in low levels, in dry powdered infant formulae, and it has been linked to cases of meningitis in neonates, especially those born prematurely. In order to prevent illness, product contamination at manufacture and during preparation, as well as growth after reconstitution, must be minimized by appropriate control measures. In this publication, several determinants of the growth of E. sakazakii in reconstituted infant formula are reported. The following key growth parameters were determined: lag time, specific growth rate, and maximum population density. Cells were harvested at different phases of growth and spiked into powdered infant formula. After reconstitution in sterile water, E. sakazakii was able to grow at temperatures between 8 and 47 degrees C. The estimated optimal growth temperature was 39.4 degrees C, whereas the optimal specific growth rate was 2.31 h(-1). The effect of temperature on the specific growth rate was described with two secondary growth models. The resulting minimum and maximum temperatures estimated with the secondary Rosso equation were 3.6 degrees C and 47.6 degrees C, respectively. The estimated lag time varied from 83.3 +/- 18.7 h at 10 degrees C to 1.73 +/- 0.43 h at 37 degrees C and could be described with the hyperbolic model and reciprocal square root relation. Cells harvested at different phases of growth did not exhibit significant differences in either specific growth rate or lag time. Strains did not have different lag times, and lag times were short given that the cells had spent several (3 to 10) days in dry powdered infant formula. The growth rates and lag times at various temperatures obtained in this study may help in calculations of the period for which reconstituted infant formula can be stored at a specific temperature without detrimental impact on health.