• Uitbraak door norovirus genogroep I op de camping.

      van der Moeren, N; Raven, CFH (2019-11-03)
    • Een uitbraak met Campylobacter fetus na het eten van rauwmelkse schapenkaas : Hoe traceer je de bron van een uitbraak

      Koppenaal, H; Groenendijk, F; van den Berge, M; Verkade, E; Verduin, K; Zomer, A L; Duim, B; Wagenaar, J A; Tijsma, A S L; Spierenburg, M A H; et al. (2017-10-17)
      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.
    • Ultra-processed food consumption patterns among older adults in the Netherlands and the role of the food environment.

      Pinho, Maria Gabriela M; Lakerveld, Jeroen; Harbers, Marjolein C; Sluijs, Ivonne; Vermeulen, Roel; Huss, Anke; Boer, Jolanda M A; Verschuren, W M Monique; Brug, Johannes; Beulens, Joline W J; et al. (2020-11-24)
    • Uncovering Distinct Primary Vaccination-Dependent Profiles in Human Specific CD4+ T-Cell Responses Using a Novel Whole Blood Assay.

      Lambert, Eleonora E; Corbière, Véronique; van Gaans-van den Brink, Jacqueline A M; Duijst, Maxime; Venkatasubramanian, Prashanna Balaji; Simonetti, Elles; Huynen, Martijn; Diavatopoulos, Dimitri D; Versteegen, Pauline; Berbers, Guy A M; et al. (2020-05-15)
      To advance research and development of improved pertussis vaccines, new immunoassays are needed to qualify the outcome of Bordetella pertussis (Bp) specific CD4+ T-cell differentiation. Here, we applied a recently developed whole blood assay to evaluate Bp specific CD4+ T-cell responses. The assay is based on intracellular cytokine detection after overnight in vitro Bp antigen stimulation of diluted whole blood. We show for the first time that CD4+ T-cell memory of Th1, Th2, and Th17 lineages can be identified simultaneously in whole blood. Participants ranging from 7 to 70 years of age with different priming backgrounds of whole-cell pertussis (wP) and acellular pertussis (aP) vaccination were analyzed around an acellular booster vaccination. The assay allowed detection of low frequent antigen-specific CD4+ T-cells and revealed significantly elevated numbers of activated and cytokine-producing CD4+ T-cells, with a significant tendency to segregate recall responses based on primary vaccination background. A stronger Th2 response hallmarked an aP primed cohort compared to a wP primed cohort. In conclusion, analysis of Bp specific CD4+ T-cell responses in whole blood showed separation based on vaccination background and provides a promising tool to assess the quantity and quality of CD4+ T-cell responses induced by vaccine candidates.
    • Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews.

      Fournet, N; Mollema, L; Ruijs, W L; Harmsen, I A; Keck, F; Durand, J Y; Cunha, M P; Wamsiedel, M; Reis, R; French, J; et al. (2018-01-30)
      Despite effective national immunisation programmes in Europe, some groups remain incompletely or un-vaccinated ('under-vaccinated'), with underserved minorities and certain religious/ideological groups repeatedly being involved in outbreaks of vaccine preventable diseases (VPD). Gaining insight into factors regarding acceptance of vaccination of 'under-vaccinated groups' (UVGs) might give opportunities to communicate with them in a trusty and reliable manner that respects their belief system and that, maybe, increase vaccination uptake. We aimed to identify and describe UVGs in Europe and to describe beliefs, attitudes and reasons for non-vaccination in the identified UVGs.
    • Underreporting of meningococcal disease incidence in the Netherlands: results from a capture-recapture analysis based on three registration sources with correction for false positive diagnoses.

      Greeff, Sabine C de; Spanjaard, Lodewijk; Dankert, Jacob; Hoebe, Christian J P A; Nagelkerke, Nico J D; Melker, Hester E de (2006-05-10)
      In order to come to a reliable evaluation of the effectiveness of the chosen vaccination policy regarding meningococcal disease, the completeness of registrations on meningococcal disease in the Netherlands was estimated with the capture-recapture method. Data over 1993-1998 were collected from (A) mandatory notifications (n = 2926); (B) hospital registration (n = 3968); (C) laboratory surveillance (n = 3484). As the standard capture-recapture method does not take into account false positive diagnoses, we developed a model to adjust for the lack of specificity of our sources. We estimated that 1363 cases were not registered in any of the three sources in the period of study. The completeness of the three sources was therefore estimated at 49% for source A, 67% for source B and 58% for source C. After adjustment for false positive diagnoses, the completeness of source A, B, and C was estimated as 52%, 70% and 62%, respectively. The capture-recapture methods offer an attractive approach to estimate the completeness of surveillance sources and hence contribute to a more accurate estimate of the disease burden under study. However, the method does not account for higher-order interactions or presence of false positive diagnoses. Being aware of these limitations, the capture-recapture method still elucidates the (in)completeness of sources and gives a rough estimate of this (in)completeness. This makes a more accurate monitoring of disease incidence possible and hence attributes to a more reliable foundation for the design and evaluation of health interventions such as vaccination programs.
    • Understanding conflicting views of endocrine disruptor experts: a pilot study using argumentation analysis

      Clahsen, SCS; van Klaveren, HS; Vermeire, TG; van Kamp, I; Garssen, B; Piersma, AH; Lebret, E (2019-01-28)
    • Understanding correlates of neighborhood aesthetic ratings: A European-based four city comparison.

      Zijlema, WL; Triguero-Mas, M; Cirach, M; Gidlow, C; Kruize, H; Grazuleviciene, R; Nieuwenhuijsen, MJ; Litt, JS (2019-12-12)
    • Understanding Dissolution Rates via Continuous Flow Systems with Physiologically Relevant Metal Ion Saturation in Lysosome.

      Keller, Johannes G; Peijnenburg, Willie; Werle, Kai; Landsiedel, Robert; Wohlleben, Wendel (2020-02-12)
      Dissolution rates of nanomaterials can be decisive for acute in vivo toxicity (via the released ions) and for biopersistence (of the remaining particles). Continuous flow systems (CFSs) can screen for both aspects, but operational parameters need to be adjusted to the specific physiological compartment, including local metal ion saturation. CFSs have two adjustable parameters: the volume flow-rate and the initial particle loading. Here we explore the pulmonary lysosomal dissolution of nanomaterials containing the metals Al, Ba, Zn, Cu over a wide range of volume flow-rates in a single experiment. We identify the ratio of particle surface area (SA) per volume flow-rate (SA/V) as critical parameter that superimposes all dissolution rates of the same material. Three complementary benchmark materials-ZnO (quick dissolution), TiO2 (very slow dissolution), and BaSO4 (partial dissolution)-consistently identify the SA/V range of 0.01 to 0.03 h/cm as predictive for lysosomal pulmonary biodissolution. We then apply the identified method to compare against non-nanoforms of the same substances and test aluminosilicates. For BaSO4 and TiO2, we find high similarity of the dissolution rates of their respective nanoform and non-nanoform, governed by the local ion solubility limit at relevant SA/V ranges. For aluminosilicates, we find high similarity of the dissolution rates of two Kaolin nanoforms but significant dissimilarity against Bentonite despite the similar composition.
    • Unifying the functional diversity in natural and cultivated soils using the overall body-mass distribution of nematodes.

      Mulder, Christian; Maas, Rob (2017-11-28)
      Sustainable use of our soils is a key goal for environmental protection. As many ecosystem services are supported belowground at different trophic levels by nematodes, soil nematodes are expected to provide objective metrics for biological quality to integrate physical and chemical soil variables. Trait measurements of body mass carried out at the individual level can in this way be correlated with environmental properties that influence the performance of soil biota.
    • Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant microorganisms (MDRO) in a Dutch tertiary care centre (2016 - 2019).

      van Hout, Denise; Bruijning-Verhagen, Patricia C J; Blok, Hetty; Troelstra, Annet; Bonten, Marc J M (2020-12-18)
      We performed a cross-sectional study using routine healthcare data in a Dutch tertiary hospital between January 1st 2015 and August 1st 2019. MDRO risk assessment upon hospitalization included assessment of: known MDRO carriage, previous hospitalization in another Dutch hospital during an outbreak or a foreign hospital, living in an asylum centre, exposure to livestock farming and household membership of a methicillin-resistant Staphylococcus aureus carrier.
    • Unknown makes unloved-A case study on improving integrated health and social care in the Netherlands using a participatory approach.

      Lette, Manon; Boorsma, Marijke; Lemmens, Lidwien; Stoop, Annerieke; Nijpels, Giel; Baan, Caroline; de Bruin, Simone (2020-03-01)
    • Unlike dietary restriction, rapamycin fails to extend lifespan and reduce transcription stress in progeroid DNA repair-deficient mice.

      Birkisdóttir, María B; Jaarsma, Dick; Brandt, Renata M C; Barnhoorn, Sander; van Vliet, Nicole; Imholz, Sandra; van Oostrom, Conny T; Nagarajah, Bhawani; Portilla Fernández, Eliana; Roks, Anton J M; et al. (2021-01-23)
      Dietary restriction (DR) and rapamycin extend healthspan and life span across multiple species. We have recently shown that DR in progeroid DNA repair-deficient mice dramatically extended healthspan and trippled life span. Here, we show that rapamycin, while significantly lowering mTOR signaling, failed to improve life span nor healthspan of DNA repair-deficient Ercc1∆/- mice, contrary to DR tested in parallel. Rapamycin interventions focusing on dosage, gender, and timing all were unable to alter life span. Even genetically modifying mTOR signaling failed to increase life span of DNA repair-deficient mice. The absence of effects by rapamycin on P53 in brain and transcription stress in liver is in sharp contrast with results obtained by DR, and appoints reducing DNA damage and transcription stress as an important mode of action of DR, lacking by rapamycin. Together, this indicates that mTOR inhibition does not mediate the beneficial effects of DR in progeroid mice, revealing that DR and rapamycin strongly differ in their modes of action.
    • Unraveling the Complexity in the Design and Implementation of Bundled Payments: A Scoping Review of Key Elements From a Payer's Perspective.

      Steenhuis, Sander; Struijs, Jeroen; Koolman, Xander; Ket, Johannes; VAN DER Hijden, Eric (2020-03-01)
    • Unraveling the diurnal atmospheric ammonia budget of a prototypical convective boundary layer.

      Schulte, RB; van Zanten, MC; Rutledge-Jonker, S; Swart, DPJ; Wichink Kruit, RJ; Krol, MC; van Pul, WAJ (2021-02-11)
    • Unraveling the drivers of regional variation in healthcare spending by analyzing prevalent chronic diseases.

      de Vries, Eline F; Heijink, Richard; Struijs, Jeroen N; Baan, Caroline A (2018-05-03)
      To indicate inefficiencies in health systems, previous studies examined regional variation in healthcare spending by analyzing the entire population. As a result, population heterogeneity is taken into account to a limited extent only. Furthermore, it clouds a detailed interpretation which could be used to inform regional budget allocation decisions to improve quality of care of one chronic disease over another. Therefore, we aimed to gain insight into the drivers of regional variation in healthcare spending by studying prevalent chronic diseases.
    • Unveiling the important roles of coexisting contaminants on photochemical transformations of pharmaceuticals: Fibrate drugs as a case study.

      Zhang, Ya-Nan; Zhou, Yangjian; Qu, Jiao; Chen, Jingwen; Zhao, Jianchen; Lu, Ying; Li, Chao; Xie, Qing; Peijnenburg, Willie J G M (2018-09-15)
      Pharmaceuticals are a group of ubiquitous emerging pollutants, many of which have been shown to undergo efficient photolysis in the environment. Photochemically produced reactive intermediates (PPRIs) sensitized by the pharmaceuticals in sunlit natural waters may induce photodegradation of coexisting compounds. In this study, the roles of coexisting contaminants on the phototransformation of pharmaceuticals were unveiled with the fibrate drugs gemfibrozil (GMF), fenofibrate (FNF), and fenofibric acid (FNFA) as model compounds. GMF undergoes initial concentration dependent photodegradation due to the involvement of singlet oxygen (1O2) initiated self-sensitized photolysis, and undergoes pH dependent photodegradation due to dissociation and hydroxyl radical (OH) generation. The decarboxylated intermediates of GMF and coexisting FNFA significantly accelerated the photodegradation of GMF. The promotional effects of the decarboxylated intermediates are attributed to generation of PPRIs, e.g. 1O2, superoxide (O2-), that subsequently react with GMF. Besides, FNFA can also promote the photodegradation of GMF through the electron transfer reaction from ground state GMF to excited state FNFA, leading to the formation of decarboxylated intermediates. The formed intermediates can subsequently also facilitate GMF photodegradation. The results presented here provided valuable novel insights into the effects of coexisting contaminants on the photodegradation of pharmaceuticals in polluted waters.
    • Update on Neonatal Herpes Simplex Epidemiology in the Netherlands: A Health Problem of Increasing Concern?

      van Oeffelen, Louise; Biekram, Manisha; Poeran, Jashvant; Hukkelhoven, Chantal; Galjaard, Sander; van der Meijden, Wim; Op de Coul, Eline (2018-01-18)
      This paper provides an update on the incidence of neonatal herpes, guideline adherence by health care professionals (HCP), and trends in genital herpes simplex virus (HSV) infection during pregnancy in the Netherlands.