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This article examines the treatment of stage I colorectal cancers (CRCs) detected within and outside of a screening program in the Netherlands. The study found that screen-detected stage I CRCs were more likely to be treated less invasively, while non-screen-detected stage I CRCs were more likely to undergo surgical oncologic resection. The reasons for this difference in treatment are not fully understood, but factors such as tumor location and differentiation may play a role. Further research is needed to better understand the factors driving these treatment differences. The article does not provide specific details about the researchers mentioned, making it difficult to form any judgments or opinions about their work. [Extracted from the article]

It is unknown whether Ivor Lewis (IL) or McKeown (McK) esophagectomy is preferred in patients with potentially curable esophageal or gastro-esophageal junction (GEJ) cancer. Patients with mid- and distal esophageal and GEJ cancer without distant metastases who underwent IL or McK esophagectomy in the Netherlands between 2015 and 2017, were selected from the Netherlands Cancer Registry. Patients were propensity score matched for sex, age, American Society of Anesthesiologist classification, comorbidity, tumor type, tumor location, clinical stage, neoadjuvant treatment and year of diagnosis. The primary outcome was a 3-year relative survival (RS). Secondary outcome parameters were number of lymph nodes examined, number of positive lymph nodes, radical resection rate, tumor regression grade, post-operative complications and mortality. A total of 1627 patients who underwent IL (n  = 1094) or McK (n  = 533) esophagectomy were included. Patient and tumor characteristics were balanced after propensity score matching, leaving 658 patients to be compared. The 3-year RS was 54% after IL and 50% after McK esophagectomy, P  = 0.140. The median number of lymph nodes examined, median number of positive lymph nodes, radical resection rate and tumor regression grade were comparable between both groups. Recurrent laryngeal nerve palsy (2 vs. 5%, P  = 0.006) occurred less frequently after IL esophagectomy. No differences were observed in post-operative anastomotic leakage rate, pulmonary complication rate and mortality rates. There was no statistically significant difference in the 3-year RS between IL and McK esophagectomy. Based on these results, both IL and McK esophagectomy can be performed in patients with mid to distal esophageal and GEJ cancer. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Does a short interval (i.e. ≤90 min), compared to a long interval (i.e. ≥180 min), between semen collection and intrauterine insemination (IUI) increase the cumulative chance of an ongoing pregnancy after six IUI cycles? SUMMARY ANSWER A long interval between semen collection and IUI resulted in a borderline significant improvement in cumulative ongoing pregnancies and a statistically significant shorter time to pregnancy. WHAT IS KNOWN ALREADY Retrospective studies assessing the effect of the time interval between semen collection and IUI on pregnancy outcomes have shown inconclusive results. Some studies have indicated a beneficial effect of a short interval between semen collection and IUI on IUI outcomes, while others have not found any differences. To date, no prospective trials have been published on this subject. STUDY DESIGN, SIZE, DURATION The study was performed as a non-blinded, single-center RCT with 297 couples undergoing IUI treatment in a natural or stimulated cycle. The study was conducted between February 2012 and December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Couples with unexplained or mild male subfertility and an indication for IUI were randomly assigned for up to six IUI cycles into either the control group (long interval, i.e. 180 min or more between semen collection and insemination) or the study group (short interval, i.e. insemination as soon as possible after semen processing and within 90 min of semen collection). The study was carried out in an academic hospital-based IVF center in the Netherlands. The primary endpoint of the study was ongoing pregnancy rate per couple, defined as a viable intrauterine pregnancy at 10 weeks after insemination. MAIN RESULTS AND THE ROLE OF CHANCE In the short interval group, 142 couples were analyzed versus 138 couples in the long interval group. In the intention-to-treat (ITT) analysis, the cumulative ongoing pregnancy rate was significantly higher in the long interval group (71/138; 51.4%) compared to that in the short interval group (56/142; 39.4%; relative risks 0.77; 95% CI 0.59–0.99; P  = 0.044). The time to pregnancy was significantly shorter in the long interval group (log-rank test, P  = 0.012). A Cox regression analysis showed similar results (adjusted hazard ratio 1.528, 95% CI 1.074–2.174, P  = 0.019). LIMITATIONS, REASONS FOR CAUTION Limitations of our study are the non-blinded design, the long inclusion and follow-up period of nearly seven years and the large number of protocol violations, especially because they predominantly occurred in the short interval group. The non-significant results in the per-protocol (PP) analyses and the weaknesses of the study should be taken into account in the assessment of the borderline significance of the results in the ITT analyses. WIDER IMPLICATIONS OF THE FINDINGS Because it is not necessary to perform the IUI immediately after semen processing, there can be more time available to choose the optimum work-flow and clinic occupancy. Clinics and laboratories should find their optimal timing of insemination, considering the time between human chorionic gonadotropin injection and insemination in relation to the sperm preparation techniques used as well as the storage time and conditions until insemination. STUDY FUNDING/COMPETING INTEREST(S) There were no external funding and no competing interests to declare. TRIAL REGISTRATION NUMBER Dutch trial registry, trial registration number NTR3144. TRIAL REGISTRATION DATE 14 November 2011. DATE OF FIRST PATIENT'S ENROLLMENT 5 February 2012. [ABSTRACT FROM AUTHOR]

Background: In 2014, the national population-based colorectal cancer (CRC) screening program was implemented in the Netherlands. Biennial fecal immunochemical testing (FIT) for hemoglobin (Hb) is used at a cut-off of 47 µg Hb per gram feces. The CRC screening program successfully started, with high participation rates and yield of screening. Now that the program has reached a steady state, there is potential to further optimize the program. Previous studies showed that prior fecal Hb (f-Hb) concentrations just below the FIT cut-off are associated with a higher risk for detection of advanced neoplasia (AN) at subsequent screening rounds. We aim to achieve a better balance between the harms and benefits of CRC screening by offering participants tailored invitation intervals based on prior f-Hb concentrations after negative FIT. Methods: This mixed-methods study will be performed within the Dutch national CRC screening program and will consist of: (1) a randomized controlled trial (RCT), (2) focus group studies, and (3) decision modelling. The primary outcome is the yield of AN per screened individual in personalized screening vs. uniform screening. Secondary outcomes are perspectives on, acceptability of and adherence to personalized screening, as well as long-term outcomes of personalized vs. uniform screening. The RCT will include 20,000 participants of the Dutch CRC screening program; 10,000 in the intervention and 10,000 in the control arm. The intervention arm will receive a personalized screening interval based on the prior f-Hb concentration (1, 2 or 3 years). The control arm will receive a screening interval according to current practice (2 years). The focus group studies are designed to understand individuals' perspectives on and acceptability of personalized CRC screening. Results of the RCT will be incorporated into the MISCAN-Colon model to determine long-term benefits, harms, and costs of personalized vs. uniform CRC screening. Discussion: The aim of this study is to evaluate the yield, feasibility, acceptability and (cost-) effectiveness of personalized CRC screening through tailored invitation intervals based on prior f-Hb concentrations. This knowledge may be of guidance for health policy makers and may provide evidence for implementing personalized CRC screening in The Netherlands and/or other countries using FIT as screening modality. Trial registration: ClinicalTrials.gov, NCT05423886, June 21, 2022, https://clinicaltrials.gov/ct2/show/NCT05423886 [ABSTRACT FROM AUTHOR]

Background: The probability of undergoing treatment with curative intent according to the hospital of diagnosis varies for esophagogastric cancer in the Netherlands. Little is known about the factors contributing to this variation. This study aimed to improve the understanding of the differences between the multidisciplinary team meeting treatment proposal and the treatment that was actually carried out and to qualitatively investigate the differences in treatment decision‐making after the multidisciplinary team meeting treatment proposal between hospitals. Methods: To gain an in‐depth understanding of treatment decision‐making, quantitative data (i.e., multidisciplinary team meeting proposal and treatment that was carried out) were collected from the Netherlands Cancer Registry. Changes in the multidisciplinary team meeting proposal and applied treatment comprised changes in the type of treatment option (i.e., curative or palliative, or no change) and were calculated according to the multivariable multilevel probability of undergoing treatment with curative intent (low, middle, and high). Qualitative data were collected from eight hospitals, including observations of 26 outpatient clinic consultations, 30 in‐depth interviews with clinicians, seven focus groups with clinicians, and three focus groups with patients. Clinicians and patients' perspectives were assessed using thematic content analysis. Results: The multidisciplinary team meeting proposal and applied treatment were concordant in 97% of the cases. Clinicians' implementation of treatment decision‐making in clinical practice varied, which was mentioned by the clinicians to be due to the clinician's personality and values. Differences between clinicians consisted of discussing all treatment options versus only the best fitting treatment option and the extent of discussing the benefits and harms. Most patients aimed to undergo curative treatment regardless of the consequences, since they believed this could prolong their life. Conclusion: Since changes in the multidisciplinary team meeting‐proposed treatment and actual treatment were rarely observed, this study emphasizes the importance of an adequately formulated multidisciplinary team meeting proposal. [ABSTRACT FROM AUTHOR]

Background: The Netherlands is currently considered a low endemic country for carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE), experiencing only sporadic hospital outbreaks. This study aims to describe susceptibility to carbapenems and the epidemiology of carbapenemase production in Enterobacterales in the Netherlands in 2017–2019. Methods: Three complementary nationwide surveillance systems are in place to monitor carbapenem susceptibility in the Netherlands. Routine antimicrobial susceptibility test results from medical microbiology laboratories were used to study phenotypic susceptibility of Escherichia coli and Klebsiella pneumoniae. Pathogen surveillance (of all Enterobacterales species) and mandatory notifications were used to describe the characteristics of CPE positive isolates and affected persons. Results: The prevalence of isolates with gradient strip test-confirmed elevated meropenem (> 0.25 mg/L) or imipenem (> 1 mg/L) minimum inhibitory concentration (MIC) in the Netherlands was very low in 2017–2019, with percentages of 0.06% in E. coli and 0.49% in K. pneumoniae, and carbapenem resistances of 0.02% and 0.18%, respectively. A total of 895 unique species/carbapenemase-encoding allele combinations of CPE from 764 persons were submitted between 2017 and 2019, with the annual number of submissions increasing slightly each year. Epidemiological data was available for 660 persons. Screening because of presumed colonisation risk was the reason for sampling in 70.0% (462/660) of persons. Hospitalization abroad was the most common risk factor, being identified in 45.9% of persons. Conclusions: Carbapenem resistance of E. coli and K. pneumoniae remains low in the Netherlands. The annual number of CPE isolates slightly increased during the period 2017–2019. Recent hospitalization abroad is the main risk factor for acquisition of CPE. [ABSTRACT FROM AUTHOR]

Chronic pain is frequently reported after total hip and knee arthroplasties (THA/TKA) in osteoarthritis (OA) patients. We investigated if severity of acute postoperative pain following THA/TKA in OA patients was associated with pain during the first postoperative year. From an observational study, OA patients scheduled for primary THA/TKA (June 2012–December 2017) were included from two hospitals in the Netherlands. Acute postoperative pain scores were collected within 72 h postoperatively and categorized as no/mild (NRS ≤ 4) or moderate/severe (NRS > 4). Pain was assessed preoperatively, 3, 6 and 12 months postoperatively using the HOOS/KOOS subscale pain. With Multilevel Mixed-effects-analyses, we estimated associations between acute and chronic pain until one year postoperative, adjusted for confounders and including an interaction term (Time*Acute pain). 193 THA and 196 TKA patients were included, 29% of THA and 51% of TKA patients reported moderate/severe pain acutely after surgery. In the THA group, the difference in pain at 3 months between the no/mild and moderate/severe groups, was approximately six points, in favor of the no/mild group (95% CI [−12.4 to 0.9]) this difference became smaller over time. In the TKA group we found similar differences, with approximately four points (95% CI [−9.6 to 1.3]) difference between the no/mild and moderate/severe group at 6 months, this difference attenuated at 12 months. No association between severity of acute postoperative pain and pain during the first postoperative year was found. These findings suggest that measures to limit acute postoperative pain will likely not impact development of chronic pain. [ABSTRACT FROM AUTHOR]

Gene fusions involving NTRK1, NTRK2, and NTRK3 are rare drivers of cancer that can be targeted with histology-agnostic inhibitors. This study aimed to determine the nationwide landscape of NTRK/TRK testing in the Netherlands and the usage of pan-TRK immunohistochemistry (IHC) as a preselection tool to detect NTRK fusions. All pathology reports in 2017–2020 containing the search term 'TRK' were retrieved from the Dutch Pathology Registry (PALGA). Patient characteristics, tumor histology, NTRK/TRK testing methods, and reported results were extracted. NTRK/TRK testing was reported for 7457 tumors. Absolute testing rates increased from 815 (2017) to 3380 (2020). Tumors were tested with DNA/RNA-based molecular assay(s) (48%), IHC (47%), or in combination (5%). A total of 69 fusions involving NTRK1 (n = 22), NTRK2 (n = 6) and NTRK3 (n = 41) were identified in tumors from adult (n = 51) and pediatric (n = 18) patients. In patients tested with both IHC and a molecular assay (n = 327, of which 29 NTRK fusion-positive), pan-TRK IHC had a sensitivity of 77% (95% confidence interval (CI), 56–91) and a specificity of 84% (95% CI, 78–88%). These results showed that pan-TRK IHC has a low sensitivity in current routine practice and warrants the introduction of quality guidelines regarding the implementation and interpretation of pan-TRK IHC. [ABSTRACT FROM AUTHOR]

Summary: Studies on the conditional life expectancy of patients with chronic myeloid leukaemia (CML) are lacking. Using data from the Netherlands Cancer Registry, we examined the life expectancy of patients with CML in the Netherlands diagnosed during 1989–2018. As of the early 2010s, the life expectancy of patients with CML who survived several years after diagnosis came narrowly close to the general population's life expectancy, regardless of age. This finding can essentially be ascribed to the introduction and broader application of tyrosine kinase inhibitors (TKIs) and provide optimism to patients with CML who can look forward to a near‐normal life expectancy in a modern TKI era. [ABSTRACT FROM AUTHOR]

Background: Given the major changes in internet use for health communication, the objective of the current study was to compare the internet use and wishes of cancer survivors between 2005 and 2017.Methods: The authors drew a sample of 390 patients in 2005 and 539 patients in 2017 who were diagnosed with breast (128 patients in 2005 and 143 patients in 2017), prostate (96 patients in 2005 and 126 patients in 2017), or gynecologic (89 patients in 2005 and 188 patients in 2017) cancer or lymphoma (77 patients in 2005 and 82 patients in 2017) in 4 different hospitals for the periods 2002 through 2004 and 2014 through 2016. These patients were sent a paper-based questionnaire that contained 45 questions regarding demographics and 4 functions of internet use: content, communication, community, and e-health.Results: The response in 2017 (53%) was lower than that in 2005 (75%). Survivors browsed the internet most frequently to search for information regarding cancer shortly after being diagnosed and while waiting for treatment. There was little change noted with regard to the relative importance attached to the various subjects. In 2017, significant increases were evident with regard to finances (+33%), health care insurance (+29%), and genetics and/or heritability (+27%). The wishes expressed in 2005 by patients were realized in part in 2017.Conclusions: A significant sample of cancer survivors in the Netherlands have indicated that the internet is an important source of information regarding their illness. However, little change was evident over the past 15 years with regard to patients' priorities regarding their wishes for internet use. The wishes of users in 2005 were found to accurately reflect the internet use of the majority of patients in 2017. The results of the current study support the belief that health care professionals should expand their online services and tailor them toward the needs and wishes of their patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the consequences of the new definition of rectal cancer for decision‐making in multidisciplinary team meetings (MDT). The new definition of rectal cancer, the lower border of the tumour is located below the sigmoid take‐off (STO), was implemented in the Dutch guideline in 2019 after an international Delphi consensus meeting to reduce interhospital variations. Method: All patients with rectal cancer according to the local MDT, who underwent resection in 2016 in the Netherlands were eligible for this nationwide collaborative cross‐sectional study. MRI‐images were rereviewed, and the tumours were classified as above or on/below the STO. Results: This study registered 3107 of the eligible 3178 patients (98%), of which 2784 patients had an evaluable MRI. In 314 patients, the tumour was located above the STO (11%), with interhospital variation between 0% and 36%. Based on TN‐stage, 175 reclassified patients with colon cancer (6%) would have received different treatment (e.g., omitting neoadjuvant radiotherapy, candidate for adjuvant chemotherapy). Tumour location above the STO was independently associated with lower risk of 4‐year locoregional recurrence (HR 0.529; p = 0.030) and higher 4‐year overall survival (HR 0.732; p = 0.037) compared to location under the STO. Conclusion: By using the STO, 11% of the prior MDT‐based diagnosis of rectal cancer were redefined as sigmoid cancer, with potential implications for multimodality treatment and prognostic value. Given the substantial interhospital variation in proportion of redefined cancers, the use of the STO will contribute to standardisation and comparability of outcomes in both daily practice and trial settings. [ABSTRACT FROM AUTHOR]

Most youth in residential youth care institutions have a long history of adverse childhood experiences, and show (severe) emotional, behavioral, and academic problems. The present study used adolescent self-report questionnaires to examine associations between living group climate, classroom climate, identification with school, general self-worth and academic self-concept of students attending schools for special education in residential youth care institutions in the Netherlands. The sample consisted of 184 adolescents (63.6% male, age M = 16.40, SD = 1.99) with severe emotional and behavioral problems. Results showed a weak association between living group climate and classroom climate, and somewhat stronger associations between classroom climate, identification with school and general self-worth on the one hand and academic self-concept on the other hand. We conclude that group workers and teachers should collaborate for the benefit of integrated care and education in residential youth care facilities. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic is more than a public health crisis. Lockdown measures have substantial societal effects, including a significant impact on parents with (young) children. Given the existence of persistent gender inequality prior to the pandemic, particularly among parents, it is crucial to study the societal impact of COVID-19 from a gender perspective. The objective of this paper is to use representative survey data gathered among Dutch parents in April 2020 to explore differences between mothers and fathers in three areas: paid work, the division of childcare and household tasks, and three dimensions of quality of life (leisure, work-life balance, relationship dynamics). Additionally, we explore whether changes take place in these dimensions by comparing the situation prior to the lockdown with the situation during the lockdown. Method: We use descriptive methods (crosstabulations) supported by multivariate modelling (linear regression modelling for continuous outcomes; linear probability modelling (LPM) for binary outcomes (0/1 outcomes); and multinomial logits for multinomial outcomes) in a cross-sectional survey design. Results: Results show that the way in which parents were impacted by the COVID-19 pandemic reflects a complex gendered reality. Mothers work in essential occupations more often than fathers, report more adjustments of the times at which they work, and experience both more and less work pressure in comparison to before the lockdown. Moreover, mothers continue to do more childcare and household work than fathers, but some fathers report taking on greater shares of childcare and housework during the lockdown in comparison to before. Mothers also report a larger decline in leisure time than fathers. We find no gender differences in the propensity to work from home, in perceived work-life balance, or in relationship dynamics. Conclusion: In conclusion, we find that gender inequality in paid work, the division of childcare and household work, and the quality of life are evident during the first lockdown period. Specifically, we find evidence of an increase in gender inequality in relation to paid work and quality of life when comparing the situation prior to and during the lockdown, as well as a decrease in gender inequality in the division of childcare and household work. We conclude that the unique situation created by restrictive lockdown measures magnifies some gender inequalities while lessening others. Discussion: The insights we provide offer key comparative evidence based on a representative, probability-based sample for understanding the broader impact of lockdown measures as we move forward in the COVID-19 pandemic. One of the limitations in this study is the cross-sectional design. Further study, in the form of a longitudinal design, will be crucial in investigating the long-term impact of the COVID-19 pandemic on gender inequality. [ABSTRACT FROM AUTHOR]

Objectives : Oral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood. Methods: Within the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants. Research outcomes: In total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health–related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements. Conclusions: Several research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study. Clinical relevance: Being embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population. [ABSTRACT FROM AUTHOR]

Background and purpose — Dislocation is the leading reason for early revision surgery after total hip arthroplasty (THA). The dual-mobility (DM) cup was developed to provide more stability and mechanically reduce the risk of dislocation. Despite the increased use of DM cups, high-quality evidence of their (cost-)effectiveness is lacking. The primary objective of this randomized controlled trial (RCT) is to investigate whether there is a difference in the number of hip dislocations following primary THA, using the posterolateral approach, with a DM cup compared with a unipolar (UP) cup in elderly patients 1 year after surgery. Secondary outcomes include the number of revision surgeries, patient-reported outcome measures (PROMs), and cost-effectiveness. Methods and analysis — This is a prospective multicenter nationwide, single-blinded RCT nested in the Dutch Arthroplasty Registry. Patients ≥ 70 years old, undergoing elective primary THA using the posterolateral approach, will be eligible. After written informed consent, 1,100 participants will be randomly allocated to the intervention or control group. The intervention group receives a THA with a DM cup and the control group a THA with a UP cup. PROMs are collected preoperatively, and 3 months, 1 and 2 years postoperatively. Primary outcome is the difference in number of dislocations between the UP and DM cup within 1 year, reported in the registry (revisions), or by the patients (closed or open reduction). Data will be analyzed using multilevel models as appropriate for each outcome (linear/logistic/survival). An economic evaluation will be performed from the healthcare and societal perspective, for dislocation and quality adjusted life years (QALYs). Trial registration — This RCT is registered at with identification number NCT04031820. [ABSTRACT FROM AUTHOR]

The introduction of bowel cancer population screening programs has had a profound impact on gastrointestinal pathology. While the focus is mainly on quality assurance of diagnoses relevant for the outcome of these programs (colorectal cancer and its precursors), incidental findings are increasingly diagnosed. The incidence of such findings is largely unknown. Therefore, we investigated the incidence of incidental findings within the national screening program of the Netherlands. From the Dutch nationwide pathology databank (PALGA), we retrieved all histological diagnoses of patients participating in the national bowel cancer screening program from the start in 2014 until 1/ 1/2021. Descriptive statistics were used. During these 7 years, in total 9407 other polyps and malignancies (262 per 10,000 colonoscopies) were diagnosed. The majority (65%) were classified as inflammatory polyps. The most common malignancies were neuroendocrine tumours (n = 198, 6 per 10,000 colonoscopies); less common were lymphomas (n = 64) and metastases (n = 33). Mesenchymal polyps, such as leiomyomas and lipomas, were relatively common (27 and 16 per 10,000 colonoscopies, respectively), in comparison with neural polyps such as perineuriomas, ganglioneuromas, and neurofibromas (respectively 3, 2, and 1 per 10,000 colonoscopies). This is the largest study into the incidence of nonconventional colorectal polyps and malignancies in a homogeneous cohort of asymptomatic patients. Several of these diagnoses may have consequences for treatment and followup, in particular the malignancies and detection of patients with hereditary cancer syndromes. [ABSTRACT FROM AUTHOR]

The introduction of bowel cancer population screening programs has had a profound impact on gastrointestinal pathology. While the focus is mainly on quality assurance of diagnoses relevant for the outcome of these programs (colorectal cancer and its precursors), incidental findings are increasingly diagnosed. The incidence of such findings is largely unknown. Therefore, we investigated the incidence of incidental findings within the national screening program of the Netherlands. From the Dutch nationwide pathology databank (PALGA), we retrieved all histological diagnoses of patients participating in the national bowel cancer screening program from the start in 2014 until 1/1/2021. Descriptive statistics were used. During these 7 years, in total 9407 other polyps and malignancies (262 per 10,000 colonoscopies) were diagnosed. The majority (65%) were classified as inflammatory polyps. The most common malignancies were neuroendocrine tumours (n = 198, 6 per 10,000 colonoscopies); less common were lymphomas (n = 64) and metastases (n = 33). Mesenchymal polyps, such as leiomyomas and lipomas, were relatively common (27 and 16 per 10,000 colonoscopies, respectively), in comparison with neural polyps such as perineuriomas, ganglioneuromas, and neurofibromas (respectively 3, 2, and 1 per 10,000 colonoscopies). This is the largest study into the incidence of nonconventional colorectal polyps and malignancies in a homogeneous cohort of asymptomatic patients. Several of these diagnoses may have consequences for treatment and follow‐up, in particular the malignancies and detection of patients with hereditary cancer syndromes. [ABSTRACT FROM AUTHOR]

Greenhouse gas (GHG) emissions from drained peatlands have been studied extensively. Considerably less attention has been paid to the emissions from the ditches used to drain peatlands. High within‐ditch GHG production and lateral inflow of GHGs may lead to ditches emitting considerable amounts of GHGs on the landscape scale.We quantified annual emissions of ebullitive and diffusive methane (CH4), carbon dioxide (CO2), and nitrous oxide (N2O) in 10 drainage ditches in intensively used temperate peatlands used for dairy farming, in The Netherlands. Additionally, we assessed water and sediment quality to determine proxies for emissions via the two emission pathways.The mean annual emissions from the studied ditches varied between 3.57 and 60.1 g CO2‐eq. m−2 day−1 (based on a global warming potential over a 100‐year timeframe), where CO2 contributed on average 43% (ranging between 1.9 and 22.0 g CO2 m−2 day−1) and diffusive CH4 contributed 16% (0.1–16.5 g CO2‐eq. m−2 day−1) to the total GHG emission. Ebullition of CH4 made up nearly half of the total GHG emission (40%, 1.3–40.9 g CO2‐eq. m−2 day−1). N2O emissions were mostly low. CO2 emissions were higher in winter months, while CH4 ebullition was higher during spring and summer. Diffusive CH4 emissions did not show a seasonal pattern.The mean emission factor, the estimate of average emissions per unit area (EF), for CH4 was 2144 kg CH4 ha−1 year−1, which is two times higher than the tier 1 EF reported by the IPCC (with underrepresented ebullition data), underlining the high variability of ditch emissions.Ditch emissions were also higher than the EF used for the surrounding drained peatlands indicating that ditch emissions can be important on the landscape scale and should be considered to be included in national greenhouse gas reporting. [ABSTRACT FROM AUTHOR]

This article discusses the risk of interval post-colonoscopy colorectal cancer (iPCCRC) in individuals who have a negative colonoscopy following a positive fecal immunochemical test (FIT) in a screening program. The study conducted in the Netherlands suggests that there is a risk of iPCCRC in FIT-positive individuals, and the recommended screening interval of 10 years may not be appropriate for this population. The document provides information on the characteristics and risk factors associated with iPCCRC and interval colorectal cancer (FIT IC) after a negative FIT. The study also emphasizes the importance of colonoscopy quality in preventing iPCCRCs and suggests re-evaluating the screening interval after a negative colonoscopy in FIT-based programs. [Extracted from the article]

Simple Summary: Oropharyngeal dysphagia (OD), malnutrition, sarcopenia, and frailty often co-occur with head-and-neck cancer (HNC) and may affect treatment outcomes, but the presence, severity, and consequences of these phenomena vary from patient to patient. It is a challenge to predict which patients have a higher risk of these phenomena, and early identification using a 'quick and easy' multi-domain screening may allow us to obtain a more holistic view of the patient's risk profile, enabling the prevention of complications and prehabilitation before the start of cancer treatment. The aim of our study was to identify the prevalence of the risk of OD, malnutrition, sarcopenia, and frailty and their co-occurrence in all newly diagnosed HNC patients. More than three quarters of the 128 patients were at risk for OD, malnutrition, sarcopenia, and/or frailty. The advanced cancer stage was related to an increased risk of OD and higher levels of distress. Background: Head-and-neck cancer (HNC) can give rise to oropharyngeal dysphagia (OD), malnutrition, sarcopenia, and frailty. Early identification of these phenomena in newly diagnosed HNC patients is important to reduce the risk of complications and to improve treatment outcomes. The aim of this study was (1) to determine the prevalence of the risk of OD, malnutrition, sarcopenia, and frailty; and (2) to investigate the relation between these phenomena and patients' age, performance status, and cancer group staging. Methods: Patients (N = 128) underwent multi-domain screening consisting of the Eating Assessment Tool-10 for OD, Short Nutritional Assessment Questionnaire and BMI for malnutrition, Short Physical Performance Battery and Hand Grip Strength for sarcopenia, and Distress Thermometer and Maastricht Frailty Screening Tool for frailty. Results: 26.2%, 31.0%, 73.0%, and 46.4% of the patients were at risk for OD, malnutrition, sarcopenia, or frailty, respectively. Patients with an advanced cancer stage had a significantly higher risk of OD and high levels of distress prior to cancer treatment. Conclusions: This study identified the risk profile of newly diagnosed HNC patients using a standardized 'quick and easy' multi-domain screening prior to cancer treatment. [ABSTRACT FROM AUTHOR]

Background. This longitudinal study aimed to investigate (risk factors for) persistence of carriage and molecular characteristics of extended-spectrum and plasmid-encoded AmpC β-lactamase–producing (ESBL/pAmpC) Escherichia coli and Klebsiella pneumoniae (ESBL-E/K) in adults in the Dutch community. Methods. Following a cross-sectional study (ESBL-E/K prevalence, 4.5%), a subset of ESBL-E/K–positive (n = 76) and –negative (n = 249) individuals volunteered to provide 5 monthly fecal samples and questionnaires. ESBL-E/K was cultured using selective enrichment/ culture and multilocus sequence types (MLSTs) were determined. ESBL/pAmpC-genes were analyzed using polymerase chain reaction (PCR) and sequencing. Plasmids were characterized and subtyped by plasmid MLST. Risk factors for persistent carriage were analyzed using logistic regression. Results. Of the initially ESBL-E/K–positive participants, 25 of 76 (32.9%) remained positive in all subsequent samples; 51 of 76 persons (67.1%) tested ESBL-E/K negative at some time point during follow-up, of which 31 (40.8%) stayed negative throughout the longitudinal study. Carriers often carried the same ESBL gene and plasmid, but sometimes in different ESBL-E/K strains, indicative for horizontal transfer of plasmids. Of the 249 initially ESBL-E/K–negative participants, the majority (n = 218 [87.6%]) tested negative during 8 months of follow-up, whereas 31 of 249 (12.4%) participants acquired an ESBL-E/K. Escherichia coli phylogenetic group B2 and D and travel to ESBL high-prevalence countries were associated with prolonged carriage. Conclusions. ESBL-E/K carriage persisted for >8 months in 32.9% of the initially ESBL-positive individuals, while 12.4% of initially negative individuals acquired ESBL-E/K during the study. A single positive test result provides no accurate prediction for prolonged carriage. Acquisition/loss of ESBL-E/K does not seem to be a random process, but differs between bacterial genotypes. [ABSTRACT FROM AUTHOR]

Purpose:Duchenne muscular dystrophy can lead to upper extremity limitations, pain and stiffness. In a previous study, these domains have been investigated using extensive questionnaires, which are too time-consuming for clinical practice. This study aimed at gaining insight into the underlying dimensions of these questionnaires, and to construct a short questionnaire that can be used for clinical assessment. Methods:Exploratory factor analysis was performed on the responses of 213 participants to a web-based survey to find the underlying dimensions in the Capabilities of Upper Extremity questionnaire, the ABILHAND questionnaire, and questionnaires regarding pain and stiffness. Based on these underlying dimensions, a stepwise approach was formulated. In addition, construct validity of the factors was investigated. Results:In total, 14 factors were identified. All had high internal consistency (Cronbach's alpha >0.89) and explained 80–88% of the variance of the original questionnaires. Construct validity was supported, because participants in the early ambulatory stage performed significantly better (p< 0.001) than participants in the late non-ambulatory stage. Conclusion:The factors identified from the set of questionnaires provide a valid representation of upper extremity function, pain and stiffness in Duchenne muscular dystrophy. Based on the factor commonalities, the Upper Limb Short Questionnaire was formulated. Implications for RehabilitationNew insights into the underlying dimensions of upper extremity function, pain and stiffness in Duchenne muscular dystrophy are gained.Fourteen factors, with good internal consistency and construct validity, are identified regarding upper extremity function, pain and stiffness in Duchenne muscular dystrophy. Based on these factors, the Upper Limb Short Questionnaire is presented.The Upper Limb Short Questionnaire can be used as an identifier of arm-hand limitations and the start of more thorough clinical investigation. [ABSTRACT FROM PUBLISHER]

Background: Quality indicators (QIs) are used to monitor quality of care and adherence to osteoarthritis (OA) standards of care. Patient reported QIs can identify the most important gaps in quality of care and the most vulnerable patient groups. The aim of this study was to capture the perspective of people with knee OA (KOA) in the Netherlands on the quality of care received, and explore determinants related to lower achievement rates. Methods: We sent an online survey to all members of The Dutch Knee Panel (n = 622) of the Sint Maartenskliniek Nijmegen, the Netherlands between September and October 2019. The survey consisted of a slightly adapted version of the "OsteoArthritis Quality Indicator" (OA-QI) questionnaire (18 items; yes, no, N/A); a rating of quality of KOA care on a 10-point scale; a question on whether or not one wanted to see change in the care for KOA; and an open-ended question asking recommendations for improvement of OA care. Furthermore, sociodemographic and disease related characteristics were collected. Pass rates for separate QIs and pass rates on patient level were calculated by dividing the number of times the indicator was achieved by the number of eligible persons for that particular indicator. Results: A total of 434 participants (70%) completed the survey. The mean (SD) pass rate (those answering "Yes") for separate QIs was 49% (20%); ranging from 15% for receiving referral for weight reduction to 75% for patient education on how to manage knee OA. The mean (SD) pass rate on patient level was 52% (23%). Presence of OA in other joints, comorbidities, and having a knee replacement were associated with higher pass rates. On average, a score of 6.5 (1.6) was given for the quality of care received, and the majority of respondents (59%) wanted change in the care for KOA. Of 231 recommendations made, most often mentioned were the need for tailoring of care (14%), more education (13%), and more empathy and support from healthcare providers (12%). Conclusion: This study found patients are only moderately satisfied with the OA care received, and showed substantial gaps between perceived quality of care for OA and internationally accepted standards. Future research should focus on the underlying reasons and provide strategies to bridge these gaps. [ABSTRACT FROM AUTHOR]

Background: Quality indicators (QIs) are used to monitor quality of care and adherence to osteoarthritis (OA) standards of care. Patient reported QIs can identify the most important gaps in quality of care and the most vulnerable patient groups. The aim of this study was to capture the perspective of people with knee OA (KOA) in the Netherlands on the quality of care received, and explore determinants related to lower achievement rates.Methods: We sent an online survey to all members of The Dutch Knee Panel (n = 622) of the Sint Maartenskliniek Nijmegen, the Netherlands between September and October 2019. The survey consisted of a slightly adapted version of the "OsteoArthritis Quality Indicator" (OA-QI) questionnaire (18 items; yes, no, N/A); a rating of quality of KOA care on a 10-point scale; a question on whether or not one wanted to see change in the care for KOA; and an open-ended question asking recommendations for improvement of OA care. Furthermore, sociodemographic and disease related characteristics were collected. Pass rates for separate QIs and pass rates on patient level were calculated by dividing the number of times the indicator was achieved by the number of eligible persons for that particular indicator.Results: A total of 434 participants (70%) completed the survey. The mean (SD) pass rate (those answering "Yes") for separate QIs was 49% (20%); ranging from 15% for receiving referral for weight reduction to 75% for patient education on how to manage knee OA. The mean (SD) pass rate on patient level was 52% (23%). Presence of OA in other joints, comorbidities, and having a knee replacement were associated with higher pass rates. On average, a score of 6.5 (1.6) was given for the quality of care received, and the majority of respondents (59%) wanted change in the care for KOA. Of 231 recommendations made, most often mentioned were the need for tailoring of care (14%), more education (13%), and more empathy and support from healthcare providers (12%).Conclusion: This study found patients are only moderately satisfied with the OA care received, and showed substantial gaps between perceived quality of care for OA and internationally accepted standards. Future research should focus on the underlying reasons and provide strategies to bridge these gaps. [ABSTRACT FROM AUTHOR]

Predicting current and future tennis performance can lead to improving the development of junior tennis players. The aim of this study is to investigate whether age, maturation, or physical fitness in junior elite tennis players in U13 can explain current and future tennis performance. The value of current tennis performance for future tennis performance is also investigated. A total of 86 junior elite tennis players (boys, n = 44; girls, n = 42) U13 (aged: 12.5 ± 0.3 years), and followed to U16, took part in this study. All players were top-30 ranked on the Dutch national ranking list at U13, and top-50 at U16. Age, maturation, and physical fitness, were measured at U13. A principal component analysis was used to extract four physical components from eight tests (medicine ball throwing overhead and reverse, ball throwing, SJ, CMJas, Sprint 5 and 10 meter, and the spider test). The possible relationship of age, maturation, and the physical components; "upper body power", "lower body power", "speed", and "agility" with tennis performance at U13 and U16 was analyzed. Tennis performance was measured by using the ranking position on the Dutch national ranking list at U13 and U16. Regression analyses were conducted based on correlations between variables and tennis performance for boys and girls, separately. In boys U13, positive correlations were found between upper body power and tennis performance (R² is 25%). In girls, positive correlations between maturation and lower body power with tennis performance were found at U13. Early maturing players were associated with a better tennis performance (R² is 15%). In girls U16, only maturation correlated with tennis performance (R² is 13%); later-maturing girls at U13 had better tennis performances at U16. Measuring junior elite tennis players at U13 is important for monitoring their development. These measurements did not predict future tennis performance of junior elite tennis players three years later. Future research should focus on other aspects in order to predict tennis performance better. [ABSTRACT FROM AUTHOR]

The objective of this study was to better understand human variation by comparing cone‐beam computed tomography‐based cranial measurements between both sexes of individuals from two distinct populations: Brazilian and Dutch. Cone‐beam computed tomography volumes of 311 patients between 20 and 60 years from Brazil and The Netherlands were selected. Two radiologists performed 16 linear measurements in the maxillary sinuses and mandibular canal. Kruskall–Wallis test compared measurements of the two cranial structures between male and female for the two populations and four age ranges (20–30, 31–40, 41–50, 51–60). Mann–Whitney test compared individual measurements obtained from the cranial structures between male and female for each population, and between both populations for both sexes. Intra‐ and inter‐observer reliability was assessed by intraclass correlation test (α = 0.05). No significant differences were found in the linear measurements among the experimental groups including sex, population and age group for both cranial structures (p > 0.05). Most of the cranial linear measurements were significantly higher for male than those for female irrespective of the population (p ≤ 0.05). When the populations were compared regardless of sex, Brazilians presented four significantly higher measurements, and Dutch presented seven significantly higher measurements (p ≤ 0.05). The assessed cranial structures did not differ between Brazilian and Dutch populations for both sexes and four age ranges. Multiple linear measurements differed between both populations with a predominance of larger dimensions for the Dutch population. [ABSTRACT FROM AUTHOR]

How the Bible functions in (Christian) education in the international discourse on religious education, particularly in the Dutch context, has rarely been empirically investigated. The purpose of this article is to gain insight into how the Bible is functioning in the context of Protestant secondary schools in the Netherlands. In addition to providing a theoretical account, it presents the results of an empirical, explorative, and qualitative study on how the Bible is used in Protestant Christian secondary education in the Netherlands, with a focus on exploring the perspectives of teachers, including religious educators. Seventeen focus group interviews with teachers and school administrators from six secondary schools revealed a variety of goals held by teachers with regard to the use of the Bible in education and identified a variety of divisions in terms of teacher–learner roles. This article reflects on these findings through the use of religious education literature and concepts from the field of Bible didactics. [ABSTRACT FROM AUTHOR]

Climate change will result in large challenges that require societies to adapt to and manage increased risks. Regional practices of climate adaptation often take shape within multilevel governance networks in which representatives of different levels of government, policy sectors, public and private parties may discuss and negotiate potential measures. This paper aims to explore the role of leadership in enhancing the adaptive capacity of multilevel governance networks and in supporting regional practices of climate adaptation. The paper reviews two initiatives toward climate adaptation, the WaalWeelde initiative in the Netherlands and the Manhood Peninsula Partnership in the UK, based on policy documentation and analysis of in total 17 semistructured interviews with public and private actors. The study illustrates both the large differences in organization of water management, spatial planning, and flood risk policies, as well as strong similarities in the way in which leadership may contribute to the development of initiatives. [ABSTRACT FROM AUTHOR]

Background: From 2007 to 2009, the Netherlands experienced a major Q fever epidemic, with higher hospitalization rates than the 2–5% reported in the literature for acute Q fever pneumonia and hepatitis. We describe epidemiological and clinical features of hospitalized acute Q fever patients and compared patients presenting with Q fever pneumonia with patients admitted for other forms of community-acquired pneumonia (CAP). We also examined whether proximity to infected ruminant farms was a risk factor for hospitalization. Methods: A retrospective cohort study was conducted for all patients diagnosed and hospitalized with acute Q fever between 2007 and 2009 in one general hospital situated in the high incidence area in the south of the Netherlands. Pneumonia severity scores (PSI and CURB-65) of acute Q fever pneumonia patients (defined as infiltrate on a chest x-ray) were compared with data from CAP patients. Hepatitis was defined as a >twofold the reference value for alanine aminotransferase and for bilirubin. Results: Among the 183 hospitalized acute Q fever patients, 86.0% had pneumonia. Elevated liver enzymes (alanine aminotransferase) were found in 32.3% of patients, although hepatitis was not observed in any of them. The most frequent clinical signs upon presentation were fever, cough and dyspnoea. The median duration of admission was five days. Acute Q fever pneumonia patients were younger, had less co-morbidity, and lower PSI and CURB-65 scores than other CAP patients. Anecdotal information from attending physicians suggests that some patients were admitted because of severe subjective dyspnoea, which was not included in the scoring systems. Proximity to an infected ruminant farm was not associated with hospitalization. Conclusion: Hospitalized Dutch acute Q fever patients mostly presented with fever and pneumonia. Patients with acute Q fever pneumonia were hospitalized despite low PSI and CURB-65 scores, presumably because subjective dyspnoea was not included in the scoring systems. [ABSTRACT FROM AUTHOR]

The present study examined whether performance characteristics discriminated between selected and deselected players in talent development programmes. This examination was carried out in talented soccer players, aged 16–18 years using objective measurement instruments. Four domains of multidimensional performance characteristics (physiological, technical, tactical and psychological) were assessed by using a test battery consisting of soccer-specific field tests and questionnaires. Multivariate analyses of covariance revealed that the physiological characteristics peak and repeated shuttle sprint, the technical characteristics of peak and repeated shuttle dribble and the tactical characteristic of ‘positioning and deciding’, significantly differed between the selected (n=76) and deselected players (n=37), with selected players performing better (P<0.05). Discriminant function analysis showed that the combination of the technical characteristic ‘peak dribbling’, the tactical characteristic ‘positioning and deciding’ and the physiological characteristic of ‘peak sprinting’ classified 69% of talented players correctly. In conclusion, the decisions made by the investigated clubs to either select or deselect players in their talent development programme, whom were aged 16–18 years, were mostly discriminated by aspects of the players' technical, tactical and physiological skill performances. Sports research can play an essential role in investigating the club's perception of important performance characteristics in talented players. [ABSTRACT FROM PUBLISHER]

For several years work has been ongoing to compile information to facilitate the identification of non-native plants that (potentially) pose a threat to the biodiversity of the ecozone comprising Northern Germany, the Netherlands, Belgium and North-Western France. Such identification information may also be used for species that are regulated by other countries and are likely to be present as contaminants in commercial exports originating from the Netherlands. This information system comprises a set of interactive image-driven identification keys for invasive plants at various growth stages for use in a range of different situations: seed contaminants in bird feed, weeds in bonsai plants, seedling identification, identification keys of invasive terrestrial plants and invasive aquatic plants. The advantage of image-driven identification keys using a multiple entry system lies in limiting misunderstandings in terminology and failure in identification, in the absence of certain characters, as is sometimes the case in dichotomous keys. The interactive keys are linked to the species information in the Q-bank database, including datasheets, worldwide distribution maps, specimen level information, barcodes of selected species, etc. This information is now available at http://www.q-bank.eu/Plants/ [ABSTRACT FROM AUTHOR]

Time-lapse monitoring is increasingly used in fertility laboratories to culture and select embryos for transfer. This method is offered to couples with the promise of improving pregnancy chances, even though there is currently insufficient evidence for superior clinical results. We aimed to evaluate whether a potential improvement by time-lapse monitoring is caused by the time-lapse-based embryo selection method itself or the uninterrupted culture environment that is part of the system. In this three-armed, multicentre, double-blind, randomised controlled trial, couples undergoing in-vitro fertilisation or intracytoplasmic sperm injection were recruited from 15 fertility clinics in the Netherlands and randomly assigned using a web-based, computerised randomisation service to one of three groups. Couples and physicians were masked to treatment group, but embryologists and laboratory technicians could not be. The time-lapse early embryo viability assessment (EEVA; TLE) group received embryo selection based on the EEVA time-lapse selection method and uninterrupted culture. The time-lapse routine (TLR) group received routine embryo selection and uninterrupted culture. The control group received routine embryo selection and interrupted culture. The co-primary endpoints were the cumulative ongoing pregnancy rate within 12 months in all women and the ongoing pregnancy rate after fresh single embryo transfer in a good prognosis population. Analysis was by intention to treat. This trial is registered on the ICTRP Search Portal, NTR5423, and is closed to new participants. 1731 couples were randomly assigned between June 15, 2017, and March 31, 2020 (577 to the TLE group, 579 to the TLR group, and 575 to the control group). The 12-month cumulative ongoing pregnancy rate did not differ significantly between the three groups: 50·8% (293 of 577) in the TLE group, 50·9% (295 of 579) in the TLR group, and 49·4% (284 of 575) in the control group (p=0·85). The ongoing pregnancy rates after fresh single embryo transfer in a good prognosis population were 38·2% (125 of 327) in the TLE group, 36·8% (119 of 323) in the TLR group, and 37·8% (123 of 325) in the control group (p=0·90). Ten serious adverse events were reported (five TLE, four TLR, and one in the control group), which were not related to study procedures. Neither time-lapse-based embryo selection using the EEVA test nor uninterrupted culture conditions in a time-lapse incubator improved clinical outcomes compared with routine methods. Widespread application of time-lapse monitoring for fertility treatments with the promise of improved results should be questioned. Health Care Efficiency Research programme from Netherlands Organisation for Health Research and Development and Merck. [ABSTRACT FROM AUTHOR]

Objectives: Although the Surviving Sepsis Campaign bundle recommends obtaining blood cultures within 1 hour of sepsis recognition, adherence is suboptimal in many settings. We, therefore, implemented routine blood culture collection for all nonelective ICU admissions (regardless of infection suspicion) and evaluated its diagnostic yield.Design: A before-after analysis.Setting: A mixed-ICU of a tertiary care hospital in the Netherlands.Patients: Patients acutely admitted to the ICU between January 2015 and December 2018.Measurements and Main Results: Automatic orders for collecting a single set of blood cultures immediately upon ICU admission were implemented on January 1, 2017. Blood culture results and the impact of contaminated blood cultures were compared for 2015-2016 (before period) and 2017-2018 (after period). Positive blood cultures were categorized as bloodstream infection or contamination. Blood cultures were obtained in 573 of 1,775 patients (32.3%) and in 1,582 of 1,871 patients (84.5%) in the before and after periods, respectively (p < 0.0001), and bloodstream infection was diagnosed in 95 patients (5.4%) and 154 patients (8.2%) in both study periods (relative risk 1.5; 95% CI 1.2-2.0; p = 0.0006). The estimated number needed to culture for one additional patient with bloodstream infection was 17. Blood culture contamination occurred in 40 patients (2.3%) and 180 patients (9.6%) in the before period and after period, respectively (relative risk 4.3; 95% CI 3.0-6.0; p < 0.0001). Rate of vancomycin use or presumed episodes of catheter-related bloodstream infections treated with antibiotics did not differ between both study periods.Conclusions: Implementation of routine blood cultures was associated with a 1.5-fold increase of detected bloodstream infection. The 4.3-fold increase in contaminated blood cultures was not associated with an increase in vancomycin use in the ICU. [ABSTRACT FROM AUTHOR]

Background: During the Dutch Q fever epidemic more than 4,000 Q fever cases were notified. This provided logistical challenges for the organisation of serological follow-up, which is considered mandatory for early detection of chronic infection. The aim of this study was to investigate the proportion of acute Q fever patients that received serological follow-up, and to identify regional differences in follow-up rates and contributing factors, such as knowledge of medical practitioners. Methods: Serological datasets of Q fever patients diagnosed between 2007 and 2009 (N = 3,198) were obtained from three Laboratories of Medical Microbiology (LMM) in the province of Noord-Brabant. One LMM offered an active follow-up service by approaching patients; the other two only tested on physician's request. The medical microbiologist in charge of each LMM was interviewed. In December 2011, 240 general practices and 112 medical specialists received questionnaires on their knowledge and practices regarding the serological follow-up of Q fever patients. Results: Ninety-five percent (2,226/2,346) of the Q fever patients diagnosed at the LMM with a follow-up service received at least one serological follow-up within 15 months of diagnosis. For those diagnosed at a LMM without this service, this was 25% (218/852) (OR 54, 95% CI 43–67). Although 80% (162/203) of all medical practitioners with Q fever patients reported informing patients of the importance of serological follow-up, 33% (67/203) never requested it. Conclusions: Regional differences in follow-up are substantial and range from 25% to 95%. In areas with a low follow-up rate the proportion of missed chronic Q fever is potentially higher than in areas with a high follow-up rate. Medical practitioners lack knowledge regarding the need, timing and implementation of serological follow-up, which contributes to patients receiving incorrect or no follow-up. Therefore, this information should be incorporated in national guidelines and patient information forms. [ABSTRACT FROM AUTHOR]

Objective The development of osteoarthritis (OA) may be caused by activation of hypertrophic differentiation of articular chondrocytes. Healthy articular cartilage is highly resistant to hypertrophic differentiation, in contrast to other hyaline cartilage subtypes, such as growth plate cartilage. The purpose of this study was to elucidate the molecular mechanism responsible for the difference in the propensity of human articular cartilage and growth plate cartilage to undergo hypertrophic differentiation. Methods Whole-genome gene-expression microarray analysis of healthy human growth plate and articular cartilage derived from the same adolescent donors was performed. Candidate genes, which were enriched in the articular cartilage, were validated at the messenger RNA (mRNA) and protein levels and examined for their potential to inhibit hypertrophic differentiation in two models. In addition, we studied a possible genetic association with OA. Results Pathway analysis demonstrated decreased Wnt signaling in articular cartilage as compared to growth plate cartilage. This was at least partly due to increased expression of the bone morphogenetic protein and Wnt antagonists Gremlin 1, Frizzled-related protein (FRP), and Dkk-1 at the mRNA and protein levels in articular cartilage. Supplementation of these proteins diminished terminal hypertrophic differentiation without affecting chondrogenesis in long-bone explant cultures and chondrogenically differentiating human mesenchymal stem cells. Additionally, we found that single-nucleotide polymorphism rs12593365, which is located in a genomic control region of GREM1, was significantly associated with a 20% reduced risk of radiographic hip OA in 2 population-based cohorts. Conclusion Taken together, our study identified Gremlin 1, FRP, and Dkk-1 as natural brakes on hypertrophic differentiation in articular cartilage. As hypertrophic differentiation of articular cartilage may contribute to the development of OA, our findings may open new avenues for therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background: The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands. Methods: The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters. Results: The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza. Conclusions: This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands. [ABSTRACT FROM PUBLISHER]

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]

Finding ways to retain nurse anesthetists in the profession to meet the increasing demands of the healthcare system is of paramount importance. The present study investigates the relationship between work climate and job satisfaction among Dutch nurse anesthetists. A questionnaire was distributed to Dutch nurse anesthetists to assess their perceptions of their work climates, and their levels of job satisfaction. Multiple regression analyses were performed to obtain the predictive value of work climate for job satisfaction. All of the work climate characteristics had statistically significant correlations to job satisfaction, and explained 20% of the variance in job satisfaction. To achieve a higher level of job satisfaction among nurse anesthetists, it is necessary to improve some essential work climate characteristics, such as: (1) making the nurse anesthetist feel an important part of the organization's mission statement, (2) discussing progress at work, (3) giving recognition for delivered work, (4) encouraging development, and (5) providing sufficient opportunities to learn and to grow. [ABSTRACT FROM AUTHOR]

In this revision the Late Westphalian C and Westphalian D palaeobotanic subdivisions of Wagner (1966, 1979) Cleal (1997) and others were recognized and applied. Two diachronous discontinuities are demonstrated: an important one at the Westphalian C / D transition (the Symon unconformity) and one below the base of the Neeroeteren formation (the Neeroeteren unconformity). The Neeroeteren formation has a 'middle' to 'late' Late Westphalian D age. Within the earliest and latest realms of the Late Westphalian D other discontinuities are suspected as well; at the end of the 'early' Late Westphalian D and on top of the Neeroeteren formation. They were caused by intermitted pro-and retrograding and gradual northwardly shifting of (terminal) parts of alluvial fans. In the western and northwestern realms these fan deposits intermittently interfinger with limnic and floodplain sediments. Next to some initial Late Westphalian C sourcing from the north / northeast, local sediment supply during the Westphalian D predominantly came from eastern / southeastern areas. These fan sediments and accompanying discontinuities reflect the effects of the Late Malvernian (Late Westphalian C) and Leonese (Mid / Late Westphalian D) Variscan orogenic pulses. The palaeobotanic datings permitted correlations and comparisons with contemporaneous developments in the northeastern Netherlands. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether young Dutch adults had ever heard of human papillomavirus (HPV) and whether they would accept vaccination, and to assess the factors influencing their decision. Study design: Cross-sectional survey. Methods: Six hundred participants aged 18-25 years were recruited from two university departments and one non-university technical college. Results: One hundred and six (17.7%) participants had heard of HPV and 536 (94%) had heard of cervical carcinoma. Women had significantly more knowledge of cervical carcinoma than men. A medical education, knowledge of HPV, knowledge of cervical cancer and knowledge of the cervical screening programme were not significantly associated with acceptance of HPV vaccination, whereas gender and age did show a significant relationship. In total, 61% of the female participants and 48% of the male participants were willing to accept a 'catch-up' HPV vaccination. Conclusions: This study found that average knowledge levels of HPV and cervical cancer were tow. Despite this lack of knowledge, a small majority of the study population would accept a 'catch-up' HPV vaccination. Women and younger participants were significantly more willing to accept HPV vaccination. However, in these subgroups, acceptance of HPV vaccination seems to be affected by other, stilt unidentified, factors. These factors could be evaluated in a more qualitative orientated study. An educational campaign is needed to cover knowledge about HPV and cervical carcinoma, and beliefs and behaviours associated with the acceptance of vaccination. [ABSTRACT FROM AUTHOR]

More and more agricultural land in the Netherlands is becoming available for ecological restoration projects. However, nutrient levels in the top layer of the soils are high because the agricultural lands have been heavily fertilized for decades. As drainage ditches are no longer maintained when agricultural use ends, the agricultural lands usually become much wetter. As a result, former agricultural soils tend to develop extensive monotonous stands of Juncus effusus, which have little value from an ecological point of view. In this article, we present the results of field measurements/observations and experiments to examine the relationship between nutrient availability and J. effusus growth. In addition, we present and discuss results of experiments to study the potential beneficial effects of liming. Our findings show that the growth of J. effusus on moist or wet soils seems to be strongly determined by the Olsen-P concentration in the soil. The restoration of diverse, species-rich vegetation types on former agricultural lands with a noncalcareous sandy soil will in most cases not be possible within a reasonable time span without topsoil removal. Liming might be a valuable additional measure to enhance the quality of the soil after topsoil removal, and to prevent mobilization of P to groundwater or surface water. If removal of the topsoil is considered to create P limitation, it is important to study P concentrations at various depths to establish the amount of soil that has to be removed. [ABSTRACT FROM AUTHOR]

Graph: Figure 1. class="chapter-para">wgMLST tree of 394 carbapenemase-producing E. coli isolates showing a genetic cluster of OXA-244-producing E. coli ST38. Genetic cluster of OXA-244 carbapenemase-producing Escherichia coli ST38 with putative uropathogenicity factors in the Netherlands Seventeen of these 30 OXA-244-producing ST38 I E. coli i isolates formed a genetic cluster based on wgMLST and was termed EcoCluster-023. [Extracted from the article]

Background: Alosetron is a 5-hydroxytryptamine-3 receptor antagonist reducing symptoms in female patients with diarrhoea-predominant irritable bowel syndrome, and is known to increase the colonic transit time. Aim: To study the effect of alosetron on left colonic phasic motility in ambulant non-constipated patients with irritable bowel syndrome and healthy volunteers. Methods: In a double-blind, randomized, crossover design, 10 patients with irritable bowel syndrome and 12 sex- and age-matched volunteers were treated for two 7-day periods with alosetron, 4 mg b.d., or placebo b.d. On day 6 of each treatment period, a six-channel solid-state manometric catheter was positioned in the left colon and 24 h motility was studied on day 7. The periprandial phasic motility around dinnertime was evaluated in the descending and sigmoid colon. The high-amplitude propagated contraction frequency and characteristics were calculated. Results: Alosetron appeared to increase the overall periprandial frequency in the sigmoid colon (P =0.043) and the mean amplitude of colonic contractions in the descending colon (P =0.007). The high-amplitude propagated contraction frequency was higher on alosetron during the second half of the day for patients with irritable bowel syndrome (P =0.002), with increased mean propagation length of high-amplitude propagated contractions (P =0.001). The stool frequency (P =0.024) and stool consistency score (P =0.002) were decreased by alosetron. Conclusions: The 5-hydroxytryptamine-3 receptor antagonist alosetron marginally increased left colonic periprandial phasic motility. Alosetron increased the number and propagation length of high-amplitude propagated contractions, which were paradoxically accompanied by a decrease in stool frequency and a firming of stool consistency. [ABSTRACT FROM AUTHOR]

Studies the intake of catechins in the Dutch population and assesses the relation between catechin intake and other dietary factors. Survey on total catechin intake of 4,661 adults; Contribution of various food groups to the mean catechin intake in the total population by age group; Mean total catechin intake according to smoking status and socio-economic status, standardized for age and sex.

Background: To meet the needs of high-vulnerable families with severe and enduring problems across several life domains, professionals must improve their ability to provide integrated care timely and adequately. The aim of this study was to identify facilitators and barriers professionals encounter when providing integrated care. Methods: Experiences and perspectives of 24 professionals from integrated care teams in the Netherlands were gathered by conducting semi-structured interviews. A theory-driven framework method was applied to systematically code the transcripts both deductively and inductively. Results: There was a consensus among professionals regarding facilitators and barriers influencing their daily practice, leading to an in depth, thematic report of what facilitates and hinders integrated care. Themes covering the facilitators and barriers were related to early identification and broad assessment, multidisciplinary expertise, continuous pathways, care provision, autonomy of professionals, and evaluation of care processes. Conclusions: Professionals emphasized the need for flexible support across several life domains to meet the needs of high-vulnerable families. Also, there should be a balance between the use of guidelines and a professional's autonomy to tailor support to families' needs. Other recommendations include the need to improve professionals' ability in timely stepping up to more intensive care and scaling down to less restrictive support, and to further our insight in risk factors and needs of these families. [ABSTRACT FROM AUTHOR]

In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007-2010, new chronic QF (CQF) patients continue to be detected. We developed a health-economic decision model to evaluate the cost-effectiveness of a 1-time screening program for CQF 7 years after the epidemic. The model was parameterized with spatial data on QF notifications for the Netherlands, prevalence data from targeted screening studies, and clinical data from the national QF database. The cost-effectiveness of screening varied substantially among subpopulations and geographic areas. Screening that focused on cardiovascular risk patients in areas with high QF incidence during the epidemic ranged from cost-saving to €31,373 per quality-adjusted life year gained, depending on the method to estimate the prevalence of CQF. The cost per quality-adjusted life year of mass screening of all older adults was €70,000 in the most optimistic scenario. [ABSTRACT FROM AUTHOR]

Background: The 2016 Dutch national guidelines on handling of a removed gallbladder for cholelithiasis proposes a selective histopathologic policy (Sel-HP) rather than routine policy (Rout-HP). The aim of this study was to determine the current implementation of the present guideline and the daily practice of Sel-HP. Methods: Surgeons who were engaged in gallbladder surgery in the Netherlands and were involved in local hospitals' gallbladder protocols completed a questionnaire study regarding gallbladder policy, between December 2017 and May 2018. Data were analyzed using standard statistics. Results: A 100% response rate was obtained (n = 74). Approximately 64% of all gallbladders (n = 22,500) were examined microscopically. Sixty-nine (93.2%) hospitals confirmed they were aware of the new guidelines, and 56 (75.7%) knew the guideline was adjusted in favor of Sel-HP. Half of the hospitals (n = 35, 47.3%) had adopted a Sel-HP, and 39 (52.7%) a Rout-HP. Of the 39 hospitals who had a Rout-HP, 36 were open to a transition to a Sel-HP although some expressed the need for more evidence on safety or novel guidelines. Conclusions: The current implementation of the 2016 Dutch guideline advising a selective microscopic analysis of removed gallbladders for gallstone disease is suboptimal. Evidence demonstrating safety and cost-effectiveness of an on demand histopathological examination will aid in the implementation process. [ABSTRACT FROM AUTHOR]

Objectives: The presence and size of lateral lymph nodes (LLNs) are important factors influencing treatment decisions for rectal cancer. Awareness of the clinical relevance and describing LLNs in MRI reports is therefore essential. This study assessed whether LLNs were mentioned in primary MRI reports at a national level and investigated the concordance with standardised re-review. Methods: This national, retrospective, cross-sectional cohort study included 1096 patients from 60 hospitals treated in 2016 for primary cT3-4 rectal cancer ≤ 8 cm from the anorectal junction. Abdominal radiologists re-reviewed all MR images following a 2-h training regarding LLNs. Results: Re-review of MR images identified that 41.0% of enlarged (≥ 7 mm) LLNs were not mentioned in primary MRI reports. A contradictory anatomical location was stated for 73.2% of all LLNs and a different size (≥/< 7 mm) for 41.7%. In total, 49.4% of all cases did not mention LLNs in primary MRI reports. Reporting LLNs was associated with stage (cT3N0 44.3%, T3N+/T4 52.8%, p = 0.013), cN stage (N0 44.1%, N1 48.6%, N2 59.5%, p < 0.001), hospital type (non-teaching 34.6%, teaching 52.2%, academic 53.2% p = 0.006) and annual rectal cancer resection volumes (low 34.8%, medium 47.7%, high 57.3% p < 0.001). For LLNs present according to original MRI reports (n = 226), 64.2% also mentioned a short-axis size, 52.7% an anatomical location and 25.2% whether it was deemed suspicious. Conclusions: Almost half of the primary MRI reports for rectal cancer patients treated in the Netherlands in 2016 did not mention LLNs. A significant portion of enlarged LLNs identified during re-review were also not mentioned originally, with considerable discrepancies for location and size. These results imply insufficient awareness and indicate the need for templates, education and training. [ABSTRACT FROM AUTHOR]

To observe the actual laboratory screening for side effects of disease modifying antirheumatic drugs (DMARDs) in daily rheumatological practice, a retrospective multi-center cohort study was performed on the laboratory tests in DMARD treated rheumatoid arthritis (RA) patients. RA patients were investigated by chart review if they started with a DMARD (cohort 1) or were treated with a DMARD for at least one year (cohort 2). Hematological, hepatic, and renal tests were collected. In cohort 1 and 2, 513 and 1209 patients were included, respectively. A fairly outlined screening profile was observed for each DMARD studied. Except for antimalarials, the testing frequency decreased with time in cohort 1. For all DMARDs the testing frequency in cohort 1 was higher than in cohort 2. In general, rheumatologists requested laboratory tests less frequently than is internationally recommended. This discrepancy raises questions about the relation between the efficacy and costs of laboratory screening for side effects of DMARDs in patients with RA. [ABSTRACT FROM AUTHOR]