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Background: Forcibly displaced women in the Netherlands face increased chances of perinatal mortality and other adverse pregnancy and childbirth outcomes compared to the resident country population, which has been linked to suboptimal care. This study was conducted to gain insights from the experiences of Dutch midwives to inform and enhance the provision of tailored and equitable care for forcibly displaced women. Methods: We conducted a qualitative study using semistructured interviews with community midwives who provide care for forcibly displaced women (asylum seekers and recognized refugees) in the Netherlands. Through thematic analysis, we identified the barriers midwives encounter in providing care and explored their strategies for navigating these barriers, aiming to inform recommendations that advance equitable care provision. Results: Interviews with eleven midwives revealed barriers across three thematic levels: (1) the interactional level, where barriers related to language and interpreters, cultural differences, and building trust impeded positive interactions between midwives and forcibly displaced women; (2) the organizational level, where barriers concerning relocations of asylum seekers, delays in accessing care, and interdisciplinary collaboration impeded optimal care; and (3) the contextual level, where barriers related to women's housing conditions, the resettlement process and the mental health of forcibly displaced women impeded midwives' to respond to clients' needs. These levels of barriers culminated in a core theme of imbalance between midwives' expanded responsibilities and the limited resources and strategies available to them in care for forcibly displaced women. This imbalance forced midwives into multiple roles, increased both the practical and emotional burden on them, and undermined their ability to provide optimal, equitable care. Conclusions: To enhance the provision o

As clinical mastitis (CM) treatments are responsible for a large portion of antimicrobial use on dairy farms, many selective CM treatment protocols have been developed and evaluated against a blanket treatment approach of CM cases. Selective treatment protocols use outcomes of diagnostic tests to exclude CM cases from antimicrobial treatment when they are unlikely to benefit. To tailor interventions to increase uptake of selective treatment strategies, a comprehension of current on-farm treatment practices and factors affecting treatment decisions is vital. Two questionnaires were conducted among 142 farms across 5 provinces participating in the Canadian Dairy Network for Antimicrobial Stewardship and Resistance in this cross-sectional study. Self-reported adoption of selective CM treatments by dairy farmers was 64%, with median of 82% of cows treated in those herds using selective treatment. Using logistic regression models, the odds to implement a selective CM treatment protocol increased with a decreasing average cow somatic cell count. No other associations were identified between use of a selective CM treatment protocol and farm characteristics (herd size, CM incidence, province, milking system, and housing system). Three subsets of farmers making cow-level CM treatment decisions were identified using a cluster analysis approach: those who based decisions almost exclusively on severity of clinical signs, those who used various udder health indicators, and farmers who also incorporated more general cow information such as production, age, and genetics. When somatic cell count was considered, the median threshold used for treating was >300,000 cells/mL at the last Dairy Herd Improvement test. Various thresholds were present among those considering CM case history. Veterinary laboratories were most frequently used for bacteriological testing. Test results were used to start, change, and stop treatments. Regardless of protocol, reasons for antimicrobial treatmen

Introduction Refugees and their healthcare providers face numerous challenges in receiving and providing maternal and newborn care. Research exploring how these challenges are related to adverse perinatal and maternal outcomes is scarce. Therefore, this study aims to identify suboptimal factors in maternal and newborn care for asylum-seeking and refugee women and assess to what extent these factors may contribute to adverse pregnancy outcomes in the Netherlands. Methods We conducted a retrospective analysis of national perinatal audit data from 2017 to 2019. Our analysis encompassed cases with adverse perinatal and maternal outcomes in women with a refugee background (n = 53). Suboptimal factors in care were identified and categorized according to Binder et al.’s Three Delays Model, and the extent to which they contributed to the adverse outcome was evaluated. Results We identified 29 suboptimal factors, of which seven were related to care-seeking, six to the accessibility of services, and 16 to the quality of care. All 53 cases contained suboptimal factors, and in 67.9% of cases, at least one of these factors most likely or probably contributed to the adverse perinatal or maternal outcome. Conclusion The number of suboptimal factors identified in this study and the extent to which they contributed to adverse perinatal and maternal outcomes among refugee women is alarming. The wide range of suboptimal factors identified provides considerable scope for improvement of maternal and newborn care for refugee populations. These findings also highlight the importance of including refugee women in perinatal audits as it is essential for healthcare providers to better understand the factors associated with adverse outcomes to improve the quality of care. Adjustments to improve care for refugees could include culturally sensitive education for healthcare providers, increased workforce diversity, minimizing the relocation of asylum seekers, and permanent reimbursement of pr

RIVM rapport:Plant protection products are used to protect crops against diseases and pests. The EU Member States are looking to make agriculture more sustainable, among other things by using fewer chemicals. To that end, new plant protection products are being developed that are less harmful to the environment, growers, and consumers. One of these developments concerns plant protection products on the basis of double-stranded RNA (dsRNA). These are natural alternatives to chemical pesticides that work specifically against certain diseases and pests. Plant protection products are assessed for their safety for humans and the environment before they receive market authorisation. However, it turns out that the existing risk assessment is unsuitable for assessing the potentially harmful effects of this latest type of plant protection products, as it focuses primarily on the effects of chemicals. RIVM has made a number of recommendations to facilitate the assessment of dsRNA-based plant protection products. Among other things, it advises risk assessors about which data they need from the entire product in order to evaluate its effects on the environment. Normally, dsRNA degrades rapidly in the environment, causing little exposure. When used in a plant protection product, however, it may be more stable. For the purpose of this study, RIVM investigated which applications on the basis of dsRNA are currently in development. It also looked at the risks that dsRNA might pose for human health and the environment., Gewasbeschermingsmiddelen beschermen landbouwgewassen tegen ziekten en plagen. Binnen Europa willen lidstaten de landbouw verduurzamen, onder andere door minder chemische middelen te gebruiken. Daarom worden nieuwe gewasbeschermingsmiddelen ontwikkeld die minder schadelijk zijn voor het milieu, de gebruikers van de middelen en voor consumenten. Zo zijn gewasbeschermingsmiddelen op basis van dubbelstrengs RNA(ribonucleic acid) (dsNA) in ontwikkeling. Dit zijn natuurlijke alternatieven voor chemische bestrijdingsmiddelen die specifiek tegen bepaalde ziekten en plagen werken. Deze producten worden beoordeeld op hun veiligheid voor mens en milieu, voordat ze op de markt worden toegelaten. Alleen blijkt dat de bestaande risicobeoordeling niet geschikt is om mogelijke schadelijke effecten van dit type gewasbeschermingsmiddelen te beoordelen. Deze is nu vooral gericht op effecten van chemische stoffen. Het RIVM doet aanbevelingen om de beoordeling van dsRNA-middelen mogelijk te maken. Het adviseert onder andere aan risicobeoordelaars welke data uit de bestaande testen voor de beoordeling nodig zijn. Ook raadt het RIVM aan het hele product te beoordelen om de effecten op het milieu te kunnen onderzoeken. dsRNA breekt namelijk snel af in het milieu, waardoor het milieu er weinig aan wordt blootgesteld. Maar in een product kan het stabieler zijn. Voor dit onderzoek heeft het RIVM in kaart gebracht welke toepassingen op basis van dsRNA in ontwikkeling zijn. Ook is gekeken welke risico's van dsRNA er voor mens en milieu zouden kunnen zijn.

Background. Although the Netherlands is a country with a low endemic level, methicillin-resistant Staphylococcus aureus (MRSA) poses a significant health care problem. Therefore, high coverage national MRSA surveillance has been in place since 1989. To monitor possible changes in the type-distribution and emergence of resistance and virulence, MRSA isolates are molecularly characterized. Methods. All 43,321 isolates from 36,520 persons, collected 2008–2019, were typed by multiple-locus variable number tandem repeats analysis (MLVA) with simultaneous PCR detection of the mecA, mecC and lukF-PV genes, indicative for PVL. Next-generation sequencing data of 4991 isolates from 4798 persons were used for whole genome multi-locus sequence typing (wgMLST) and identification of resistance and virulence genes. Results. We show temporal change in the molecular characteristics of the MRSA population with the proportion of PVL-positive isolates increasing from 15% in 2008–2010 to 25% in 2017–2019. In livestock-associated MRSA obtained from humans, PVL-positivity increases to 6% in 2017–2019 with isolates predominantly from regions with few pig farms. wgMLST reveals the presence of 35 genogroups with distinct resistance, virulence gene profiles and specimen origin. Typing shows prolonged persistent MRSA carriage with a mean carriage period of 407 days. There is a clear spatial and a weak temporal relationship between isolates that clustered in wgMLST, indicative for regional spread of MRSA strains. Conclusions. Using molecular characterization, this exceptionally large study shows genomic changes in the MRSA population at the national level. It reveals waxing and waning of types and genogroups and an increasing proportion of PVL-positive MRSA.

Background: Early mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM. Methods: A survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists). Results: Response rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained. Conclusion: Skin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.