Highly frequent infections with human rhinovirus in healthy young children: A longitudinal cohort study

AbstractBackgroundHuman rhinoviruses (HRVs) are an important cause of respiratory tract infections.ObjectivesWe questioned whether the high prevalence rates of HRVs found in epidemiological studies is due to long-term individual continuity or a result of frequent infections with different HRV subtypes.Study designIn a 6-month winter period 18 healthy controls, aged 0–7 years, were at least sampled every two weeks for HRV-PCR, irrespective of respiratory symptoms. All HRV positive samples were genotyped to determine HRV diversity.ResultsIn total 272 samples were collected. HRV was found in 101/272 (37%) samples. Genotyping revealed 27 different HRV subtypes. A median of 3.0 different HRV subtypes was found per child. Re-infections and continuity with identical HRV sequences were observed. The number of HRVs were higher in the youngest age group (p=0.01) and they had more different HRV subtypes (p=0.05) compared to oldest age group.ConclusionsWe found a high HRV exposition with a considerable diverse population of HRV subtypes in young children. These results have major implications for future research into the pathogenic role of HRV in respiratory diseases. Characterisation of subtypes will be necessary to discriminate between prolonged continuity and re-infections in patients with respiratory diseases

Prevalence and Pathogenicity of WU and KI Polyomaviruses in Children, the Netherlands

A longitudinal study in 2004 and 2005 detected polyomaviruses WU and KI in 44% and 17% of children with and without respiratory symptoms, respectively, in the Netherlands. In some children both viruses were detected for long periods. In several symptomatic children no other respiratory pathogen was detected

Risk factors for intensive care admission in children with severe acute asthma in the Netherlands:a prospective multicentre study

Rationale: Severe acute asthma (SAA) can be fatal, but is often preventable. We previously observed in a retrospective cohort study, a three-fold increase in SAA paediatric intensive care (PICU) admissions between 2003 and 2013 in the Netherlands, with a significant increase during those years of numbers of children without treatment of inhaled corticosteroids (ICS). Objectives: To determine whether steroid-naïve children are at higher risk of PICU admission among those hospitalised for SAA. Furthermore, we included the secondary risk factors tobacco smoke exposure, allergic sensitisation, previous admissions and viral infections. Methods: A prospective, nationwide multicentre study of children with SAA (2-18 years) admitted to all Dutch PICUs and four general wards between 2016 and 2018. Potential risk factors for PICU admission were assessed using logistic regression analyses. Measurements and main results: 110 PICU and 111 general ward patients were included. The proportion of steroid-naïve children did not differ significantly between PICU and ward patients. PICU children were significantly older and more exposed to tobacco smoke, with symptoms >1 week prior to admission. Viral susceptibility was not a significant risk factor for PICU admission. Conclusions: Children with SAA admitted to a PICU were comparable to those admitted to a general ward with respect to ICS treatment prior to admission. Preventable risk factors for PICU admission were >7 days of symptoms without adjustment of therapy and exposure to tobacco smoke. Physicians who treat children with asthma must be aware of these risk factors

Multidisciplinary treatment in children with problematic severe asthma: A prospective evaluation

For children with problematic severe asthma, achieving adequate control of asthma is difficult. The aim of this prospective observational study was to evaluate the effects of intensive multidisciplinary inpatient treatment on multiple outcome variables in children with problematic severe asthma. Participants were 89 children with problematic severe asthma (mean age 13.6 ± 2.5 years) treated in tertiary care clinics at high altitude (Switzerland) or sea level (Netherlands) and their parents (85 mothers, 55 fathers). The primary outcome variable was the Childhood Asthma Control Test (C-ACT). Other outcome variables were forced expiratory volume in 1 sec (FEV1 ), fractional concentration of exhaled nitric oxide (FeNO), quality of life [PAQLQ(S)], children's coping (UCL-A), parents' report of behavioral problems (CBCL), and parenting stress (PSI/NOSI). Evaluations were taken pre-treatment, post-treatment, and 3-6 months follow-up. Median [P25;P75] treatment duration 74 [56;80] days; Median follow-up interval 131 [103;177] days. The percentages of children showing controlled asthma (C-ACT) were 18% (pre-treatment), 69% (post-treatment), and 44% (follow-up). The vast majority of the children (80%) showed an improvement on C-ACT with 4% showing a deterioration. On C-ACT, FeNO, quality of life, and behavioral problems, improvements at post-treatment were highly significant. Improvements generally remained at a functional level at follow-up. Children's coping and parenting stress in parents did not change. The improvement in asthma control and other outcome variables suggests that multidisciplinary inpatient treatment is an effective approach for a heterogeneous group of children with asthma that remained uncontrolled in secondary care. Pediatr Pulmonol. 2017;52:588-597. © 2016 Wiley Periodicals, In

De Routekaart naar een Meer Integrale Benadering van Wonen, Zorg en Pensioen

Het thema wonen, zorg en pensioen staat hoog op de agenda van de SER en verschillende ministeries. Het is ook onderwerp binnen de brede maatschappelijke pensioendialoog. In de Hoofdlijnennota over de toekomstige inrichting van het pensioenstelsel in Nederland van 6 juli 2015 benoemt het kabinet ‘een op maat gesneden pensioen’ als een van de zeven waarden waaraan een toekomstbestendig pensioenstelsel moet voldoen. Het kabinet is daarbij voorstander van een combinatie van meer maatwerk en keuzemogelijkheden. Op die manier sluiten pensioenregelingen beter aan op de kenmerken en voorkeuren van deelnemers. Het kabinet onderzoekt ook of een betere koppeling met wonen en zorg wenselijk is.De afgelopen jaren is vooral op macroniveau al op meerdere plekken onderzoek gedaan naar de combinatie van wonen, zorg en pensioen. Gelet op de actualiteit van het thema geeft Netspar het onderwerp hoge prioriteit op de onderzoeksagenda. Met dit rapport wil Netspar de discussie verder brengen door de financiële planning van het individuele huishouden als uitgangspunt te nemen.<br/

The expert network and electronic portal for children with respiratory and allergic symptoms: rationale and design

Abstract Data on baseline characteristics of children with asthma to predict individual treatment responses are lacking. We aimed to set up a data-collection system which can easily fill this gap in clinical practice. A web-based application was developed, named 'Portal for children with respiratory and allergic symptoms', hereafter called Electronic Portal (EP). It contains health- and disease-related questionnaires on respiratory- and allergic diseases. All patients, 1–18 years of age, with respiratory- and/or allergic complaints are invited to enter the EP before their first visit. By using the EP large amounts of data, gathered during routine patient care can be used for research purposes. This may help to further investigate the different treatment related asthma phenotypes and will be helpful to monitor risk factors for other atopic diseases and respiratory infections.</p

Barriers and Facilitators When Implementing Web-Based Disease Monitoring and Management as a Substitution for Regular Outpatient Care in Pediatric Asthma: Qualitative Survey Study

Contains fulltext : 197415.pdf (publisher's version ) (Open Access

Frequency and Duration of Rhinovirus Infections in Children with Cystic Fibrosis and Healthy Controls : A Longitudinal Cohort Study

BACKGROUND: Respiratory viral infections are an important cause of morbidity in patients with chronic respiratory diseases, such as cystic fibrosis (CF). We hypothesized that patients with CF are more susceptible to human rhinovirus (HRV) infections than healthy controls. METHODS: In a 6-months winter period 20 young children with CF (0-7 years) and 18 age-matched healthy controls were sampled bi-weekly for HRV-PCR using nasopharyngeal swabs, irrespective of respiratory symptoms. Respiratory symptoms were scored twice a week. If any symptom was present an additional sample was obtained. All HRV positive samples were genotyped to distinguish HRV subtypes. RESULTS: We analyzed 645 samples, with comparable total numbers of samples in both groups. HRV was detected in 40.8% of all analyzed samples. Children with CF had significantly more HRV positive samples compared to healthy controls, with a mean number (± SD) of 8.1 ± 2.3 versus 5,7 ± 2.9 positive samples per individual (p2 weeks) with the same HRV subtype occurred more frequently in the CF patients (p<0.01). The genetic distribution and pattern of phylogenetic diversity of the different HRV subtypes was similar in both groups. CONCLUSION: This is the first in vivo longitudinal study showing that HRV is detected more frequently and persists for longer periods in CF patients compared to healthy controls. This might indicate increased viral replication and/or decreased anti-viral defense in patients with CF