Trends in Antibiotic Prescribing in Adults in Dutch General Practice

Background: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this study was to determine the antibiotic prescriptions of different antibiotic classes in general practice in relation to age. Methodology: Retrospective study of 22 rural and urban general practices from the Dutch Registration Network Family Practices (RNH). Antibiotic prescribing data were extracted from the RNH database from 2000-2009. Trends over time in antibiotic prescriptions were assessed with multivariate logistic regression including interaction terms with age. Registered ADEs as a result of antibiotic prescriptions were also analyzed. Principal Findings: In total 658,940 patients years were analyzed. In 11.5% (n = 75,796) of the patient years at least one antibiotic was prescribed. Antibiotic prescriptions increased for all age categories during 2000-2009, but the increase in elderly patients (>80 years) was most prominent. In 2000 9% of the patients >80 years was prescribed at least one antibiotic to 22% in 2009 (P<0.001). Elderly patients had more ADEs with antibiotics and co-medication was identified as the only independent determinant for ADEs. Conclusion/Discussion: The rate of antibiotic prescribing for patients who made a visit to the GP is increasing in the Netherlands with the most evident increase in the elderly patients. This may lead to more ADEs, which might lead to higher consumption of health care and more antibiotic resistance

High and persistent excretion of hepatitis A virus in immunocompetent patients.

The duration and level of virus excretion in blood and faeces of patients with hepatitis A virus (HAV) infection were studied in relation to levels of alanine aminotransferase (ALT), disease severity and HAV genotype. Clinical data, blood and faeces were collected from 27 patients with acute hepatitis A (median age: 33 years) for a maximum of 26 weeks. Single blood donations from 55 other patients with acute HAV (median age: 32 years) were also used. Virus loads were quantified by competitive nested RT-PCR. HAV was excreted in faeces for a median period of 81 days after disease onset, with 50% of patients still excreting high levels at Day 36 (2 x 10(6) - 2 x 10(8) copies/ml faeces suspension). Viraemia was detected, but not quantifiable, for a median period of 42 days. In the first 10 days of illness, higher ALT levels were correlated with higher viraemia levels. Comparison of patients infected with genotype 1a with those infected with type 1b did not differ significantly in terms of the duration of HAV excretion or jaundice. In conclusion, faecal excretion of HAV is at a high titre in the first month, perhaps making patients infectious for a longer period than assumed currently. Blood banks should be aware that viraemia may be present for more than 1 month, and genotype did not affect the duration of virus excretion or jaundice

A Web-Based Respondent Driven Sampling Pilot Targeting Young People at Risk for Chlamydia Trachomatis in Social and Sexual Networks with Testing: A Use Evaluation

YesWith the aim of targeting high-risk hidden heterosexual young people for Chlamydia trachomatis (CT) testing, an innovative web-based screening strategy using Respondent Driven Sampling (RDS) and home-based CT testing, was developed, piloted and evaluated. Two STI clinic nurses encouraged 37 CT positive heterosexual young people (aged 16-25 years), called index clients, to recruit peers from their social and sexual networks using the web-based screening strategy. Eligible peers (young, living in the study area) could request a home-based CT test and recruit other peers. Twelve (40%) index clients recruited 35 peers. Two of these peers recruited other peers (n = 7). In total, 35 recruited peers were eligible for participation; ten of them (29%) requested a test and eight tested. Seven tested for the first time and one (13%) was positive. Most peers were female friends (80%). Nurses were positive about using the strategy. The screening strategy is feasible for targeting the hidden social network. However, uptake among men and recruitment of sex-partners is low and RDS stopped early. Future studies are needed to explore the sustainability, cost-effectiveness, and impact of strategies that target people at risk who are not effectively reached by regular health care

Social networks in relation to self-reported symptomatic infections in individuals aged 40-75 - the Maastricht study.

Most infections are spread through social networks (detrimental effect). However, social networks may also lower infection acquisition (beneficial effect). This study aimed to examine associations between social network parameters and prevalence of self-reported upper and lower respiratory, gastrointestinal and urinary tract infections in a population aged 40-75

Bouwen langs de Maas:Huizen in Limburgse steden circa 1200-1600

Het proefschrift ‘Bouwen langs de Maas’ behandelt de bouwpraktijk van stedelijke huizen in de late middeleeuwen in de steden Maastricht, Sittard, Roermond en Venlo. Het onderzoek richt zich op de factoren die het uiterlijk van deze huizen bepalen. Er wordt eerst gekeken naar de historische context van de steden, zoals politieke omstandigheden, de specifieke stadsgeschiedenis, handelscontacten en naar de heersende bouwvoorschriften en de organisatie van bouwambachten. Vervolgens wordt per stad de ruimtelijke ontwikkeling geschetst en de positie van de huizen daarin. In Hoofdstuk 3 wordt aandacht besteed aan de verschillende huisvormen die in de steden voorkomen: woontorens, huizen met een hofachtige aanleg (‘poorten’), diepe huizen, dubbelhuizen en dubbelbrede huizen. Hoofdstuk 4 is gewijd aan de bouwmaterialen die kenmerkend zijn voor de huizenbouw in de vier steden tot ongeveer 1600 n. Chr.. Hier wordt gekeken naar de herkomst, verspreiding en toepassing van bouwmaterialen, zoals kolenzandsteen, mergel, baksteen en eikenhout. Hoofdstuk 4 behandelt ook de constructie van de huizen. Zowel vakwerkbouw als steenbouw komen aan bod, evenals de verstening van de huizen en constructieve elementen zoals kelders, balklagen en kapconstructies. In hoofdstuk 5 wordt de vormgeving van de huizen besproken, zowel die van vroege steenbouw, als die van vakwerkhuizen in Maastricht en Sittard en bakstenen huizen in Roermond en Venlo. Het proefschrift wordt afgesloten met hoofdstuk 6, waarin de resultaten van de onderzoeksthema’s in een bredere, interregionale en internationale context worden geplaatst

Design of the FemCure study: prospective multicentre study on the transmission of genital and extra-genital Chlamydia trachomatis infections in women receiving routine care

BACKGROUND: In women, anorectal infections with Chlamydia trachomatis (CT) are about as common as genital CT, yet the anorectal site remains largely untested in routine care. Anorectal CT frequently co-occurs with genital CT and may thus often be treated co-incidentally. Nevertheless, post-treatment detection of CT at both anatomic sites has been demonstrated. It is unknown whether anorectal CT may play a role in post-treatment transmission. This study, called FemCure, in women who receive routine treatment (either azithromycin or doxycycline) aims to understand the post-treatment transmission of anorectal CT infections, i.e., from their male sexual partner(s) and from and to the genital region of the same woman. The secondary objective is to evaluate other reasons for CT detection by nucleic acid amplification techniques (NAAT) such as treatment failure, in order to inform guidelines to optimize CT control. METHODS: A multicentre prospective cohort study (FemCure) is set up in which genital and/or anorectal CT positive women (n = 400) will be recruited at three large Dutch STI clinics located in South Limburg, Amsterdam and Rotterdam. The women self-collect anorectal and vaginal swabs before treatment, and at the end of weeks 1, 2, 4, 6, 8, 10, and 12. Samples are tested for presence of CT-DNA (by NAAT), load (by quantitative polymerase chain reaction -PCR), viability (by culture and viability PCR) and CT type (by multilocus sequence typing). Sexual exposure is assessed by online self-administered questionnaires and by testing samples for Y chromosomal DNA. Using logistic regression models, the impact of two key factors (i.e., sexual exposure and alternate anatomic site of infection) on detection of anorectal and genital CT will be assessed. DISCUSSION: The FemCure study will provide insight in the role of anorectal chlamydia infection in maintaining the CT burden in the context of treatment, and it will provide practical recommendations to reduce avoidable transmission. Implications will improve care strategies that take account of anorectal CT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02694497

Language-sites: Accessing and presenting language resources via geographic information systems

The emerging area of Geographic Information Systems (GIS) has proven to add an interesting dimension to many research projects. Within the language-sites initiative we have brought together a broad range of links to digital language corpora and resources. Via Google Earth's visually appealing 3D-interface users can spin the globe, zoom into an area they are interested in and access directly the relevant language resources. This paper focuses on several ways of relating the map and the online data (lexica, annotations, multimedia recordings, etc.). Furthermore, we discuss some of the implementation choices that have been made, including future challenges. In addition, we show how scholars (both linguists and anthropologists) are using GIS tools to fulfill their specific research needs by making use of practical examples. This illustrates how both scientists and the general public can benefit from geography-based access to digital language dat

Bouwen langs de Maas:Huizen in Limburgse steden circa 1200-1600

Het proefschrift ‘Bouwen langs de Maas’ behandelt de bouwpraktijk van stedelijke huizen in de late middeleeuwen in de steden Maastricht, Sittard, Roermond en Venlo. Het onderzoek richt zich op de factoren die het uiterlijk van deze huizen bepalen. Er wordt eerst gekeken naar de historische context van de steden, zoals politieke omstandigheden, de specifieke stadsgeschiedenis, handelscontacten en naar de heersende bouwvoorschriften en de organisatie van bouwambachten. Vervolgens wordt per stad de ruimtelijke ontwikkeling geschetst en de positie van de huizen daarin. In Hoofdstuk 3 wordt aandacht besteed aan de verschillende huisvormen die in de steden voorkomen: woontorens, huizen met een hofachtige aanleg (‘poorten’), diepe huizen, dubbelhuizen en dubbelbrede huizen. Hoofdstuk 4 is gewijd aan de bouwmaterialen die kenmerkend zijn voor de huizenbouw in de vier steden tot ongeveer 1600 n. Chr.. Hier wordt gekeken naar de herkomst, verspreiding en toepassing van bouwmaterialen, zoals kolenzandsteen, mergel, baksteen en eikenhout. Hoofdstuk 4 behandelt ook de constructie van de huizen. Zowel vakwerkbouw als steenbouw komen aan bod, evenals de verstening van de huizen en constructieve elementen zoals kelders, balklagen en kapconstructies. In hoofdstuk 5 wordt de vormgeving van de huizen besproken, zowel die van vroege steenbouw, als die van vakwerkhuizen in Maastricht en Sittard en bakstenen huizen in Roermond en Venlo. Het proefschrift wordt afgesloten met hoofdstuk 6, waarin de resultaten van de onderzoeksthema’s in een bredere, interregionale en internationale context worden geplaatst

Venlo, verrassend middeleeuws

For a long time it was thought that in the North-Limburg town of Venlo few houses from before the nineteenth century survived, although the town centre dates back to the Middle Ages. On the one hand, this idea was caused by incomplete inventories in the past, when it was chiefly the facades of houses that were looked at. On the other hand, parts of the town were severely damaged during the Second World War and the reconstruction and redevelopment work made the impression that just a small historical area had been preserved. However, a recent, rough inventory of the town centre, which also took the structures behind the facades into account, showed that there were sixty late-medieval buildings and thirty buildings possibly containing medieval remains. Further building-historical research in some of these buildings confirmed the selection of the inventory drawn up. Markt 24 and 26, two buildings on the market square of Venlo, were studied and in both cases they turned out to be latemedieval. Markt 24 is originally a fifteenth-century mercantile house which was extended in the sixteenth century and acquired a side house. Markt 26 was also extended in the sixteenth century, but it had a public function (for instance, as a reception hall), judging from the first floor with the remains of a sixteenth-century fireplace and several decorated bolsters. The changes to both buildings seem to be connected with the increased importance of the Markt in the sixteenth century. In that period the town centre moved from Oude Markt on the river Maas to the present Markt and obtained a higher status. This also had consequences for Houtstraat, situated behind the Markt, which initially was an important commercial street leading to Oude Markt, but in the course of the sixteenth and seventeenth centuries changed into a service providing street. Thus the former mercantile houses changed as well. Houtstraat 9, previously a tall mercantile house with a gable on the street was combined under one single roof with its side house and adjacent premises no. 11 and probably acquired a brewery function. A similar process took place for the adjacent premises Houtstraat 13. On the basis of this rough inventory and the building-historical studies three types of houses are to be distinguished in Venlo so far: a large double house, four or more bays wide with a dividing wall up to the roof; a large, deep mercantile house with a gable on the street and thirdly, a smaller, deep mercantile house with low floors. Future research in Venlo should result in more information on the types of houses and the historical development of the town. Further research may also lead to better protection of the premises, which at present is rather arbitrary and not based on any structured study

Presence of Epstein-Barr virus latency type III at the single cell level in post- transplantation lymphoproliferative disorders and AIDS related lymphomas

AIMS: To investigate the expression pattern of Epstein-Barr virus (EBV) latent genes at the single cell level in post-transplantation lymphoproliferative disorders and acquired immunodefiency syndrome (AIDS) related lymphomas, in relation to cellular morphology. METHODS: Nine post-transplantation lymphoproliferative disorders and three AIDS related lymphomas were subjected to immunohistochemistry using monoclonal antibodies specific for EBV nuclear antigen 1 (EBNA1) (2H4), EBNA2 (PE2 and the new rat anti-EBNA2 monoclonal antibodies 1E6, R3, and 3E9), and LMP1 (CS1-4 and S12). Double staining was performed combining R3 or 3E9 with S12. RESULTS: R3 and 3E9 anti-EBNA2 monoclonal antibodies were more sensitive than PE2, enabling the detection of more EBNA2 positive lymphoma cells. Both in post-transplantation lymphoproliferative disorders and AIDS related lymphomas, different expression patterns were detected at the single cell level. Smaller neoplastic cells were positive for EBNA2 but negative for LMP1. Larger and more blastic neoplastic cells, sometimes resembling Reed-Sternberg cells, were LMP1 positive but EBNA2 negative (EBV latency type II). Morphologically intermediate neoplastic cells coexpressing EBNA2 and LMP1 (EBV latency type III), were detected using R3 and 3E9, and formed a considerable part of the neoplastic population in four of nine post-transplantation lymphoproliferative disorders and two of three AIDS related lymphomas. All samples contained a subpopulation of small tumour cells positive exclusively for Epstein-Barr early RNA and EBNA1. The relation between cellular morphology and EBV expression patterns in this study was less pronounced in AIDS related lymphomas than in post-transplantation lymphoproliferative disorders, because the AIDS related lymphomas were less polymorphic than the post-transplantation lymphoproliferative disorders. CONCLUSIONS: In post-transplantation lymphoproliferative disorders and AIDS related lymphomas, EBV latency type III can be detected by immunohistochemistry in a subpopulation of tumour cells using sensitive monoclonal antibodies R3 and 3E9. Our data suggest that EBV infected tumour cells in these lymphomas undergo gradual changes in the expression of EBV latent genes, and that these changes are associated with changes in cellular morphology