Определение предельного состояния при усталости титанового сплава ПТ5В

Полученная характеристика локальной неупругости позволяет контролировать кинетику повреждаемости титанового сплава ПТ5В, косвенно выраженной через ее статистические характеристики распределения на поверхности образца исследуемого материала. Предельное состояние конструкционного материала может быть определено из характеристики упрочнения, как уменьшение интенсивности упрочнения до граничного значения.Отримано характеристику локальної непружності, яка дозволяє контролювати кінетику пошкоджуваності титанового сплаву ПТ5В і непрямо виражена через її статистичні характеристики розподілу на поверхні зразка досліджуваного материалу. Граничний стан конструкційного матеріалу може бути визначено з характеристики зміцнення, як зменшення інтенсивності зміцнення до граничного значення.The obtained characteristic of local inelasticity allows controlling the kinetics of damageability in the PT5V titanium alloy, which is implicitly expressed via its statistical characteristics of distribution along the surface of the specimen made of the material studied. The limiting state of the structural material can be determined from its hardening response as a reduction in the hardening rate to its limiting value

An evidence synthesis approach to estimating the incidence of seasonal influenza in the Netherlands.

OBJECTIVES: To estimate, using Bayesian evidence synthesis, the age-group-specific annual incidence of symptomatic infection with seasonal influenza in the Netherlands over the period 2005-2007. METHODS: The Netherlands population and age group distribution for 2006 defined the base population. The number of influenza-like illness (ILI) cases was estimated from sentinel surveillance data and adjusted for underascertainment using the estimated proportion of ILI cases that do not consult a general practitioner. The estimated number of symptomatic influenza (SI) cases was based on indirect evidence from the surveillance of ILI cases and the proportions of laboratory-confirmed influenza cases in the 2004/5, 2005/6 and 2006/7 respiratory years. In scenario analysis, the number of SI cases prevented by increasing vaccination uptake within the 65 +  age group was estimated. RESULTS: The overall symptomatic infection attack rate (SIAR) over the period 2005-2007 was estimated at 2·5% (95% credible interval [CI]: 2·1-3·2%); 410 200 SI cases (95% CI: 338 500-518 600) were estimated to occur annually. Age-group-specific SIARs were estimated for <5 years at 4·9% (2·1-13·7%), for 5-14 years at 3·0% (2·0-4·7%), for 15-44 years at 2·6% (2·1-3·2%), for 45-64 years at 1·9% (1·4-2·5%) and for 65 +  years at 1·7% (1·0-3·0%). Under assumed vaccination uptake increases of 5% and 15%, 1970 and 5310 SI cases would be averted. CONCLUSIONS: By synthesising the available information on seasonal influenza and ILI from diverse sources, the annual extent of symptomatic infection can be derived. These estimates are useful for assessing the burden of seasonal influenza and for guiding vaccination policy

Associations between proximity to livestock farms, primary health care visits and self-reported symptoms

BACKGROUND: Living in a neighbourhood with a high density of livestock farms has been associated with adverse respiratory health effects, but less is known about healthcare utilisation. This study aimed at investigating the associations between livestock exposure and primary health care visits and self-reported symptoms. In addition, we examined the potentially confounding effect of distance from home to general practice. METHODS: Contact data between 2006 and 2009 were obtained from electronic medical records of 54,777 persons registered within 16 general practices in an area with a high density of livestock farms in the Netherlands. Data on self-reported symptoms were used from a cross-sectional sample of 531 patients in 2010. Livestock presence in a 500 m radius from home was computed using Geographic Information System data. RESULTS: In general, livestock exposure was associated with fewer contacts and self-reported symptoms for respiratory and other conditions. The number of poultry within 500 m was positively associated with the number of contacts. A longer distance to general practice was associated with fewer contacts, but did not confound associations. CONCLUSIONS: People living close to livestock farms less often see their general practitioner and report symptoms

Influenza vaccine effectiveness against influenza A subtypes in Europe: Results from the 2021-2022 I-MOVE primary care multicentre study

Background: In 2021-2022, influenza A viruses dominated in Europe. The I-MOVE primary care network conducted a multicentre test-negative study to measure influenza vaccine effectiveness (VE). Methods: Primary care practitioners collected information on patients presenting with acute respiratory infection. Cases were influenza A(H3N2) or A(H1N1)pdm09 RT-PCR positive, and controls were influenza virus negative. We calculated VE using logistic regression, adjusting for study site, age, sex, onset date, and presence of chronic conditions. Results: Between week 40 2021 and week 20 2022, we included over 11 000 patients of whom 253 and 1595 were positive for influenza A(H1N1)pdm09 and A(H3N2), respectively. Overall VE against influenza A(H1N1)pdm09 was 75% (95% CI: 43-89) and 81% (95% CI: 45-93) among those aged 15-64 years. Overall VE against influenza A(H3N2) was 29% (95% CI: 12-42) and 25% (95% CI: -41 to 61), 33% (95% CI: 14-49), and 26% (95% CI: -22 to 55) among those aged 0-14, 15-64, and over 65 years, respectively. The A(H3N2) VE among the influenza vaccination target group was 20% (95% CI: -6 to 39). All 53 sequenced A(H1N1)pdm09 viruses belonged to clade 6B.1A.5a.1. Among 410 sequenced influenza A(H3N2) viruses, all but eight belonged to clade 3C.2a1b.2a.2. Discussion: Despite antigenic mismatch between vaccine and circulating strains for influenza A(H3N2) and A(H1N1)pdm09, 2021-2022 VE estimates against circulating influenza A(H1N1)pdm09 were the highest within the I-MOVE network since the 2009 influenza pandemic. VE against A(H3N2) was lower than A(H1N1)pdm09, but at least one in five individuals vaccinated against influenza were protected against presentation to primary care with laboratory-confirmed influenza.This project has received funding from the European Centre for Disease Prevention and Control with in the framework contract ECDC/2018/029.S

multicentre analysis, I-MOVE-COVID-19 and ECDC networks, July to August 2021

Funding Information: This project received funding from the European Centre for Disease Prevention and Control (ECDC) under the contract ECD.11486. Funding Information: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 101003673. Publisher Copyright: © 2022 European Centre for Disease Prevention and Control (ECDC). All rights reserved.Introduction: In July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe. Aim: Using a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection. Methods: Individuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-CoV-2. We measured complete primary course overall VE by vaccine brand and by time since vaccination. Results: Overall VE was 74% (95% CI: 69-79), 76% (95% CI: 71-80), 63% (95% CI: 48-75) and 63% (95% CI: 16-83) among those aged 30-44, 45-59, 60-74 and ≥ 75 years, respectively. VE among those aged 30-59 years was 78% (95% CI: 75-81), 66% (95% CI: 58-73), 91% (95% CI: 87-94) and 52% (95% CI: 40-61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among people 60 years and older was 67% (95% CI: 52-77), 65% (95% CI: 48-76) and 83% (95% CI: 64-92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30-59 years was 87% (95% CI: 83-89) at 14-29 days and 65% (95% CI: 56-71%) at ≥ 90 days between vaccination and onset of symptoms. Conclusions: VE against symptomatic infection with the SARS-CoV-2 Delta variant varied among brands, ranging from 52% to 91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% at 90 days or more between vaccination and onset.publishersversionpublishe

Vaccine effectiveness against symptomatic SARS-CoV-2 infection in adults aged 65 years and older in primary care: I-MOVE-COVID-19 project, Europe, December 2020 to May 2021

I-MOVE-COVID-19 primary care study team (in addition to authors above): Nick Andrews, Jamie Lopez Bernal, Heather Whitaker, Caroline Guerrisi, Titouan Launay, Shirley Masse, Sylvie van der Werf, Vincent Enouf, John Cuddihy, Adele McKenna, Michael Joyce, Cillian de Gascun, Joanne Moran, Ana Miqueleiz, Ana Navascués, Camino Trobajo-Sanmartín, Carmen Ezpeleta, Paula López Moreno, Javier Gorricho, Eva Ardanaz, Fernando Baigorria, Aurelio Barricarte, Enrique de la Cruz, Nerea Egüés, Manuel García Cenoz, Marcela Guevara, Conchi Moreno-Iribas, Carmen Sayón, Verónica Gomez, Baltazar Nunes, Rita Roquete, Adriana Silva, Aryse Melo, Inês Costa, Nuno Verdasca, Patrícia Conde, Diogo FP Marques, Anna Molesworth, Leanne Quinn, Miranda Leyton, Selin Campbell, Janine Thoulass, Jim McMenamin, Ana Martínez Mateo, Luca Basile, Daniel Castrillejo, Carmen Quiñones Rubio, Concepción Delgado-Sanz, Jesús Oliva.The I-MOVE-COVID-19 network collates epidemiological and clinical information on patients with coronavirus disease (COVID-19), including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virological characterisation in 11 European countries [1]. One component of I-MOVE-COVID-19 is the multicentre vaccine effectiveness (VE) study at primary care/outpatient level in nine European study sites in eight countries. We measured overall and product-specific COVID-19 VE against symptomatic SARS-CoV-2 infection among those aged 65 years and older. We also measured VE by time since vaccination.This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 101003673.info:eu-repo/semantics/publishedVersio

Establishing a National Syndromic Surveillance System among Asylum Seekers

ObjectiveFacing challenges to establish a new national syndromicsurveillance system in the Netherlands for infectious diseases amongasylum seekers.IntroductionMost European countries are facing a continuous increased influxof asylum seekers [1]. Poor living conditions in crowded shelters andrefugee camps increase the risk for - outbreaks of - infectious diseasesin this vulnerable population. In line with ECDC recommendations[2], we aim to improve information on infectious diseases amongasylum seekers by establishing a new syndromic surveillance systemin the Netherlands. This system will complement the notifiabledisease system for infectious diseases.The aim of the syndromic surveillance system is to improve thedetecting of outbreaks of infectious diseases in asylum seekers’centres in an early stage of development to be able to take adequateand timely measures to prevent further spread, and to collectinformation on the burden of infection within this population.MethodsPrimary health care for asylum seekers in the Netherlands isorganized nationally by the Asylum Seekers Health Centre, withgeneral practitioners providing care in each reception centre. Generalpractitioners (GPs) act as gatekeepers for specialized, secondaryhealth care and the GP is the first professional to consult for healthproblems. Therefore, electronic health records (EHR) kept by GPsprovide a complete picture of this population. These EHRs containdata on diagnoses/symptoms and treatment of asylum seekers, usingthe International Classification of Primary Care (ICPC). This data isrecorded routinely, as part of the health care process. During summer2016, about 30,000 asylum seekers were housed in about 60 receptioncentres across the Netherlands.ResultsThe governance structure was layed down in a collaborationagreement between the Asylum Seekers Health Centre, the nationalinstitute of public health RIVM and NIVEL. To ensure privacy ofthe asylum seekers, a privacy protocol has been drawn, taking intoaccount strict privacy regulations in the Netherlands. The informationsystem provider of the health care centre developed an extraction toolthat automatically generates weekly data extracts from the electronichealth records system to a Trusted Third Party (TTP). Beforetransferring the data to NIVEL, the TTP removes directly identifyingpatient information, indirectly identifying information like date ofbirth is replaced by quarter and year, and the personal identificationnumber is replaced by a pseudonym. At NIVEL, all data is storedin a relational database, from which weekly research extracts aregenerated for infectious disease surveillance at RIVM after applyinga second pseudonymisation step (two-way pseudonimisation) [3].First data extracts are being expected mid-October 2016, after whichdata quality will be evaluated. Weekly, or daily, consultations rateswill be calculated based on the number of cases meeting predefineddefinitions, stratified by immigration centre, age group, sex andnationality. Numerators will be based on the number of populationhoused in the immigration centres.ConclusionsWith the cooperation of a national health care centre, providingprimary care to asylum seekers housed at several locations, and theinformation system provider of the health care centre, EHRs can beused for syndromic surveillance, taking into account strict privacyregulations. The new surveillance system will be evaluated after oneyear, focusing on data quality, usefulness, and the added value aboveto the notification of diseases

Establishing a National Syndromic Surveillance System among Asylum Seekers

ObjectiveFacing challenges to establish a new national syndromicsurveillance system in the Netherlands for infectious diseases amongasylum seekers.IntroductionMost European countries are facing a continuous increased influxof asylum seekers [1]. Poor living conditions in crowded shelters andrefugee camps increase the risk for - outbreaks of - infectious diseasesin this vulnerable population. In line with ECDC recommendations[2], we aim to improve information on infectious diseases amongasylum seekers by establishing a new syndromic surveillance systemin the Netherlands. This system will complement the notifiabledisease system for infectious diseases.The aim of the syndromic surveillance system is to improve thedetecting of outbreaks of infectious diseases in asylum seekers’centres in an early stage of development to be able to take adequateand timely measures to prevent further spread, and to collectinformation on the burden of infection within this population.MethodsPrimary health care for asylum seekers in the Netherlands isorganized nationally by the Asylum Seekers Health Centre, withgeneral practitioners providing care in each reception centre. Generalpractitioners (GPs) act as gatekeepers for specialized, secondaryhealth care and the GP is the first professional to consult for healthproblems. Therefore, electronic health records (EHR) kept by GPsprovide a complete picture of this population. These EHRs containdata on diagnoses/symptoms and treatment of asylum seekers, usingthe International Classification of Primary Care (ICPC). This data isrecorded routinely, as part of the health care process. During summer2016, about 30,000 asylum seekers were housed in about 60 receptioncentres across the Netherlands.ResultsThe governance structure was layed down in a collaborationagreement between the Asylum Seekers Health Centre, the nationalinstitute of public health RIVM and NIVEL. To ensure privacy ofthe asylum seekers, a privacy protocol has been drawn, taking intoaccount strict privacy regulations in the Netherlands. The informationsystem provider of the health care centre developed an extraction toolthat automatically generates weekly data extracts from the electronichealth records system to a Trusted Third Party (TTP). Beforetransferring the data to NIVEL, the TTP removes directly identifyingpatient information, indirectly identifying information like date ofbirth is replaced by quarter and year, and the personal identificationnumber is replaced by a pseudonym. At NIVEL, all data is storedin a relational database, from which weekly research extracts aregenerated for infectious disease surveillance at RIVM after applyinga second pseudonymisation step (two-way pseudonimisation) [3].First data extracts are being expected mid-October 2016, after whichdata quality will be evaluated. Weekly, or daily, consultations rateswill be calculated based on the number of cases meeting predefineddefinitions, stratified by immigration centre, age group, sex andnationality. Numerators will be based on the number of populationhoused in the immigration centres.ConclusionsWith the cooperation of a national health care centre, providingprimary care to asylum seekers housed at several locations, and theinformation system provider of the health care centre, EHRs can beused for syndromic surveillance, taking into account strict privacyregulations. The new surveillance system will be evaluated after oneyear, focusing on data quality, usefulness, and the added value aboveto the notification of diseases

Patients with tinnitus use more primary healthcare compared to people without tinnitus

Tinnitus is a heterogeneous condition not only in terms of nature of the sound, but also in co-morbidities such as mental health issues. Prevalence number range widely between 5 and 43%. Even though the etiologic pathway between tinnitus and its comorbidities remains unclear, in this study we aim to assess whether people with tinnitus use more primary health care than people without tinnitus. To compare primary healthcare consumption between patients with tinnitus and people without tinnitus. In this cross-sectional study, data on number of consultations with the general practitioner or nurse practitioner mental health services were obtained from Nivel (Netherlands Institute for Health Service Research) Primary Care Database in 2018 (n = 963,880 people). People with an open tinnitus episode (n = 8050) were defined as a patient with tinnitus and compared to all other people. Percentages, means, ranges and mean differences were calculated for the total number of consultations and for organ specific diagnoses registered as ICPC-1 code on the day of consultation. Secondary, the total number of referrals to medical specialists and number of drug prescriptions was collected. Logistic regressions were performed to predict having one or more contacts, referrals, and prescriptions,with having tinnitus, this was corrected for age and gender. Patients with tinnitus had a mean of 9.8 (SD 10.9) primary care consultations in 2018, compared to 5.7 (SD 7.9) for people without tinnitus. More patients with tinnitus had more than one referral to medical specialists (47%) compared to people without tinnitus (25%). Patients with tinnitus have 1.2 (mean difference) more drug prescriptions than people without tinnitus. Compared to people without tinnitus, patients with tinnitus were more likely to have one or more of primary healthcare contact, independent of age group and gender. Patients with tinnitus had more consultations in primary health care than people without tinnitus. They are more often referred to medical specialists and receive more drug prescriptions. The causal relationship between tinnitus and the higher healthcare consumption remains to be researched

Trends in suicidal behaviour in Dutch general practice 1983-2013: A retrospective observational study.

<strong>Objectives</strong> To analyse trends in suicidal behaviour as reported by the Dutch sentinel general practices from 1983 to 2013. Second, to examine the relationship between suicidal behaviour and several patient characteristics. Finally, to compare the relationship between suicidal behaviour and patient characteristics before (1983–2007) and after (2008–2013) the start of the crisis. <strong>Setting</strong> 40 general practices in the Netherlands during the period 1983–2013. <strong>Participants</strong> Patients with an ICPC code of P77 (suicide attempt). <strong>Primary and secondary outcomes </strong> Primary outcomes were age-adjusted and gender-specific trends in reported suicides (342) and suicide attempts (1614). Secondary outcomes were the relationship between suicidal behaviour and age, household composition, history of depression, recognition of suicide ideation, treatment before the suicidal behaviour and contact within the past month before suicidal behaviour for the period 1983–2013. Additionally, separate frequencies for the periods 1983–2007 and 2008–2013 were presented. <strong>Results</strong> Join-point analyses revealed a significant rise in male suicides from 2008 (b=0.32, SE=0.1, p=0.008), and an increase in male suicide attempts since 2009 (b=0.19, SE=0.04, p<0.001). Female suicidal behaviour showed a steady decrease from 1989 to 2013(b=−0.03, SE=0.007, p<0.0001 for female suicide, b=−0.02, SE=0.002, p<0.001 for female attempts). Before 2007, a history of depression was reported in 65% (168/257) of the suicides. After the start of the recession, a depression was recognised in 44% (22/50) of the patients who died by suicide. <strong>Conclusions</strong> Since 2008, there was a rise in the male suicide rate while female suicide behaviour has continued to decline. General practitioners less often reported a history of depression within patients who died due to suicide after 2007 than before. Training in the early recognition of suicide ideation in depressive patients might improve suicide prevention in primary care. (aut. ref.