Cost-effectiveness of a screening strategy for Q fever among pregnant women in risk areas: a clustered randomized controlled trial

Contains fulltext : 87399.pdf (publisher's version ) (Open Access)BACKGROUND: In The Netherlands the largest human Q fever outbreak ever reported in the literature is currently ongoing with more than 2300 notified cases in 2009. Pregnant women are particularly at risk as Q fever during pregnancy may cause maternal and obstetric complications. Since the majority of infected pregnant women are asymptomatic, a screening strategy might be of great value to reduce Q fever related complications. We designed a trial to assess the (cost-)effectiveness of a screening program for Q fever in pregnant women living in risks areas in The Netherlands. METHODS/DESIGN: We will conduct a clustered randomized controlled trial in which primary care midwife centres in Q fever risk areas are randomized to recruit pregnant women for either the control group or the intervention group. In both groups a blood sample is taken around 20 weeks postmenstrual age. In the intervention group, this sample is immediately analyzed by indirect immunofluorescence assay for detection of IgG and IgM antibodies using a sensitive cut-off level of 1:32. In case of an active Q fever infection, antibiotic treatment is recommended and serological follow up is performed. In the control group, serum is frozen for analysis after delivery. The primary endpoint is a maternal (chronic Q fever or reactivation) or obstetric complication (low birth weight, preterm delivery or fetal death) in Q fever positive women. Secondary aims pertain to the course of infection in pregnant women, diagnostic accuracy of laboratory tests used for screening, histo-pathological abnormalities of the placenta of Q fever positive women, side effects of therapy, and costs. The analysis will be according to the intention-to-screen principle, and cost-effectiveness analysis will be performed by comparing the direct and indirect costs between the intervention and control group. DISCUSSION: With this study we aim to provide insight into the balance of risks of undetected and detected Q fever during pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov, protocol record NL30340.042.09

Bestandsoverzicht van snoekbaars, baars, blankvoorn en brasem in het IJssel-/Markermeer

Dit rapport geeft een overzicht van de bestandsontwikkelingen van snoekbaars, baars, blankvoorn en brasem in het IJsselmeer en Markermeer sinds 1992. De nadruk ligt op de ontwikkeling van de bestanden sinds het aangepaste beheer in visseizoen 2014/2015. De vraag is, of sinds het aangepaste beheer verbeteringen in het bestand te zien zijn, in de bestandsgrootte en in de lengte/leeftijd-opbouw van het bestand (i.e., de bestandsopbouw). Om de ontwikkelingen sinds het nieuwe beheer te evalueren worden de gegevens van 2015-2017 (i.e., de nieuwe beheersituatie) afgezet tegen de gegevens van de drie jaar ervoor (i.e., de oude beheersituatie)

The commons tragedy in the North Sea brown shrimp fishery: how horizontal institutional interactions inhibit a self-governance structure

Self-regulation is now widely regarded as an effective mechanism for collective action aimed at sustainable management of common pool resources. The brown shrimp (Crangon crangon) fishing industry in the Netherlands has been working on the implementation of a self-management strategy since 2007, as part of its ambition to get certified to the Marine Stewardship Council standard. Part of the self-management strategy is the development of a harvest control rule for reducing fishing effort when catches are low. Until recently, these attempts failed. The failure of the initiatives for self-management is examined within Ostrom’s nested framework for understanding institutions for managing resource use. This framework emphasises the importance of strong vertical embeddedness of institutional arrangements for resource (co)management. Our analysis shows that, despite a strong vertical embeddedness, mismatches between different institutional frameworks at the same level (horizontal interaction) affect the performance of self-management at the organizational level. This inhibits the resource users’ collective actions to self-manage their brown shrimp fishery, leading to a potential commons tragedy

Food from the ocean; towards a research agenda for sustainable use of our oceans’ natural resources

By 2050 it is expected that food, clean drinking water and sustainable energy has to be produced for world population of closeto10 billion people. Ourseasandoceansrepresent71%ofearth'ssurface,yetitsspaceandresources today are not sustainably utilised to their full extent. The importance of the use of the marine environment is within the EU widely acknowledged and reflected in such agendas as the EU Blue Growth strategy, the Food 2030 agenda and the Food from our Oceans vision. In order to substantiate the vision to increasingly feed the world population from our oceans, a foresight exercise was implemented to construct an agenda of the science needed in the realm of fisheries, aquaculture and seafood. This resulted in a research agenda that is logically argued and based on an analysis made by stakeholders and experts which led to the identification of priorities having a scientific analytical basis as well as a societal reference. The process and the results of this foresight exercise are presented and are put int he wider context of Europe's research agenda towards 2050. In order to bring about the required Blue Revolution, substantial effort should be rendered to the science and innovation needed to support this development

Navigating the future IV

The monograph reviews the recent trends in marine sciences and identifies research priorities that will characterize marine research in Europe in the next decade