Risk Factors and Transmission of Healthcare-Related Pathogens

The literature reviews and observational studies in this thesis are about the role of epidemiology in describing, identifying and controlling transmission of healthcare-related pathogens. The ultimate goal of conducting these studies is to optimize care and to provide safer care for p

Wilde leesclubs:Een veldonderzoek naar cultuuroverdracht en sociale waarde

Veel onderzoek is gedaan naar het reilen en zeilen in leesclubs die aangesloten zijn bij verschillende instanties, waaronder Stichting Senia (een organisatie voor senioren die mensen met dezelfde interesse – literatuur – samenbrengt in leesclubs). Maar er bestaan ook (naar schatting) honderden leesclubs in Nederland die niet aangesloten zijn bij een organisatie. Onderzoek naar deze zogenaamde ‘wilde’ leesclubs is echter nog weinig gedaan. Het is interessant voor stichtingen als Senia als ook bibliotheken om meer te weten te komen over ‘wilde’ leesclubs en te zien hoe dergelijke leesclubs in zijn werk gaan. Zij kunnen door deze inzichten inspiratie opdoen om hun eigen leesclubs te verbeteren. Daarnaast komt men meer te weten over de achterliggende motivaties van lezers die liever in een ‘wilde’ leesclub lezen dan zich bij een overkoepelende organisatie aan te sluiten. Hierop kunnen stichtingen of bibliotheken wellicht inspelen in de toekomst. Aan de hand van een veldonderzoek naar deze wilde leesclubs met behulp van observaties, (korte) interviews en een vragenlijst wordt in dit referaat antwoord gezocht op de volgende vraag: “Hoe verhouden cultuuroverdracht en de sociale waarde zich tot elkaar in wilde leesclubs?

Musculoskeletal Outcomes From Chronic High-Speed, High-Impulse Resistance Exercise

While bones and muscles adapt to mechanical loading, it appears that very specific types of stimuli must be applied to achieve osteogenesis. Our study assessed musculoskeletal outcomes to 30 training sessions on an Inertial Exercise Trainer (Newnan, GA). Subjects (n = 13) performed workouts with their left leg, while their right served as an untreated control. Work-outs entailed three 60-s sets each of knee extension, hip extension and calf press exercises, separated by 90-s rests. Before and after the 30 training sessions, subjects underwent strength tests (knee and ankle extensors of both legs), DEXA scans (hip, knee and ankles of both legs), and blood draws. After 30 training sessions 2 × 2 ANOVAs showed left leg peak torques rose significantly. 2 × 2 ANCOVAs, with bone scan area as a covariate, showed significant left leg calcaneal bone mineral content ( + 29 %) and density ( + 33 %) increases after 30 training sessions. A significant decline in C-terminal telopeptides of type I collagen, a blood marker of bone resorption, also occurred after 30 training sessions. The Inertial Exercise Trainer’s large volume of training session repetitions elicited high peak force, peak acceleration and impulses that likely provided a mechanical loading stimulus that evoked calcaneal accretion

Contact tracing for vancomycin-resistant Enterococcus faecium (VRE):evaluation of the Dutch policy of quintuple screening cultures

Detection of vancomycin-resistant Enterococcus faecium (VRE) is hampered by low sensitivity of rectal swab cultures. This study aimed to define the number of screening cultures needed to increase sensitivity to detect VRE transmission, and to determine time from presumed exposure to detectable colonization. In a tertiary care setting, we retrospectively analyzed data from 9 VRE outbreaks. As a proxy or estimation for time to detectable colonization, the time between first positive culture of the presumed index patient and that of their contacts was determined. Only 64% of secondary cases were positive in the first out of five cultures. By using the first three out of five rectal swabs, 89% (95%CI: 78–95%) of all secondary cases would have been identified. The median number of days between the positive culture of the index patient and the first positive culture of secondary cases was 9 days. Eleven percent of secondary cases would have been missed if only three rectal samples would have been obtained. Furthermore, our results show that one or more rectal swabs taken around day 9 after presumed exposure should at least be included in the screening approach. In our setting, obtaining a fourth and a fifth rectal swab showed a relevant additional value compared to only one to three swabs. Our findings are useful for determining the most effective VRE contact tracing approach to prevent transmission.</p

VIM-positive Pseudomonas aeruginosa in a large tertiary care hospital: Matched case-control studies and a network analysis

Background: Emergence of multidrug-resistant Pseudomonas aeruginosa is of global concern. We aimed to identify epidemiological relationships, the most common way of transmission, and risk factors for presence of Verona Integron-encoded Metallo-β-lactamase (VIM)-positive P. aeruginosa (VIM-PA). Methods: We conducted a network analysis and matched case-control studies (1:2:2). Controls were hospital-based and matched with cases for ward, day of admission (control group 1 and 2) and time between admission and the identification of VIM-PA (control group 1). The network was visualized using Cytoscape, an