GGD Haaglanden

Evidence on risk factors for a complicated course of lower respiratory tract infections (LRTIs) in primary care remains limited and often consensus based. While socioeconomic status (SES) and migration background have been linked to complicated LRTIs in population-based studies, their predictive value in primary care remains unclear. Consequently, these factors are not incorporated within current guidelines, which may contribute to health inequalities. Therefore, we aimed to evaluate the added value of SES and migration background as predictive factors of a complicated course of LRTIs in primary care. Routine care data from Dutch general practices participating in the Extramural LUMC Academic Network database (Leiden-The Hague-Zoetermeer region) from 2014 to 2023, excluding COVID-19 years, was linked to sociodemographic and hospital claims data from Statistic Netherlands. Adults presenting with LRTI complaints were included (n = 145,445). Multivariable logistic regression models were constructed to predict 30-day hospitalisation or death following LRTI. Models included conventional risk factors with SES and migration background subsequently added. In this study we show that after adjusting for conventional clinical factors, SES is a strong predictor of a complicated course of LRTI, whereas migration background is not. Patients in the lowest SES category have an adjusted odds ratio of 1.46 (95%CI: 1.31 - 1.62) for a complicated course compared to the highest. SES is a strong predictor of a complicated course of LRTI in primary care, even after adjusting for conventional risk factors. The incorporation of SES into clinical decision tools and guidelines has the potential to enhance risk-stratification of patients with LRTI in daily practice of primary care, thereby supporting more equitable care.

Capillary electrophoresis (CE) often provides superior separation of macromolecules such as monoclonal antibodies (mAbs), a major biopharmaceutical class, compared with liquid chromatography. However, electropherograms frequently exhibit complex baselines and peak shapes that are not reliably handled by integration algorithms designed for chromatographic data, and manual integration is often required. Many concepts have been proposed to improve peak integration, ranging from incremental algorithmic refinements and signal-to-noise (S/N)-based approaches to artificial intelligence (AI)-driven strategies, but objective performance comparisons are not possible without shared reference data sets and agreed peak limits. To address this gap, we initiated a multinational collaboration involving industrial and academic laboratories to create a comprehensive reference data set for CE peak integration. A total of 227 challenging and practically relevant electropherograms were collected from diverse applications, converted to a standardized format, and independently integrated by multiple experts. Using dedicated software tools and a structured consensus process, mutually accepted reference integration limits were established for each data set. These reference electropherograms, together with the underlying integration rules, are now made available to the scientific community. Analysis of the reference data set identified general principles for reliable peak integration, including the importance of standardized zoom levels and consistent handling of small peaks near the noise level. The data set provides a common foundation for benchmarking commercial chromatography data systems (CDS) and for developing and validating new algorithmic and AI-based integration methods. We expect this work to speed up the development of practical, automated integration strategies for CE and that these core concepts can be applied to other separation techniques.

Electroconvulsive therapy (ECT) is an effective treatment for major depressive episodes, though its mechanisms remain unclear. Its use is limited by stigma and potential cognitive side-effects. Repeated magnetic resonance imaging (MRI) may provide further insights into brain changes related to ECT’s efficacy and cognitive outcomes. We analyzed cognitive, efficacy, and MRI data from depressed patients undergoing ECT in two prospective longitudinal trials (NCT04028596, NL-OMON43040), using 26 matched healthy controls (2020-BC-12375) to control for test-retest effects. All participants were scanned on the same MRI system. Structural and diffusion tensor imaging (DTI) scans were acquired at baseline, after the initial ECT sessions, within two weeks post-treatment, and at three-month follow-up. Linear and nonlinear changes in grey matter (GM) volume, white matter (WM) volume, mean diffusivity (MD), and fractional anisotropy (FA) were assessed. Early brain changes were examined in relation to clinical outcomes. After the 3rd ECT session (n = 19), subcortical GM volume increased with a right-lateralized MD decrease. Two weeks post-ECT (n = 30), cortical GM volume increased, returning to baseline by three months. In WM, MD increased linearly post-ECT and remained elevated at follow-up, with no widespread FA changes (n = 30). ECT transiently impaired verbal learning (n = 23, pbonferroni = 0.04), letter fluency (n = 22, pbonferroni = 0.04), and animal fluency (n = 62, pbonferroni = 0.02). Early brain changes were not associated with cognitive or efficacy outcomes. These results suggest that ECT induces rapid changes in brain macrostructure and microstructure. While macrostructural increases are temporary, microstructural changes in brain structure are longer-lasting.

Late-stage HIV diagnoses among heterosexuals remain a problem in Europe, yet little is known about its risk factors. We aimed to identify the trends and factors associated with late-stage HIV diagnosis among heterosexuals in the Netherlands. We used national HIV surveillance data and included individuals diagnosed between 2012 and 2022, with heterosexual contact as the suspected transmission route. We applied descriptive statistics and logistic regression analyses. Of 1637 HIV diagnoses among heterosexuals, 932 (57%) were late-stage disease. The proportion of late-stage diagnoses was stable during 2012-2022 (range 51-62%). Significant risk factors for late-stage diagnosis were male sex (adjusted odds ratio [AOR] = 1.72; 95% confidence interval [CI] = 1.40-2.13), older age (every 10-year increase: AOR = 1.48; 95% CI = 1.34-1.62), being born in Africa (AOR = 2.21; 95% CI = 1.70-2.88), and Asia (AOR = 2.93; 95% CI = 1.88-4.65). People born in eastern Europe approached significance (AOR = 1.70; 95% CI = 0.97-3.05). Most late-stage diagnoses occurred in hospitals. The proportion of late-stage HIV diagnoses remains high among heterosexuals in the Netherlands. Men; older people; and those born in Africa, Asia, and eastern Europe were associated with late-stage diagnosis.

Case summaryA 9-year-old intact female domestic shorthair cat was evaluated for lethargy, vaginal discharge and intermittent perineal swelling that resolved after urination. Ultrasonography revealed severe uterine enlargement consistent with pyometra. During ovariohysterectomy, the urinary bladder was found retroflexed into the pelvic canal and manually repositioned. Despite initial improvement, perineal swelling recurred. CT confirmed persistent urinary bladder retroflexion in the absence of perineal hernia, pelvic trauma or pelvic canal mass. Exploratory celiotomy demonstrated complete absence of the ventral and left lateral vesical ligaments, providing a structural explanation for the recurrent displacement. The bladder was surgically stabilised with an incisional cystopexy, resulting in an uneventful recovery and no recurrence over 7 years.Relevance and novel informationUrinary bladder retroflexion is exceptionally rare in cats and has been described only in association with pelvic disruption or perineal hernia. This case is the first to describe bladder retroflexion in a cat independent of pelvic diaphragm failure and instead driven by severe uterine distension from pyometra. The case introduces a previously unrecognised pathophysiological mechanism in which chronic uterine enlargement exerts caudal traction on the bladder, potentially compromising vesical ligament integrity and permitting retroflexion. These findings expand current understanding of the factors influencing bladder positioning in cats and demonstrate that reproductive tract pathology alone can lead to bladder malposition. Long-term resolution after incisional cystopexy underscores the effectiveness of surgical stabilisation when bladder support structures are deficient. This case broadens the differential diagnosis for perineal swelling in female cats and highlights pyometra-induced uterine distension as an under-recognised cause of urinary bladder displacement.

Abstract Issue The burden of disease caused by air pollution in the Haaglanden region is higher than the national average in the Netherlands. This exposure leads to premature death and a range of serious health effects. As air pollution is a problem that transcends borders, governmental organizations in the region should take measures in a coordinated way. Yet collaboration of municipalities on this topic is difficult as it involves a range of policy domains such as mobility, construction, and public health. Description Over a two-year span, the municipal health service (GGD) has been supporting a regional approach to enhance collaboration between nine municipalities and governmental stakeholders on 5 key themes: protecting vulnerable residents, working towards clean construction, active mobility, reducing wood burning, and improving sustainability of glasshouse horticulture. These themes were based on the most relevant local sources of air pollution identified in 2023. Key questions are: what are the most effective measures on air quality to collaborate in the Haaglanden region? And; what do municipalities need to implement these measures? Results A collaborative strategy has been developed, including the following steps: 1) mapping, 2) thematic meetings, 3) discussion and consensus on collaboration themes, 4) defining measures, and 5) exploring how to implement them in municipalities. Lessons Building collaboration on air quality issues requires time and effort, as it involves several domains and multiple organizational layers in both civil service and governance. Given air pollution's cross-border impact, coordinated action is vital for long-term impact on policies, and will lead to indirect reductions in air pollution (NO2, PM2,5) and protect vulnerable populations. Key messages • The Haaglanden region faces a higher air pollution-related health burden than the national average. • A regional strategy is developed to improve collaboration and reduce air pollution.

Abstract Background We assessed whether participants in the EZI-PrEP study, a non-inferiority trial evaluating online and six-monthly monitoring of oral HIV pre-exposure prophylaxis (PrEP), represent the broader population of PrEP users in the Netherlands. Methods We conducted a cross-sectional study using routinely collected data from September 2021 to August 2022 at four sexual health centres (SHCs) in the Netherlands. Socio-demographic characteristics, sexual behaviour, and prevalence of bacterial STIs were compared between EZI-PrEP participants at baseline and other PrEP users during their first PrEP monitoring visit in said time period. Results The analysis included 469 EZI-PrEP participants and 5196 other PrEP users; respectively 99% and 96% were men who have sex with men (MSM). EZI-PrEP participants were less often transgender or gender divers persons (TGDP) (1% vs. 4%, p<0.001), older (median age=36 vs. 34 years, p=0.004), more often born in the Netherlands (68% vs. 58%, p<0.001), and more often completed a university/college degree (81% vs. 76%, p=0.01). They reported more group sex (38% vs. 33%, p=0.023) and condomless anal sex (95% vs. 92%, p=0.004), but less often sex work (1% vs. 6%, p<0.001). Prevalence of bacterial STIs was similar between groups (19% vs 18%, p=0.766). Conclusions The similar STI prevalence suggests comparable risk for HIV acquisition among EZI-PrEP participants and other PrEP users, making EZI-PrEP study outcomes applicable to a broader population of PrEP users. However, under-representation of TGDPs, sex workers, individuals not born in the Netherlands, and individuals without university or college degree may limit generalizability.

ABSTRACTBackground/objectiveVarious studies have demonstrated, European data regarding ethnic disparities in health-related quality of life (HRQOL) after stroke is scarce and none used patient reported outcomes measurements (PROMs). This study explores whether ethnicity predict HRQOL using PROMs and cognitive function after stroke in the Netherlands.Patients and methodsPatients admitted to the hospital with a first ever stroke were included. Outcome assessments included the Patient Reported Outcomes Measurement Information System (PROMIS) Profile and EuroQoL-5D (EQ-5D index and EQ-5D-L Visual Analogue Scale, VAS) for HRQOL and the PROMIS Cognitive Function for cognitive functioning. Measurements were done at hospital admission and after 3 and 12 months (EQ-5D-3L and EQ-VAS only at 12 months). Ethnicity (migration background yes/no), other demographics and stroke characteristics were collected at admission. Outcomes were compared between patients with and without a migration background by a multivariate linear mixed-effects model, adjusted for age, sex, education level and severity of stroke (NIHSS at admission).Results262 patients were included, of whom 74 (28.2%) did and 188 (71.8%) did not have a migration background. A significant difference was observed at admission for the physical function score (estimate=3.30, SE=1.25, p=0.01), at three months for anxiety score (estimate=-2.95, SE=1.48, p=0.05) and twelve months for sleep disturbance score (estimate=-5.43, SE=1.61, p<0.01). These results are all to the disadvantage of patients with a migration background. The EQ-5D index and EQ-5D VAS at twelve months follow-up was significantly lower in patients with a migration background compared to patients without a migration background (respectively adjusted B −0.09 (95% CI −0.17; −0.01)) and adjusted B −7.27 (95% CI (−13.99; −0.56)).ConclusionUp to twelve months after hospital admission, stroke patients with a migration background had significantly worse scores regarding several domains of HRQOL compared to patients without a migration background.

Little is known about the implications of multivessel occlusions (MVO) in large vessel occlusion stroke patients who undergo endovascular treatment (EVT). We report data from the MR CLEAN Registry: a prospective, observational study on all stroke patients who underwent EVT in the Netherlands (March 2014-November 2017). We included patients with an intracranial target occlusion in the anterior circulation. An MVO was defined as an MCA occlusion (M1/M2) or intracranial ICA/ICA-T occlusion, with a concurrent second occlusion in the ACA or PCA territory confirmed on baseline CTA. To compare outcomes, we performed a 10:1 propensity score matching analysis with a logistic regression model including potential confounders. Outcome measures included 90-day functional outcome (modified Rankin Scale, mRS) and mortality. Of 2946 included patients, 71 patients (2.4%) had an MVO (87% concurrent ACA occlusion, 10% PCA occlusion, 3% ⩾3 occlusions). These patients were matched to 71 non-MVO patients. Before matching, MVO patients had a higher baseline NIHSS (median 18 vs 16, p = 0.001) and worse collateral status (absent collaterals: 17% vs 6%, p < 0.001) compared to non-MVO patients. After matching, MVO patients had worse functional outcome at 90 days (median mRS 5 vs 3, cOR 0.39; 95%CI 0.25-0.62). Mortality was higher in MVO patients (46% vs 27%, OR 2.11, 95%CI 1.24-3.57). MVOs on baseline imaging were uncommon in LVO stroke patients undergoing EVT, but were associated with poor functional outcome.