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Among dental hygienists and dentists in the Netherlands, the impact of the SARS-CoV-2 pandemic on oral healthcare practices from March to July 2020 was investigated. Of the 1,700 healthcare providers approached, 433 completed questionnaires could be used. The results show that the pandemic has had a profound impact on both the accessibility of oral healthcare and on care provided in oral healthcare practices. Extra attention was paid to hygiene and infection prevention: the types of personal protective equipment and the protocols and procedures were adjusted by many oral healthcare providers. The confirmed prevalence of oral healthcare providers with COVID-19 in this study was 1.6%. However, testing was not available to all respondents with complaints during this initial period. Over half of the respondents estimated that even with additional measures there is an increased risk of infection to oral healthcare providers during their work. The efficacy of the various additional measures in oral healthcare practices related to COVID-19 is still unknown.

De Gezondheidsraad doet in haar recente advies over HPV-vaccinatie ter voorkoming van HPV-gerelateerde kanker géén uitspraak over het type vaccin. Een gemiste kans, denken wij. Want het humaan papillomavirus (HPV) kan naast maligniteiten ook anogenitale wratten en larynxpapillomatose veroorzaken; aandoeningen met een grote impact door ziektelast en kosten. Wanneer de Gezondheidsraad expliciet voor brede HPV-vaccins had gekozen, zouden deze niet-oncogene HPV-types ook relatief eenvoudig en efectief aangepakt kunnen worden.

The Artificial Insemination Donor Data Act was first evaluated in 2012, and a second time in 2018. The aim of the most recent evaluation was to gain insight into the effectiveness and side effects of the law. The researchers did not only conduct a judicial analysis of the legislation and parliamentary history; they also visited fertility clinics, they undertook research at SDKB (Foundation for Artificial Insemination Donor Data), and interviewed stakeholders and key people involved in the process. From this, 17 recommendations were made, addressed to the Ministry of Health, Welfare and Sport, SDKB, fertility clinics and the Health and Youth Care Inspectorate. Some of these recommendations also affect the actions of fertility physicians and gynaecologists working in clinics and hospitals that perform donor treatments.

Sleep and physical activity are related, but the direction of this relationship is unclear and it is not known whether the direction differs in depressed and non-depressed persons.To study the bidirectional relationship between physical activity and sleep in daily life by making repeated measurements in depressed and non-depressed people.Every day for 30 consecutive days each depressed (N = 27) and non-depressed (N = 27) participant in our study had to complete an electronic questionnaire relating to subjective sleep quality and sleep duration and were required to wear an accelerometer that recorded physical activity.Multi-level analysis showed that an increase in subjective sleep duration resulted in a decrease in physical activity. The differences between individuals with regard to the direction and strength of this relationship were significant. Changes in physical activity did not predict changes in sleep quality or sleep duration. We did not find any differences in the relationships for depressed and non-depressed participants.Change in sleep duration predicts change in physical activity, although there was significant heterogeneity in the results for individuals. Our findings underline the importance of further research and of the development of interventions that are tailored to the precise needs of the individual patient.

ACHTERGROND Beweging en slaap zijn aan elkaar gerelateerd. Onduidelijk is wat de richting van het verband is tussen beweging en slaap en of dit verschillend is voor personen met en zonder depressieve stoornis. DOEL Onderzoeken van de bidirectionele relatie tussen beweging en slaap in het dagelijks leven met herhaalde metingen bij personen met en zonder depressieve stoornis. METHODE Alle deelnemers met (n = 27) en zonder depressie (n = 27) vulden 30 opeenvolgende dagen 3 keer per dag een elektronische vragenlijst in met vragen over subjectieve slaapkwaliteit en slaapduur en droegen gedurende deze periode 24 uur per dag een bewegingsmeter die fysieke activiteit registreerde. RESULTATEN Multilevelanalyses toonden dat toename van de subjectieve slaapduur afname van beweging tot gevolg had. De verschillen tussen de individuen in de richting en sterkte van dit verband waren significant. Veranderingen in beweging waren niet voorspellend voor veranderingen in slaapkwaliteit en slaapduur. De gevonden verbanden verschilden niet tussen deelnemers met en zonder depressie. CONCLUSIE Verandering in slaapduur voorspelt verandering in beweging, met een significante heterogeniteit tussen individuen. De bevindingen onderstrepen het belang van onderzoek en het ontwikkelen van interventies op het niveau van de individuele patiënt

In criminal law, increased interest is being shown in brain disorders, cognitive impairment and neuroimaging, particularly in connection with pre-trial reports. In a number of cases the contribution made by neuropsychology to the forensic diagnosis is considerable, and there is a need for further clarification.br/AIM: To clarify the relevance of the neuropsychological assessment of suspects and to explore the implications for forensic psychiatry.br/METHOD: We discuss recent literature and present a characteristic case selected from the Dutch jurisdiction.br/RESULTS: On the basis of neuropsychological assessment it is possible to obtain insight into the relation between brain disorders and criminal behaviour. The case that we present shows that the court may consider the influence of cognitive impairment on behavior to be very important.br/CONCLUSION: Neurocognitive disorders can make an important contribution to psychiatric assessments of defendants. In the forensic practice a combined diagnostic approach consisting of psychiatric evaluation, neurological assessment of behaviour, imaging techniques and neuropsychological assessment, is clearly preferable.

BACKGROUND: In criminal law, increased interest is being shown in brain disorders, cognitive impairment and neuroimaging, particularly in connection with pre-trial reports. In a number of cases the contribution made by neuropsychology to the forensic diagnosis is considerable, and there is a need for further clarification. AIM: To clarify the relevance of the neuropsychological assessment of suspects and to explore the implications for forensic psychiatry. METHOD: We discuss recent literature and present a characteristic case selected from the Dutch jurisdiction. RESULTS: On the basis of neuropsychological assessment it is possible to obtain insight into the relation between brain disorders and criminal behaviour. The case that we present shows that the court may consider the influence of cognitive impairment on behavior to be very important. CONCLUSION: Neurocognitive disorders can make an important contribution to psychiatric assessments of defendants. In the forensic practice a combined diagnostic approach consisting of psychiatric evaluation, neurological assessment of behaviour, imaging techniques and neuropsychological assessment, is clearly preferable.

Complaints concerning restorative treatments at disciplinary tribunals are relatively rare. The nature of the complaints, the judgements, and the implicit view on caries management are, however, a cause of concern. Usually, the complaints are on alleged negligence because lesions were not or were too late restored. Modern caries management concentrating on disease control rather than on damage repair and its minimally invasive nature could be reasons of complaints concerning perceived negligence. As usual, careful documentation of findings, diagnostics, risk assessment, and monitoring decisions and good patient communication are decisive in preventing complaints. However, post-graduate education of dentists in caries detection, diagnosis, and management is needed to reduce the variability of caries care provided.

In a patient with hypoaesthesia of the central region of the mandible, no oral cause could be found which could explain his complaint. Further examination by a neurologist and a specialist in internal medicine revealed the numb chin syndrome. The syndrome was caused by meningeal localisation of a high-grade B-cell lymphoma stade IV. After intensive chemotherapy and radiotherapy of the skull, the complaints disappeared.

Interest in the neurobiology of criminal behaviour is increasing. Recent research emphasises the important role played by the frontal lobe in the processing of emotional and social information and in the controlling of behaviour. Damage to specific frontal structures in the brain may therefore lead to antisocial and criminal behaviour. On the basis of the case histories of two suspects with brain lesions, the impact of such damage on the forensic psychiatric diagnosis is discussed. A plea is made for the more frequent involvement of a neurologist in the diagnostic evaluation usually undertaken by the forensic psychiatrist.

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In dentistry much research focuses on the development of procedures and materials with the aim of preventing negative effects of polymerisation shrinkage stress of composite resin. The clinical implications of shrinkage stress seem to be limited as long as correct restorative procedures are precisely followed. With the introduction of a silorane-based composite resin exhibiting a low-shrinkage behaviour the dentist is confronted with some uncertain factors. Long-term clinical studies are needed before applying these materials on a large scale.

Annually, 0.5-1 million injections of contrast media containing iodine are administered in the Netherlands. Almost all contrast media nowadays are low-osmolar and nonionic. Nevertheless, the development ofcontrast-induced nephropathy is still a relevant clinical problem. Through an initiative by the Radiological Society of the Netherlands and with aid of the Dutch Institute for Healthcare Improvement (CBO), a guideline was conceived for the intravascular use of iodine-containing contrast media, based on recent scientific literature. The guideline defines the risk factors for contrast-induced nephropathy. One of the major risk factors is an impaired renal function. It is important to measure the glomerular filtration rate (GFR) in patients with a possible impaired kidney function, preferably by using the 'Modification of diet in renal disease' (MDRD)-study formula. The key measures for avoidance of contrast nephropathy are: limiting the amount of contrast agent used and to assure good hydration, by infusion of sodium chloride 0.9% 12-16 ml/kg body weight, both prior to and after contrast infusion. If time is limited, intravenous administration of sodium bicarbonate is an option. The guideline recommends discontinuation of metformin use from the day of contrast injection, if the GFR60 ml/min/1.73 m2, and to restart metformin 2 days following contrast infusion providing the GFR has not significantly deteriorated. Only in the case of previous moderate or severe adverse reactions to contrast media, prophylaxis with corticosteroids and antihistamines is recommended. Iodine allergy or an atopic condition is not a contraindication for the use of iodine-containing contrast media, and no prophylaxis is required. No specific measures are indicated in case of hyperthyroidism, acute pancreatitis, or phaeochromocytoma. Injection of contrast media is not contraindicated in case of pregnancy or lactation.

A 4-year-old boy was treated for an infection with a meningococcus type B. After a few days of recovery, he felt ill again on day 6. The patient had urticaria and arthralgia without arthritis. The infection parameters did not normalize or increase in severity. No abnormalities other than a lowered CH50 value were found in the extensive diagnostic tests performed. The diagnosis of immune-complex mediated complications following a meningococcal infection was made. The patient was sent home where he continued pain relief and physiotherapy treatment. After 2 months at outpatient follow-up, he showed complete recovery and the CH50 value had returned to normal. Other immune-complex mediated complications of meningococcal infection are arthritis, episcleritis, pericarditis, myocarditis and pleuritis. These occur in 6-15% of the patients with a meningococcal infection. Early recognition prevents unnecessary extensive and costly diagnostic testing as well as a longer than necessary hospital stay.

To determine the antibiotic sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) isolated from persons in contact with pigs.Retrospective.The pig-related MRSA collection, built up between January 1st 2003 and November 30th 2006 in the Regional Laboratory for Medical Microbiology and Infection Prevention (RLMMI) of the Jeroen Bosch Hospital, Den Bosch, The Netherlands, was tested for sensitivity to a large number ofantibiotics.A total of 65 isolates were obtained from 53 patients. All (100%) of the pig-related MRSA isolates were sensitive to vancomycin, teicoplanin, nitrofurantoin, rifampicin, linezolid, and quinupristin-dalfopristin. Variable sensitivity was found for erythromycin (40%), clindamycin (48%), cotrimoxazole (48%), aminoglycosides (92%), tetracycline (6%), and quinolones (94%).In view of the sensitivities found, clindamycin does not seem suitable for the empirical therapy ofpig-related MRSA-infections. In case of severe infection, therapy should be started either with an intravenous glycopeptide or with oral ciprofloxacin, possibly combined with rifampicin or linezolid.

Leptospirosis was diagnosed post-mortem in a 2-year-old male Dogo Argentino and a 7-week-old male Foxhound puppy. The two cases were unrelated. Clinical symptoms were mainly confined to the gastro-intestinal tract. Pathological lesions were suggestive of acute leptospirosis. Leptospires infection was confirmed by serological (indirect IgM/Ig6 ELISA and MAT) and immunohistochemical techniques.

To establish the current expert opinions on the diagnosis and treatment of hepatocellular adenoma in the Netherlands.Questionnaire.In 2005, a questionnaire concerning the incidence, diagnosis, treatment, management in case of pregnancy, and follow-up of hepatocellular adenoma was sent to 20 Dutch hospitals with a tertiary referral role. In addition, they were asked to describe the indicated treatment in 5 imaginary cases.17 hospitals (85%) responded. A median of 52 patients per hospital presented with a solid liver tumour annually. Between 1 and 40% of these patients had benign lesions with a differential diagnosis of adenoma, focal nodular hyperplasia, and haemangioma. In 15 clinics (88%), hepatic adenomas were diagnosed with contrast-enhanced, multiphasic, spiral CT or MRI series. 2 clinics (12%) required a histological diagnosis. Conservative management (withdrawal of oral contraceptives and radiological control) was initially given in all clinics. MRI, CT or ultrasound were used to follow adenoma patients with different time schedules. The criteria for surgical resection were a tumour size5 cm and abdominal complaints. In 5 clinics (29%), the patients were no longer followed after surgery. In cases in which multiple factors played a role (size, location, number of lesions, and wish to become pregnant), the treatment policy was highly variable. Pregnancy was not discouraged in 15 clinics, but in 11 (65%) only under strict conditions: frequent control, a peripheral location that makes surgery possible if necessary, a stable tumour size, and an understanding of the risks.The management of hepatocellular adenomas in the Netherlands is rather uniform, except for differences in the methods of observation and the treatment policy in cases in which multiple factors play a role.

In recent molecular-biological research it has become possible to study the activity of genes. Gene expression is characterized, among other things, by its variability and its dependence on the developmental phase of the organism, on the cell- and tissue-type, and on environmental factors. Now we have a technique by which the activity of the 30,000 or more genes that make up the human genome can be measured in one go. This technique is known as 'microarray screening', 'high-throughput-analysis, or gene-expression profiling'.To describe some of the fundamentals of the gene-expression technique and to present an overview of the results of gene-expression studies of brain tissue taken from deceased patients.We searched PubMed for relevant articles using the search terms 'schizophrenia', 'micro-array' and 'gene expression'. We located 10 articles/studies.We conclude that gene-expression profiling has produced some evidence that several functional groups of genes are involved in schizophrenia (e.g. gene groups relating to synapses, metabolism, myelination and oligodendrocytes). Several of these genes are located on known chromosomal risk loci for schizophrenia. Together these findings support the theories that postulate that schizophrenia is caused by disturbances in synaptic stability and plasticity. There is some evidence that disturbances in myelination and fatty-acid metabolism may also play a role.

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The number of patients with diabetes mellitus will increase over the coming years, so that there will also be more patients with diabetic macular oedema. Diabetic macular oedema and diabetic retinopathy are the most important causes of legal blindness in adults. The current therapy of diabetic macular oedema consists of the prevention, detection and treatment of risk factors (e.g., hypertension, hyperglycaemia, dyslipidaemia, proteinuria and obesity), complemented if necessary by photocoagulation therapy. Photocoagulation therapy may prevent or reduce vision loss in many patients, but usually does not improve visual acuity. New treatment strategies include intravitreal corticosteroids or vascular endothelial growth factor (VEGF) inhibitors, and oral protein kinase C inhibitors, angiotensin converting enzyme (ACE) inhibitors, acetylsalicylic acid or statins. The long-term positive effect of these strategies is controversial and the side effects can be serious.

In January 2002 the International Consensus Workshop on Caries Clinical Trials was organised in Scotland. The meeting was an initiative of both academic and industrial partners, in order to arrive at a consensus about ways to modernise the design of clinical trials for caries preventive agents (Caries Clinical Trials or CCTs). All presentations delivered at the workshop and the consensus statements formulated at the end of the workshop were published last year in a special issue of the Journal of Dental Research. In this paper some important aspects are highlighted and the workshop conclusions are presented.

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To offer a more comprehensive curriculum in various dental topics, the dental school of the University of Groningen developed electives. This article gives an overview of the learning objectives of the different electives, the program and the way in which students are examined. Attention is also paid to some experiences of students and teachers with this kind of education. The electives seem to effectively prepare students for specific parts of dentistry, and they give an orientation on the scientific aspects of dentistry. Students and teachers are positive about the electives. The electives give good opportunities to the assessment of professional behavior.

This paper is a comment on 'The enigma of dental amalgam' by Carl Leinfelder published in 2004 in the Journal of Esthetic and Restorative Dentistry. In that paper a warning is stated against a too abrupt change from amalgam towards resin composite, because this will bring a lot of clinical problems due to the limited skills of todays' dentists in placing posterior composite resin restorations. However, the situation in The Netherlands is different since a gradual changeover from amalgam towards resin composites has taken place during the last decades and dental schools have skipped training in placing amalgam restorations out of the curriculum. Clinical studies on the longevity of amalgam and resin composite restorations placed by dental students and dentists who are experienced in both composite resin and amalgam placement show a comparable and acceptable annual failure rate for those restorations. It is concluded that a gradual changeover from amalgam towards composite resin is preferred to avoid clinical problems.

To describe surgical complications, and patient and kidney transplant survival rates in children who have had a kidney transplant.Retrospective.Data were analysed concerning the children who had been treated with a renal transplantation in the period 1985-2001 because of terminal renal insufficiency in the Emma Children's Hospital of the Academic Medical Centre in Amsterdam, The Netherlands, with arbitrary end date October 7, 2002.In the study period, 55 primary kidney transplantations were performed on 24 girls and 31 boys. 13 living related and 42 post mortem transplantations were performed. The extra-peritoneal approach was performed in all recipients. Up to October 7, 2002, 14 surgical complications (25%) developed: 4 cases of renovascular thrombosis, 4 urinary leakages, 6 urethral strictures, 1 urethral necrosis, 5 haematomas and 3 lymphoceles. 6 patients lost their grafts due to surgical complications (11%); 4 due to thrombosis, 1 due to urethral necrosis and 1 due to haemorrhage or haematoma. Due to hypertension secondary to the underlying kidney disease 2 patients died within one year after transplantation from hypertensive encephalopathy and cerebral bleeding respectively. The one- and five-year graft survival was 83% and 74% for living related transplantations respectively, and for post mortem transplantations 78% and 68% respectively. The main causes of graft loss were chronic rejection (9/21; 43%), acute rejection (4/21; 19%), thrombosis (4/21; 19%) and surgical complications (2/21; 10%). Primary nonfunction was the only factor with a negative prognostic value for graft survival.

This paper describes some of the most used methods for caries lesion progression measurement in in vivo and in vitro research. Clinical measurements are usually limited to visual inspection. Currently available scoring systems and statistical analyses, making use of changes in lesion stage, have the potential to make caries clinical trials more efficient. A method for light fluorescence measurements is capable of measuring small changes in mineral loss for early lesions, In the laboratory, mainly destructive methods are used. The most widely accepted gold standard at the moment is transversal microradiography (TMR). Other microradiographical methods are described, that allow for longitudinal measurements.

OBJECTIVE: To describe surgical complications, and patient and kidney transplant survival rates in children who have had a kidney transplant. DESIGN: Retrospective. METHOD: Data were analysed concerning the children who had been treated with a renal transplantation in the period 1985-2001 because of terminal renal insufficiency in the Emma Children's Hospital of the Academic Medical Centre in Amsterdam, The Netherlands, with arbitrary end date October 7, 2002. RESULTS: In the study period, 55 primary kidney transplantations were performed on 24 girls and 31 boys. 13 living related and 42 post mortem transplantations were performed. The extra-peritoneal approach was performed in all recipients. Up to October 7, 2002, 14 surgical complications (25%) developed: 4 cases of renovascular thrombosis, 4 urinary leakages, 6 urethral strictures, 1 urethral necrosis, 5 haematomas and 3 lymphoceles. 6 patients lost their grafts due to surgical complications (11%); 4 due to thrombosis, 1 due to urethral necrosis and 1 due to haemorrhage or haematoma. Due to hypertension secondary to the underlying kidney disease 2 patients died within one year after transplantation from hypertensive encephalopathy and cerebral bleeding respectively. The one- and five-year graft survival was 83% and 74% for living related transplantations respectively, and for post mortem transplantations 78% and 68% respectively. The main causes of graft loss were chronic rejection (9/21; 43%), acute rejection (4/21; 19%), thrombosis (4/21; 19%) and surgical complications (2/21; 10%). Primary nonfunction was the only factor with a negative prognostic value for graft survival

A 68-year-old man under systemic corticosteroid treatment was diagnosed with widespread pediculosis caused by Phthirus pubis.

Pigmented naevi (moles) are increasingly regarded as risk factors for the development of melanoma. The probability of melanoma developing from congenital naevi is proportional to the volume of the naevi. The risk of melanoma development from large naevi (diameter20 cm) is already present in the early years of childhood. The most important risk factor is the higher number of acquired naevi. This applies particularly to dysplastic (also called clinically atypical) naevi that not only represent the highest risk group but are also considered potential melanoma precursors. The development of acquired naevi (including dysplastic naevi) is dependant on the degree of skin pigmentation. The role of sunlight (ultraviolet radiation) in the development of melanoma is less significant than is generally assumed. The indirect effect of sunlight on melanoma development is to stimulate naevogenesis. One of the risk-modifying genes is the gene coding for melanocortin-1-receptor (MC1R). The presence of some gene variants has been found to lead to changes in melanin synthesis and is associated with a higher risk of melanoma. Recent research has shown that dysplastic naevi synthesise more phaeomelanin. There are also strong indications that dysplastic naevus cells suffer from chronic oxidative stress. This situation can lead to hypermutability and genetical instability.

Zinc-induced haemolytic anaemia was diagnosed in a young dog. The origin of the zinc intoxication was the ingestion of a toy material which contained a high percentage of zinc. The level of zinc in the liver and kidneys was resp. 1050 and 1320 ppm.