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Background Recent network models propose that mutual interaction between symptoms has an important bearing on the onset of schizophrenic disorder. In particular, cross-sectional studies suggest that affective symptoms may influence the emergence of psychotic symptoms. However, longitudinal analysis offers a more compelling test for causation: the European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. We predicted that the persistence of psychotic symptoms would be driven by the continuing presence of affective disturbance. Methods EuroSC included 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures of psychotic and affective symptoms were repeated four times at 6-month intervals, thereby furnishing five time-points. To examine interactions between symptoms both within and between time-slices, we adopted a novel technique for modelling longitudinal data in psychiatry. This was a form of Bayesian network analysis that involved learning dynamic directed acyclic graphs (DAGs). Results Our DAG analysis suggests that the main drivers of symptoms in this long-term sample were delusions and paranoid thinking. These led to affective disturbance, not vice versa as we initially predicted. The enduring relationship between symptoms was unaffected by whether patients were receiving first- or second-generation antipsychotic medication. Conclusions In this cohort of people with chronic schizophrenia treated with medication, symptoms were essentially stable over long periods. However, affective symptoms appeared driven by the persistence of delusions and persecutory thinking, a finding not previously reported. Although our findings as ever remain hostage to unmeasured confounders, these enduring psychotic symptoms might nevertheless be appropriate candidates for directly targeted psychological interventions.

Het niveau van de voedselveiligheid in Nederland is hoog. Ook het consumentenvertrouwen in de veiligheid van ons voedsel is groot en al vele jaren redelijk stabiel zoals blijkt uit de recente uitkomsten van de Consumentenmonitor 2023 die door de NVWA periodiek wordt uitgevoerd.

Wet- en regelgeving, beleid - Minister Adema (LNV) en minister Kuipers (VWS) informeren de Tweede Kamer over de intensivering van de aanpak van vogelgriep. De ministers sturen het intensiveringsplan preventie vogelgriep met deze Kamerbrief mee.

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Dieren kunnen ziekteverwekkers bij zich dragen waar mensen ook ziek van kunnen worden. De ziekten die hierdoor worden veroorzaakt, noemen we zoönosen. In 2021 onderzochten het RIVM, de NVWA en WFSR (Wageningen Food Safety Research) hoe vaak een aantal van deze ziekteverwekkers voorkwamen bij melkvee op 185 Nederlandse melkveebedrijven. Ook hebben 107 melkveehouders, gezinsleden en medewerkers aan dit onderzoek meegedaan om te kijken of zij deze ziekteverwekkers ook bij zich dragen. Bij de onderzochte koeien en kalveren komen een aantal ziekteverwekkers vaak voor. Ze zitten in de darmen van de dieren en dus ook in de mest. Melk kan tijdens het melken in aanraking komen met mest en op die manier besmet raken. Mensen kunnen de kans op een besmetting verkleinen door geen rauwe melk of rauwe melkproducten, zoals kaas, te consumeren. Het vlees kan tijdens de slacht besmet raken. Het is daarom belangrijk om rundvlees goed gaar te eten. Het RIVM heeft gekeken of dezelfde ziekteverwekkers in de ontlasting of in de neus van deze mensen voorkwamen. De meeste van deze ziekteverwekkers veroorzaken bij mensen diarree, maar soms kunnen infecties ernstiger verlopen. Daarnaast is er naar ESBL-producerende bacteriën en MRSA gekeken, omdat belangrijke groepen antibiotica daar niet tegen werken. Van de onderzochte ziekteverwekkers kwam Campylobacter het meest voor bij het melkvee: op 91 procent van de bedrijven. Bij de veehouders en gezinsleden werd Campylobacter bij 1 persoon gevonden. Het hoge percentage bij de dieren is dus niet direct terug te zien bij de veehouders. Daarnaast kwamen de Listeria en STEC-bacteriën regelmatig voor bij melkvee; namelijk op 34 procent (Listeria) en 21 procent (STEC) van de bedrijven. Twee deelnemers van de veehouders en gezinsleden droegen Listeria bij zich en één deelnemer STEC. ESBL-producerende bacteriën zijn op 8 procent van de bedrijven gevonden en bij 3 deelnemers. Het percentage bij de deelnemers is ongeveer hetzelfde als bij de Nederlands

BACKGROUND & AIMS: The population prevalence of gastrointestinal (GI) disease is unclear and difficult to assess in an asymptomatic population. The aim of this study was to determine prevalence of GI lesions in a largely asymptomatic population undergoing colon capsule endoscopy (CCE).METHODS: Participants aged between 50-75 years were retrieved from the Rotterdam Study, a longitudinal epidemiological study, between 2017-2019. Participants received CCE with bowel preparation. Abnormalities defined as clinically relevant were Barrett segment >3cm, severe ulceration, polyp >10 mm or >= 3 polyps in small bowel (SB) or colon, and cancer.RESULTS: Of 2800 invited subjects, 462 (16.5%) participants (mean age 66.8 years, female 53.5%) ingested the colon capsule. A total of 451 videos were analyzed, and in 94.7% the capsule reached the descending colon. At least 1 abnormal finding was seen in 448 (99.3%) participants. The prevalence of abnormalities per GI segment, and the most common type of abnormality, were as follows: Esophageal 14.8% (Barrett's esophagus <3 cm in 8.3%), gastric 27.9% (fundic gland polyps in 18.1%), SB abnormalities 33.9% (erosions in 23.8%), colon 93.3% (diverticula in 81.2%). A total of 54 participants (12%) had clinically relevant abnormalities, 3 (0.7%) in esophagus/stomach (reflux esophagitis grade D, Mallory Weiss lesion and severe gastritis), 5 (1.1%) in SB (polyps > 10 mm; n = 4, severe ulcer n = 1,) and 46 (10.2%) in colon (polyp > 10 mm or >= 3 polyps n = 46, colorectal cancer n = 1).CONCLUSIONS: GI lesions are very common in a mostly asymptomatic Western population, and clinically relevant lesions were found in 12% at CCE. These findings provide a frame of reference for the prevalence rates of GI lesions in the general population.

Minister Kuipers (VWS) stuurt de Tweede Kamer een rapport over de risico's van het eten van vlees van grote grazers in de uiterwaarden voor de menselijke gezondheid. Ook geeft de minister een toelichting op de achtergrond van het rapport.

Background: Gastric and colorectal cancer (CRC) are both one of the most common cancers worldwide. In many countries fecal immunochemical tests (FIT)-based CRC screening has been implemented. We investigated if FIT can also be applied for detection of H. pylori, the main risk factor for gastric cancer. Methods: This prospective study included participants over 18 years of age referred for urea breath test (UBT). Patients were excluded if they had used antibiotics/bismuth in the past 4 weeks, or a proton pomp inhibitor (PPI) in the past 2 weeks. Participants underwent UBT, ELISA stool antigen test in standard feces tube (SAT), ELISA stool antigen test in FIT tube (Hp-FIT), and blood sampling, and completed a questionnaire on user friendliness. UBT results were used as reference. Results: A total of 182 patients were included (37.4% male, median age 52.4 years (IQR 22.4)). Of these, 60 (33.0%) tested H. pylori positive. SAT and Hp-FIT showed comparable overall accuracy 71.1% (95%CI 63.2–78.3) vs. 77.6% (95%CI 70.4–83.8), respectively (p = 0.97). Sensitivity of SAT was 91.8% (95%CI 80.4–97.7) versus 94.2% (95%CI 84.1–98.9) of Hp-FIT (p = 0.98). Serology scored low with an overall accuracy of 49.7% (95%CI 41.7–57.7). Hp-FIT showed the highest overall user convenience. Conclusions: FIT can be used with high accuracy and sensitivity for diagnosis of H. pylori and is rated as the most convenient test. Non-invasive Hp-FIT test is highly promising for combined upper and lower gastrointestinal (pre-) cancerous screening. Further research should investigate the clinical implications, benefits and cost-effectiveness of such an approach.

Objective:To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands. Summary Background Data:Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome. Methods:A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period).Results:During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012). Conclusions:The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.