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Biomedical subjects

Irene K Veldhuijzen

Publications and source records attributed to Irene K Veldhuijzen.

8 recordsLinked to original sources
PubMed2006

Population prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the Netherlands. Should asymptomatic persons be tested during population-based Chlamydia screening also for gonorrhoea or only if chlamydial infection is found?

BACKGROUND: Screening and active case finding for Chlamydia trachomatis (CT) is recommended to prevent reproductive morbidity. However insight in community prevalence of gonococcal infections and co-infections with Neisseria gonorrhoea (NG) is lacking. METHODS: Nested study within a large population-based Chlamydia Screening Pilot among 21.000 persons 15-29 year. All CT-positive (166) and a random sample of 605 CT-negative specimens were as well tested for gonococcal infection. RESULTS: Overall Chlamydia prevalence in the Pilot was 2.0% (95% CI: 1.7-2.3), highest in very urban settings (3.2%; 95% CI: 2.4-4.0) and dependent of several risk factors. Four gonococcal infections were found among 166 participants with CT infection (4/166 = 2.4%; 95% CI: 0.1%-4.7%). All four had several risk factors and reported symptoms. Among 605 CT-negative persons, no infection with NG could be confirmed. CONCLUSION: A low rate of co-infections and a very low community prevalence of gonococcal infections were found in this population based screening programme among young adults in the Netherlands. Population screening for asymptomatic gonococcal infections is not indicated in the Netherlands. Although co-infection with gonorrhoea among CT-positives is dependent on symptoms and well-known algorithms for elevated risks, we advise to test all CT-positives also for NG, whether symptomatic or asymptomatic.

Adolescent↗
PubMed2006

Prediction of Chlamydia trachomatis infection: application of a scoring rule to other populations.

BACKGROUND: Active case finding is crucial to reduce transmission and consequences of Chlamydia trachomatis (CT) infections. We previously proposed the use of a prediction rule for CT infection for selective screening of high-risk individuals in a population. To support such an application, the prediction rule needs to be validated in other populations. METHODS: We studied participants aged 15 to 29 years in a population-based study in Amsterdam (n = 1,788) and an outreach screening project among high-risk youth in Rotterdam (n = 172). Validity was indicated by discriminative ability (area under the receiver operating characteristic curve [AUC]) and by calibration, which was visualized in plots and tested with the Hosmer-Lemeshow (H-L) goodness-of-fit test. Cutoffs of predicted risk were examined for their effect on sensitivity and the fraction of participants that would need to be screened. RESULTS: Discriminative ability was reasonable both for the Amsterdam study (AUC 0.66; 95% confidence interval [CI], 0.58-0.74) and for the Rotterdam study (AUC 0.68; 95% CI, 0.58-0.79). The observed CT prevalence was lower than predicted in Amsterdam (H-L P = 0.02) and nonsignificantly higher in Rotterdam (H-L P = 0.20). By screening 77% of the Amsterdam population, 93% of the cases would have been detected, whereas in the Rotterdam study, no cases would be missed by screening 75%. CONCLUSION: The chlamydia prediction rule showed a reasonable external validity in two studies. These findings support the use of the rule as a tool for selective chlamydia screening, although only a limited fraction of participants can be excluded when a high sensitivity is required.

Adolescent↗
PubMed2006

Lessons learned from a population-based chlamydia screening pilot.

We evaluated process organization and response optimization in a home-based Chlamydia trachomatis (Ct) screening project in the Netherlands among 15- to 29-year-old women and men. The method used was computer-supported data flow, from population sampling to informing participants of the result. A new test kit or a letter reminded non-respondents after six weeks. Fifteen-year olds required parental consent. Urine arrived at the laboratory within 29 days from invitation, and four (1-11) days after collection, indicating good specimen quality. Test kits had a higher response than letters (15 versus 10%). Response in 15-year olds was 33%; with 2% Ct infected sexually active 15 year olds. In Conclusion, purpose made computer software is essential for an efficient screening programme. Sending urine by mail does not impair diagnostics. Reminders are necessary and effective after four weeks. Necessary parental consent for under 16-year olds should not be a deterrent to offer Ct screening to this age group.

Adolescent↗
PubMed2005

Management of Chlamydia cases and their partners: results from a home-based screening program organized by municipal public health services with referral to regular health care.

BACKGROUND: We evaluated the management of Chlamydia trachomatis cases and partners found in a systematic home-based chlamydia screening project in the Netherlands among 15- to 29-year-old women and men, organized by the Municipal Public Health Services (MHS). METHODS: Infected participants (165/8339 = 2%) were referred to regular curative services. The treating physician provided feedback on treatment and partner notification. RESULTS: Including the effect of a reminder, the treatment rate of all index cases was 91% (150/165); among persons with non-Dutch ethnicity, 81% (25/31). The majority of cases (82%) consulted the general practitioner for treatment as opposed to sexually transmitted disease/MHS clinics (18%). Eighty-five percent of cases were treated within 2 weeks. The confirmed treatment rate of partners in the last 6 months was 49% (86/176); 57% (81/141) for current versus 14% (5/35) for other partners. Patient referral was advised in an additional 18% (25/141) of current partners and in 9% (3/35) of other partners (potential treatment). CONCLUSION: Home-based chlamydia screening and treatment through regular treatment facilities has proven to be effective in the Netherlands. The necessity of a reminder to increase treatment rate and the lower treatment rate in non-Dutch high-risk groups deserve attention. Low confirmed treatment rate of current partners carries the potential of reinfection, and patient-delivered treatment should be expanded.

Adolescent↗
PubMed2005

Acceptability and consequences of screening for chlamydia trachomatis by home-based urine testing.

OBJECTIVE: The objective of this study was to study the acceptability and consequences of home-based chlamydia (CT) screening by Municipal Health Services (MHS) among 15- to 29-year-old participants. STUDY: This study consisted of a cross-section of 156 CT-positives and 600 random sampled CT-negatives after receiving the result of their CT test. RESULTS: Thirty-eight percent of the men and 59% of the women responded. The screening method was well-accepted. Seventy percent (52) of the CT-positives were surprised about their result. Infected women more often than men reported a feeling of being dirty and of anxiety about infertility. Curiosity for the CT result was decisive for participation in 68% and perception of personal risk was poor. The willingness to be tested regularly was determined by present chlamydial infection, young age, multiple lifetime partners, short relationship, and earlier test for chlamydia. CONCLUSIONS: Chlamydia screening organised by MHS is acceptable for future screening. Participants with an elevated risk are interested in screening as long as test kits are easily available. Counseling with focus on effects of CT, especially on women, is essential. Alternative approaches are needed to motivate men and non-Dutch high-risk groups.

Adolescent↗
PubMed2005

Reinfections, persistent infections, and new infections after general population screening for Chlamydia trachomatis infection in the Netherlands.

OBJECTIVES: The objectives of this study were to determine the rate of new infections and reinfections or persistent infections with Chlamydia trachomatis to define appropriate screening intervals and to identify risk factors for reinfection. DESIGN: This was a cross-sectional study among a subsample of participants in a population-based screening. SETTING: This study was conducted in urban and rural areas in The Netherlands. PARTICIPANTS: A total of 21,000 15- to 29-year-old women and men were invited for home-based urine testing. One year after the study, a subsample of 299 participants were offered retesting. MAIN OUTCOME MEASURES: The authors studied the rate of infection with C. trachomatis. Serovar determination was used to potentially discriminate between new infections and reinfections or persistent infections. RESULTS: Nine C. trachomatis infections were found among 187 responders (4.8% confidence interval, 1.7-7.9). The prevalence was 10.4% (5 of 48) in previous positives and 2.9% (4 of 139) in negatives. Three of 5 repeatedly positive participants were infected with a different C. trachomatis serovar. CONCLUSIONS: Our study indicates that infected persons found in a systematic, population-based screening should be re-screened within 1 year. Optimal screening intervals still need to be determined.

Adolescent↗
PubMed2002

A European study on the relationship between antimicrobial use and antimicrobial resistance.

In Europe, antimicrobial resistance has been monitored since 1998 by the European Antimicrobial Resistance Surveillance System (EARSS). We examined the relationship between penicillin nonsusceptibility of invasive isolates of Streptococcus pneumoniae and antibiotic sales. Information was collected on 1998-99 resistance data for invasive isolates of S. pneumoniae to penicillin, based on surveillance data from EARSS and on outpatient sales during 1997 for beta-lactam antibiotics and macrolides. Our results show that in Europe antimicrobial resistance of S. pneumoniae to penicillin is correlated with use of beta-lactam antibiotics and macrolides.

Anti-Bacterial Agents↗