Nationwide study on open tibial fractures in the Netherlands: Incidence, demographics and level of hospital care

OBJECTIVES

Open tibial fractures are relatively common injuries following traffic accidents. The vulnerability of the soft tissues surrounding the tibia increases the susceptibility to complications, including infection and nonunion. To minimize complications, a multidisciplinary, timely approach is crucial. To date, the Dutch incidence and level of hospital treatment remain unknown due to a lack of condition-specific nationwide registries. This study aimed to estimate the incidence and management of open tibial fractures in the Netherlands, providing essential information for public health policymaking and guideline development.

METHODS

The 2018 and 2019 Dutch National Hospital Care Basic Registration data, provided by the Dutch Hospital Data Foundation, were utilized to identify all patients admitted to Dutch hospitals with tibial fractures. Incidence rates, patient demographics, primary diagnoses, fracture classification, level of hospital, and length of hospital stays were analyzed using descriptive statistics.

RESULTS

1,079 ICD-10 codes for closed and open tibial fractures were identified in patients that were admitted to a Dutch hospital. Thirty-four percent were classified as open tibial fractures, accounting for an estimated incidence rate of 1.1 per 100,000 person-years (95 % CI 0.97-1.12). When categorized by age, the calculated incidence rate was higher in males for all age categories up until the age of 70. Notably, the overall highest incidence rate was found for females aged 90 and above (6.6 per 100,000 person-years). Open tibial fractures were predominantly treated in general or top clinical hospitals (comprising 69 % of open all tibia fractures). Notably, the minority (31 %) presented at university medical centers, all Level-1 trauma centers, equipped with orthoplastic teams.

CONCLUSION

This is the first study to report the nationwide incidence rate of open tibial fractures in the Netherlands; 34 % of tibial fractures were registered as open. Notably, a limited proportion of open tibial fractures underwent treatment within Level-1 trauma centers. Consequently, in the majority of cases, the implementation of an orthoplastic team approach was unattainable. This study underscores the need for more comprehensive data collection to assess and improve the current treatment landscape.

A usability evaluation of the perceived user friendliness, accessibility, and inclusiveness of a personalized digital care pathway tool

OBJECTIVE

This study aimed to acquire insight into the perceived user friendliness, accessibility and inclusiveness of a personalized digital care pathway.

MATERIALS & METHODS

Usability of the tool was tested in an experimental setting. Mixed methods data collection consisted of scenario-based eye tracking tests in a web- or mobile-based prototype of the tool, followed by a questionnaire assessing user friendliness (System Usability Scale; SUS) and a structured interview. Inclusiveness was assessed by subgroup comparisons based on language proficiency, age and education level. Via purposive sampling a heterogeneous population of users (N = 24) was recruited. Eye tracking was used to measure gaze behavior.

RESULTS

Overall, participants were satisfied with the tool (scale 0-10, 7.5; SD = 1.29). User friendliness of the mobile version (68.3; SD = 21.6) was higher than the web version (50.9; SD = 17.3) measured by SUS score (0-100). With regard to accessibility, eye tracking scenarios showed that the menu bar was hard to find (17% mobile, 55% web). In all scenario's, information was found faster in the mobile version than the web version. Attention was easily drawn to images. Regarding inclusiveness of the tool, we found significantly longer completing time of the scenario tasks for low language proficiency (p-value = 0.029) and higher age subgroups (p-value = 0.049). Lower language proficiency scored a significant lower SUS score (p-value = 0.012).

CONCLUSIONS

Overall, user friendliness and accessibility were positively evaluated. Assessment of inclusiveness emphasized the need for tailoring digital tools to those with low language proficiency and/or an older age. Co-creation of digital care tools with users is therefore important to match users' needs, make tools easily understandable and accessible to all users, and ultimately result in better uptake and impact.

Pegbovigrastim treatment resulted in an economic benefit in a large randomized clinical trial in grazing dairy cows

This randomized controlled trial on 4 commercial grazing dairy farms investigated whether pegbovigrastim (PEG) treatment affected partial net return as calculated from milk revenues and costs for feed, medical treatments [clinical mastitis, uterine disease, and other diseases (i.e., any medical treatment that was not intended for clinical mastitis or uterine disease)], inseminations, and culling during a full lactation in grazing dairy cows. We also explored the effect of potential interactions of PEG treatment with parity, prepartum body condition score, and prepartum nonesterified fatty acids concentration on partial net return, milk revenues, and the costs mentioned above. Holstein cows were randomly assigned to 1 of the 2 following trial arms: a first PEG dose 9.4 ± 0.3 (mean ± standard error) days before the calving date and a second dose within 24 hours after calving (PEG: primiparous = 342; multiparous = 697) compared with untreated controls (control: primiparous = 391; multiparous = 723). The effect of PEG treatment on the outcomes of interest expressed per year was tested using general linear mixed models. Results are presented as least squares means ± standard error. Overall, PEG treatment increased the partial net return, resulting in an economic benefit per cow per year of $210 ± 100. The cost of treatment of clinical mastitis was lower for PEG treated cows compared with control cows ($9 ± 3). The largest nonsignificant difference was seen for the cost of culling; additionally, PEG treatment numerically reduced the cost of culling by $145 ± 77.

Evaluation of culturally sensitive educational video for informed screening decisions among migrants

Background

In the Netherlands, especially Turkish- and Moroccan-Dutch women show low cervical cancer screening participation and limited informed decision-making in this regard. To meet the needs of these women, a culturally sensitive educational video was developed. The objective was to evaluate the effect of the video on informed decision-making regarding cervical cancer screening participation among Turkish and Moroccan women aged 30-60 years in the Netherlands.

Methods

Initial respondents were recruited via several social media platforms and invited to complete an online questionnaire. Following respondent-driven sampling, respondents were asked to recruit a number of peers from their social network to complete the same questionnaire. Respondents were randomly assigned to the control condition (current information brochure) or intervention condition (brochure and video). We evaluated the added effect of the video on knowledge, attitude, intention, and informed decision-making using intention-to-treat analyses.

Results

The final sample included 686 Turkish- and 878 Moroccan-Dutch women. Of this sample, 793 were randomised to the control group (350 Turkish and 443 Moroccan) and 771 to the intervention group (336 Turkish and 435 Moroccan). Among Turkish-Dutch women, 33.1% of the control respondents and 40.5% of the intervention respondents consulted the brochure (not statistically significant). Among Moroccan-Dutch women, these percentages were 28.2% and 37.9%, respectively (P = 0.003). Of all intervention respondents, 96.1% (Turkish) and 84.4% (Moroccan) consulted the video. The video resulted in more positive screening attitudes among Moroccan-Dutch women, in comparison to the brochure (74.3% versus 68.4%, P = 0.07).

Conclusions

Our short, easily implementable video resulted in more positive screening attitudes in Turkish- and Moroccan-Dutch women and can thus contribute to informed cervical cancer screening decisions.

Key messages

Effect of pegbovigrastim on fertility and culling in grazing dairy cows and its association with prepartum nonesterified fatty acids

This randomized controlled trial on 4 commercial grazing dairy farms investigated whether treatment with pegbovigrastim (PEG) affected fertility and culling as measured during the full lactation. We also explored the effect of potential interactions of PEG treatment with parity, prepartum body condition score, prepartum nonesterified fatty acid concentration (pre-NEFA), and early-lactation clinical disease on these outcomes. Holstein cows were randomly assigned to 1 of 2 trial arms: a first PEG dose approximately 7 d before the expected calving date and a second dose within 24 h after calving (PEG: primiparous = 342; multiparous = 697) compared with untreated controls (control: primiparous = 391; multiparous = 723). Cox's proportional hazards regression models were used to analyze rate of first insemination, rate of pregnancy [within 150 and 305 d in milk (DIM)], and hazard of culling. Additional analyses were performed on data that were stratified by parity group and pre-NEFA class (low ≤0.3; high >0.3 mM). In high pre-NEFA cows, PEG treatment increased the rate of first insemination [hazard ratio (HR) = 1.15]. Early-lactation clinical mastitis (CM) and uterine disease (UD: retained placenta, metritis, or both) were associated with a reduced rate of pregnancy within 150 DIM (HR = 0.49 and 0.78, respectively). Pegbovigrastim treatment in high pre-NEFA cows with CM and UD increased the rate of pregnancy within 150 DIM (HR = 1.75 and 1.46, respectively). In high pre-NEFA cows, PEG treatment resulted in a lower hazard of culling (HR = 0.79). No treatment effect was detected in low pre-NEFA cows. This study shows that the effect of PEG treatment on fertility and culling interacts with pre-NEFA. In high pre-NEFA cows, PEG treatment increased the rate of first insemination, counteracted the negative association of early-lactation CM and UD with the rate of pregnancy, and decreased the hazard of culling.

Effect of pegbovigrastim on clinical mastitis and uterine disease during a full lactation in grazing dairy cows

In this randomized controlled trial on four commercial grazing dairy farms, we investigated whether pegbovigrastim (PEG) treatment affects clinical mastitis (CM) and uterine disease (i.e. retained placenta (RP), metritis and endometritis) occurrence during a full lactation. The association of prepartum body condition score and prepartum non-esterified fatty acid (NEFA) concentration with disease occurrence was also evaluated. Holstein cows were randomly assigned to one of two treatments: first PEG dose approximately 7 d before the expected calving date and a second dose within 24 h after calving (PEG) compared to untreated controls (Control). In total, 2,153 animals were included in the study: 733 primiparous cows (Control = 391, PEG = 342) and 1420 multiparous cows (Control = 723, PEG = 697). Treatment effects were evaluated with generalized linear mixed models and Cox's proportional hazard models. Treatment with PEG reduced the occurrence of a first case of CM during the first 30 days in milk (DIM) by 24.6% and reduced the hazard of a first case and the rate of total cases of CM during the full lactation. All PEG treatment effects were independent of parity. Prepartum body condition score interacted with PEG treatment: in over-conditioned cows, PEG reduced the occurrence of a first case of CM during the first 30 DIM by 49.5%. The hazard analysis of a first case of CM during the full lactation suggested that the preventive effect of PEG disappeared with increasing DIM. Treatment with PEG did not affect the occurrence of RP or metritis. Pegbovigrastim treated cows with metritis subsequently showed a reduced occurrence of endometritis compared to control cows with metritis. Pegbovigrastim reduces the occurrence of CM particularly in cows at risk of elevated lipid mobilization, and PEG ameliorates the uterine healing process in cows that experienced metritis.

The multilayered structure of the human corpus spongiosum

PURPOSE

Urethral reconstruction is performed in patients with urethral strictures or for correction of congenital disorders. In the case of shortage of tissue, engineered tissue may enhance urethral reconstruction. As the corpus spongiosum (CS) is important in supporting the function of the urethra, tissue engineering of the urethra should be combined with reconstruction of a CS. For that purpose, detailed knowledge of the composition of the CS, more specifically its extracellular matrix (ECM) and vascularization is needed for scaffold design. The objective of this study is to analyze the microarchitecture of the CS through (immuno) histology and scanning electron microscopy (SEM).

METHODS

The CS including the urethra of patients undergoing male-to-female genital confirming surgery was harvested. This CS was fixed and processed for either (immuno) histology or for SEM.

RESULTS

Four layers could be distinguished in the CS; first a transition zone from urethra epithelium to a collagen rich layer, which was highly vascularized, followed by a second, elastin rich layer. The third layer was formed by veins, arteries and vascular spaces and the last layer showed the transition from this vascular rich region to the collagen rich tunica albuginea. In this layer collagen bundles intertwined with elastic fibres. In the CS different components of the ECM were visible and distinguishable.

CONCLUSION

This study provides novel and detailed information on the microarchitecture of the CS and the distribution of vascularization, which is important for scaffold design in tissue engineering.

Milking machine and udder health management factors associated with bulk milk somatic cell count in Uruguayan herds

This paper describes the findings of static milking machine tests and milking observations on Uruguayan dairy farms. The aim of this study was to investigate the association between both milking machine performance and udder health management factors and bulk milk somatic cell count (BMSCC) in Uruguayan dairy herds. Data from 907 visits were used for the analysis. The farm visits were made between April 2006 and November 2015 and farms were located in 17 of the 19 departments of Uruguay. Each visit involved a short static machine test and observation of the milking process; the use of blanket dry cow therapy was also recorded. The BMSCC was the variable of interest. Univariable analysis was applied to explore the best set of predictors to be included in the multivariable model. A multivariable linear regression model was fitted. The median BMSCC over the years was 376 thousand cells/mL (interquartile range = 280,000-500,000 cells/mL). The final model showed a lower BMSCC for herds that used post-milking teat disinfection, applied the teat cups to dry teats and maintained the pulsation system in good working order. There was no significant association between BMSCC and blanket dry cow therapy in the final model. The association of these milking machine and udder health management factors with the BMSCC under Uruguayan conditions is relevant information for a dairy industry that needs low BMSCCs to compete on the world market.

Refractory diversion neovaginitis in a sigmoid-colon-derived neovagina: clinical and histopathological considerations

Colonic segments are being used as pedicled grafts in neovaginoplasty, a surgical procedure to (re)construct a (neo)vagina. A disadvantage of using colonic grafts is the potential occurrence of neovaginal complications due to diversion from the faecal stream. Here, we report a case of severe, refractory diversion colitis of the sigmoid neovagina, so-called 'diversion neovaginitis', in a 42-year-old woman with complete androgen insensitivity syndrome. Neovaginal biopsy specimens showed colonic-type mucosa with strong increase of lymphoplasmacellular infiltrate in the lamina propria, ulceration with fibrinoid deposition and some crypt irregularity. Endoscopy showed erythematous mucosa, superficial ulceration, mucus discharge and multiple pseudopolyp-like lesions. Local application of mesalazine foam enemas and sodium butyrate enemas initially gave symptom relief. However, this was a temporary effect, ultimately necessitating removal of the neovaginal construct. It is important that all patients are informed about neovaginal bowel complications, for example, diversion neovaginitis. Regular medical and endoscopic follow-up appears recommendable.

Mycobacterium avium subspecies paratuberculosis in bioaerosols after depopulation and cleaning of two cattle barns

Settled dust samples were collected on a commercial dairy farm in the Netherlands with a high prevalence of Mycobacterium avium subspecies paratuberculosis (MAP) (barn A) and on a Dutch experimental cattle farm (barn B) stocked with cattle confirmed to be MAP shedders. Barns were sampled while animals were present, after both barns were destocked and cleaned by cold high-pressure cleaning, and after being kept empty for two weeks (barn A) or after additional disinfection (barn B). MAP DNA was detected by IS900 real-time PCR and viable MAP were detected by liquid culture. MAP DNA was detected in 78 per cent of samples from barn A and 86 per cent of samples from barn B collected while animals were still present. Viable MAP was detected in six of nine samples from barn A and in three of seven samples from barn B. After cold high-pressure cleaning, viable MAP could be detected in only two samples from each barn. After leaving barn A empty for two weeks, and following additional disinfection of barn B, no viable MAP could be detected in any settled dust sample.

Health education in television entertainment--Medisch Centrum West: a Dutch drama serial

World-wide a number of groups have sought ways to incorporate health messages into television entertainment like popular drama and soap serials. In the Netherlands, the Heart Foundation incorporated its cardiovascular health message in several episodes of a popular Dutch hospital serial called Medisch Centrum West. To obtain greater insight into the impact of this so-called 'entertainment-education (E & E) strategy', an evaluation study was carried out. Medisch Centrum West was both entertaining and informative at the same time. Although viewers were well aware that the programme included a health message, they did not find it intrusive to their enjoyment of the storyline. It was interesting to learn that fans were more tolerant and positive towards the E & E strategy than non-fans. Age, sex and education level explained only 5% of the variance.

The study population: general characteristics and potential confounding factors

OBJECTIVE

To test the representativity of the study population and to identify potential selection bias.

DESIGN

Non-response analysis and comparison with other representative samples from the Dutch population. Description of physical and clinical biochemical variables as well as health and lifestyle characteristics among low vitamin B6 groups and reference groups.

RESULTS AND CONCLUSIONS

The non-response rate for the food frequency questionnaire was 54%; subsequently, non-response for the detail study was 42%. A greater proportion of respondents to the FFQ and of participants in the reference group of the study followed a special dietary regimen or a therapeutic diet or used dietary supplements compared with non-respondents, indicating that we may have selected a somewhat more health conscious reference group. There were no differences in vitamin B6 intake (absolute or per g protein) between participants and the total group of non-respondents for the detail study. Selection of a low B6 group did not result in important bias regarding physical, biochemical or general health and lifestyle characteristics. Exceptions were a difference in the proportion of dieters (younger women) and supplement users (older women) and a difference in creatinine clearance and supplement use between reference and low B6 groups. The differences found, however, were small. Nonetheless, these factors have to be taken into account when analysing and interpreting the results.

Dietary intake among adults with special reference to vitamin B6

OBJECTIVE

To assess the adequacy of the dietary intake in general, and that of vitamin B6 intake especially.

DESIGN AND SUBJECTS

Dietary intake based on 3 d diet-records was assessed among a random sample of the adult Dutch population (the reference group, n = 300) aged 20-79 y, stratified for age and gender and among a group with a low vitamin B6 intake, selected by means of a food frequency questionnaire.

RESULTS

Among the reference group, absolute vitamin B6 intake on average amply met the RDA in all age-gender categories, whereas the adequate level of 20 microg vitamin B6 per gram protein, was on average met by men only. The prevalences of a vitamin B6 intake below the minimum requirement (absolute) of 1 mg/d was 1-11% and below the average minimum requirement of 15 microg/g protein was 5-12% for the various age-sex reference groups. Average intake of folate among women of childbearing age did not meet the recommendation of 400 microg/d for those who want to become pregnant. Average intake of iron and iodine was also below recommended levels among women aged 20-49 y. Both absolute vitamin B6 intake and the vitamin B6/protein ratio calculated with the diet records was lower among the low vitamin B6 groups than among the reference groups, indicating that the preselection of groups with low vitamin B6 intakes on the basis of a food frequency questionnaire was successful. Intake of energy and macro- and micronutrients, as well as a nutrient density of the diet were lower among low vitamin B6 groups than among reference groups.

CONCLUSIONS

It is concluded that a low vitamin B6 intake is the result of both the quantity (energy) and quality (nutrient density) of the food consumed. The effects of this are not restricted to vitamin B6 and therefore, the low vitamin B6 groups have a combination of relatively low intakes.

Iron intake and iron status among adults in the Netherlands

OBJECTIVE

To assess the adequacy of iron intake and status, the prevalence of marginal iron status, the physiological and lifestyle factors influencing iron status and the role of dietary factors affecting the bioavailability of iron among Dutch adults.

DESIGN

Food consumption was measured with 3 d diet records. Iron status and prevalence of iron deficiency and iron accumulation were evaluated using different criteria. Physical, biochemical and lifestyle characteristics were determined and relationships with iron status were evaluated by bi- and multivariate regression analysis.

SUBJECTS

A sample of 444 adults, aged 20-79 y stratified for sex and 10 y age classes, with an overrepresentation of people with a low habitual intake of vitamin B6.

RESULTS

Average iron intake was higher than the recommended daily allowance for the Netherlands in all sex-age groups except women aged 20-49, in which group average iron intake was 23% below the recommendation. Early iron deficiency, as reflected in low ferritin levels, was not found among men aged 20-49, but was observed in 5% of women aged 50-79, 11% of men aged 50-79, and 16% of women aged 20-49. Iron deficiency anaemia as reflected in low haemoglobin levels was found in 0-5% of the age-sex groups. Among men and women, 16% and 13% of variance in haemoglobin level, respectively, could be explained by physiological and dietary factors. For ferritin, the proportions were 36% and 34%, respectively. Iron status was correlated negatively with the vegetable fraction of the diet, and positively with factors from the animal fraction (haem iron, animal protein, meat). Further, haemoglobin was positively correlated with body weight among men, and with both age and use of oral contraceptives among women. Both among men and women, blood donorship in the six months prior to the study was negatively associated with serum ferritin levels.

CONCLUSIONS

Women aged 20-49 are the adult sex-age group with the greatest risk of developing (an early stage of) iron depletion. The most important dietary factors influencing the iron status are the type of iron (haem/non-haem) and factors affecting the bioavailability of iron.