Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study.

BACKGROUND AND AIMS: Women with inflammatory bowel disease [IBD] may be at higher risk for cervical intraepithelial neoplasia [CIN]. However, data are conflicting. The aim of this study was to assess the risk of high-grade dysplasia and cancer [CIN2+] in IBD women and identify risk factors. METHODS: Clinical data from adult IBD women in a multicentre Dutch IBD prospective cohort [PSI] from 2007 onwards were linked to cervical cytology and histology records from the Dutch nationwide cytology and pathology database [PALGA], from 2000 to 2016. Patients were frequency-matched 1:4 to a general population cohort. Standardised detection rates [SDR] were calculated for CIN2+. Longitudinal data were assessed to calculate CIN2+ risk during follow-up using incidence rate ratios [IRR] and risk factors were identified in multivariable analysis. RESULTS: Cervical records were available from 2098 IBD women [77%] and 8379 in the matched cohort; median follow-up was 13 years. CIN2+ detection rate was higher in the IBD cohort than in the matched cohort (SDR 1.27, 95% confidence interval [CI] 1.05-1.52). Women with IBD had an increased risk of CIN2+ [IRR 1.66, 95% CI 1.21-2.25] and persistent or recurrent CIN during follow-up (odds ratio [OR] 1.89, 95% CI 1.06-3.38). Risk factors for CIN2+ in IBD women were smoking and disease location (ileocolonic [L3] or upper gastrointestinal [GI] [L4]). CIN2+ risk was not associated with exposure to immunosuppressants. CONCLUSIONS: Women with IBD are at increased risk for CIN2+ lesions. These results underline the importance of human papillomavirus [HPV] vaccination and adherence to cervical cancer screening guidelines in IBD women, regardless of exposure to immunosuppressants.

Exclusive breastfeeding after home versus hospital birth in primary midwifery care in the Netherlands.

BACKGROUND: Breastfeeding has short-term and long-term health benefits for mother and child. We evaluated in what way birthplace was associated with the rate of exclusive breastfeeding among low risk women who gave birth in midwife-led care and who had expressed the intention to breastfeed. METHODS: We used data from the DELIVER study, which includes pregnant women from twenty midwifery practices across the Netherlands between September 2009 and April 2011. We used data from two questionnaires: one in the third trimester (after 34 weeks) and one after the birth (median 39 days postpartum). Only women who indicated an intention to breastfeed were included in the analyses. Multivariable logistic regression analysis was used to assess the association between birthplace and exclusive breastfeeding, adjusted for relevant confounders. RESULTS: The exclusive breastfeeding rate was 75.0% for the 547 women who gave birth at home, and 68.5% for the 165 women who gave birth in midwife-led care in hospital. The adjusted odds ratio for exclusive breastfeeding after a hospital birth compared to a home birth was 0.79 (95% CI 0.53-1.18). The most frequently reported reason for not breastfeeding at the time of completing the postpartum questionnaire was 'my baby was not drinking enough' (47%). CONCLUSIONS: In the Netherlands, among low risk women who intended to breastfeed their baby, the breastfeeding success rate did not differ significantly between home and midwife-led hospital births. As breastfeeding has short-term and long-term health benefits for mother and child, women should receive adequate lactation support by healthcare workers during the critical postpartum period, regardless of the place where they give birth.

Prevalence of nosocomial infections in The Netherlands, 2007-2008: results of the first four national studies.

The PREZIES national network for the surveillance of nosocomial infections (NI) in The Netherlands has organised a national prevalence study twice a year since 2007. This paper presents the results of the first four surveys. Of 95 hospitals in The Netherlands, 41 participated in 92 surveys and 26 937 patients were included. On the survey day 6.2% had an NI (prevalence of infections 7.2%). The prevalence of infections varied from 1.4% to 16.5% between hospitals. The prevalence of surgical site infections was 4.8%, pneumonia 1.1%, primary bloodstream infection 0.5% and symptomatic urinary tract infection 1.7%. On admission to hospital, 3.3% of patients had an NI. On the day of the survey, 30.9% of the patients were receiving antibiotics. The use of antibiotics as well as medical devices differed considerably between hospitals. Both the prevalence of NI in The Netherlands and the use of antibiotics and devices were comparable to other European countries.

Comparison of the National Surgical Site Infection surveillance data between The Netherlands and Germany: PREZIES versus KISS.

As there has been increasing interest in comparing surgical site infection (SSI) rates between countries, we compared the SSI surveillance data for The Netherlands ('PREZIES') and Germany ('KISS'). Both surveillance systems have comparable protocols with many similar risk factors, including SSI definitions developed by the Centers for Disease Control and Prevention and optional postdischarge surveillance. Nine surgical procedure categories from several specialities were included, the reporting of which were similar, with respect to content and with enough data for proper comparison. Differences for the SSI data were found between PREZIES and KISS for duration of surgery, wound contamination class, American Society of Anesthesiologists physical status classification and the postoperative duration of hospitalization. A significantly higher superficial SSI rate was found for seven surgical procedures according to PREZIES and a higher deep SSI rate for five procedures. When considering only deep SSI during hospitalization, the differences in SSI rates were much smaller. Differences in intensity of postdischarge surveillance led to 34% of SSI being detected after discharge for PREZIES and 21% for KISS. In conclusion, even though similar infection surveillance protocols are used in The Netherlands and Germany, differences occurred in the implementation. Comparisons between countries are most reliable if only deep SSIs during hospitalization are taken into account, since these SSI are not affected by postdischarge surveillance and the diagnostic sensitivity for deep SSI is probably more alike between countries than for superficial SSI.

Validation of surgical site infection surveillance in the Netherlands.

OBJECTIVES: To describe how continuous validation of data on surgical site infection (SSI) is being performed in the Dutch National Nosocomial Infection Surveillance System (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), to assess the quality and accuracy of the PREZIES data, and to present the corresponding outcomes of the assessment. DESIGN: Mandatory, 1-day on-site validation visit to participating hospitals every 3 years. The process of surveillance, including the quality of the method of data collection, is validated by means of a structured interview. The use of SSI criteria is validated by review of medical records, with the judgment of the validation team as the criterion standard. SETTING: Hospitals participating in PREZIES. RESULTS: During 1999-2004, the validation team visited 40 hospitals and reviewed 859 medical charts. There was no deviation between reports of SSI by infection control professionals and findings by the PREZIES validation team at 30 hospitals and 1 deviation in each of 10 hospitals; the positive predictive value was 0.97, and the negative predictive value was 0.99. The validation team often gave advice to the hospital, aimed at perfecting the process of surveillance. On 2 occasions, data were removed from the PREZIES database after the validation visit revealed deviations from the SSI surveillance protocol that could have resulted in nonrepresentative SSI rate data. CONCLUSIONS: PREZIES is confident that the assembled Dutch SSI surveillance data are reliable and robust and are sufficiently accurate to be used as a reference for interhospital comparison. PREZIES will continue performing on-site validation visits, to improve the process of surveillance and ensure the reliability of the surveillance data.