[Is it a sexually transmitted disease?].

STD-associated questions and symptoms are submitted frequently to general practitioners and STD outpatient-clinics. In this teaching article we address 10 important clinical questions regarding epidemiology, risk assessment, testing policy, diagnostics and prevention. STD's form a separate category of infectious diseases because of the role of sexuality.

Catatonia Associated With Systemic Lupus Erythematosus (SLE): A Report of Two Cases and a Review of the Literature.

Background: Systemic lupus erythematosus (SLE) is known to cause neuropsychiatric symptoms (NPSLE). While not formally recognized as a syndrome associated with NPSLE, catatonia has frequently been reported.

Objective: It is important for clinicians to recognize and treat catatonia as a potential manifestation of NPSLE.

[Psychiatric manifestations due to abnormal glucocorticoid levels].

This clinical case presentation describes the disease trajectory in two patients who presented with psychiatric symptoms as a result of abnormal serum glucocorticoid levels. One case involves a 58-year-old man with hypercortisolism, the other case concerns a 55-year-old woman with hypocortisolism. In both cases there was a considerable diagnostic delay in recognizing the underlying adrenal gland pathology.

MEF2D drives photoreceptor development through a genome-wide competition for tissue-specific enhancers.

Organismal development requires the precise coordination of genetic programs to regulate cell fate and function. MEF2 transcription factors (TFs) play essential roles in this process but how these broadly expressed factors contribute to the generation of specific cell types during development is poorly understood. Here we show that despite being expressed in virtually all mammalian tissues, in the retina MEF2D binds to retina-specific enhancers and controls photoreceptor cell development.

Effect of moderate-dose vitamin D supplementation on insulin sensitivity in vitamin D-deficient non-Western immigrants in the Netherlands: a randomized placebo-controlled trial.

Background: Low serum 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with insulin resistance, the metabolic syndrome, and type 2 diabetes. Because many non-Western immigrants in the Netherlands are vitamin D deficient, obese, and at high risk of diabetes, vitamin D supplementation may contribute to prevent diabetes and insulin resistance.

Objective: We examined the effect of vitamin D supplementation on insulin sensitivity and β cell function in overweight, vitamin D-deficient, non-Western immigrants at high risk of diabetes.

[Summary of the NHG guideline 'The STD consultation'].

The guideline 'The STD consultation' of the Dutch College of General Practitioners provides guidelines for the diagnosis and management of patients with symptoms of a sexually transmitted disease (STD), patients at high risk of being infected with a STD (risk groups), and patients with questions or concerns about STDs. The test policy depends on the patient's symptoms and risks and is extensively described in the guideline. Men who have sex with men (MSM), prostitutes, people who visit prostitutes, people from countries in which STDs are endemic, people with multiple sexual partners, and people with a partner from one of these groups are at increased risk of contracting one of the five major STDs (chlamydia, gonorrhoea, syphilis, hepatitis B, and HIV).

[Pre-exposure prophylaxis for HIV transmission? No, unless].

Pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) will soon be available in the Netherlands. Moderate evidence concerning practical efficacy, small absolute risk reduction (1-2%) and a high number needed to treat (50-75) are key figures. Prevention of one HIV infection will cost EUR 350,000 to 500,000.

Vector production in an academic environment: a tool to assess production costs.

Generating gene and cell therapy products under good manufacturing practices is a complex process. When determining the cost of these products, researchers must consider the large number of supplies used for manufacturing and the personnel and facility costs to generate vector and maintain a cleanroom facility. To facilitate cost estimates, the Indiana University Vector Production Facility teamed with the Indiana University Kelley School of Business to develop a costing tool that, in turn, provides pricing.

Synthetic chromosome arms function in yeast and generate phenotypic diversity by design.

Recent advances in DNA synthesis technology have enabled the construction of novel genetic pathways and genomic elements, furthering our understanding of system-level phenomena. The ability to synthesize large segments of DNA allows the engineering of pathways and genomes according to arbitrary sets of design principles. Here we describe a synthetic yeast genome project, Sc2.

Addition of a general practitioner to the accident and emergency department: a cost-effective innovation in emergency care.

Background: Many patients visit the accident and emergency department (AED) on their own initiative, although their medical problem can be adequately treated by a general practitioner (GP). Objective To evaluate the cost-effectiveness of addition of a GP to the AED (new care method) in comparison with usual care (usual care method).

Methods: This study followed a before/after design.

Effectiveness of GPs in accident and emergency departments.

Background: Many self-attending patients make inappropriate use of accident and emergency departments.

Aim: To determine whether a new care method consisting of the involvement of a GP during the day with the staff of the accident and emergency department of an academic city hospital and application of the Nederlands Triage System by a practice nurse is more effective than usual care.

Design: Before and after intervention design.

Sunlight exposure or vitamin D supplementation for vitamin D-deficient non-western immigrants: a randomized clinical trial.

Unlabelled: Vitamin D deficiency is very common in non-western immigrants. In this randomized clinical trial, vitamin D 800 IU/day or 100,000 IU/3 months were compared with advised sunlight exposure. Vitamin D supplementation was more effective than advised sunlight exposure in improving vitamin D status and lowering parathyroid hormone levels.

Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview.

Unlabelled: Vitamin D status of nonwestern immigrants in Europe was poor. Vitamin D status of nonwestern populations in their countries of origin varied, being either similar to the immigrant populations in Europe or higher than in European indigenous populations. Vitamin D concentrations in nonwestern immigrant populations should be improved.

[Summary of the practice guideline for shoulder complaints from the Dutch College of General Practitioners].

The second revision of the practice guideline for shoulder complaints was presented in 2008 by the Dutch College of General Practitioners. This guideline provides a standard for the diagnosis and treatment of shoulder complaints by general practitioners. The most important items in this new guideline are reviewed.

[Advisory report from the Health Council of the Netherlands to include human papillomavirus vaccination in the national immunisation programme for the prevention of cervical cancer].

The Health Council of the Netherlands has advised the Minister of Health, Welfare and Sport to include vaccination against Human papillomavirus (HPV) for girls aged 12 years as part of the National Immunisation Programme. A catch-up vaccination is proposed for girls aged 13-16 years. High-risk HPV infections cause cervical cancer.

[Carotid calcification on a panoramic radiograph: what to do?].

A 71-year-old man is discussed in whom the oral and maxillofacial surgeon observed, by chance, a radiopacity on the panoramic radiograph that was highly suggestive of a calcification at the bifurcation of the internal and external carotid artery. While, on the basis of international literature, various treatments are advanced with respect to the importance of vascular investigation and possible surgical removal of significant calcification, at present the view in The Netherlands is that the family doctor has the responsibility to assess whether such patient should be referred for further evaluation by the neurologist or vascular surgeon. The same applies to the possible indication for prescription of antitrombotics.

Comorbid depression, but not comorbid anxiety disorders, predicts poor outcome in anxiety disorders.

Influence of type of comorbidity was studied over the course of 1 year in a sample of 141 outpatients with panic disorder with or without agoraphobia and generalized anxiety disorder, who were receiving different forms of cognitive behavior therapy. Influence of type of comorbidity was determined on the basis of change scores (linear regression analysis) and remission data (Kaplan-Meier survival analysis). Three categories, as assessed at baseline, were compared: no comorbidity, comorbidity among anxiety disorders, and comorbidity with mood disorders.

Fatty fish and supplements are the greatest modifiable contributors to the serum 25-hydroxyvitamin D concentration in a multiethnic population.

Objective: Because vitamin D synthesis is lower in a heavily pigmented skin than in a lighter skin, the relative contribution of determinants to the vitamin D concentration might differ between ethnic groups. The aim of this study was to assess the prevalence of vitamin D deficiency and the relative contribution of vitamin D consumption and exposure to sunlight to the vitamin D concentration in a multiethnic population.

Design: Cross-sectional study.

Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial.

Background: Tests for the DNA of high-risk types of human papillomavirus (HPV) have a higher sensitivity for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) than does cytological testing, but the necessity of such testing in cervical screening has been debated. Our aim was to determine whether the effectiveness of cervical screening improves when HPV DNA testing is implemented.

Methods: Women aged 29-56 years who were participating in the regular cervical screening programme in the Netherlands were randomly assigned to combined cytological and HPV DNA testing or to conventional cytological testing only.

Good generalizability of a prediction rule for prediction of persistent shoulder pain in the short term.

Objective: To evaluate the generalizability of recently developed clinical prediction rules for the prognosis of shoulder pain in general practice.

Study Design And Setting: A large research program, consisting of a prognostic cohort study and three randomized controlled trials with 6 months follow-up, was carried out in The Netherlands. The clinical prediction rules were derived from the results of the prognostic cohort study (n=587).

[Summary of the practice guideline 'Vaginal discharge' (first revision) from the Dutch College of General Practitioners].

The 1996 practice guideline of the Dutch College of General Practitioners (NHG) on vaginal discharge has been updated. Most women who visit their doctor with complaints about vaginal discharge do not have an increased risk of a sexually-transmitted disease. Investigations into vaginal discharge comprise history taking, physical examination and microscopic analysis in the laboratory of the general practitioner.

Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months.

Adding a test for high-risk human papillomavirus (hrHPV) to cytological screening enhances the detection of high-grade cervical intraepithelial neoplasia (>or=CIN2), but data are required that enable long-term evaluation of screening. We investigated the >or=CIN2 risk for women participating in population-based screening as a function of hrHPV and cytology testing results at baseline and at 6 months. We included 2,193 women aged 30-60 years participating in a population-based screening trial who received colposcopy or a repeat testing advice at baseline.

Vitamin D status predicts physical performance and its decline in older persons.

Context: Vitamin D deficiency is common among older people and can cause mineralization defects, bone loss, and muscle weakness.

Objective: The aim of this study was to investigate the association of serum 25-hydroxyvitamin D (25-OHD) concentration with current physical performance and its decline over 3 yr among elderly.

Design: The study consisted of a cross-sectional and longitudinal design (3-yr follow-up) within the Longitudinal Aging Study Amsterdam.