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To determine the number and proportion of healthcare worker (HCW) tuberculosis (TB) cases infected while working in healthcare institutions in the Netherlands and to learn from circumstances that led to these infections.
We included all HCW TB patients reported to the Netherlands TB Register from 2000 to 2015. Using data from this register, including DNA fingerprints of the bacteria profile and additional information from public health clinics, HCW TB cases were classified into 4 categories: (1) infected during work in the Netherlands, (2) infected in the community, (3) infected outside the Netherlands, or (4) outside these 3 categories. An in-depth analysis of category 1 cases was performed to identify factors contributing to patient-to-HCW transmission.
In total, 131 HCW TB cases were identified: 32 cases (24%) in category 1; 13 cases (10%) in category 2; 42 cases (32%) in category 3; and 44 cases (34%) in category 4. The annual number of HCW TB cases (P<.05), the proportion among reported cases (P<.01), and the number of category 1 HCW TB cases (P=.12) all declined over the study period. Delayed diagnosis in a TB patient was the predominant underlying factor of nosocomial transmission in 47% of category 1 HCW TB patients, most of whom were subsequently identified in a contact investigation. Performing high-risk procedures was the main contributing factor in the other 53% of cases.
In low-incidence countries, every HCW TB case should warrant timely and thorough investigation to help further define and fine-tune the HCW screening policy and to monitor its proper implementation.
A large part of agricultural soils in Europe are exposed to high N inputs because of animal manure and chemical fertiliser use. Large parts of the European natural soils are exposed to high atmospheric N deposition.
High N inputs threaten soil quality, which may negatively affect food and biomass production and biodiversity and enhance emissions of harmful N compounds from soils to water and the atmosphere.
An overview of the major soil functions and soil threats are presented, including a description of the objectives of the European Soil Strategy.
The major N threats on soil quality for both agricultural and natural soils are related to changes in soil organic content and quality, soil acidification, and loss of soil diversity. These threats are described using literature.
Key findings/state of knowledge
Generally, N has a positive effect on soil quality of agricultural soils, because it enhances soil fertility and conditions for crop growth. However, it generally has a negative effect on soil quality of natural soils, because it results in changes in plant diversity.
Soil acts as a filter and buffer for N, and protects water and atmosphere against N pollution. However, the filter and buffer capacity of soils is frequently exceeded by excess of N in both agricultural and natural soils, which results in emission of N to the environment.
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