Context Matters: Patterns in Physical Distancing Behavior Across Situations and Over Time During the Covid-19 Pandemic in the Netherlands.

BACKGROUND: Physical distancing is an effective preventative measure during respiratory infectious disease outbreaks. Prior studies on distancing behaviors have largely ignored context characteristics (physical, social) and time. PURPOSE: We investigated patterns in physical distancing over time and across situations, as well as sociodemographic variation herein. METHODS: We employed data from five rounds of a cohort study conducted throughout the pandemic by the Dutch public health institute (RIVM; N ≈ 50.000 per round). We conducted Latent Class Analyses to investigate patterns of physical distancing in a range of situations, followed by regression models to investigate associations between distancing behavior and sociodemographic and context characteristics. RESULTS: Participants differed in their general tendency to adhere to distancing guidelines across situations, but there were also substantial differences in distancing behavior between situations, particularly at work, with friends and family and outdoors. Distancing at work was strongly associated with work environment characteristics. Younger age groups reported less distancing behavior, particularly with close relations (friends or family) and at work. In periods when the pandemic situation was most severe, people adhered more strongly to distancing guidelines and age differences were most pronounced during these periods. CONCLUSIONS: Physical and social context matters for physical distancing, highlighting the importance of developing strategies for pandemic preparedness that improve opportunities for physical distancing (e.g., reducing crowding, one-way traffic) and accommodate young people to safely meet even in times of high pandemic severity and lockdowns. Future studies should account for the physical and social context in which distancing behavior is observed.

Physical distancing helps reduce the transmission of infectious diseases, but people's opportunities and willingness to keep distance from others can vary between situations. In a survey conducted at various time points during the Covid-19 pandemic, The Dutch National Public Health Institute asked people about their distancing behavior in various such situations, such as at work, when grocery shopping or when visiting with friends and family. We found that people mainly differed in their general tendency to keep distance from others: some individuals were more likely to keep distance than others in all situations. However, there were also substantial differences in distancing behavior at work, with friends and family and outdoors. Differences in distancing at work resulted from the specific work context and activities people had to perform. Younger age groups reported less distancing behavior in social situations such as when meeting with friends and family or with colleagues. In periods when the pandemic situation was most severe, people were more likely to keep their distance from others and there were larger age differences in distancing behavior. These results highlight the importance of improving people's opportunities to keep their distance from others and safely meet in times of a severe pandemic.

How well do surveys on adherence to pandemic policies assess actual behaviour: Measurement properties of the Dutch COVID-19 adherence to prevention advice survey (CAPAS).

BACKGROUND: Survey data on adherence to COVID-19 prevention measures have often been used to inform policy makers and public health professionals. Although behavioural survey data are often considered to suffer from biases, there is a lack of studies critically examining the validity, reliability and responsiveness of population-survey data on behaviour throughout the COVID-19 pandemic. AIM: We studied the measurement properties of the COVID-19 Adherence to Prevention Advice Survey (CAPAS), a novel questionnaire implemented in a repeated cross-sectional (i.e., 'Trend') Study and a Cohort Study in the Netherlands during the COVID-19 pandemic. METHODS: The CAPAS is a novel questionnaire developed in March 2020, with the aim to assess social activity and adherence to COVID-19 prevention measures. Items were formulated to minimise social desirability and aid memory retrieval. Based on the COSMIN framework, we selected the most suitable test for each behavioural question. We investigated criterion validity of vaccination, testing behaviour and mobility by comparing (aggregate) trends of self-reported behaviour to trends in objective data. Responsiveness of mobility and ventilation behaviour was assessed by studying whether self-reported behaviour changed following contextual (e.g., policy) changes. Test-retest reliability of hygienic behaviour, wearing face masks, ventilation behaviour and social distancing was examined during a period in which the context was stable. RESULTS: Overall, aggregate trends in self-reported behaviour closely corresponded to trends in external objective data. Self-reported behaviours were responsive to contextual changes and test-retest reliabilities were adequate. For infrequent behaviours reliability improved when measures were dichotomised. We were able to examine national representativeness for vaccination, which suggested a modest overestimation of on average 3.7%. CONCLUSIONS: This study supports the suitability of using carefully designed, self-reported surveys (and the CAPAS specifically) to study changes in protective behaviours in a dynamic context.

General Mental Health, Loneliness, and Life Satisfaction in the Context of COVID-19 Policies: A 2-Year Cohort Study in the Netherlands, April 2020-January 2022.

OBJECTIVE: Although the COVID-19 pandemic has affected mental health, understanding who has been affected most and why is incomplete. We sought to understand changes in mental health in the context of transmission numbers and pandemic (social) restrictions and whether changes in mental health varied among population groups. METHODS: We analyzed data from 92 062 people (aged ≥16 years and able to read Dutch) who participated in the Corona Behavioral Unit cohort study at the National Institute for Public Health and the Environment, the Netherlands, from April 17, 2020, through January 25, 2022. Participants self-reported mental well-being through multiple rounds of surveys. We used a multivariable linear mixed-effects model to analyze loneliness, general mental health, and life satisfaction. RESULTS: As strictness of pandemic prevention measures and social restrictions increased, people's feelings of loneliness increased and mental health and life satisfaction decreased. As restrictions were relaxed, loneliness decreased and general mental health improved. Younger people (aged 16-24 y) versus older people (aged ≥40 y), people with low (vs high) education levels, and people living alone (vs living together) were more likely to have negative well-being outcomes. We observed that trajectories over time differed considerably only by age, with participants aged 16-24 years affected substantially more than participants aged ≥40 years by pandemic social restrictions. These patterns were consistent across multiple waves of SARS-CoV-2 infection. CONCLUSIONS: Our findings suggest that the social restrictions imposed by the Dutch government during the study period were associated with reduced mental well-being, especially among younger people. However, people appeared resilient as they recovered during periods when restrictions were relaxed. Monitoring and supporting well-being, in particular to reduce loneliness, may help younger people during periods of intense social restrictions.

Cohort profile: The Corona Behavioral Unit cohort, a longitudinal mixed-methods study on COVID-19-related behavior, well-being and policy support in the Netherlands.

This 'cohort profile' aims to provide a description of the study design, methodology, and baseline characteristics of the participants in the Corona Behavioral Unit cohort. This cohort was established in response to the COVID-19 pandemic by the Dutch National Institute for Public Health and the Environment (RIVM) and the regional public health services. The aim was to investigate adherence of and support for COVID-19 prevention measures, psychosocial determinants of COVID-19 behaviors, well-being, COVID-19 vaccination, and media use. The cohort also examined specific motivations and beliefs, such as for vaccination, which were collected through either closed-ended items or open text responses. In April 2020, 89,943 participants aged 16 years and older were recruited from existing nation-wide panels. Between May 2020 and September 2022, 99,676 additional participants were recruited through online social media platforms and mailing lists of higher education organizations. Participants who consented were initially invited every three weeks (5 rounds), then every six weeks (13 rounds), and since the summer of 2022 every 12 weeks (3 rounds). To date, 66% of participants were female, 30% were 39 years and younger, and 54% completed two or more questionnaires, with an average of 9.2 (SD = 5.7) questionnaires. The Corona Behavioral Unit COVID-19 cohort has published detailed insights into longitudinal patterns of COVID-19 related behaviors, support of COVID-19 preventive measures, as well as peoples' mental wellbeing in relation to the stringency of these measures. The results have informed COVID-19 policy making and pandemic communication in the Netherlands throughout the COVID-19 pandemic. The cohort data will continuously be used to examine COVID-19 related outcomes for scientific analyses, as well as to inform future pandemic preparedness plans.

PrEP Use in Times of COVID-19 in the Netherlands: Men Who Have Sex With Men (MSM) on PrEP Test Less for HIV and Renal Functioning During a COVID-19 Related Lockdown.

As a result of the COVID-19 pandemic, HIV care and prevention efforts have been disrupted. We investigated pre-exposure prophylaxis (PrEP) use and testing behaviors among MSM in the Netherlands, and the factors that influenced testing behaviors during the COVID-19 pandemic. A cohort of 766 MSM, established in 2017, was asked in August 2020 to report on their experiences during the COVID-19 pandemic via an online survey. Participants (n = 319) reported increased PrEP use and, among PrEP users (n = 211), significantly lower rates of having tested in the last 3 months for HIV and renal functioning compared to before the pandemic. Daily PrEP use and a higher number of sexual partners during the pandemic was significantly associated with continued HIV testing. Continued renal functioning testing was associated with older age. Correcting for pandemic-related disruptions in PrEP use and care will require sustained effort to understand and address missed opportunities.

RéSUMé: Como resultado de la pandemia de COVID-19, los cuidados y esfuerzos de prevención de VIH han sido interrumpidos. Investigamos el uso de la profilaxis preexposición (PrEP) y el comportamiento de diagnóstico de HSH en los Países Bajos y los factores de influencia durante la pandemia. Una cohorte de 766 HSH, establecida en 2017, reportó en agosto 2020 sus experiencias mediante una encuesta en línea. Los participantes (n = 319) reportaron un incremento en el uso de PrEP y, entre los usuarios de PrEP (n = 211), tasas menores de pruebas de VIH y funcionamiento renal comparado con tasas pre-pandemia. El uso diario de PrEP y un número mayor de parejas sexuales en pandemia fue asociado con la solicitud continua de pruebas de VIH. La solicitud continua de pruebas de funcionamiento renal fue asociada al incremento de edad. Un esfuerzo constante será necesario para corregir las interrupciones del uso y cuidado asociado a la PrEP.

Bridging the serodivide: attitudes of PrEP users towards sex partners living with HIV.

The introduction of biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), holds the potential to overcome the serodivide. We investigated the attitudes of PrEP users towards having sex with partners living with HIV. PrEP users in the Netherlands were recruited online and completed three questionnaires over a period of six months. We investigated changes over time in feelings of fear of HIV, comfort, and attitudes towards condom use when having sex with men living with HIV (MLHIV). A majority of PrEP users in our sample (up to 71.6%) had sex with MLHIV. Feeling comfortable to have sex with MLHIV did not change over time, but was already at a high level at T1. Most importantly, feeling safe not to use condoms with HIV-positive partners significantly increased, and did so in a rather short period of time after the onset of PrEP use (3-6 months). Taken together, the findings suggest that that PrEP may contribute to decreasing the serodivide between MSM rather quickly after the onset of PrEP use.

Quality of Sex Life and Perceived Sexual Pleasure of PrEP Users in the Netherlands.

Next to its benefits for HIV prevention, PrEP may have psychosocial benefits relating to improved quality of sex life. The aim of the current study was to investigate the onset of changes in the quality of sex life and sexual pleasure of PrEP users in the first months of commencing PrEP use. Moreover, we investigated what factors were related to the quality of sex life of PrEP users. We recruited 145 participants via the Dutch PrEP-advocacy website PrEPnu.nl, and they received follow-up questionnaires after three and six months. We found that PrEP users reported an increase in the quality of their sex life, which was related to reduced fear of HIV since they started using PrEP but not to decreased condom use. PrEP users were more interested in experimenting with sex practices, but they did not always feel more desirable as a sex partner because of PrEP use. Health-care providers and health promotion campaigns could emphasize the positive effects of PrEP on the quality of sex life, in addition to the HIV-preventive effects of PrEP, to decrease PrEP stigma and increase PrEP uptake.

The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis.

INTRODUCTION: Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. METHODS: We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). RESULTS: Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4-84.8) for trans feminine individuals and 6.8 (95% CI 3.6-13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. CONCLUSION: Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.

Understanding a national increase in COVID-19 vaccination intention, the Netherlands, November 2020-March 2021.

The intention to get the COVID-19 vaccine increased from 48% (November 2020) to 75% (March 2021) as national campaigning in the Netherlands commenced. Using a mixed method approach we identified six vaccination beliefs and two contextual factors informing this increase. Analysis of a national survey confirmed that shifting intentions were a function of shifting beliefs: people with stronger intention to vaccinate were most motivated by protecting others and reopening society; those reluctant were most concerned about side effects.

Slow Uptake of PrEP: Behavioral Predictors and the Influence of Price on PrEP Uptake Among MSM with a High Interest in PrEP.

Despite the improved availability and affordability of PrEP in the Netherlands, PrEP uptake is low among men who have sex with men (MSM). To optimize uptake, it is important to identify facilitators and barriers of PrEP use. During our study period, the price of PrEP dropped significantly after generic PrEP was introduced. We investigated whether the price drop predicts PrEP uptake, alongside behavioral and demographic characteristics. Participants (N = 349) were recruited online and completed three questionnaires over a period of 6 months, between February 2017 and March 2019. After 6 months, 159 (45.6%) participants were using PrEP. PrEP uptake was greater among MSM who ever had postexposure prophylaxis (PEP) treatment, among MSM with a better perceived financial situation, and when the price of PrEP dropped. MSM in a tighter perceived financial situation may use PrEP more when it would be free or fully reimbursed.

RESUMEN: A pesar de la disponibilidad y asequibilidad a PrEP en Los Paises Bajos, el consumo de PrEP es bajo entre hombres que tienen sexo con hombres (HSH). Para optimizar su consumo, es importante identificar los factores facilitadores y las barreras del uso de PrEP. Durante nuestro estudio, el precio de PrEP se redujo significativamente, después de que se introdujo la PrEP genérica al mercado. Investigamos las características demograficas y de conducta y si la caída en el precio predice el consumo de PrEP. Participantes (N = 349) fueron reclutados en linea y completaron tres cuestionarios en un periodo de seis meses, entre Febrero de 2017 y Marzo de 2019. Despues de seis meses, 159 participantes (45.6%) estaban usando PrEP. El consumo de PrEP fue mayor cuando el precio de PrEP bajó y entre HSH que se sometieron a un tratamiento de profilaxis posexposición (PEP) y que tenían una buena situación financiera. HSH con una percibida situacion finaciera más precaria podrían usar PrEP más cuando sea gratis o reembolsada totalmente.

Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands.

The aim of this qualitative study was to explore the experiences of informal PrEP users regarding access to PrEP and PrEP-related healthcare, community responses, sexual behavior and well-being. We interviewed 30 men who have sex with men (MSM) in semi-structured online interviews between March and August 2018. Interviews were analyzed using interpretive description. Informal PrEP users were well informed about the use of PrEP, but sometimes did not make use of renal testing. Participants reported a lack of PrEP knowledge among healthcare providers, which limited their access to PrEP and put them at risk, as they received incorrect information. Although some participants reported negative reactions from potential sex partners, most received positive reactions and were sometimes seen as more desirable sex partners. PrEP healthcare services should not only be accessible to formal PrEP users, but also to PrEP users who procure PrEP informally.

PrEP Interest Among Men Who Have Sex with Men in the Netherlands: Covariates and Differences Across Samples.

Despite increased availability of pre-exposure prophylaxis (PrEP), PrEP uptake has remained low. To promote uptake, factors related to PrEP interest among relevant target populations warrant investigation. The aim of this study was to provide an analysis of PrEP interest among men who have sex with men (MSM) in the Netherlands, while taking study recruitment strategies into account. We recruited 154 MSM from an LGBT research panel (AmsterdamPinkPanel) and 272 MSM from convenience sampling. Both samples were part of the Flash! PrEP in Europe Survey and were compared on their PrEP interest, usage intentions, and sexual behavior. We conducted logistic regression analyses to discover variables associated with PrEP interest and intentions. Participants from the AmsterdamPinkPanel were less likely to use PrEP, had less knowledge of PrEP, and were less interested in PrEP than participants from convenience sampling. Significant covariates of PrEP interest were being single, more prior PrEP knowledge, sexual risk behaviors, such as not having used a condom during last sex and having ever used drugs in a sexual context, and not participating in the AmsterdamPinkPanel. Adding the recruitment strategy to the regression increased explained variance on top of predictors already described in the literature. Increased sexual risk behavior is related to increased PrEP interest and it helps to identify PrEP target groups. Recruitment strategies have a substantial impact on findings regarding PrEP interest and usage intentions. This study emphasizes the importance of using multiple strategies for recruiting participants to obtain a more comprehensive view of MSM's attitudes toward PrEP.

The effect of target speed on perception of visual motion direction in a patient with akinetopsia.

Although much research has been devoted to the neural correlates of motion perception, the processing of speed of motion is still a topic of discussion. Apart from patient LM, no in-depth clinical research has been done in the past 20 years on this topic. In the present study, we investigated patient TD, who suffered from the rare disorder akinetopsia due to bilateral lesions of V5 after stroke. By means of a Random-Dot-Kinematogram (RDK) in which speed was varied systematically, it was found that TD was impaired in perceiving the direction of movement at speeds exceeding 9 deg/s. Our study suggests that V5 plays an important role in processing high-speed visual motion and further implies that V5 does not play a crucial role in processing low-speed visual motion. A remarkable finding, which has not been shown before, was that TD always reported the opposite direction of the actual movement at a speed of 24 deg/s. This suggests a form of the continuous wagon wheel illusion, which might have been caused by intact brain areas operating at different sampling rates than area V5.

Effects of Additional Low-Pass-Filtered Speech on Listening Effort for Noise-Band-Vocoded Speech in Quiet and in Noise.

OBJECTIVES: Residual acoustic hearing in electric-acoustic stimulation (EAS) can benefit cochlear implant (CI) users in increased sound quality, speech intelligibility, and improved tolerance to noise. The goal of this study was to investigate whether the low-pass-filtered acoustic speech in simulated EAS can provide the additional benefit of reducing listening effort for the spectrotemporally degraded signal of noise-band-vocoded speech. DESIGN: Listening effort was investigated using a dual-task paradigm as a behavioral measure, and the NASA Task Load indeX as a subjective self-report measure. The primary task of the dual-task paradigm was identification of sentences presented in three experiments at three fixed intelligibility levels: at near-ceiling, 50%, and 79% intelligibility, achieved by manipulating the presence and level of speech-shaped noise in the background. Listening effort for the primary intelligibility task was reflected in the performance on the secondary, visual response time task. Experimental speech processing conditions included monaural or binaural vocoder, with added low-pass-filtered speech (to simulate EAS) or without (to simulate CI). RESULTS: In Experiment 1, in quiet with intelligibility near-ceiling, additional low-pass-filtered speech reduced listening effort compared with binaural vocoder, in line with our expectations, although not compared with monaural vocoder. In Experiments 2 and 3, for speech in noise, added low-pass-filtered speech allowed the desired intelligibility levels to be reached at less favorable speech-to-noise ratios, as expected. It is interesting that this came without the cost of increased listening effort usually associated with poor speech-to-noise ratios; at 50% intelligibility, even a reduction in listening effort on top of the increased tolerance to noise was observed. The NASA Task Load indeX did not capture these differences. CONCLUSIONS: The dual-task results provide partial evidence for a potential decrease in listening effort as a result of adding low-frequency acoustic speech to noise-band-vocoded speech. Whether these findings translate to CI users with residual acoustic hearing will need to be addressed in future research because the quality and frequency range of low-frequency acoustic sound available to listeners with hearing loss may differ from our idealized simulations, and additional factors, such as advanced age and varying etiology, may also play a role.