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1.
BMC Psychiatry ; 21(1): 233, 2021 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-33947374

RESUMEN

BACKGROUND: Several evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved. The D*Phase study directly compares short-term psychodynamic supportive psychotherapy (SPSP) and cognitive behavioural therapy (CBT) for Major Depressive Disorder (MDD). The objectives are 1. to investigate if, from a group level perspective, SPSP is not inferior to CBT in the treatment of major depressive disorder, 2. to build a model that may help predict the optimal type of treatment for a specific individual; and 3. to determine whether a change of therapist or a change of therapist and treatment method are effective strategies to deal with non-response. Furthermore (4.), the effect of the therapeutic alliance, treatment integrity and therapist allegiance on treatment outcome will be investigated. METHOD: In this pragmatic randomised controlled trial, 308 patients with a primary diagnosis of MDD are being recruited from a specialised mental health care institution in the Netherlands. In the first phase, patients are randomised 1:1 to either SPSP or CBT. In case of treatment non-response, a second phase follows in which non-responders from treatment phase one are randomised 1:1:1 to one of three groups: continuing the initial treatment with the same therapist, continuing the initial treatment with another therapist or continuing the other type of treatment with another therapist. In both treatment phases, patients are offered sixteen twice-weekly psychotherapy sessions. The primary outcome is an improvement in depressive symptoms. Process variables, working alliance and depressive symptoms, are frequently measured. Comprehensive assessments take place before the start of the first phase (at baseline), in week one, two and four during the treatment, and directly after the treatment (week eight). DISCUSSION: While the naturalistic setting of the study involves several challenges, we expect, by focusing on a large and diverse number of research variables, to generate important knowledge that may help enhance the effect of psychotherapeutic treatment for MDD. TRIAL REGISTRATION: The study was registered on 26 August 2016 with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NL5753), https://www.trialregister.nl/trial/5753.


Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Depresión , Trastorno Depresivo Mayor/terapia , Humanos , Países Bajos , Psicoterapia , Ensayos Clínicos Controlados Aleatorios como Asunto
2.
Value Health ; 24(5): 658-667, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33933234

RESUMEN

OBJECTIVES: Our study investigates the extent to which uptake of a COVID-19 digital contact-tracing (DCT) app among the Dutch population is affected by its configurations, its societal effects, and government policies toward such an app. METHODS: We performed a discrete choice experiment among Dutch adults including 7 attributes, that is, who gets a notification, waiting time for testing, possibility for shops to refuse customers who have not installed the app, stopping condition for contact tracing, number of people unjustifiably quarantined, number of deaths prevented, and number of households with financial problems prevented. The data were analyzed by means of panel mixed logit models. RESULTS: The prevention of deaths and financial problems of households had a very strong influence on the uptake of the app. Predicted app uptake rates ranged from 24% to 78% for the worst and best possible app for these societal effects. We found a strong positive relationship between people's trust in government and people's propensity to install the DCT app. CONCLUSIONS: The uptake levels we find are much more volatile than the uptake levels predicted in comparable studies that did not include societal effects in their discrete choice experiments. Our finding that the societal effects are a major factor in the uptake of the DCT app results in a chicken-or-the-egg causality dilemma. That is, the societal effects of the app are severely influenced by the uptake of the app, but the uptake of the app is severely influenced by its societal effects.


Asunto(s)
/diagnóstico , Trazado de Contacto/instrumentación , Aplicaciones Móviles/normas , Cambio Social , /epidemiología , Trazado de Contacto/estadística & datos numéricos , Política de Salud , Humanos , Países Bajos , Salud Pública/instrumentación , Salud Pública/métodos , Encuestas y Cuestionarios
3.
Lancet Neurol ; 20(5): 373-384, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33894192

RESUMEN

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is considered to be caused by both genetic and environmental factors. The causal cascade is, however, not known. We aimed to assess lifestyle during the presymptomatic phase of ALS, stratified by C9orf72 mutation, and examine evidence supporting causality of lifestyle factors. METHODS: This study was a longitudinal, population-based, case-control study that used data from the Prospective ALS study the Netherlands. We included patients with a C9orf72 mutation (C9+ group), patients without a C9orf72 mutation (C9- group), and controls. Patients fulfilled the revised El Escorial criteria and were recruited through neurologists and rehabilitation physicians in the Netherlands as well as the Dutch Neuromuscular Patient Association and ALS Centrum website. 1322 population-based controls, matched for age and sex, were enrolled via the patients' general practitioners. Blood relatives or spouses of patients were not eligible as controls. We studied the relationship between ALS risk and smoking, alcohol, physical activity, body-mass index (BMI), and energy intake by the use of structured questionnaires. Smoking, physical activity, and BMI were longitudinally assessed up to 50 years before onset (defined as the period before onset of muscle weakness or bulbar symptoms for cases, or age at completing the questionnaire for controls). We calculated posterior probabilities (P(θ|x)) for causal effects of smoking, alcohol, and BMI, using Bayesian instrumental variable analyses. FINDINGS: Between Jan 1, 2006 and Jan 27, 2016, we included 143 patients in the C9+ group, 1322 patients in the C9- group, and 1322 controls. Compared with controls, cigarette pack-years (C9+ group mean difference from control 3·15, 95% CI 0·36 to 5·93, p=0·027; C9- group 3·20, 2·02 to 4·39, p<0·0001) and daily energy intake at symptom onset (C9+ group 712 kJ, 95% CI 212 to 1213, p=0·0053; C9- group 497, 295 to 700, p<0·0001) were higher in the C9+ and C9- groups, whereas current BMI (C9+ group -2·01 kg/m2, 95% CI -2·73 to -1·29, p<0·0001; C9- group -1·35, -1·64 to -1·06, p<0·0001) and lifetime alcohol consumption (C9+ group -5388 units, 95% CI -9113 to -1663, p=0·0046; C9- group -2185, -3748 to -622, p=0·0062) were lower in the C9+ and C9- groups. Median BMI during the presymptomatic phase for the C9+ group was lower (-0·69 kg/m2, 95% CI -1·24 to -0·13, p=0·015) and physical activity was similar (-348 metabolic equivalent of task [MET], 95% CI -966 to 270, p=0·27) to controls, whereas both the median BMI during the presymptomatic phase (0·27 kg/m2, 95% CI 0·04 to 0·50, p=0·022) and physical activity (585 MET, 291 to 878, p=0·0001) were higher in the C9- group than controls. Longitudinal analyses showed more cigarette pack-years in the C9- (starting 47 years pre-onset) and C9+ (starting 24 years pre-onset) groups, and higher physical activity over time in the C9- group (starting >30 years pre-onset). BMI of the C9+ group increased more slowly and was significantly lower (starting at 36 years pre-onset) than in controls, whereas the BMI of the C9- group was higher than controls (23-49 years pre-onset, becoming lower 10 years pre-onset). Instrumental variable analyses supported causal effects of alcohol consumption (P(θ|x)=0·9347) and smoking (P(θ|x)=0·9859) on ALS in the C9- group. We found evidence supporting a causal effect of increased BMI at younger age (mean 33·8 years, SD 11·7) in the C9- group (P[θ|x]=0·9272), but not at older ages. INTERPRETATION: Lifestyle during the presymptomatic phase differs between patients with ALS and controls decades before onset, depends on C9- status, and is probably part of the presymptomatic causal cascade. Identification of modifiable disease-causing lifestyle factors offers opportunities to lower risk of developing neurodegenerative disease. FUNDING: Netherlands ALS Foundation.


Asunto(s)
Esclerosis Amiotrófica Lateral/genética , Esclerosis Amiotrófica Lateral/psicología , Proteína C9orf72/genética , Estilo de Vida , Mutación/genética , Factores de Edad , Anciano , Esclerosis Amiotrófica Lateral/fisiopatología , Índice de Masa Corporal , Estudios de Casos y Controles , Ingestión de Energía , Ejercicio Físico , Femenino , Genotipo , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Países Bajos , Fumar , Encuestas y Cuestionarios
4.
Artículo en Inglés | MEDLINE | ID: mdl-33804810

RESUMEN

Food environments play a role in immigrants' dietary acculturation, but little is known about the directionality of the relationship. The objective was to explore the interaction between the food environment and food procurement behaviors in the process of dietary acculturation. A qualitative study design using in-depth interviews and a mapping exercise was conducted. The immigrant group studied used a variety of factors to select which foods to procure. Traditional foods were readily available, shifting the determining factors to a combination of affordability, acceptability and accessibility. The food environment is dynamic and responds to shifting market demands. Policies regarding food procurement behaviors should consider these upstream effects and be aware of the availability of traditional foods for immigrant groups.


Asunto(s)
Aculturación , Emigrantes e Inmigrantes , Dieta , Alimentos , Humanos , Países Bajos
5.
Environ Monit Assess ; 193(5): 307, 2021 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-33909163

RESUMEN

Metal and metalloid contamination in drinking water sources is a global concern, particularly in developing countries. This study used hollow membrane water filters and metal-capturing polyurethane foams to sample 71 drinking water sources in 22 different countries. Field sampling was performed with sampling kits prepared in the lab at Hope College in Holland, MI, USA. Filters and foams were sent back to the lab after sampling, and subsequent analysis of flushates and rinsates allowed the estimation of suspended solids and metal and other analayte concentrations in source waters. Estimated particulate concentrations were 0-92 mg/L, and consisted of quartz, feldspar, and clay, with some samples containing metal oxides or sulfide phases. As and Cu were the only analytes which occurred above the World Health Organization (WHO) guidelines of 10 µg/L and 2000 µg/L, respectively, with As exceeding the guideline in 45% of the sources and Cu in 3%. Except for one value of ~ 285 µg/L, As concentrations were 45-200 µg/L (river), 65-179 µg/L (well), and 112-178 µg/L (tap). Other metals (Ce, Fe, Mg, Mn, Zn) with no WHO guideline were also detected, with Mn the most common. This study demonstrated that filters and foams can be used for reconnaissance characterization of untreated drinking water. However, estimated metal and other analyte concentrations could only be reported as minimum values due to potential incomplete retrieval of foam-bound analytes. A qualitative reporting methodology was used to report analytes as "present" if the concentration was below the WHO guideline, and "present-recommend retesting" if the concentration was quantifiable and above the WHO guideline.


Asunto(s)
Agua Potable , Metaloides , Metales Pesados , Contaminantes Químicos del Agua , Monitoreo del Ambiente , Humanos , Metaloides/análisis , Metales Pesados/análisis , Países Bajos , Contaminantes Químicos del Agua/análisis
6.
BMC Med Inform Decis Mak ; 21(1): 123, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33836742

RESUMEN

BACKGROUND: Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient's preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands-based on the principles of multi-criteria decision analysis (MCDA) -was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. RESULTS: After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users' informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient's preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. CONCLUSION: This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.


Asunto(s)
Esclerosis Múltiple , Preparaciones Farmacéuticas , Toma de Decisiones , Técnicas de Apoyo para la Decisión , Humanos , Esclerosis Múltiple/tratamiento farmacológico , Países Bajos , Prioridad del Paciente
7.
Artículo en Inglés | MEDLINE | ID: mdl-33807270

RESUMEN

(1) Background: accident rates prove the uneven development of the member countries in the area of work safety. Remedial actions and structural programmes should take into account, e.g., the level of work safety in all European Union (EU) countries. Aim: the identification of differences in the level of work safety in the production sector of EU countries, especially the so-called "old" and "new" EU countries. (2) Methods: for each country UE (in 2008-2018), the relative risk (RR) of an accident at work was determined and a comparative analysis was conducted. (3) Results: an increase in the RR of an accident at work was observed along with an increase in the GDP of a given country. It was found that the level of occupational safety in Sweden and the United Kingdom is higher than in other countries, and lower in Spain and Portugal. In the three largest economies of the EU, Germany, France, and Italy, the RR of the accident in the industrial sector in relation to the national data is one of the lowest in the entire EU, not exceeding 1.3. In The Netherlands, an increase of 1.7 RR of fatal accidents in the industrial sector was observed between 2008 and 2018. (4) Conclusions: RR in the manufacturing sector of the so-called "old" EU is higher than in the so-called "new" EU, which may result from the implementation of Industry 4.0 assumptions in the "old" EU. The presented results and conclusions may be useful in shaping the EU policy in the field of sustainable development of production sectors of individual member countries.


Asunto(s)
Accidentes , Estudios de Cohortes , Unión Europea , Francia , Alemania , Humanos , Italia , Países Bajos , Portugal , España , Suecia , Reino Unido
8.
Artículo en Inglés | MEDLINE | ID: mdl-33807352

RESUMEN

The development and enhancement of occupational health services (OHS) at the national level is central to ensuring the sustainable health, well-being and work engagement of the working population. However, due to differences in national health, social security and occupational safety and health systems, the content, capacity, coverage and provisions of OHS vary considerably across national contexts. Obtaining a better understanding in terms of such similarities and variations internationally is essential as such comparative information can help inform evidenced-based decision-making on OHS at both policy and practice levels. This paper therefore reviews and analyses the key policies, standards and approaches in OH systems and services, using both academic and grey literature, across 12 industrialised countries (Australia, Canada, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, United Kingdom and the United States of America). It provides a detailed overview and categorization of OHS in these selected countries in terms of the legal and policy context, organisation and financing and coverage and staffing while specifically discussing variations aimed at psychosocial risk management and the promotion of mental health and well-being at work. It draws conclusions on key development needs of OHS internationally to ensure psychosocial risk management and mental health promotion are prioritised effectively in a preventive manner.


Asunto(s)
Servicios de Salud del Trabajador , Salud Laboral , Australia , Canadá , Finlandia , Francia , Alemania , Humanos , Irlanda , Italia , Japón , Salud Mental , Países Bajos , Polonia , Gestión de Riesgos , Reino Unido , Estados Unidos
9.
Ned Tijdschr Tandheelkd ; 128(4): 203-210, 2021 Apr.
Artículo en Holandés | MEDLINE | ID: mdl-33890935

RESUMEN

From the age of 18, dental care is no longer covered by basic healthcare insurance [in the Netherlands]. Individuals can voluntarily take out additional insurance however. The aim of this study was to map out what information those nearly 18 years old receive about the changes in coverage of dental care (Part A) and what their preferences were concerning information on this topic (Part B). Part A consisted of desk research on the websites of 4 health insurers and government agencies, complemented with interviews with portfolio holders. Part B consisted of a questionnaire survey among 18-year-old secondary school pupils training for university and vocational students (n = 106).The websites of health insurers and government agencies contained some information, 2 health insurers sent information by post about dental insurance and 1 also got in touch by phone. The level of knowledge about the insurance system among 18-year-olds was low, information often did not seem to have been received and they did not look for information themselves. Secondary school pupils training for university preferred to receive written information, vocational students preferred to receive it orally. Conclusion: Information about the changing health insurance status is available but does not reach those nearly 18 years old effectively. Cooperation and clarity on the responsibilities regarding the provision of information is recommended.


Asunto(s)
Prestación de Atención de Salud , Seguro de Salud , Adolescente , Humanos , Países Bajos
10.
Ned Tijdschr Tandheelkd ; 128(4): 211-220, 2021 Apr.
Artículo en Holandés | MEDLINE | ID: mdl-33890936

RESUMEN

Among dental hygienists and dentists in the Netherlands, the impact of the SARS-CoV-2 pandemic on oral healthcare practices from March to July 2020 was investigated. Of the 1,700 healthcare providers approached, 433 completed questionnaires could be used. The results show that the pandemic has had a profound impact on both the accessibility of oral healthcare and on care provided in oral healthcare practices. Extra attention was paid to hygiene and infection prevention: the types of personal protective equipment and the protocols and procedures were adjusted by many oral healthcare providers. The confirmed prevalence of oral healthcare providers with COVID-19 in this study was 1.6%. However, testing was not available to all respondents with complaints during this initial period. Over half of the respondents estimated that even with additional measures there is an increased risk of infection to oral healthcare providers during their work. The efficacy of the various additional measures in oral healthcare practices related to COVID-19 is still unknown.


Asunto(s)
Coronavirus , Prestación de Atención de Salud , Humanos , Países Bajos/epidemiología , Encuestas y Cuestionarios
11.
BMC Geriatr ; 21(1): 224, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794804

RESUMEN

BACKGROUND: This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS: This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS: Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS: The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION: Netherlands Trial Register: NTR5695 (7 March 2016).


Asunto(s)
Accidentes por Caídas , Fracturas de Cadera , Accidentes por Caídas/prevención & control , Anciano , Cognición , Miedo , Estudios de Factibilidad , Fracturas de Cadera/diagnóstico , Fracturas de Cadera/terapia , Humanos , Países Bajos/epidemiología , Estudios Prospectivos
12.
Artículo en Inglés | MEDLINE | ID: mdl-33802715

RESUMEN

Understanding of public health adaptation (PHA) to climate change and implementation is limited. This study therefore focuses on one specific PHA issue: adaptation to the oak processionary moth (OPM). The aim is to examine the development of OPM adaptation in order to offer a problem description of the complexities involved in OPM adaptation. In this explorative case study, we investigate adaptation strategies based on semi-structured interviews with 26 actors involved in OPM adaptation in The Netherlands. The results indicate that the context of OPM adaptation is relatively complex, given the involvement of many interdependent actors. OPM adaptation was developed with limited knowledge and strategies were based on ad hoc approaches in which there was ambiguity about tasks and expertise. In addition, different actors have different perceptions and values concerning health, sustainability, risks and responsibilities influencing decision-making processes, while also posing a challenge to collaboration and the development of a coordinated approach. The generation of knowledge and its translation into practical strategies calls for interdisciplinary cooperation in knowledge development. PHA adaptation involves more than technical and organisational solutions alone. It also entails the development of a shared problem perception and solution space in which citizens are also engaged.


Asunto(s)
Cambio Climático , Mariposas Nocturnas , Adaptación Fisiológica , Animales , Países Bajos , Salud Pública
13.
BMC Geriatr ; 21(1): 237, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33836669

RESUMEN

BACKGROUND: Green care farms, which offer care for people with dementia in a farm setting, have been emerging in the Netherlands. The aim of this study was to 1) implement green care farms which use rice farming in Japan, 2) explore the positive experiences of rice farming care, and 3) compare the effect of rice farming care to that of usual care on well-being and cognitive ability. METHODS: We developed a new method of green care farm in Japan which uses rice farming, a farming that is practiced all over East Asia. The participants were 15 people with dementia (mean age = 75.6 ± 9.8 years) who participated in a one-hour rice farming care program once a week for 25 weeks. We also collected qualitative data on the positive experiences of study participants after the program. As a reference data, we also collected the corresponding data of the usual care group which included 14 people with dementia (mean age = 79.9 ± 5.8 years) who were attending the near-by day-care. RESULTS: The mean participation rate on the rice farming care group was 72.1%. After the intervention, participants reported experiencing enjoyment and connection during the program. It also changed the staff's view on dementia. The green care farm group showed a significant improvement in well-being but no significant difference in cognitive function compared to the usual care group. CONCLUSIONS: Green care farms by using rice farming is promising care method which is evidence-based, empowerment-oriented, strengths-based, community-based dementia service, which also delivers meaningful experience for the people with dementia in East Asia. TRIAL REGISTRATION: UMIN, UMIN000025020 , Registered 1 April 2017.


Asunto(s)
Demencia , Oryza , Anciano , Anciano de 80 o más Años , Agricultura , Demencia/terapia , Granjas , Humanos , Japón , Países Bajos/epidemiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-33801520

RESUMEN

Background: Outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, as many people, including youth, spend a large portion of their free time participating in sports. Nevertheless, the majority of sports clubs worldwide still have not adopted an outdoor SFP. The aim of this study is to explore the perceptions of key stakeholders at different Dutch sports clubs concerning the adoption of an outdoor SFP. Methods: Semi-structured interviews were held with 41 key stakeholders at seven Dutch sports clubs (in field hockey, football, tennis, or korfball) without an outdoor SFP. A thematic approach was used to analyze the data. Results: The majority of respondents reported considerations that were favorable towards adoption of an outdoor SFP, including expected support from club members, changing social norms with regard to smoking, and few members who smoke. Most of all, respondents valued the protection of children from the harmful effects of smoking. However, they also foresaw a number of problems in case of adoption, including impaired social functioning of the sports club, problems with compliance and enforcement, conflict with smokers' interest, and low priority in club management. Conclusions: Although stakeholders at sports clubs recognize the intrinsic value of an outdoor SFP, they foresee practical problems that are inherent to sports clubs. Adoption could be enhanced by articulating the importance of protecting children from the harmful effects of smoking, referring to 'success stories' at sports clubs that are already smoke-free, and actively involving smokers in the adoption process.


Asunto(s)
Política para Fumadores , Deportes , Contaminación por Humo de Tabaco , Adolescente , Niño , Humanos , Países Bajos , Fumar , Prevención del Hábito de Fumar
15.
Ned Tijdschr Geneeskd ; 1652021 03 26.
Artículo en Holandés | MEDLINE | ID: mdl-33793135

RESUMEN

GOAL: To study the effect of the first COVID-19 wave in combination with the lockdown on acute care in the Netherlands. DESIGN: Retrospective cohort study METHOD: For this study, data was collected from patients who visited the emergency department (ED) and Cardiac Care Unit of Noordwest Ziekenhuisgroep in Alkmaar and Den Helder. This data collection took place from 1 February to 28 June in 2019 and during the same period in 2020. The number of visits per day was investigated. The outcome measures for hospital occupation were the number of admissions per day and the average length of stay. Outcome measures for health damage were length of stay and mortality. RESULTS: The number of ED visits fell by 27% during the lockdown. For the specialties of internal medicine and pulmonary medicine, the number of admissions from the ED was the same during the lockdown, but the length of stay was longer. For all other specialties, the number of admissions from the ED was lower during the lockdown, but the admission duration was the same. Mortality was higher and hospital stay longer for patients admitted to the specialties of internal medicine and pulmonary medicine. In all other specialisms studied, there was no higher mortality or longer hospital stay. CONCLUSION: From the start of the lockdown, there was a sharp drop in the number of ED visits. The number of ED visits recovered slowly after this drop. For specialties that did not treat COVID-19 patients, hospital occupation was lower than usual. The number of admissions from the ED had decreased for these specialties. Based on the outcome measures length of stay and mortality, we were unable to find any indications of health damage as a result of the drop in admissions.


Asunto(s)
Ocupación de Camas/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , /prevención & control , Control de Enfermedades Transmisibles , Mortalidad Hospitalaria , Humanos , Países Bajos , Neumología/estadística & datos numéricos , Estudios Retrospectivos
16.
Viruses ; 13(3)2021 03 22.
Artículo en Inglés | MEDLINE | ID: mdl-33810168

RESUMEN

Cape Town was the first city in South Africa to experience the full impact of the coronavirus disease 2019 (COVID-19) pandemic. We acquired samples from all suspected cases and their contacts during the first month of the pandemic from Tygerberg Hospital. Nanopore sequencing generated SARS-CoV-2 whole genomes. Phylogenetic inference with maximum likelihood and Bayesian methods were used to determine lineages that seeded the local epidemic. Three patients were known to have travelled internationally and an outbreak was detected in a nearby supermarket. Sequencing of 50 samples produced 46 high-quality genomes. The sequences were classified as lineages: B, B.1, B.1.1.1, B.1.1.161, B.1.1.29, B.1.8, B.39, and B.40. All the sequences from persons under investigation (PUIs) in the supermarket outbreak (lineage B.1.8) fall within a clade from the Netherlands with good support (p > 0.9). In addition, a new mutation, 5209A>G, emerged within the Cape Town cluster. The molecular clock analysis suggests that this occurred around 13 March 2020 (95% confidence interval: 9-17 March). The phylogenetic reconstruction suggests at least nine early introductions of SARS-CoV-2 into Cape Town and an early localized transmission in a shopping environment. Genomic surveillance was successfully used to investigate and track the spread of early introductions of SARS-CoV-2 in Cape Town.


Asunto(s)
/epidemiología , /fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brotes de Enfermedades , Femenino , Genoma Viral , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Filogenia , /genética , Sudáfrica/epidemiología , Viaje , Secuenciación Completa del Genoma , Adulto Joven
17.
Proc Natl Acad Sci U S A ; 118(17)2021 04 27.
Artículo en Inglés | MEDLINE | ID: mdl-33827987

RESUMEN

Suspension of face-to-face instruction in schools during the COVID-19 pandemic has led to concerns about consequences for students' learning. So far, data to study this question have been limited. Here we evaluate the effect of school closures on primary school performance using exceptionally rich data from The Netherlands (n ≈ 350,000). We use the fact that national examinations took place before and after lockdown and compare progress during this period to the same period in the 3 previous years. The Netherlands underwent only a relatively short lockdown (8 wk) and features an equitable system of school funding and the world's highest rate of broadband access. Still, our results reveal a learning loss of about 3 percentile points or 0.08 standard deviations. The effect is equivalent to one-fifth of a school year, the same period that schools remained closed. Losses are up to 60% larger among students from less-educated homes, confirming worries about the uneven toll of the pandemic on children and families. Investigating mechanisms, we find that most of the effect reflects the cumulative impact of knowledge learned rather than transitory influences on the day of testing. Results remain robust when balancing on the estimated propensity of treatment and using maximum-entropy weights or with fixed-effects specifications that compare students within the same school and family. The findings imply that students made little or no progress while learning from home and suggest losses even larger in countries with weaker infrastructure or longer school closures.


Asunto(s)
Aprendizaje , Pandemias , Cuarentena , Instituciones Académicas , /epidemiología , Niño , Femenino , Humanos , Masculino , Países Bajos
18.
Artículo en Inglés | MEDLINE | ID: mdl-33805097

RESUMEN

The COVID-19 pandemic may be of particular concern for pregnant and breastfeeding women. We aimed to explore their beliefs about the coronavirus and COVID-19 vaccine willingness and to assess the impact of the pandemic on perinatal experiences and practices. A multinational, cross-sectional, web-based study was performed in six European countries between April and July 2020. The anonymous survey was promoted via social media. In total, 16,063 women participated (including 6661 pregnant and 9402 breastfeeding women). Most responses were collected from Belgium (44%), Norway (18%) and the Netherlands (16%), followed by Switzerland (11%), Ireland (10%) and the UK (3%). Despite differences between countries, COVID-19 vaccine hesitancy was identified among 40-50% of the respondents at the end of the first wave of the pandemic and was higher among pregnant women. Education level and employment status were associated with vaccine hesitancy. The first wave had an adverse impact on pregnancy experiences and disrupted access to health services and breastfeeding support for many women. In the future, access to health care and support should be maintained at all times. Evidence-based and tailored information on COVID-19 vaccines should also be provided to pregnant and breastfeeding women to avoid unfounded concerns about the vaccines and to support shared decision making in this population.


Asunto(s)
Pandemias , Bélgica , Estudios Transversales , Europa (Continente) , Femenino , Humanos , Irlanda , Países Bajos , Noruega , Pandemias/prevención & control , Embarazo , Suiza
19.
Artículo en Inglés | MEDLINE | ID: mdl-33917334

RESUMEN

National governments took action to delay the transmission of the coronavirus (SARS-CoV-2) by implementing different containment measures. We developed an online survey that included 44 different containment measures. We aimed to assess how effective citizens perceive these measures, which measures are perceived as violation of citizens' personal freedoms, which opinions and demographic factors have an effect on compliance with the measures, and what governments can do to most effectively improve citizens' compliance. The survey was disseminated in 11 countries: UK, Belgium, Netherlands, Bulgaria, Czech Republic, Finland, India, Latvia, Poland, Romania, and Sweden. We acquired 9543 unique responses. Our findings show significant differences across countries in perceived effectiveness, restrictiveness, and compliance. Governments that suffer low levels of trust should put more effort into persuading citizens, especially men, in the effectiveness of the proposed measures. They should provide financial compensation to citizens who have lost their job or income due to the containment measures to improve measure compliance. Policymakers should implement the least restrictive and most effective public health measures first during pandemic emergencies instead of implementing a combination of many restrictive measures, which has the opposite effect on citizens' adherence and undermines human rights.


Asunto(s)
Pandemias , Bélgica , Bulgaria , República Checa , Finlandia , Humanos , India , Letonia , Masculino , Países Bajos , Pandemias/prevención & control , Polonia , Rumanía , Suecia
20.
Artículo en Inglés | MEDLINE | ID: mdl-33925036

RESUMEN

Maintaining hospital workers' psychological health is essential for hospitals' capacities to sustain organizational functioning during the COVID-19 pandemic. Workers' personal resilience can be an important factor in preserving psychological health, but how this exactly works in high stakes situations, such as the COVID-19 pandemic, requires further exploration. Similarly, the role of team social climate as contributor to individual psychological health seems obvious, but how it exactly prevents workers from developing depressive complaints in prolonged crises remains under investigated. The present paper therefore applies conservation of resources theory to study the relationships between resilience, team social climate, and depressive complaints, specifically focusing on worries about infections as an important explanatory mechanism. Based on questionnaire data of 1126 workers from five hospitals in the Netherlands during the second peak of the pandemic, this paper estimates a moderated-mediation model. This model shows that personal resilience negatively relates to depressive complaints (ß = -0.99, p < 0.001, 95%CI = -1.45--0.53), partially as personal resilience is negatively associated with worries about infections (ß = -0.42, p < 0.001, 95%CI = -0.50--0.33) which in turn are positively related to depressive complaints (ß = 0.75, p < 0.001, 95% CI = 0.31-1.19). Additionally, team social climate is associated with a lower effect of worries about being infected and infecting others on depressive complaints (ß = -0.88, p = 0.03, 95% CI = -1.68--0.09). These findings suggest that resilience can be an important individual level resource in preventing depressive complaints. Moreover, the findings imply that hospitals have an important responsibility to maintain a good team social climate to shield workers from infection related worries building up to depressive complaints.


Asunto(s)
Resiliencia Psicológica , Hospitales , Humanos , Países Bajos/epidemiología , Pandemias
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