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1.
Ned Tijdschr Geneeskd ; 1642020 08 13.
Artigo em Holandês | MEDLINE | ID: mdl-33030318

RESUMO

The Dutch example shows that there are not only differences but also several similarities between COVID-19 and the Spanish flu, although risk of infection and death toll were much higher than they are now, especially at the end of 1918. These similarities include emphasis on the importance of hand washing, prohibition of gatherings (and disregard of these rules), disruption of public life, uncertainty about the nature of the cause, praise of and warnings against ineffective medication as well as debate on use and necessity of certain measures. There is also the social context in which the disease and the measures taken to combat it are happening, with the poor paying the highest price, now as well as then.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Vírus da Influenza A Subtipo H1N1 , Influenza Pandêmica, 1918-1919/história , Influenza Humana/história , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/prevenção & controle , História do Século XX , Humanos , Influenza Pandêmica, 1918-1919/mortalidade , Influenza Pandêmica, 1918-1919/prevenção & controle , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Países Baixos/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
2.
Stud Health Technol Inform ; 273: 117-122, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087600

RESUMO

INTRODUCTION: The electronically submitted data from midwives and hospitals to the Netherlands perinatal registry vary significantly in their data definitions, and electronic message versions. The purpose of this article is to describe the semantic cross-mapping tool and execution procedure to prepare the data for statistical analysis. METHODS: requirements analysis, design, development and testing. RESULTS: The tool for governance of versions of datasets, CIMs, data, and value sets is designed, developed, and tested. The test is based on the data-mart of version PRN 1.3 based data from 2019. Data are semantically cross mapped to current version perinatology data 2.2. CONCLUSION: The cross-mapping of PRN 1.3 data to perinatology 2.2 data are defined in the tool, testing revealed this mapping is successful.


Assuntos
Tocologia , Semântica , Feminino , Humanos , Países Baixos/epidemiologia , Parto , Gravidez , Sistema de Registros
3.
BMC Psychol ; 8(1): 108, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076995

RESUMO

BACKGROUND: Self-efficacy is an important determinant of adjustment following spinal cord injury. Self-efficacy is defined as the belief that one can successfully execute behavior required to produce the desired outcomes. In its original conceptualization, self-efficacy refers to the confidence that people have in their ability to accomplish specific tasks and behaviors within a specific context. Over the years these situation specific aspects have been unconfined and multiple constructs of self-efficacy have been proposed. The most common is a division in trait and state self-efficacy. Another used division that is utilized is between general, domain-specific and task-specific self-efficacy. The scientific support for these constructs is to date still unclear. The objective of this study was to enhance the understanding of the self-efficacy construct by comparing four self-efficacy scales designed to measure three aspects of self-efficacy (general versus domain-specific versus task-specific) in people with spinal cord injury. METHODS: Dutch and Australian adults with spinal cord injury (N = 140) completed four frequently used self-efficacy scales; the Moorong Self-efficacy Scale, General Self-efficacy Scale, University of Washington Self-efficacy Scale and a Self-care Self-efficacy Scale approximately 6 months after their inpatient rehabilitation. Pearson correlations examined inter-relationships between the scales. RESULTS: Hypothesized strong correlations between scales measuring similar aspects of self-efficacy were found (correlations 0.50-0.65). However, the hypothesized weak to moderate correlations between scales measuring diverging aspects of self-efficacy were only partly found (correlations 0.31-0.74), with 7 out of 12 correlations being strong instead of moderate. CONCLUSIONS: The expected distinctions between the three aspects of self-efficacy was not demonstrated. All four scales measure a common latent construct, most likely general self-efficacy aspects. Further research is necessary to find ways to improve the measurement of domain-specific and task-specific aspects of SE, so that they are sensitive enough to capture change over time, and thus enhance clinical outcomes of people with SCI as they adjust to their disability.


Assuntos
Autoeficácia , Traumatismos da Medula Espinal/psicologia , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Psicometria , Reprodutibilidade dos Testes
4.
Nat Commun ; 11(1): 4930, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004804

RESUMO

Inference of causality between gene expression and complex traits using Mendelian randomization (MR) is confounded by pleiotropy and linkage disequilibrium (LD) of gene-expression quantitative trait loci (eQTL). Here, we propose an MR method, MR-link, that accounts for unobserved pleiotropy and LD by leveraging information from individual-level data, even when only one eQTL variant is present. In simulations, MR-link shows false-positive rates close to expectation (median 0.05) and high power (up to 0.89), outperforming all other tested MR methods and coloc. Application of MR-link to low-density lipoprotein cholesterol (LDL-C) measurements in 12,449 individuals with expression and protein QTL summary statistics from blood and liver identifies 25 genes causally linked to LDL-C. These include the known SORT1 and ApoE genes as well as PVRL2, located in the APOE locus, for which a causal role in liver was not known. Our results showcase the strength of MR-link for transcriptome-wide causal inferences.


Assuntos
LDL-Colesterol/sangue , Regulação da Expressão Gênica , Predisposição Genética para Doença , Modelos Genéticos , Locos de Características Quantitativas , Proteínas Adaptadoras de Transporte Vesicular/genética , Proteínas Adaptadoras de Transporte Vesicular/metabolismo , Apolipoproteínas E/genética , Apolipoproteínas E/metabolismo , LDL-Colesterol/metabolismo , Simulação por Computador , Conjuntos de Dados como Assunto , Pleiotropia Genética , Humanos , Desequilíbrio de Ligação , Metabolismo dos Lipídeos/genética , Análise da Randomização Mendeliana , Redes e Vias Metabólicas/genética , Herança Multifatorial , Nectinas/genética , Nectinas/metabolismo , Países Baixos , Proteômica , RNA-Seq
5.
BMC Public Health ; 20(1): 1516, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023561

RESUMO

BACKGROUND: To evaluate the association between crowding and transmission of viral respiratory infectious diseases, we investigated the change in transmission patterns of influenza and COVID-19 before and after a mass gathering event (i.e., carnival) in the Netherlands. METHODS: Information on individual hospitalizations related to the 2017/2018 influenza epidemic were accessed from Statistics Netherlands. The influenza cases were stratified between non-carnival and carnival regions. Distributions of influenza cases were plotted with time and compared between regions. A similar investigation in the early outbreak of COVID-19 was also conducted using open data from the Dutch National Institute for Public Health and the Environment. RESULTS: Baseline characteristics between non-carnival and carnival regions were broadly similar. There were 13,836 influenza-related hospitalizations in the 2017/2018 influenza epidemic, and carnival fell about 1 week before the peak of these hospitalizations. The distributions of new influenza-related hospitalizations per 100,000 inhabitants with time between regions followed the same pattern with a surge of new cases in the carnival region about 1 week after carnival, which did not occur in the non-carnival region. The increase of new cases for COVID-19 in the carnival region exceeded that in the non-carnival region about 1 week after the first case was reported, but these results warrant caution as for COVID-19 there were no cases reported before the carnival and social measures were introduced shortly after carnival. CONCLUSION: In this study, a mass gathering event (carnival) was associated with aggravating the spread of viral respiratory infectious diseases.


Assuntos
Infecções por Coronavirus/epidemiologia , Aglomeração , Epidemias , Influenza Humana/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Humanos , Países Baixos/epidemiologia
6.
Ned Tijdschr Tandheelkd ; 127(9): 473-480, 2020 Sep.
Artigo em Holandês | MEDLINE | ID: mdl-33011752

RESUMO

The practical training in dental schools in the Netherlands is largely organised within the walls of the educational institution, while many other medical educational programmes provide practical training to a large extent in the professional environment. The external practical internship is a form of practical learning with which positive experience has been gained in foreign dental schools, both by students and dentist-supervisors. The Dutch dental schools have a joint plan to set up practical internships in dental practices for master's students in the final year of their education. The aim of such an internship is that students in the last phase of their programme learn to apply the acquired knowledge and skills in an actual professional environment. This includes both clinical and dental treatment and the ability to organise oral health care for patients and everything that comes with it. This article describes the outline of this programme.


Assuntos
Internato e Residência , Currículo , Educação em Odontologia , Educação Continuada em Odontologia , Humanos , Países Baixos , Paladar
7.
Ned Tijdschr Tandheelkd ; 127(9): 487-491, 2020 Sep.
Artigo em Holandês | MEDLINE | ID: mdl-33011754

RESUMO

The character of a consent for treatment is not a mere hobby for lawyers; it also has consequences in daily practicein the Netherlands, particularly if it concerns questions of who should prove what in proceedings. In general, consent agreements can be divided into an obligation to achieve results and an obligation to use reasonable endeavours. In oral healthcare, there is usually a question of an obligation to use reasonable endeavours, in which professional standards must play a leading role in the behaviour of the dentist; and here there have been a number of recent developments, such as an increase in the number of (clinical) guidelines and the acceptance of wish fulfilling medicine, under strict conditions. It is concluded that recent developments in the dentist's requirement to provide evidence in proceedings have definitely not made things simpler.


Assuntos
Medicina , Odontólogos , Humanos , Consentimento Livre e Esclarecido , Países Baixos
8.
Ned Tijdschr Tandheelkd ; 127(9): 493-498, 2020 Sep.
Artigo em Holandês | MEDLINE | ID: mdl-33011755

RESUMO

In patients with a new squamous cell carcinoma in the oral cavity, factors were investigated that determine the time interval between the occurrence of the first symptoms, the diagnosis and the start of treatment. Status research was conducted on 87 patients who were diagnosed in 2017 at the department of Oral and Maxillofacial Surgery at the Radboud university medical centre (Radboudumc), Nijmegen, the Netherlands. Patients were asked about the length of time between the appearance of the first symptoms and their visit to the dentist or general practioner. Especially patients who were not registered with a dentist waited on average 2 months longer, the most important reasons being that they thought it would solve itself and treatment anxiety. It was concluded that in the case of a squamous cell carcinoma, patients who are not registered with a dentist, are more often toothless and present later with a larger tumour than patients registered with a dentist. Training on recognising the first symptoms of squamous cell carcinomas in the oral cavity should be intensified among dentists and also general practitioners, dental hygienists and dental prosthetic technicians.


Assuntos
Neoplasias Bucais/diagnóstico , Neoplasias Bucais/terapia , Cirurgia Bucal , Humanos , Países Baixos
10.
PLoS Med ; 17(9): e1003296, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32960885

RESUMO

BACKGROUND: Based on different genetic and environmental risk factors and histology, it has been proposed that rheumatoid arthritis (RA) consists of 2 types: autoantibody-positive and autoantibody-negative RA. However, until now, this remained hypothetical. To assess this hypothesis, we studied whether the long-term outcomes differed for these 2 groups of RA patients. METHODS AND FINDINGS: In the Leiden Early Arthritis Clinic cohort, 1,285 consecutive RA patients were included between 1993 and 2016 and followed yearly. Treatment protocols in routine care improved over time, irrespective of autoantibody status, and 5 inclusion periods were used as instrumental variables: 1993-1996, delayed mild disease-modifying antirheumatic drug (DMARD) initiation (reference period); 1997-2000, early mild DMARDs; 2001-2005, early methotrexate; 2006-2010, early methotrexate followed by treat-to-target adjustments; 2011-2016, similar to 2006-2010 plus additional efforts for very early referral. Three long-term outcomes were studied: sustained DMARD-free remission (SDFR) (persistent absence of clinical synovitis after DMARD cessation), mortality, and functional disability measured by yearly Health Assessment Questionnaire (HAQ). Treatment response in the short term (disease activity) was measured by Disease Activity Score-28 with erythrocyte sedimentation rate (DAS28-ESR). Linear mixed models and Cox regression were used, stratified for autoantibody positivity, defined as IgG anti-CCP2 and/or IgM rheumatoid factor positivity. In total, 823 patients had autoantibody-positive RA (mean age 55 years, 67% female); 462 patients had autoantibody-negative RA (age 60 years, 64% female). Age, gender, and percentage of autoantibody-positive patients were stable throughout the inclusion periods. Disease activity significantly decreased over time within both groups. SDFR rates increased after introduction of treat-to-target (hazard ratio [HR] 2006-2010 relative to 1993-1996: 3.35 [95% CI 1.46 to 7.72; p = 0.004]; HR 2011-2016: 4.57 [95% CI 1.80 to 11.6; p = 0.001]) in autoantibody-positive RA, but not in autoantibody-negative RA. In autoantibody-positive RA, mortality decreased significantly after the introduction of treat-to-target treatment adjustments (HR 2006-2010: 0.56 [95% CI 0.34 to 0.92; p = 0.023]; HR 2011-2016: 0.33 [95% CI 0.14 to 0.77; p = 0.010]), but not in autoantibody-negative RA (HR 2006-2010: 0.79 [95% CI 0.40 to 1.56; p = 0.50]; HR 2011-2016: 0.36 [95% CI 0.10 to 1.34; p = 0.13]). Similarly, functional disability improved in autoantibody-positive RA for the periods after 2000 relative to 1993-1996 (range -0.16 [95% CI -0.29 to -0.03; p = 0.043] to -0.32 [95% CI -0.44 to -0.20; p < 0.001] units of improvement), but not in autoantibody-negative RA (range 0.10 [95% CI -0.12 to 0.31; p = 0.38] to -0.13 [95% CI -0.34 to 0.07; p = 0.20] units of improvement). Limitations to note were that treatment was not randomized-but it was protocolized and instrumental variable analysis was used to obtain comparable groups-and that a limited spread of ethnicities was included. CONCLUSIONS: Although disease activity has improved in both autoantibody-positive and autoantibody-negative RA in recent decades, the response in long-term outcomes differed. We propose that it is time to subdivide RA into autoantibody-positive RA (type 1) and autoantibody-negative RA (type 2), in the hope that this leads to stratified treatment in RA.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/genética , Adulto , Idoso , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Autoanticorpos/genética , Autoanticorpos/imunologia , Biomarcadores Farmacológicos/sangue , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Índice de Gravidade de Doença
11.
Nat Commun ; 11(1): 4556, 2020 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917883

RESUMO

Previous genetic studies have identified local population structure within the Netherlands; however their resolution is limited by use of unlinked markers and absence of external reference data. Here we apply advanced haplotype sharing methods (ChromoPainter/fineSTRUCTURE) to study fine-grained population genetic structure and demographic change across the Netherlands using genome-wide single nucleotide polymorphism data (1,626 individuals) with associated geography (1,422 individuals). We identify 40 haplotypic clusters exhibiting strong north/south variation and fine-scale differentiation within provinces. Clustering is tied to country-wide ancestry gradients from neighbouring lands and to locally restricted gene flow across major Dutch rivers. North-south structure is temporally stable, with west-east differentiation more transient, potentially influenced by migrations during the middle ages. Despite superexponential population growth, regional demographic estimates reveal population crashes contemporaneous with the Black Death. Within Dutch and international data, GWAS incorporating fine-grained haplotypic covariates are less confounded than standard methods.


Assuntos
Grupos Étnicos/genética , Genética Populacional , Estudo de Associação Genômica Ampla , Estudos de Casos e Controles , Análise por Conglomerados , Emigração e Imigração , Grupo com Ancestrais do Continente Europeu/genética , Fluxo Gênico , Variação Genética/genética , Genoma , Geografia , Haplótipos , Humanos , Pessoa de Meia-Idade , Modelos Genéticos , Países Baixos , Polimorfismo de Nucleotídeo Único
12.
PLoS One ; 15(9): e0238683, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936815

RESUMO

We report and interpret preferences of a sample of the Dutch adult population for different strategies to end the so-called 'intelligent lockdown' which their government had put in place in response to the COVID-19 pandemic. Using a discrete choice experiment, we invited participants to make a series of choices between policy scenarios aimed at relaxing the lockdown, which were specified not in terms of their nature (e.g. whether or not to allow schools to re-open) but in terms of their effects along seven dimensions. These included health-related effects, but also impacts on the economy, education, and personal income. From the observed choices, we were able to infer the implicit trade-offs made by the Dutch between these policy effects. For example, we find that the average citizen, in order to avoid one fatality directly or indirectly related to COVID-19, is willing to accept a lasting lag in the educational performance of 18 children, or a lasting (>3 years) and substantial (>15%) reduction in net income of 77 households. We explore heterogeneity across individuals in terms of these trade-offs by means of latent class analysis. Our results suggest that most citizens are willing to trade-off health-related and other effects of the lockdown, implying a consequentialist ethical perspective. Somewhat surprisingly, we find that the elderly, known to be at relatively high risk of being affected by the virus, are relatively reluctant to sacrifice economic pain and educational disadvantages for the younger generation, to avoid fatalities. We also identify a so-called taboo trade-off aversion amongst a substantial share of our sample, being an aversion to accept morally problematic policies that simultaneously imply higher fatality numbers and lower taxes. We explain various ways in which our results can be of value to policy makers in the context of the COVID-19 and future pandemics.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Política de Saúde , Modelos Econométricos , Pandemias , Pneumonia Viral/psicologia , Quarentena/psicologia , Valor da Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Altruísmo , Comportamento de Escolha , Controle de Doenças Transmissíveis/legislação & jurisprudência , Controle de Doenças Transmissíveis/métodos , Comportamento do Consumidor , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Efeitos Psicossociais da Doença , Pesquisa Empírica , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pandemias/economia , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/economia , Quarentena/legislação & jurisprudência , Quarentena/estatística & dados numéricos , Risco , Instituições Acadêmicas , Valores Sociais , Impostos , Adulto Jovem
13.
J Med Internet Res ; 22(10): e21211, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-32997642

RESUMO

The physical and social distancing measures that have been adopted worldwide because of COVID-19 will probably remain in place for a long time, especially for senior adults, people with chronic conditions, and other at-risk populations. Teleconsultations can be useful in ensuring that patients continue to receive clinical care while reducing physical crowding and avoiding unnecessary exposure of health care staff. Implementation processes that typically take months of planning, budgeting, pilot testing, and education were compressed into days. However, in the urgency to deal with the present crisis, we may be forgetting that the introduction of digital health is not exclusively a technological issue, but part of a complex organizational change problem. This viewpoint offers insight regarding issues that rapidly adopted teleconsultation systems may face in a post-COVID-19 world.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Consulta Remota/tendências , Telemedicina/tendências , Centros Médicos Acadêmicos , Betacoronavirus , Humanos , Países Baixos/epidemiologia , Pandemias , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Consulta Remota/organização & administração , Software , Telemedicina/organização & administração , Interface Usuário-Computador
14.
J Med Internet Res ; 22(9): e19716, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32975521

RESUMO

BACKGROUND: Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. OBJECTIVE: The goal of this study was to assess MIRROR's use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. METHODS: MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR's outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale-21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). RESULTS: In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range -.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. CONCLUSIONS: MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.


Assuntos
Inquéritos Epidemiológicos , Aplicativos Móveis , Encaminhamento e Consulta , Resiliência Psicológica , Autocuidado/métodos , Autocuidado/normas , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Ansiedade/diagnóstico , Lista de Checagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/diagnóstico , Análise Fatorial , Feminino , Humanos , Internet , Masculino , Países Baixos/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Psicometria , Reprodutibilidade dos Testes , Estresse Psicológico/diagnóstico
15.
J Transl Med ; 18(1): 358, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32957995

RESUMO

COVID-19 caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan (Hubei province, China) during late 2019. It has spread across the globe affecting nearly 21 million people with a toll of 0.75 million deaths and restricting the movement of most of the world population during the past 6 months. COVID-19 became the leading health, economic, and humanitarian challenge of the twenty-first century. In addition to the considerable COVID-19 cases, hospitalizations, and deaths in humans, several cases of SARS-CoV-2 infections in animal hosts (dog, cat, tiger, lion, and mink) have been reported. Thus, the concern of pet owners is increasing. Moreover, the dynamics of the disease requires further explanation, mainly concerning the transmission of the virus from humans to animals and vice versa. Therefore, this study aimed to gather information about the reported cases of COVID-19 transmission in animals through a literary review of works published in scientific journals and perform genomic and phylogenetic analyses of SARS-CoV-2 isolated from animal hosts. Although many instances of transmission of the SARS-CoV-2 have been reported, caution and further studies are necessary to avoid the occurrence of maltreatment in animals, and to achieve a better understanding of the dynamics of the disease in the environment, humans, and animals. Future research in the animal-human interface can help formulate and implement preventive measures to combat the further transmission of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/veterinária , Pandemias/veterinária , Pneumonia Viral/veterinária , Zoonoses/transmissão , Criação de Animais Domésticos , Animais , Betacoronavirus/classificação , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Gatos , Coronavirus/classificação , Coronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Reservatórios de Doenças/veterinária , Reservatórios de Doenças/virologia , Cães , Genoma Viral , Humanos , Vison/virologia , Países Baixos/epidemiologia , Exposição Ocupacional , Animais de Estimação/virologia , Filogenia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Glicoproteína da Espícula de Coronavírus/genética , Pesquisa Médica Translacional , Zoonoses/epidemiologia
16.
BMJ Open ; 10(9): e040175, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994259

RESUMO

INTRODUCTION: The course of the disease in SARS-CoV-2 infection in mechanically ventilated patients is unknown. To unravel the clinical heterogeneity of the SARS-CoV-2 infection in these patients, we designed the prospective observational Maastricht Intensive Care COVID cohort (MaastrICCht). We incorporated serial measurements that harbour aetiological, diagnostic and predictive information. The study aims to investigate the heterogeneity of the natural course of critically ill patients with a SARS-CoV-2 infection. METHODS AND ANALYSIS: Mechanically ventilated patients admitted to the intensive care with a SARS-CoV-2 infection will be included. We will collect clinical variables, vital parameters, laboratory variables, mechanical ventilator settings, chest electrical impedance tomography, ECGs, echocardiography as well as other imaging modalities to assess heterogeneity of the course of a SARS-CoV-2 infection in critically ill patients. The MaastrICCht is also designed to foster various other studies and registries and intends to create an open-source database for investigators. Therefore, a major part of the data collection is aligned with an existing national intensive care data registry and two international COVID-19 data collection initiatives. Additionally, we create a flexible design, so that additional measures can be added during the ongoing study based on new knowledge obtained from the rapidly growing body of evidence. The spread of the COVID-19 pandemic requires the swift implementation of observational research to unravel heterogeneity of the natural course of the disease of SARS-CoV-2 infection in mechanically ventilated patients. Our study design is expected to enhance aetiological, diagnostic and prognostic understanding of the disease. This paper describes the design of the MaastrICCht. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the medical ethics committee (Medisch Ethische Toetsingscommissie 2020-1565/3 00 523) of the Maastricht University Medical Centre+ (Maastricht UMC+), which will be performed based on the Declaration of Helsinki. During the pandemic, the board of directors of Maastricht UMC+ adopted a policy to inform patients and ask their consent to use the collected data and to store serum samples for COVID-19 research purposes. All study documentation will be stored securely for fifteen years after recruitment of the last patient. The results will be published in peer-reviewed academic journals, with a preference for open access journals, while particularly considering deposition of the manuscripts on a preprint server early. TRIAL REGISTRATION NUMBER: The Netherlands Trial Register (NL8613).


Assuntos
Infecções por Coronavirus , Cuidados Críticos/métodos , Estado Terminal , Imagem Multimodal/métodos , Pandemias , Pneumonia Viral , Respiração Artificial , Betacoronavirus/isolamento & purificação , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Sistema de Registros/estatística & dados numéricos , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença
17.
J Frailty Aging ; 9(4): 219-225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996558

RESUMO

BACKGROUND: Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. OBJECTIVES: We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. MEASUREMENTS: Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. RESULTS: The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781-0.899), 0.782 (95% CI 0.696-0.868), and 0.769 (95% CI 0.686-0.859), respectively. CONCLUSIONS: The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Idoso , Estudos Transversais , Humanos , Vida Independente , Países Baixos , Reprodutibilidade dos Testes
18.
J Affect Disord ; 277: 540-548, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889378

RESUMO

BACKGROUND: The effects of the COVID-19 pandemic on the mental health and emotional support among the general population are unclear. We therefore assessed if the prevalence of high Anxiety and Depression Symptoms (ADS) levels and lack of Emotional Support (ES) increased, and if risk factors of ADS and ES changed. METHODS: Data was extracted from surveys conducted with the Dutch longitudinal population-based LISS panel (N = 3,983). ADS and ES were assessed in March 2019 and 2020. Risk factors for ADS and ES were extracted from surveys in November 2018 and 2019. These were: ADS, gender, education, domestic situation, employment, age, ethnicity, lung and heart problems, and diabetes. RESULTS: The prevalence of high ADS levels and lack of ES did not increase compared to the pre-outbreak prevalence. ADS, non-native ethnic background, (partial) work disabilities and lung problems were predictive of both ADS and lack of ES in March 2019 and 2020. Job seekers, students and those who take care of housekeeping were more at risk for ADS in March 2020, but not in 2019. While 35-49 years old respondents were less at risk for ADS in March 2019, they were more at risk in 2020. Parents with child(ren) at home and those who take care of housekeeping more often lacked ES in March 2020, but not in 2019. LIMITATIONS: No other mental health problems were assessed. CONCLUSIONS: No increase in the prevalence of ADS and lack of ES was found. Some risk factors remained significant after the outbreak, while others changed notably.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus , Depressão/epidemiologia , Pandemias , Pneumonia Viral , Apoio Social , Adolescente , Adulto , Idoso , Ansiedade/psicologia , Betacoronavirus , Depressão/psicologia , Feminino , Serviço de Limpeza , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pais , Prevalência , Estudos Prospectivos , Fatores de Risco , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Desemprego/estatística & dados numéricos , Adulto Jovem
19.
PLoS Pathog ; 16(9): e1008744, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898182

RESUMO

In HIV-hepatitis B virus (HBV) co-infection, adverse liver outcomes including liver fibrosis occur at higher frequency than in HBV-mono-infection, even following antiretroviral therapy (ART) that suppresses both HIV and HBV replication. To determine whether liver disease was associated with intrahepatic or circulating markers of inflammation or burden of HIV or HBV, liver biopsies and blood were collected from HIV-HBV co-infected individuals (n = 39) living in Bangkok, Thailand and naïve to ART. Transient elastography (TE) was performed. Intrahepatic and circulating markers of inflammation and microbial translocation were quantified by ELISA and bead arrays and HIV and HBV infection quantified by PCR. Liver fibrosis (measured by both transient elastography and liver biopsy) was statistically significantly associated with intrahepatic mRNA for CXCL10 and CXCR3 using linear and logistic regression analyses adjusted for CD4 T-cell count. There was no evidence of a relationship between liver fibrosis and circulating HBV DNA, qHBsAg, plasma HIV RNA or circulating cell-associated HIV RNA or DNA. Using immunohistochemistry of liver biopsies from this cohort, intrahepatic CXCL10 was detected in hepatocytes associated with inflammatory liver infiltrates in the portal tracts. In an in vitro model, we infected an HBV-infected hepatocyte cell line with HIV, followed by interferon-γ stimulation. HBV-infected cells lines produced significantly more CXCL10 than uninfected cells lines and this significantly increased in the presence of an increasing multiplicity of HIV infection. Conclusion: Enhanced production of CXCL10 following co-infection of hepatocytes with both HIV and HBV may contribute to accelerated liver disease in the setting of HIV-HBV co-infection.


Assuntos
Quimiocina CXCL10/metabolismo , Coinfecção/complicações , Infecções por HIV/complicações , HIV/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Hepatite B/complicações , Cirrose Hepática/epidemiologia , Adulto , Austrália/epidemiologia , Estudos de Coortes , Coinfecção/virologia , Feminino , Infecções por HIV/virologia , Hepatite B/virologia , Humanos , Incidência , Cirrose Hepática/metabolismo , Cirrose Hepática/virologia , Masculino , Países Baixos/epidemiologia , Prognóstico , Tailândia/epidemiologia
20.
J Med Internet Res ; 22(9): e19992, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32877352

RESUMO

BACKGROUND: In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. OBJECTIVE: We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)-base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. METHODS: We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post hoc Dunn tests to assess differences in these features among baseline, prelockdown, and during lockdown periods. We also studied behavioral differences by age, gender, BMI, and educational background. RESULTS: We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between prelockdown and during lockdown periods (P<.001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone use. People were more active on their phones (P<.001 for Italy, Spain, and the United Kingdom), spending more time using social media apps (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), particularly around major news events. Furthermore, participants had a lower heart rate (P<.001 for Italy and Spain; P=.02 for Denmark), went to bed later (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), and slept more (P<.001 for Italy, Spain, and the United Kingdom). We also found that young people had longer homestay than older people during the lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. CONCLUSIONS: RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioral changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epidemics and pandemics, and could help countries ease out of lockdown.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Coleta de Dados , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Smartphone , Isolamento Social , Telemedicina , Dispositivos Eletrônicos Vestíveis , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Dinamarca/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Monitorização Fisiológica , Países Baixos/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Mídias Sociais , Espanha/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
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