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The paper describes the international research conducted in collaboration between the University of Padova, University of North Texas, and Windesheim University of Applied Sciences. The study explores how higher education faculty involved in professionalizing courses for the educational area perceive the pandemic-induced transition to digitalized education (DE), after one year of experience with it. This paper introduces the second phase of a research study that began as early as spring 2020, with an online survey distributed worldwide. It seeks to investigate possible changes after one year of digitalized education related to (1) perceptions of institutional support and professional training offered; (2) potential and challenges of DE; and (3) professional intentions for future uses of DE. Details on the instrument's reliability and structure will also be provided. We are exploring how the DE is changing teachers' routines and whether these changes are paving the way for collaborative, reflective, and student-centred approaches that could have long-term consequences. This is to help focus future training pathways to better support teachers in teaching effectively and efficiently for learning, both in times of crisis and in times of normalcy.

This paper examines the impact of a structured, multi-dimensional reflection track of a 16-week pilot programme in experimental pedagogics (XP) in The Netherlands. XP is an elective undergraduate programme in which students investigate socially relevant educational problems in local communities and design educational interventions to address these issues through problem-oriented project work (PPL). To accompany the learning journey, students follow a reflection track structured with workshops, learning diaries, and articulated learning essays, that cover cognitive, phenomenological, relational, social, and global dimensions of reflection. The design of the track was informed by an interdisciplinary reflection framework combining inputs from cognitive and critical paradigms. To evaluate and improve the impact of this novel approach to reflection in problem-oriented education, the authors undertook an Education Action Research (EAR) process with the 17 participating students. The evaluation phase of the EAR was conducted using a phenomenographic design to draw out qualitative variations in conceptions of reflection among students who participated in the pilot. Focusing on variations of conceptions allowed the teachers-as-action-researchers to gain a fine-grained understanding of reflection within the XP problem-oriented setting. The findings reveal an outcome space comprising seven increasingly complex reflection categories. A phenomenographic analysis of the categories led us to conclude that there exists a reflection "sweet spot" inside which there is growth in reflection breadth and depth. Outside the sweet spot, students either do not reflect at all, or become so entangled in reflection that an infinite reflection regress appears to derail learning. We conclude by discussing the contributions of these findings to strengthening critical, socially relevant reflection in problem-oriented project work in the context of current global crises, focusing on the role of supervisors in fostering productive reflection.

The genesis and spread of COVID-19 around the world since 2020 have caused severe impacts in every aspect of people's lives, from work life to recreation, social activities to physical health. Higher education has not been excluded. Universities have altered curriculum, changed delivery methods, provided more counseling, purchased new technology, and altered attendance policy for classroom, athletic, social and artistic events (Hamlin, 2021). To assess the impacts of these changes on college students, the authors created a questionnaire to ask students about their perceptions of these COVID-related impacts on their own personal lives. The survey had 56 questions about how the virus affected their academic, social, financial, physical and emotional lives. Over 800 students responded with objective input and subjective comments. Due to the volume of data, the authors have split the study into two parts. The survey results for the first part, academic and social aspects of the survey, were published in "Understanding the Impact of Covid-19 on College Student Academic and Social Lives," Research in Higher Education Journal Volume 41 (see http://www.aabri.com/manuscripts/213347.pdf). It will sometimes be referred to herein to provide clarity to the reader. The actual survey itself can also be found at that site. This paper focuses on the impact of the coronavirus on student financial and physical well-being, which have become major stressors to this age group and have contributed to higher levels of anxiety and depression. It also examines how the virus has affected their social and emotional well-being. Lastly, recommendations are made to help educators understand the severity of the problem, and to take action to provide assistance for those students who have been adversely affected.

The coronavirus pandemic has led to drastic measures around the world, which have also affected the education system. Schools were closed in the spring of 2020 in almost every country in the world, and many children and young people are still involved in distance learning to this day. What effect these measures have on children's and young people's learning performance is important in view of the time pressure under which educational policy decisions have to be taken. The rapid review presented in this paper delivers evidence on the effects of school closures to contain the coronavirus pandemic in the spring of 2020 on children's and young people's learning performance in five countries (USA, Belgium, the Netherlands, Switzerland and Germany).

The school closures necessitated by the COVID-19 pandemic created a rapid shift to alternative modes of educational delivery, primarily online learning and teacher-supported home-schooling. This shift has revealed deep inequities in education systems worldwide, as many children lost access to teachers and schooling. An effective response to these changes has tested teachers' personal capacities and individual and collective agency intensely. The research lab we report on within this paper aimed to develop a better understanding of teacher agency in meeting the challenges of the pandemic and the physical and relational enablers and constraints of their environment. Drawing on case study reports from six international contexts and a series of online discussions with research lab participants, this study explores teachers' enactment of agency in the context of various circumstances and environments. The authors argue that it is imperative that education systems support the enhancement of teachers' personal and collective agency in the face of continued disruption to schooling and ongoing challenges to educational equity.

Several studies have linked air pollution to COVID-19 morbidity and severity. However, these studies do not account for exposure levels to SARS-CoV-2, nor for different sources of air pollution. We analyzed individual-level data for 8.3 million adults in the Netherlands to assess associations between long-term exposure to ambient air pollution and SARS-CoV-2 infection (i.e., positive test) and COVID-19 hospitalisation risks, accounting for spatiotemporal variation in SARS-CoV-2 exposure levels during the first two major epidemic waves (February 2020-February 2021). We estimated average annual concentrations of PM 10 , PM 2.5 and NO 2 at residential addresses, overall and by PM source (road traffic, industry, livestock, other agricultural sources, foreign sources, other Dutch sources), at 1 × 1 km resolution, and weekly SARS-CoV-2 exposure at municipal level. Using generalized additive models, we performed interval-censored survival analyses to assess associations between individuals' average exposure to PM 10 , PM 2.5 and NO 2 in the three years before the pandemic (2017-2019) and COVID-19-outcomes, adjusting for SARS-CoV-2 exposure, individual and area-specific confounders. In single-pollutant models, per interquartile (IQR) increase in exposure, PM 10 was associated with 7% increased infection risk and 16% increased hospitalisation risk, PM 2.5 with 8% increased infection risk and 18% increased hospitalisation risk, and NO 2 with 3% increased infection risk and 11% increased hospitalisation risk. Bi-pollutant models suggested that effects were mainly driven by PM. Associations for PM were confirmed when stratifying by urbanization degree, epidemic wave and testing policy. All emission sources of PM, except industry, showed adverse effects on both outcomes. Livestock showed the most detrimental effects per unit exposure, whereas road traffic affected severity (hospitalisation) more than infection risk. This study shows that long-term exposure to air pollution increases both SARS-CoV-2 infection and COVID-19 hospitalisation risks, even after controlling for SARS-CoV-2 exposure levels, and that PM may have differential effects on these COVID-19 outcomes depending on the emission source., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Prior studies show that long COVID has a heterogeneous presentation. Whether specific risk factors are related to subclusters of long COVID remains unknown. This study aimed to determine pre-pandemic predictors of long COVID and symptom clustering., Methods: A total of 3,022 participants of a panel representative of the Dutch population completed an online survey about long COVID symptoms. Data was merged into 2018/2019 panel data covering sociodemographic, medical, and psychosocial predictors. A total of 415 participants were classified as having long COVID. K-means clustering was used to identify patient clusters. Multivariate and lasso regression was used to identify relevant predictors compared to a COVID-19 positive control group., Results: Predictors of long-term COVID included older age, Western ethnicity, BMI, chronic disease, COVID-19 reinfections, severity, and symptoms, lower self-esteem, and higher positive affect (AUC = 0.79, 95%CI 0.73-0.86). Four clusters were identified: a low and a high symptom severity cluster, a smell-taste and respiratory symptoms cluster, and a neuro-cognitive, psychosocial, and inflammatory symptom cluster. Predictors for the different clusters included regular health complaints, healthcare use, fear of COVID-19, anxiety, depressive symptoms, and neuroticism., Conclusions: A combination of sociodemographic, medical, and psychosocial factors predicted long COVID. Heterogenous symptom clusters suggest that there are different phenotypes of long COVID-19 presentation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Much research on the early stages of the COVID-19 pandemic demonstrates the unequal impact on men and women in many countries but empirical evidence on later stages of the pandemic remains limited. The objective of this paper is to study differences between men and women in work location, the relative division of childcare, and perceived work-life balance across and throughout different phases of the pandemic using six waves of probability-based survey data collected in the Netherlands between April 2020 and April 2022 (including retrospective pre-pandemic measures)., Method: The study used descriptive methods (longitudinal crosstabulations) and multivariate modelling (cross-sectional multinomial logits, with and without moderators) in a repeated cross-sectional design., Results: Results suggest the pandemic is associated with several phase-specific differences between men and women in where they worked and their relative division of childcare in the Netherlands. Men were less likely than women to work fully from home at the start of each lockdown and to work on location during the first lockdown. Amongst parents, fathers increased their share of childcare throughout the first phase of the pandemic, and this increase remains visible at the end of the pandemic. Women in the Netherlands did not experience worse work-life balance than men throughout the pandemic, but mothers did experience worse work-life balance than fathers at various points during the pandemic., Discussion: Our results suggest varying long-term implications for gender inequality in society. Gender differences in work location raise concerns about the possible longer-term impact on gender inequalities in career development. Our findings on childcare suggest that many households have experienced different divisions of childcare at different stages of the pandemic, with some potential for longer-term change., Conclusion: Inequalities between men and women in work, childcare, and wellbeing have neither been alleviated by nor unilaterally worsened during the COVID-19 pandemic., Competing Interests: No authors have competing interests., (Copyright: © 2024 Yerkes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: To explore how patients and general practice professionals in low-income neighborhoods experienced the increase of remote care during COVID-19., Background: As the GP (general practitioner) is the first point of contact in Dutch health care, there are concerns about access to remote care for patients from low-income neighborhoods. Now that general practice professionals have returned to the pre-pandemic ways of healthcare delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care and their satisfaction., Methods: In this qualitative study, 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals were interviewed. Interviews were held on the phone and face-to-face in the native language of the participants., Findings: Remote care, especially telephone consultation, was generally well-approachable for patients from low-income neighborhoods. Contrarily, video calling was rarely used. This was partly because patients did not know how to use it. The majority of patients thought remote care was possible for minor ailments but would also still like to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care. In conclusion, it is important to take the opinions and barriers of patients and care providers into account and to increase patient-centered care elements and care provider satisfaction in remote care. Integrating remote care is not only important in times of crisis but also for future care that is becoming increasingly digitalized.

Background: Collaborative comparisons and combinations of epidemic models are used as policy-relevant evidence during epidemic outbreaks. In the process of collecting multiple model projections, such collaborations may gain or lose relevant information. Typically, modellers contribute a probabilistic summary at each time-step. We compared this to directly collecting simulated trajectories. We aimed to explore information on key epidemic quantities; ensemble uncertainty; and performance against data, investigating potential to continuously gain information from a single cross-sectional collection of model results., Methods: We compared projections from the European COVID-19 Scenario Modelling Hub. Five teams modelled incidence in Belgium, the Netherlands, and Spain. We compared July 2022 projections by incidence, peaks, and cumulative totals. We created a probabilistic ensemble drawn from all trajectories, and compared to ensembles from a median across each model's quantiles, or a linear opinion pool. We measured the predictive accuracy of individual trajectories against observations, using this in a weighted ensemble. We repeated this sequentially against increasing weeks of observed data. We evaluated these ensembles to reflect performance with varying observed data., Results: By collecting modelled trajectories, we showed policy-relevant epidemic characteristics. Trajectories contained a right-skewed distribution well represented by an ensemble of trajectories or a linear opinion pool, but not models' quantile intervals. Ensembles weighted by performance typically retained the range of plausible incidence over time, and in some cases narrowed this by excluding some epidemic shapes., Conclusions: We observed several information gains from collecting modelled trajectories rather than quantile distributions, including potential for continuously updated information from a single model collection. The value of information gains and losses may vary with each collaborative effort's aims, depending on the needs of projection users. Understanding the differing information potential of methods to collect model projections can support the accuracy, sustainability, and communication of collaborative infectious disease modelling efforts., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The aim of this paper is to inform on the surge of cases of acute macular neuroretinopathy (AMN) – a rare disease characterized by the sudden onset of acute scotomas caused by ischemia of the retinal capillary plexus – during the COVID-19 pandemic. In 2021, during the COVID-19 pandemic, a sudden rise in patients with AMN was observed in our clinic. In this paper, 4 cases from a hospital in the south of the Netherlands are reported, all of which could directly be linked to a COVID-19 infection or vaccination against the corona virus. A search for similar cases in the PubMed database produced thirteen relevant reports, which revealed that a similar increase in cases of AMN, all linked to COVID-19, has been observed worldwide. Analysis of the literature revealed that AMN is seen more often during the pandemic and that AMN after COVID-19 happens at a significantly older age than typically reported. This is the largest case series of patients with AMN after COVID-19 infection or vaccination. With the ongoing pandemic and extensive vaccination programs, it is expected that cases of AMN will surge. It is important for ophthalmologists to be aware of this disease, especially since typical patient characteristics may differ. [ABSTRACT FROM AUTHOR]

Introduction: Cross-border mobility (CBM) to visit social network members or for everyday activities is an important part of daily life for citizens in border regions, including the Meuse-Rhine Euroregion (EMR: neighboring regions from the Netherlands, Belgium, and Germany). We assessed changes in CBM during the COVID-19 pandemic and how participants experienced border restrictions., Methods: Impact of COVID-19 on the EMR' is a longitudinal study using comparative cross-border data collection. In 2021, a random sample of the EMR-population was invited for participation in online surveys to assess current and pre-pandemic CBM. Changes in CBM, experience of border restrictions, and associated factors were analyzed using multinomial and multivariable logistic regression analysis., Results: Pre-pandemic, 82% of all 3,543 participants reported any CBM: 31% for social contacts and 79% for everyday activities. Among these, 26% decreased social CBM and 35% decreased CBM for everyday activities by autumn 2021. Negative experience of border restrictions was reported by 45% of participants with pre-pandemic CBM, and was higher (p < 0.05) in Dutch participants (compared to Belgian; aOR= 1.4), cross-border [work] commuters (aOR= 2.2), participants with cross-border social networks of friends, family or acquaintances (aOR= 1.3), and those finding the measures 'limit group size' (aOR= 1.5) and 'minimalize travel' (aOR= 2.0) difficult to adhere to and finding 'minimalize travel' (aOR= 1.6) useless., Discussion: CBM for social contacts and everyday activities was substantial in EMR-citizens, but decreased during the pandemic. Border restrictions were valued as negative by a considerable portion of EMR-citizens, especially when having family or friends across the border. When designing future pandemic control strategies, policy makers should account for the negative impact of CBM restrictions on their citizens., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 van Bilsen, Brinkhues, Hoebe, Stabourlos, Moonen, Demarest, Hanssen, van Loo, Savelkoul, Philippsen, van der Zanden and Dukers-Muijrers.)

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands., Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used., Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option., Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care., (© 2023. The Author(s).)

Background: Since the coronavirus disease 2019 (COVID-19) has spread throughout the world, many studies on innate immunity in COVID-19 have been published, and great progress has been achieved, while bibliometric analysis on hotspots and research trends in this field remains lacking. Methods: On 17 November 2022, articles and reviews on innate immunity in COVID-19 were recruited from the Web of Science Core Collection (WoSCC) database after papers irrelevant to COVID-19 were further excluded. The number of annual publications and the average citations per paper were analyzed by Microsoft Excel. Bibliometric analysis and visualization of the most prolific contributors and hotspots in the field were performed by VOSviewer and CiteSpace software. Results: There were 1,280 publications that met the search strategy on innate immunity in COVID-19 and were published from 1 January 2020 to 31 October 2022. Nine hundred thirteen articles and reviews were included in the final analysis. The USA had the highest number of publications (Np) at 276 and number of citations without self-citations (Nc) at 7,085, as well as an H-index of 42, which contributed 30.23% of the total publications, followed by China (Np: 135, Nc: 4,798, and H-index: 23) with 14.79% contribution. Regarding Np for authors, Netea, Mihai G. (Np: 7) from the Netherlands was the most productive author, followed by Joosten, Leo A. B. (Np: 6) and Lu, Kuo-Cheng (Np: 6). The Udice French Research Universities had the most publications (Np: 31, Nc: 2,071, H-index: 13), with an average citation number (ACN) at 67. The journal Frontiers in Immunology possessed the most publications (Np: 89, Nc: 1,097, ACN: 12.52). “Evasion” (strength 1.76, 2021-2022), “neutralizing antibody” (strength 1.76, 2021-2022), “messenger RNA” (strength 1.76, 2021-2022), “mitochondrial DNA” (strength 1.51, 2021-2022), “respiratory infection” (strength 1.51, 2021-2022), and “toll-like receptors” (strength 1.51, 2021-2022) were the emerging keywords in this field. Conclusion: The study on innate immunity in COVID-19 is a hot topic. The USA was the most productive and influential country in this field, followed by China. The journal with the most publications was Frontiers in Immunology. “Messenger RNA,” “mitochondrial DNA,” and “toll-like receptors” are the current hotspots and potential targets in future research. [ABSTRACT FROM AUTHOR]

Introduction: Hospitals generate large amounts of data and this data is generally modeled and labeled in a proprietary way, hampering its exchange and integration. Manually annotating data element names to internationally standardized data element identifiers is a time-consuming effort. Tools can support performing this task automatically. This study aimed to determine what factors influence the quality of automatic annotations., Methods: Data element names were used from the Dutch COVID-19 ICU Data Warehouse containing data on intensive care patients with COVID-19 from 25 hospitals in the Netherlands. In this data warehouse, the data had been merged using a proprietary terminology system while also storing the original hospital labels (synonymous names). Usagi, an OHDSI annotation tool, was used to perform the annotation for the data. A gold standard was used to determine if Usagi made correct annotations. Logistic regression was used to determine if the number of characters, number of words, match score (Usagi's certainty) and hospital label origin influenced Usagi's performance to annotate correctly., Results: Usagi automatically annotated 30.5% of the data element names correctly and 5.5% of the synonymous names. The match score is the best predictor for Usagi finding the correct annotation. It was determined that the AUC of data element names was 0.651 and 0.752 for the synonymous names respectively. The AUC for the individual hospital label origins varied between 0.460 to 0.905., Discussion: The results show that Usagi performed better to annotate the data element names than the synonymous names. The hospital origin in the synonymous names dataset was associated with the amount of correctly annotated concepts. Hospitals that performed better had shorter synonymous names and fewer words. Using shorter data element names or synonymous names should be considered to optimize the automatic annotating process. Overall, the performance of Usagi is too poor to completely rely on for automatic annotation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: Healthcare systems in European countries, including METEOR partner countries, are faced with the aging population, an increase in costs for innovative technologies and medication, a shortage of health professionals, and inequality in access to healthcare. Presented paper aimed to recognize and compare the functioning of healthcare systems between METEOR partner countries and simultaneously check if the current epidemiological situation of COVID-19 has some relationship with the number of medical staff, yearly gross domestic product, or documented percentage of fully vaccinated people., Material and Methods: In the model of descriptive epidemiological study, available demographic, socioeconomic, and healthcare organizational data in the Netherlands, Belgium, Italy, and Poland were compared to the epidemiological situation of the COVID-19 pandemic (percentage of fully vaccinated people, incidence, and mortality) in all mentioned countries., Results: Obtained data confirmed that the lowest number of physicians, as well as the life expectancy and gross domestic product per capita, is in Poland. Simultaneously, the lower number of medical staff and lower gross domestic product (GDP) correspond to higher mortality due to COVID-19. The percentage of fully vaccinated with the last dose of the primary series was also the lowest in Poland., Conclusions: Obtained results confirmed that higher mortality due to COVID-19 in METEOR participants' countries is related to a lower number of medical staff and weaker GDP. The worse situation was noted in Poland, a country with problems in the functioning healthcare system, including hospital care and a serious shortage of practicing medical staff. Int J Occup Med Environ Health. 2023;36(3):417-27., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

The study evaluates the global research output (820 records) on "Use of Convalescent Plasma Therapy for COVID-19" on metrics with the aim to understand the current status of research at the global, national, institutional, and individual author level. The study is based on publications and citations data sourced from the Scopus database during 2020-21. The publications and citations data was statistically analyzed on various metrics such as document type, country of publication, collaboration patterns, author affiliation, journal name, and citation patterns. The USA, China and India lead the world ranking of 15 most productive countries in the subject. China, U.K. and Netherlands lead in the ranking of most cited countries. In addition, the study maps key productive institutions, key authors, key source journals, as well as most significant keywords in the subject to visually present their inter-relationships using Biblioshiny and VOSviewer software. This results and findings from the study describe the progress made by the world in this hot area of global interest. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to evaluate the nurses' experiences with the Nursing Crisis Meetings and to identify nurses' needs regarding the future governance structure. Design: Qualitative study. Methods: Two focus groups were conducted in February 2022 with participants of the Nursing Crisis Meetings (N = 15). We used thematic analysis to describe themes. Results: We identified five themes: opportunity to speak up, call for nursing leadership, call for control over practice and autonomy, development of a governance infrastructure and development of the professional nurse role. Conclusion: Nurses experienced the Nursing Crisis Meetings to be a positive and empowering infrastructure, which facilitates the unique opportunity to speak up and share experiences and concerns. This new infrastructure is a promising strategy to engage nurses during a pandemic and to build on a professional governance structure. Impact: This paper highlights the need for nurses to speak up and be engaged during the COVID‐19 pandemic and gives a practical example of how to put this infrastructure into practice. [ABSTRACT FROM AUTHOR]

Objectives: NEMESIS-3 (Netherlands Mental Health Survey and Incidence Study-3) is a psychiatric epidemiological cohort study of the Dutch general population that replicates and expands on two previous NEMESIS-studies conducted in 1996-1999 and 2007-2018 respectively. The main aims of NEMESIS-3 are to provide up-to-date information on the prevalence, incidence, course and consequences of mental disorders, their risk indicators, and to study the relevant time trends. This paper gives an overview of the objectives and methods of NEMESIS-3, especially of the recently completed first wave, and describes the sample characteristics., Methods: NEMESIS-3 is based on a multistage, stratified random sampling of individuals aged 18-75 years. Face-to-face interviews were laptop computer-assisted and held at the respondent's home. A slightly modified Composite International Diagnostic Interview (CIDI) version 3.0 was used to assess both Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and DSM-5 mental disorders. Two follow-up waves are planned three and six years after baseline., Results: In the first wave, performed from November 2019 to March 2022, 6194 individuals were interviewed: 1576 respondents before and 4618 respondents during the COVID-19 pandemic. The average interview duration was 91 min and the response rate was 54.6%. The sample consisted of 50.4% women and had a mean age of 47.9 years. The sample was reasonable nationally representative, although some sociodemographic groups were somewhat underrepresented., Conclusions: Despite the COVID-19 restrictions, we were able to build a large and comprehensive dataset of good quality, permitting us to investigate the latest trends in mental health status, various new topics related to mental health, and the extent to which the pandemic has had an effect on the population's mental health., (© 2022 The Authors. International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.)

Background: In the management of epidemics, like COVID-19, trade-offs have to be made between reducing mortality and morbidity and minimizing socioeconomic and political consequences. Traditionally, epidemic management (EM) has been guided and executed attentively by experts and policymakers. It can, however, still be controversial in the public sphere. In the last decades, public engagement (PE) has been successfully applied in various aspects of healthcare. This leads to the question if PE could be implemented in EM decision-making., Methods: From June to October 2020, seven deliberative discussion focus groups were executed with 35 Dutch citizens between 19 and 84 years old. Their views on PE in COVID-19 management were explored. The deliberative approach allows for the education of participants on the topic before the discussion. The benefits, barriers, timing and possible forms of PE in EM were discussed., Results: Almost all participants supported PE in EM, as they thought that integrating their experiences and ideas would benefit the quality of EM, and increase awareness and acceptance of measures. A fitting mode for PE was consultation, as it was deemed important to provide the public with possibilities to share ideas and feedback; however, final authority remained with experts. The publics could particularly provide input about communication campaigns and control measures. PE could be executed after the first acute phase of the epidemic and during evaluations., Conclusions: This paper describes the construction of an empirically informed framework about the values and conditions for PE in EM from the perspective of the public. Participants expressed support to engage certain population groups and considered it valuable for the quality and effectiveness of EM; however, they expressed doubts about the feasibility of PE and the capabilities of citizens. In future studies, these results should be confirmed by a broader audience., Patient or Public Contribution: No patients or members of the public were involved in the construction and execution of this study. This study was very exploratory, to gain a first insight into the views of the public in the Netherlands, and will be used to develop engagement practices accordingly. At this stage, the involvement of the public was not yet appropriate., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: In this paper we explore how staff involved with infection prevention managed the emerging COVID-19 crisis in the context of scarcity of Personal Protective Equipment (PPE), focussing specifically on the (re)writing of guidelines. We conceptualize guidelines as 'mediating devices' as they translate between evidence and clinical practice, between management and the workplace, as well as the different values embedded in these domains. It is this mediation, we argue, that adds to the resilience of healthcare organizations. The setting for this research is an elite academic hospital in the Netherlands during the emergence of the COVID-19 pandemic., Methods: We conducted non-participative observations, semi-structured interviews, and document analysis during the emerging pandemic (March-July 2020). We observed meetings from the crisis team and the unit for infection prevention (210 hours), interviewed members of these teams (21 interviews) and analysed guidelines and flowcharts concerning infection prevention, as such collecting a unique and rich qualitative dataset. Analysis was done through thematic coding., Results: Our results show the writing and rewriting of guidelines as a fundamental characteristic of dealing with scarcity and adding to resilience. We found three main practices our research participants engage in while trying to manage the uncertain situations emerging from the scarcity of personal protection equipment. The first practice we observe is defining safety; dealing with different perspectives and experiences of what 'working safely' means. The second entails the anticipation of scarcity by which our participants aim to control the situation through monitoring, research and creating scenarios. The third practice we observe is finding new ways to use PPE that is available, by experimenting and tinkering with the material., Conclusion: Infection prevention guidelines are crucial in managing the emerging crisis. We discuss how the writing of guidelines mediates between different settings, timeframes, and different worlds of quality. Through (re)writing there is a constant negotiation and discussion with the various actors about what works, and there is a continuous adaptive attitude. At the cost of a lot of work and struggle, this creates a resilient and inclusive work environment useful in a long-lasting crisis., (© 2022. The Author(s).)

Purpose: To assess, validate and compare the predictive performance of models for in-hospital mortality of COVID-19 patients admitted to the intensive care unit (ICU) over two different waves of infections. Our models were built with high-granular Electronic Health Records (EHR) data versus less-granular registry data., Methods: Observational study of all COVID-19 patients admitted to 19 Dutch ICUs participating in both the national quality registry National Intensive Care Evaluation (NICE) and the EHR-based Dutch Data Warehouse (hereafter EHR). Multiple models were developed on data from the first 24 h of ICU admissions from February to June 2020 (first COVID-19 wave) and validated on prospective patients admitted to the same ICUs between July and December 2020 (second COVID-19 wave). We assessed model discrimination, calibration, and the degree of relatedness between development and validation population. Coefficients were used to identify relevant risk factors., Results: A total of 1533 patients from the EHR and 1563 from the registry were included. With high granular EHR data, the average AUROC was 0.69 (standard deviation of 0.05) for the internal validation, and the AUROC was 0.75 for the temporal validation. The registry model achieved an average AUROC of 0.76 (standard deviation of 0.05) in the internal validation and 0.77 in the temporal validation. In the EHR data, age, and respiratory-system related variables were the most important risk factors identified. In the NICE registry data, age and chronic respiratory insufficiency were the most important risk factors., Conclusion: In our study, prognostic models built on less-granular but readily-available registry data had similar performance to models built on high-granular EHR data and showed similar transportability to a prospective COVID-19 population. Future research is needed to verify whether this finding can be confirmed for upcoming waves., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

The Corona crisis hit Europe with great force and power, causing deaths, distress and anxiety on the old continent. The goal of this paper was to analyze if religiosity - the level of religious commitment could alleviate the negative psychological outcomes of this crisis. The method used was to analyze data from a large longitudinal panel in the Netherlands that provides highly detailed information about respondents. Analysis showed that individuals with higher levels of religiosity had higher fear and distress levels and lower happiness levels compared to respondents with lower religiosity levels. So it appears that religion could do more harm that good regarding psychological wellbeing but that could be just one side of the coin. [ABSTRACT FROM AUTHOR]

Background: Worldwide, efforts are being made to stop the COVID-19 pandemic caused by SARS-CoV-2. Contact tracing and quarantining are key in limiting SARS-CoV-2 transmission. Mathematical models have shown that the time between infection, isolation of cases, and quarantining of contacts are the most important components that determine whether the pandemic can be controlled. Mobile contact-tracing apps could accelerate the tracing and quarantining of contacts, including anonymous contacts. However, real-world observational data on the uptake and determinants of contact-tracing apps are limited., Objective: The aim of this paper is to assess the use of a national Dutch contact-tracing app among notified cases diagnosed with SARS-CoV-2 infection and investigate which characteristics are associated with the use of the app., Methods: Due to privacy regulations, data from the app could not be used. Instead, we used anonymized SARS-CoV-2 routine contact-tracing data collected between October 28, 2020, and February 26, 2021, in the region of Amsterdam, the Netherlands. Complete case logistic regression analysis was performed to identify which factors (age, gender, country of birth, municipality, number of close contacts, and employment in either health care or education) were associated with using the app. Age and number of close contacts were modelled as B-splines due to their nonlinear relationship., Results: Of 29,766 SARS-CoV-2 positive cases, 4824 (16.2%) reported app use. Median age of cases was 41 (IQR 29-55) years, and 46.7% (n=13,898) were male. In multivariable analysis, males (adjusted odds ratio [AOR] 1.11, 95% CI 1.04-1.18) and residents of municipalities surrounding Amsterdam were more likely to use the app (Aalsmeer AOR 1.34, 95% CI 1.13-1.58; Ouder-Amstel AOR 1.96, 95% CI 1.54-2.50), while people born outside the Netherlands, particularly those born in non-Western countries (AOR 0.33, 95% CI 0.30-0.36), were less likely to use the app. Odds of app use increased with age until the age of 58 years and decreased sharply thereafter (P<.001). Odds of app use increased with number of contacts, peaked at 8 contacts, and then decreased (P<.001). Individuals working in day care, home care, and elderly nursing homes were less likely to use the app., Conclusions: Contact-tracing app use among people with confirmed SARS-CoV-2 infection was low in the region of Amsterdam. This diminishes the potential impact of the app by hampering the ability to warn contacts. Use was particularly low among older people, people born outside the Netherlands, and people with many contacts. Use of the app was also relatively low compared to those from some other European countries, some of which had additional features beyond contact tracing, making them potentially more appealing. For the Dutch contact-tracing app to have an impact, uptake needs to be higher; therefore, investing more into promotional efforts and additional features could be considered., (©Feiko Ritsema, Jizzo R Bosdriesz, Tjalling Leenstra, Mariska W F Petrignani, Liza Coyer, Anja J M Schreijer, Yvonne T H P van Duijnhoven, Janneke H H M van de Wijgert, Maarten F Schim van der Loeff, Amy Matser. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 24.08.2022.)

The paper aims to perform an objective comparative analysis of the business climate for entrepreneurship development in European countries in 2021 and group them according to the quality of the business climate. The research uses thirteen criteria from the Global Entrepreneur)ship Monitor report and TOPSIS methodology combined with entropy to perform a comparative analysis of the business climate for entrepreneurship development in selected European economies in 2021. Usage of TOPSIS and entropy method based on the last available data enabled objective and the most accurate evaluation and ranking of countries, taking into account all observed criteria. According to the study, the ranking of European economies indicates that the Netherlands has the most favorable business climate for entrepreneurship development, considering all observed criteria, while Belarus is ranked in the last position. According to relative closeness to the ideal solution (Ci*), the four clusters of countries are derived. Besides the Netherlands, Lithuania, Norway, and Finland were also dedicated to the first cluster, indicating that these economies obtained the most favorable conditions for entrepreneurship development during the pandemic crisis. On the other hand, former command economies and Greece and Cyprus are placed in Cluster IV since they haven’t supported entrepreneurs with sufficient and appropriate economic policy and regulatory reforms. [ABSTRACT FROM AUTHOR]

We aim to assess the impact of a pandemic data point on the calibration of a stochastic multi-population mortality projection model and its resulting projections for future mortality rates. Throughout the paper, we put focus on the Li and Lee mortality model, which has become a standard for projecting mortality in Belgium and the Netherlands. We calibrate this mortality model on annual death counts and exposures at the level of individual ages. This type of mortality data are typically collected, produced and reported with a significant delay of—for some countries—several years on a platform such as the Human Mortality Database. To enable a timely evaluation of the impact of a pandemic data point, we have to rely on other data sources (e.g., the Short-Term Mortality Fluctuations Data series) that swiftly publish weekly mortality data collected in age buckets. To be compliant with the design and calibration strategy of the Li and Lee model, we transform the weekly mortality data collected in age buckets to yearly, age-specific observations. Therefore, our paper constructs a protocol to ungroup the death counts and exposures registered in age buckets to individual ages. To evaluate the impact of a pandemic shock, like COVID-19 in the year 2020, we weigh this data point in either the calibration or projection step. Obviously, the more weight we place on this data point, the more impact we observe on future estimated mortality rates and life expectancies. Our paper allows for quantifying this impact and provides actuaries and actuarial associations with a framework to generate scenarios of future mortality under various assessments of the pandemic data point. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in over 340 million infection cases (as of 21 January 2022) and more than 5.57 million deaths globally. In reaction, science, technology and innovation communities across the globe have organised themselves to contribute to national responses to COVID-19 disease. A significant contribution has been from the establishment of wastewater-based epidemiological (WBE) surveillance interventions and programmes for monitoring the spread of COVID-19 in at least 55 countries. Here, we examine and share experiences and lessons learnt in establishing such surveillance programmes. We use case studies to highlight testing methods and logistics considerations associated in scaling the implementing of such programmes in South Africa, the Netherlands, Turkey and England. The four countries were selected to represent different regions of the world and the perspective based on the considerable progress made in establishing and implementing their national WBE programmes. The selected countries also represent different climatic zones, economies, and development stages, which influence the implementation of national programmes of this nature and magnitude. In addition, the four countries' programmes offer good experiences and lessons learnt since they are systematic, and cover extensive areas, disseminate knowledge locally and internationally and partnered with authorities (government). The programmes also strengthened working relations and partnerships between and among local and global organisations. This paper shares these experiences and lessons to encourage others in the water and public health sectors on the benefits and value of WBE in tackling SARS-CoV-2 and related future circumstances.

This study evaluates the performance of the PanBio COVID-19 antigen (Ag) test as part of a hospital infection control policy. Hospital staff was encouraged to get tested for COVID-19 when presenting with SARS-CoV-2-related symptoms. In a period of approximately 5 months, a steady decline in the performance of the Ag test was noted, epidemiologically coinciding with the rise of the SARS-CoV-2 B.1.1.7 (alpha) variant of concern (VOC) in the Netherlands. This led to the hypothesis that the diagnostic performance of the PanBio COVID-19 Ag test was influenced by the infecting viral variant. The results show a significantly lower sensitivity of the PanBio COVID-19 Ag test in persons infected with the B.1.1.7 (alpha) variant of SARS-CoV-2 in comparison with that in persons infected with non-B.1.1.7 variants, also after adjustment for viral load. IMPORTANCE Antigen tests for COVID-19 are widely used for rapid identification of COVID-19 cases, for example, for access to schools, festivals, and travel. There are several FDA- and CE-cleared tests on the market. Their performance has been evaluated mainly on the basis of infections by the classical variant of the causing virus, SARS-CoV-2. This paper provides evidence that the performance of one of the most widely used antigen tests detects significantly fewer cases of COVID-19 by the alpha variant than by the classical variants of SARS-CoV-2. This means that the role of antigen tests needs to be reevaluated in regions where other variants of SARS-CoV-2 predominate.

Background: During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance., Methods and Findings: On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population., Conclusions: In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences., Competing Interests: The authors have declared that no competing interests exist.

The COVID-19 pandemic has caused the reduction of services, including transport services. Companies operating in public water passenger transport were not prepared for the implementation of restrictions because, in some countries, the general procedures for the safe operation of regular public water passenger transport were not known. The main contribution of this paper is to discuss the implementation of the current system of safe operation of regular public water transport services in the Netherlands and Spain to a generally applicable model for transport companies. This article links these measures with the general plan for the release and tightening of measures of the Ministry of Health of the Slovak Republic known as COVIDAUTOMAT. [ABSTRACT FROM AUTHOR]

In the absence of a vaccine, social distancing behaviour is pivotal to mitigate COVID-19 virus spread. In this large-scale behavioural experiment, we gathered data during Smart Distance Lab: The Art Fair (n = 839) between August 28 and 30, 2020 in Amsterdam, the Netherlands. We varied walking directions (bidirectional, unidirectional, and no directions) and supplementary interventions (face mask and buzzer to alert visitors of 1.5 metres distance). We captured visitors' movements using cameras, registered their contacts (defined as within 1.5 metres) using wearable sensors, and assessed their attitudes toward COVID-19 as well as their experience during the event using questionnaires. We also registered environmental measures (e.g., humidity). In this paper, we describe this unprecedented, multi-modal experimental data set on social distancing, including psychological, behavioural, and environmental measures. The data set is available on figshare and in a MySQL database. It can be used to gain insight into (attitudes toward) behavioural interventions promoting social distancing, to calibrate pedestrian models, and to inform new studies on behavioural interventions., (© 2021. The Author(s).)

Following the outbreak of COVID-19, governments took unprecedented measures to curb the spread of the virus. Public participation in decisions regarding (the relaxation of) these measures has been notably absent, despite being recommended in the literature. Here, as one of the exceptions, we report the results of 30,000 citizens advising the government on eight different possibilities for relaxing lockdown measures in the Netherlands. By making use of the novel method Participatory Value Evaluation (PVE), participants were asked to recommend which out of the eight options they prefer to be relaxed. Participants received information regarding the societal impacts of each relaxation option, such as the impact of the option on the healthcare system. The results of the PVE informed policymakers about people's preferences regarding (the impacts of) the relaxation options. For instance, we established that participants assign an equal value to a reduction of 100 deaths among citizens younger than 70 years and a reduction of 168 deaths among citizens older than 70 years. We show how these preferences can be used to rank options in terms of desirability. Citizens advised to relax lockdown measures, but not to the point at which the healthcare system becomes heavily overloaded. We found wide support for prioritising the re-opening of contact professions. Conversely, participants disfavoured options to relax restrictions for specific groups of citizens as they found it important that decisions lead to "unity" and not to "division". 80% of the participants state that PVE is a good method to let citizens participate in government decision-making on relaxing lockdown measures. Participants felt that they could express a nuanced opinion, communicate arguments, and appreciated the opportunity to evaluate relaxation options in comparison to each other while being informed about the consequences of each option. This increased their awareness of the dilemmas the government faces., Competing Interests: No competing Interests at the time when the study was conducted. At the time of submitting the paper a startup is being created based on the method used in the study (Participatory Value Evaluation). The first author will be the scientific director of this startup. The startup Populytics was founded at the time that this paper was published. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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 (β = -0.99, p < 0.001, 95%CI = -1.45--0.53), partially as personal resilience is negatively associated with worries about infections (β = -0.42, p < 0.001, 95%CI = -0.50--0.33) which in turn are positively related to depressive complaints (β = 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 (β = -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.

Background & Objective: Mathematical modeling is the most scientific technique to understand the evolution of natural phenomena, including the spread of infectious diseases. Therefore, these modeling tools have been widely used in epidemiology for predicting risks and decision-making processes. The purpose of this paper is to provide an effective mathematical model for predicting the spread of Covid-19 pandemic., Methods: Our mathematical model is performed according to a SIDR model for infectious diseases. Epidemiological data from four countries; Belgium, Morocco, Netherlands and Russia, are used to validate this model. Also, we have evaluated the efficiency of Morocco's Covid-19 countermeasures and simulated the different relaxation plans in order to predict the effects of relaxation countermeasures., Results and Conclusions: In this paper, we developed and validated a new way of data aggregation, modeling and interpretation to predict the spread of Covid-19, evaluate the efficiency of countermeasures and suggest potential scenarios. Our results will be used to keep the spread of Covid-19 under control in the world., (Copyright © 2021. Published by Elsevier Ltd.)

As a consequence of the outbreak of the Coronavirus Disease 2019 (COVID-19) child care facilities all over the world were temporarily closed to minimize the spread of the virus. In Netherlands, the first closure lasted for almost 2 months. The return to the child care center after this significant interruption was expected to be challenging, because earlier studies demonstrated that transitions into child care can be stressful for both children and their parents. The current paper retrospectively examined the distress of Dutch children (aged 0–4) and their parents during the first 2 weeks after the reopening of child care centers, and what factors accounted for individual differences in distress. In total, 694 parents filled out an online questionnaire about stress during closure and distress after the reopening of child care centers. Furthermore, questions regarding several demographic variables and child care characteristics were included, as well as questionnaires measuring child temperament, parental separation anxiety, and parental perception of the child care quality. Results showed that younger children and children with parents scoring higher on separation anxiety experienced more distress after the reopening, as reported by parents. Furthermore, children were more distressed upon return when they attended the child care center for less hours per week after the reopening, experienced less stress during closure, and grew up in a one-parent family. With regard to parental distress after the reopening, we found that parents scoring higher on separation anxiety and fear of COVID-19 experienced more distress. Moreover, parents experiencing less stress during closure and mothers were more distressed when the child returned to the child care center. Finally, concurrent child and parental distress after reopening were positively related. The results of the current study may help professional caregivers to identify which children and parents benefit from extra support when children return to the child care center after an interruption. Especially the role that parental separation anxiety played in predicting both child and parental distress deserves attention. More research is required in order to study the underlying mechanisms of these associations and to design appropriate interventions. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic is more than a public health crisis. Lockdown measures have substantial societal effects, including a significant impact on parents with (young) children. Given the existence of persistent gender inequality prior to the pandemic, particularly among parents, it is crucial to study the societal impact of COVID-19 from a gender perspective. The objective of this paper is to use representative survey data gathered among Dutch parents in April 2020 to explore differences between mothers and fathers in three areas: paid work, the division of childcare and household tasks, and three dimensions of quality of life (leisure, work-life balance, relationship dynamics). Additionally, we explore whether changes take place in these dimensions by comparing the situation prior to the lockdown with the situation during the lockdown., Method: We use descriptive methods (crosstabulations) supported by multivariate modelling (linear regression modelling for continuous outcomes; linear probability modelling (LPM) for binary outcomes (0/1 outcomes); and multinomial logits for multinomial outcomes) in a cross-sectional survey design., Results: Results show that the way in which parents were impacted by the COVID-19 pandemic reflects a complex gendered reality. Mothers work in essential occupations more often than fathers, report more adjustments of the times at which they work, and experience both more and less work pressure in comparison to before the lockdown. Moreover, mothers continue to do more childcare and household work than fathers, but some fathers report taking on greater shares of childcare and housework during the lockdown in comparison to before. Mothers also report a larger decline in leisure time than fathers. We find no gender differences in the propensity to work from home, in perceived work-life balance, or in relationship dynamics., Conclusion: In conclusion, we find that gender inequality in paid work, the division of childcare and household work, and the quality of life are evident during the first lockdown period. Specifically, we find evidence of an increase in gender inequality in relation to paid work and quality of life when comparing the situation prior to and during the lockdown, as well as a decrease in gender inequality in the division of childcare and household work. We conclude that the unique situation created by restrictive lockdown measures magnifies some gender inequalities while lessening others., Discussion: The insights we provide offer key comparative evidence based on a representative, probability-based sample for understanding the broader impact of lockdown measures as we move forward in the COVID-19 pandemic. One of the limitations in this study is the cross-sectional design. Further study, in the form of a longitudinal design, will be crucial in investigating the long-term impact of the COVID-19 pandemic on gender inequality., Competing Interests: The authors have declared that no competing interests exist.

Covid-19 has severe economic consequences, leading to an increasing amount of businesses facing overwhelming debts. Since the financial crisis of 2008 the European Union has taken on a more rescue-oriented approach towards bankruptcy, resulting in Directive (EU) 2019/1023. This Directive creates a framework for pre-insolvency restructuring, thereby avoiding unnecessary bankruptcies. Accordingly, pre-insolvency restructuring is a valuable instrument in mitigating the negative economic effects of Covid-19. The Netherlands has recently adopted the Act on the Confirmation of Private Plans (WHOA), National Legislation on pre-insolvency restructuring. In order to balance the rights of secured and unsecured creditors the 20%-rule was adopted. This rule guarantees small-scale Small-to-Midsized (SME)-creditors the right to satisfaction of 20% of their claims in restructuring proceedings. In this paper, I evaluate whether the 20%-rule is in accordance with the Directive. I argue that the 20%-rule is in line with the Directive, but that the overly restrictive system of judicial review under the WHOA hampers its application in practice. Therefore, the Dutch legislator should allow for more room for judicial interpretation on the suitability of the application of the 20%-rule. This more nuanced approach better aligns the 20%-rule with the European Restructuring Directive. [ABSTRACT FROM AUTHOR]

Background: After initial COVID-19, immune dysregulation may persist and drive post-acute sequelae of COVID-19 (PASC). We described longitudinal trajectories of cytokines in adults up to 6 months following SARS-CoV-2 infection and explored early predictors of PASC. Methods: RECoVERED is a prospective cohort of individuals with laboratory-confirmed SARS-CoV-2 infection between May 2020 and June 2021 in Amsterdam, the Netherlands. Serum was collected at weeks 4, 12 and 24 of follow-up. Monthly symptom questionnaires were completed from month 2 after COVID-19 onset onwards; lung diffusion capacity (DLCO) was tested at 6 months. Cytokine concentrations were analysed by human magnetic Luminex screening assay. We used a linear mixed-effects model to study log-concentrations of cytokines over time, assessing their association with socio-demographic and clinical characteristics that were included in the model as fixed effects. Results: 186/349 (53%) participants had ≥2 serum samples and were included in current analyses. Of these, 101/186 (54%: 45/101[45%] female, median age 55 years [IQR = 45–64]) reported PASC at 12 and 24 weeks after COVID-19 onset. We included 37 reference samples (17/37[46%] female, median age 49 years [IQR = 40–56]). In a multivariate model, PASC was associated with raised CRP and abnormal diffusion capacity with raised IL10, IL17, IL6, IP10 and TNFα at 24 weeks. Early (0–4 week) IL-1β and BMI at COVID-19 onset were predictive of PASC at 24 weeks. Conclusions: Our findings indicate that immune dysregulation plays an important role in PASC pathogenesis, especially among individuals with reduced pulmonary function. Early IL-1β shows promise as a predictor of PASC. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 outbreak disrupted regular health care, including the Emergency Department (ED), and resulted in insufficient ICU capacity. Lockdown measures were taken to prevent disease spread and hospital overcrowding. Little is known about the relationship of stringency of lockdown measures on ED utilization. Objective: This study aimed to compare the frequency and characteristics of ED visits during the COVID-19 outbreak in 2020 to 2019, and their relation to stringency of lockdown measures. Material and methods: A retrospective multicentre study among five Dutch hospitals was performed. The primary outcome was the absolute number of ED visits (year 2018 and 2019 compared to 2020). Secondary outcomes were age, sex, triage category, way of transportation, referral, disposition, and treating medical specialty. The relation between stringency of lockdown measures, measured with the Oxford Stringency Index (OSI) and number and characteristics of ED visits was analysed. Results: The total number of ED visits in the five hospitals in 2019 was 165,894, whereas the total number of visits in 2020 was 135,762, which was a decrease of 18.2% (range per hospital: 10.5%-30.7%). The reduction in ED visits was greater during periods of high stringency lockdown measures, as indicated by OSI. Conclusion: The number of ED visits in the Netherlands has significantly dropped during the first year of the COVID-19 pandemic, with a clear association between decreasing ED visits and increasing lockdown measures. The OSI could be used as an indicator in the management of ED visits during a future pandemic. [ABSTRACT FROM AUTHOR]

The question of the sources of agricultural competitiveness is widely discussed on the farm and sectoral levels in the European Union. This paper assesses the competitiveness of the plant production using the combination of trade measures and strategic management measures in the selected European countries related to the Czech Republic. Thus, the paper evaluates and identifies the sources of competitiveness of plant production. In the case of Belgium and the Netherlands, labour and capital factors have a significant influence on production; in the case of the new member states, these factors are less important, and, conversely, market competitiveness factors are more crucial. The continuous convergence process between Belgium and the Netherlands is illustrated. The divergence between the Netherlands and the rest of the countries is also visible. There is a stable connection between the Czech Republic and Austria, France, and Slovakia. It can be mentioned that there is no statistically significant difference in the comparative advantage between 2005 and 2019, except in the case of France. Analysing sources of competitiveness among the countries of interest is a possible tool for the future direction of trade policies. [ABSTRACT FROM AUTHOR]

There has been a pronounced increase in online shopping since the start of the COVID-19 pandemic. We study the effect of the pandemic on demand for online grocery shopping specifically, using municipality-level data from a Dutch online supermarket. We find that an additional hospital admission increased app traffic by 7.3 percent and sales per order by 0.31 percent. Local hospital admissions do not correlate with the variety of groceries ordered, but online search behavior does, suggesting that hoarding behavior is driven by the general perception and impact of the virus rather than local conditions. Local COVID-19 conditions also have different effects in urban versus non-urban municipalities, with local hospital admissions increasing app traffic in urban areas but lowering sales per order as compared to non-urban areas. It remains to be seen whether the demand for online grocery shopping will permanently increase as a result of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Previous work has shown that technology can facilitate the communication of emotions, social touch, and social presence through haptic devices, meaning devices that provide a haptic stimulation. However, for special user groups living in long-term care facilities, such as people with dementia, the applications of these haptic devices are not apparent. The aim of this study is to understand how haptic devices can be used in intramural care facilities in times of social isolation, focusing on haptic devices that utilize haptic sensation. Five haptic devices were tested at three care facilities. Insights from this study highlight the potential of haptic devices to enhance sensory, affective, and social experiences during video calling between residents and their relatives. Moreover, the importance of the tactile sensation and form factor of haptic devices in the care context is addressed, along with insights on how to create the appropriate atmosphere during video calling. [ABSTRACT FROM AUTHOR]

Introduction: People who are homeless might be more at risk for getting infected by the SARS-COV-2 virus or for experiencing severe course of the infection due to their often more fragile health, unmet health needs, and poorer living conditions. This study aims to gain insight into the morbidity and mortality of the SARS-COV-2 virus among the homeless population in the Netherlands. Methods: In this observational retrospective study, anonymized data about patients experiencing homelessness who contacted a street doctor were gathered in nine cities in the Netherlands from March 2020 until March 2021. Data included patient characteristics, COVID-19 -related symptoms, diagnosis, and disease course of a SARS-COV-2 infection. Results: Of the total 1419 patients in whom 1544 COVID-19 related consults were registered, 16% tested positive for a SARS-COV-2 infection, and an additional 12% were clinically suspected of having a SARS-COV-2 infection but were seen before there were any COVID-19 tests available in General Practice or for some other reason not tested. Significantly more (p = <0.001) patients born outside the European Union tested positive for a SARS-COV-2 infection (36%) compared to the remainder of the population (20%). The most discerning symptom for being tested positive was loss of taste and smell (29% vs 6% in the negative tested group and 2% in the suspected group), fever (24% vs 13% in the negative tested group but 18% in the suspected group), and headache (26% vs 17% resp 14%), and fatigue (29% vs 20 resp 17%). Cough, dyspnea and common cold were more often seen in the clinically suspected but not tested group). Of the group that tested positive for a SARS-COV-2 infection, 10% were hospitalized. Two patients were admitted to intensive care and one patient died. Of patients who were clinically suspected of a SARS-COV-2 infection, 5% were hospitalized. Conclusion: COVID-19 was not widespread among people experiencing homelessness in the Netherlands, but the number of hospitalizations in this study was relatively high. Monitoring this population during a pandemic is necessary to take prompt action when needed. [ABSTRACT FROM AUTHOR]

In this paper, a decision support system (DSS) is presented that focuses on the capacity planning of the COVID-19 vaccination process in the Netherlands. With the Dutch national vaccination priority list as the starting point, the DSS aims to minimize the per-class waiting-time with respect to (1) the locations of the medical hubs (i.e., the vaccination locations) and (2) the distribution of the available vaccines and healthcare professionals (over time). As the user is given the freedom to experiment with different starting positions and strategies, the DSS is ideally suited for providing support in the dynamic environment of the COVID-19 vaccination process. In addition to the DSS, a mathematical model to support the assignment of inhabitants to medical hubs is presented. This model has been satisfactorily implemented in practice in close collaboration with the Dutch Municipal and Regional Health Service (GGD GHOR Nederland). [ABSTRACT FROM AUTHOR]

We explore the impact of COVID-19 hotspots and regional lockdowns on the Dutch labour market during the outbreak of COVID-19. Using weekly administrative panel microdata for 50 per cent of Dutch employees until the end of March 2020, we study whether individual labour market outcomes, as measured by employment, working hours and hourly wages, were more strongly affected in provinces where COVID-19 confirmed cases, hospitalizations and mortality were relatively high. The evidence suggests that labour market outcomes were negatively affected in all regions and local higher virus case numbers did not reinforce this decline. This suggests that preventive health measures should be at the regional level, isolating hotspots from low-risk areas. [ABSTRACT FROM AUTHOR]

At the beginning of 2020, the large and unforeseen inflow of COVID-19 patients had a deep impact on the healthcare operations of Dutch hospitals. From a patient flow logistics perspective, each hospital handled the situation largely in its own particular and improvised way. Nevertheless, some hospitals appeared to be more effective in their dealing with this sudden demand for extra care than others. This prompted a study into the factors which hindered and facilitated effective operations during this period. We provide an overview of actions and measures for organizing and managing the inflow, throughput and outflow of COVID-19 patients within Dutch hospitals from various types of departments in a large number of hospitals in The Netherlands, based on interviews with nine experts and twelve hospital managers. Ten actions or measures have been identified, which have been divided into the following three dimensions: Streamlining of the underlying in- and external processes, reducing unnecessary or undesirable inflow of patients and increasing or making more adequate use of the available (human) capacity. The main lessons learned are the importance of integral tuning in the care process, giving up habits and self-interest, good information provision and the middle manager as a linking pin. [ABSTRACT FROM AUTHOR]

During the pandemic, nursing homes in the Netherlands were heavily affected by COVID-19. This study assesses the impact of COVID-19 on infection rate, survival rate, and daily functioning over the course of two years among residents of a nursing home in the Netherlands that was amongst the first nursing homes to be affected by the pandemic. This retrospective study followed 70 residents during a two-year period, starting in March 2020. Data were collected on baseline characteristics of participants and the onset, duration, and sequelae of COVID-19 infections. Primary outcomes were mortality and infection rate. The secondary outcome was daily functioning using the Barthel Index at intervals of six months. Within two years, 44 (62.9%) residents were diagnosed with COVID-19. During this study, 72.7% (n = 32) of the COVID-positive residents died, of which 22 deaths were related to the COVID-19 infection. Overall mortality was 60% (n = 42), while COVID-related mortality was 31.4% (n = 22). COVID-19 and multimorbidity (>3 morbidities) were independent risk factors for mortality. Barthel Index scores showed no significant difference in daily functioning. Overall, a high COVID-19 infection rate was seen and was the most common cause of death. COVID-19 did not affect functional status over time. [ABSTRACT FROM AUTHOR]

The global Covid-19 pandemic exposed the fragility of urban systems and underscored the need to recalibrate regulatory and institutional frameworks for an anticipated crisis-prone future. This article explores the notion of 'adaptive law and governance' as a lens through which city authorities can test and modify legal and governance responses to future urban crises. It compares the experiences of managing Covid-19 in the two biggest cities in the Netherlands (Amsterdam and Rotterdam) and in South Africa (Johannesburg and Cape Town). This comparison, between two sets of urban municipal governments functioning under different constitutional systems and in different socio-economic contexts, provides insights pertaining to how adaptive urban governance during the pandemic was constrained or enabled by the interaction between the regulatory and institutional frameworks for and political realities of urban autonomy and intergovernmental relations. The article demonstrates that cities that govern within a flexible and decentralised legal and governance system are better positioned to develop and implement responsive measures to address crises or uncertainty. To enhance resilience, legal systems should promote transparent, riskresponsive, and reflective local governance tools to enable agile, context- specific and decisive crisis responses that can be employed as a matter of course rather than exception. [ABSTRACT FROM AUTHOR]

Objective: Access to family planning services is a human right that plays an essential role in society's health, particularly women's health. The COVID-19 pandemic has affected all aspects of human life including access to family planning services. Accordingly, the main goal of this study was to explore the experiences of women and service providers from the main challenges and obstacles of access to family planning services and abortion services in Bangladesh, Iran, and the Netherlands during the COVID-19 pandemic. Methods: In this qualitative study, the data were collected through online, telephone, or in-person semi-structured interviews with key informants. Participants selected by purposive sampling method. The participants included women aged 15 to 49 (n = 63) and service providers (n = 54) in the 3 abovementioned countries. These individuals were included from October 2020 until December 2020. Conventional thematic analysis was employed to analyze the collected data. Results: The main extracted themes were challenges (reduction of referral; disruption of access to services; insufficient knowledge; worries among staff; rising prices; and unavailability of some contraceptives), measures (time extension and visit scheduling; telephone, online, and door to door services; and support of the media) and recommendations (health facility improvements; free, online, and closer services; and ongoing trainings and awareness campaigns). Conclusion: The COVID-19 pandemic has affected family planning and reproductive health services in different ways and has uncovered existing inequalities in access to these services. However, in Iran, the reported challenges were also rooted in new population policies that have further limited access to family planning and abortion services. [ABSTRACT FROM AUTHOR]