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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 b

Behavioral insights teams (BITs) employ behavioral experts and policy professionals to collaboratively improve public policy. Most evaluations of BITs focus on the interventions that BITs develop, but not the functioning of BITs. Here, we report the first comprehensive evaluation of a BIT, the Behavioral Insights Group Rotterdam. We investigate how its resources were used, for what activities, with what outputs, and to which effects. Using quantitative and qualitative methods, we derive nine propositions to describe and improve the integration of behavioral insights into public policy and administration.

Background Worldwide the Covid-19 pandemic resulted in drastic behavioral measures and lockdowns. Vaccination is widely regarded as the true and only global exit strategy; however, a high vaccination coverage is needed to contain the spread of the virus. Vaccination rates among young people are currently lacking. We therefore studied the experienced motivations and barriers regarding vaccination in young people with the use of the health belief model. Methods We conducted a correlational study, based on a convenience sample. At the vaccination location, directly after vaccination, 194participants(16-30 years) who decided to get vaccinated at a pop-up location several weeks after receiving a formal invitation, filled out a questionnaire regarding their attitudes towards vaccination based on concepts defined in the health belief model. We used these concepts to predict vaccination hesitancy. Results Younger participants and participants with lower educational levels report higher levels of hesitancy regarding vaccination (low education level = 38.9%, high education level = 25.4%). Perceived severity (Mhesitancy = .23, Mno hesitancy = .37) and susceptibility (Mhesitancy = .38, Mno hesitancy = .69) were not associated with hesitancy. Health related and idealistic benefits of vaccination were negatively associated with experienced hesitancy (Mhesitancy = .68, Mno hesitancy = -.37), while individualistic and practical benefits were not associated with hesitancy (Mhesitancy = -.09, Mno hesitancy = .05). Practical barriers were not associated with hesitancy (Mhesitancy = .05, Mno hesitancy = -.01), while fear related barriers were strongly associated with hesitancy (Mhesitancy = -.60, Mno hesitancy = .29). Conclusions Health related, and idealistic beliefs are negatively associated with experienced hesitancy about vaccination, while fear rel

Studies on the impact of the COVID-19 pandemic on autistic children’s psychosocial outcomes have shown mixed results. In the current study we aimed to gain a better insight into the effect of the COVID-19 pandemic by comparing psychosocial outcomes collected pre-pandemic with data collected during the pandemic. We used the Strengths and Difficulties Questionnaire (SDQ) to examine change over time in psychosocial outcomes of autistic children from pre-pandemic (T0) to lockdown I (T1) and lockdown II (T2) in the Netherlands. We expected a deterioration in psychosocial outcomes. There were 224 participants in T0 and T1, of which 141 also participated in T2. The results showed a surprising improvement in psychosocial outcomes from T0 to T1. Special education and female gender were associated with increased difficulties over time, while higher age was associated with decreased difficulties. At the subdomain level we found that emotional problems remained stable, while hyperactivity, conduct problems, and peer problems decreased, and prosocial behavior increased. Attending special education predicted increased peer problems over time, while higher age predicted both decreased conduct problems and increased prosocial behavior over time. The COVID-19 pandemic may have temporarily improved the fit between the psychosocial needs and the environment for children with autism in the Netherlands.

Pre- and post-term children show increased autism risk. Little is known about gestational age (GA) prevalence among autistic children, and their respective autism phenotype. We compared prevalence of pre-, full- and post-term birth between a population-derived sample of N = 606 (137 females, 22.61%) autistic children and adolescents (mean age = 14.01, SD = 3.63, range 3–24) from the Netherlands Autism Register, and matched controls from the Dutch birth register. Autism phenotype and comorbid symptoms were assessed with the AQ-short and SDQ questionnaires. Using logistic regression, we found higher prevalence of pre- and post-term birth among autistic individuals but no phenotypical differences across GA groups. Autism risk was particularly elevated for post-term children, highlighting the need for closer investigation of autism on the whole GA range.

The COVID-19 vaccination rate is not evenly distributed across the Netherlands. In some neighborhoods, the vaccination rate is relatively low, causing individual health risks and a burden to the health care system. An explanation is the use of a national, general information campaign, while using a similar approach (equality approach) does not always lead to similar results. Therefore, we advocate the use of an equity approach instead, as defined by the WHO, which aims at achieving equal results by taking the specific needs of certain vulnerable groups into account. As an example, we describe an intervention that took place in Rotterdam, in which medical doctors, among which GPs, took the initiative to offer information about vaccinations and vaccination on the popular weekly markets of Rotterdam. Using interviews with medical volunteers who contributed to these market vaccinations, we outline the preconditions for successfully implementing such an outreach-based approach, and we make a number of practical recommendations.

Background: Examining the correlates of adolescent’s physical activity (PA) and how they may differ according to the intersection of gender and family socioeconomic status (SES) can support the development of tailored interventions to more effectively promote adolescents’ PA. This study explored how the associations between psychosocial, behavioural and environmental factors and adolescent’s PA differed according to gender and family SES. Methods: This study used data from the Dutch Youth Health Survey 2015. Adolescents (n = 9068) aged 12–19 were included in the study. The associations between psychosocial, behavioural, and environmental factors and PA (days per week engaging in at least one hour of PA) were examined with multilevel linear regression analysis. Potential interactions between these correlates, gender and family SES were explored. Results: On average, adolescents engaged in at least one hour of PA for 4,2 days per week. Poor self-perceived health, low peer social support, and a weak connection with the environment were all associated with lower PA in adolescents. Daily smoking, cannabis use, risk of problematic gaming and social media use, as well as lack of daily consumption of fruit, vegetables, water and breakfast were associated with lower PA, whereas binge drinking was not. Interactions revealed that poor self-perceived health was associated with lower PA in adolescents from moderate- and high-SES families, but not in low-SES adolescents, whereas cannabis use was only associated with lower PA amongst low-SES adolescents. Low peer social support was associated with lower PA across all groups, but it was most strongly associated with lower PA amongst male adolescents from low-SES families than in other subgroups. Amongst low-SES males, low peer social support was associated with a 1.47 reduction in days engaging in sufficient PA, compared with a 0.69 reduction for high-SES males. Conclusions: This study identified several psychosocial, behavioura

Objectives: Research has linked mindfulness to improved mental health, yet the mechanisms underlying this relationship are not well understood. This study explored the mediating role of emotion regulation strategies and sleep in the relationship between mindfulness and symptoms of depression, anxiety and psychological distress during the COVID-19 pandemic. Methods: As detailed in this study’s pre-registration (osf.io/k9qtw), a cross-sectional research design was used to investigate the impact of mindfulness on mental health and the mediating role of emotion regulation strategies (i.e., cognitive reappraisal, rumination and suppression) and insomnia. A total of 493 participants from the general population answered an online survey and were included in the final analysis. The online survey consisted of the short form of the Five-Facets Mindfulness Questionnaire (FFMQ-SF), the Impact of Event Scale-revised (IES-R), the Generalised Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-8), the Emotion Regulation Questionnaire (ERQ), the short form of the Rumination Response Scale (RSS-SF), and the Insomnia Severity Index (ISI). Results: Structural equation modelling revealed that mindfulness was related to lower symptoms of depression, anxiety and psychological distress, both directly and indirectly. Mindfulness was negatively associated with rumination and insomnia. As hypothesised, models revealed that the associations between mindfulness and depression, anxiety and psychological distress were significantly mediated by its negative associations with rumination and insomnia. Our findings also demonstrated that rumination was related to increased insomnia symptoms, which in turn was associated with increased mental health problems, indicating a mediated mediation. Mindfulness was also positively associated with cognitive reappraisal and negatively associated with suppression, which were, respectively, negatively and positively associated with depressiv

Introduction: Children who experienced mild perinatal adversity (i.e., born late preterm or small for gestational age) are at increased risk for delays in early numeracy and literacy, which increases inequality in educational opportunities. However, this group showed increased susceptibility to the characteristics of their educational environment for literacy, especially for those born late preterm. Intervening in this group may thus be particularly beneficial, provided that their educational environment is highly structured. Delays in numeracy and mathematics are most firmly acknowledged in these children. It remains unclear if these children are also more susceptible to their educational numeracy environment. We test the hypothesis of increased susceptibility to characteristics of their educational environment in the field of numeracy. Methods: We tested the efficacy of a digital intervention of two to 3 months, which focused on visual spatial skills in a large randomized controlled trial in a sample of five-to-six-year-old kindergarten pupils from 140 elementary schools. About 45% of all participants showed delays in numeracy, of whom n = 67 (11%) were born late preterm, n = 157 (26%) were born small for gestational age, and n = 389 (63%) had no mild perinatal adversities. Pupils were assigned to a guiding and structured intervention focused on visual spatial skills (n = 294) or a control program (n = 319), targeting literacy skills. Results: The intervention did not show a main effect. The program was not effective in children small for gestational age, but it was for children born late preterm (Cohen’s d =.71, CI =.07–1.36), showing stronger numeracy skills compared to term-born peers in the intervention condition. Early numeracy skills in children born late preterm fell behind compared to term-born peers in the control condition. Conclusion: A highly structured educational numeracy environment, using repetition and adaptive feedback benefited early numeracy

Illegal garbage disposals are a persistent urban problem, resulting in high clean-up costs, and nuisance and decreased satisfaction with the neighborhood among residents. We compared three adjacent city-areas in Rotterdam in the Netherlands which, for 2 weeks, either: (1) no action to decrease illegal garbage disposals was taken; (2) standard door-to-door canvassing was carried out; or (3) door-to-door canvassing was enriched with several nudges, most importantly a commitment-nudge. The nudge treatment proved highly effective, reducing illegal disposals at post-test and follow-up (2 months later) with two-thirds, resulting in a very large effect size (d = 2.60). At post-test, standard door-to-door canvassing did not differ from the control treatment, but at follow-up results were comparable to the nudging-treatment. This could, however, be due to spill-over effects. Using a commitment nudge thus proved highly effective in decreasing illegal garbage disposals, however, effects might be specific to neighborhoods with strong social cohesion.