GGD Amsterdam

Food systems are exceeding planetary boundaries and endanger both human and planetary health. Transforming these systems requires stakeholder engagement and constructive dialogue for acknowledging the diversity of views and values from different actors within the food system. Serious games have proven effective in fostering collaboration and exploring social-ecological dynamics, yet a holistic food system game linking planetary and human health remains absent. This paper presents the CiFoS Game, a serious game designed to explore food system transformation strategies, showing both the individual and collective impacts of diets, production choices and circularity principles on environment and human health. Co-designed with university students, food system experts, and game designers, the game was tested in multiple pilot sessions in different contexts. Throughout its development, multiple dynamics were added in a step-by-step process to enhance complexity, while improving and aligning already existing dynamics along the way. Results highlight its potential to facilitate learning and support discussions, connecting dietary and production choices to food sustainability challenges. By engaging stakeholders in interactive explorations of food system transformations, the CiFoS game can serve as a boundary crossing tool to foster dialogue, create common understanding and support collaboration towards sustainable food futures for human and planetary health.

RaTexT®, an innovative rapid tick exposure test, was recently developed to provide farmers with quick, on-site results to improve their acaricide resistance management. This was achieved by exposing partially engorged adult ticks to a specially designed acaricide-impregnated matrix fitted inside a transparent polypropylene box. Each RaTexT® box contains six strips of four small, interconnected compartments, in which ticks are exposed immediately after removal from cattle in the field. In this study, we assessed whether a single strip of four interconnected compartments, instead of six strips, was sufficient to accurately detect resistance to deltamethrin and to a combination of cypermethrin, chlorpyrifos and piperonyl butoxide (PBO). We also statistically analysed the optimal number of ticks per compartment (ranging between 5 and 8). Moreover, the test reproducibility was checked by two independent observers who counted dead and live ticks in each compartment. Finally, a comparative analysis was undertaken between adult ticks exposed in RaTexT® and in the adult immersion test (AIT), and also with larvae in the resistance intensity test (RIT) and in the larval packet test (LPT). The novelty of this study lies in comparing adult ticks exposed in RaTexT and in the AIT Test, thereby overcoming limitations of previous studies, in which adults in RaTexT were compared with larvae in the LPT. The internal coefficient of variation (CV) was calculated for each dose, box and acaricidal product to assess within-box consistency. The effect of the number of ticks per compartment (n = 5-8) was examined using Monte Carlo simulations. Inter-observer reliability of reading RaTexT® was statistically measured using Cohen's kappa coefficient (κ). The comparative performance analysis of the bioassays was conducted using generalised linear models (GLMs) with laboratory and field strains of Rhipicephalus microplus ticks in Brazil. Overall agreement between individual strips and their corresponding box classification was 91.3%, indicating high consistency between replicates. The predefined threshold of ≥ 90% accuracy was met by a single strip, supporting the test's robustness even with minimal replication. The internal coefficient of variation within each RaTexT® box was high for deltamethrin (1.285 at 1× dose, 1.109 at 5× dose and 1.268 at 10× dose), but lower for cypermethrin/chlorpyriphos/PBO (0.648 at 1, 0.305 at 5× dose and 0.194 at 10× dose). Variability in the controls was relatively high (CV 1.776). Monte Carlo simulations showed that diagnostic accuracy gradually increased from 81.2% with five ticks to 86.1% with eight ticks per compartment. Furthermore, there was substantial agreement between the mortality of ticks assessed by two independent observers (κ = 0.664). Finally, the comparative test analysis revealed that the deltamethrin resistance level in RaTexT® matched that observed in the AIT. Resistance to deltamethrin was also confirmed by the LPT, with resistance ratios (RR) of 33.8 and 39.5 for two different field strains (Biotech and UFRRJ, respectively). For cypermethrin/chlorpyriphos/PBO, RaTexT® exhibited significantly lower mortality than the AIT. Resistance was also confirmed by LPT, with RR of 5.2 for Biotech strain and 7.2 for the UFRRJ strain. Overall, these findings demonstrate that RaTexT® is accurate and reproducible with a single test strip, making it a practical and cost-effective test that complements traditional laboratory bioassays.

Precariousness, which refers to experiencing a high level of insecurity and instability in life, manifests in multiple life dimensions and can give rise to mental health issues. Associations with mental health are potentially influenced by migration background. In this study, we examine the associations between precariousness in different life dimensions and depressed mood among individuals with and without migration background. We included 22,039 participants from the baseline measurement of the HELIUS (HEalthy LIfe in an Urban Setting) study, representing the six largest ethnic groups in Amsterdam. We used 13 indicators of precariousness in five life dimensions (employment, financial, housing, cultural and social), 9 assessed through a self-report questionnaire and 4 from neighborhood-level data. Depressed mood was classified as > 9 on the Patient Health Questionnaire (PHQ-9, Dutch version). Network models were applied, stratified by migration background. In total, 14.6% experienced depressed mood. Among those who experienced precariousness in at least four dimensions, the corresponding number was 22.1% to 46%, depending on the specific dimensions of precariousness that were experienced. Associations between depressed mood and indicators of precariousness were similar for those with and without a migration background. Depressed mood was associated with marginal work or unemployment, social satisfaction, social frequency, income inadequacy, discrimination, and financial difficulties, and additionally with lost friendship and health literacy among those with a migration background. Individuals with and without depressed mood differ markedly in their experience of precariousness, but associations are mostly consistent between those with and without a migration background.

Patients with advanced heart failure or lung failure often experience significant changes in psychosocial needs, which may affect their quality of life, emotional wellbeing, and daily functioning. Although nurses are well-positioned to address these needs, there is limited understanding of their perspective on these conversations. Therefore, this study aimed to explore how nurses approach and experience addressing changes in psychosocial needs of patients with advanced heart failure (NYHA stage III or IV) or lung failure (GOLD 3 or 4). A qualitative study consisting of semi-structured interviews with hospital and home care nurses. Data were collected from February to April 2025. Based on a case presented by participating nurses and on the Spider Web model for Positive Health, we inquired about perceptions, approaches and challenges to discussing psychosocial needs with patients. Interviews were recorded, transcribed, and analyzed inductively following the principles of thematic analysis. We interviewed six hospital and six home care nurses (total n = 12). Nurses generally experienced conversations about psychosocial needs as meaningful and part of their professional role. They used an intuitive and organic style, attuning to the needs and boundaries of patients. In practice, their approach was challenged by competing priorities and a lack of time, especially in hospital settings. Nurses found conversations about psychosocial needs easier when they had a click and trusting relationship with patients. Some were hesitant to address sensitive topics such as sexuality and financial concerns due to discomfort, perceiving it as a lower priority, or as outside their responsibility. We identified a discrepancy between nurses' perceived importance of discussing psychosocial issues, and the extent and thoroughness with which they do this in practice. Approaches were shaped by nurses' professional intuition and attunement to patients' needs and boundaries. Topics that nurses considered sensitive, such as sexuality and financial concerns, emerged as challenging.

AimsWe assessed whether symptomatic end-stage hip and knee osteoarthritis (OA) are associated with poorer sleep quality and to what extent pain mediates these associations.MethodsWe included symptomatic end-stage hip- and knee OA participants from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-arthritis Study (LOAS) and participants without OA from the Netherlands Epidemiology of Obesity (NEO) study. We assessed sleep with the Pittsburgh Sleep Quality Index (PSQI) and performed linear regression analyses to investigate the associations between OA and sleep and the potential mediating effects of pain-related sleep disturbances.ResultsOverall, 54% of the 922 hip OA and 48% of the 870 knee OA patients reported poor sleep (total PSQI > 5), compared with 21% of the 1,165 participants without OA. Both hip and knee OA were associated with worse subjective sleep quality (adjusted difference: 0.37 points (95% CI 0.29 to 0.44) and 0.23 points (95% CI 0.15 to 0.32), respectively) and pain-related sleep disturbances (adjusted difference: 1.75 points (95% CI 1.64 to 1.86) and 1.50 points (95% CI 1.38 to 1.62), respectively). The association of hip and knee OA and worse subjective sleep quality was fully mediated by pain-related sleep disturbances (112% (95% CI 90 to 145) and 123% (95% CI 90 to 191), respectively).ConclusionSymptomatic end-stage hip and knee OA are strongly associated with worse sleep quality, which is fully mediated by pain-related sleep disturbances. While the cross-sectional design limits causal inferences, these findings underscore the importance of improving both sleep quality and pain management strategies in symptomatic end-stage OA patients. Addressing sleep disturbances, which are often overlooked in clinical practice, could significantly enhance overall health and quality of life of patients with end-stage hip- or knee OA.Cite this article: Bone Jt Open 2026;7(3):348–356.

Late-stage HIV diagnoses among heterosexuals remain a problem in Europe, yet little is known about its risk factors. We aimed to identify the trends and factors associated with late-stage HIV diagnosis among heterosexuals in the Netherlands. We used national HIV surveillance data and included individuals diagnosed between 2012 and 2022, with heterosexual contact as the suspected transmission route. We applied descriptive statistics and logistic regression analyses. Of 1637 HIV diagnoses among heterosexuals, 932 (57%) were late-stage disease. The proportion of late-stage diagnoses was stable during 2012-2022 (range 51-62%). Significant risk factors for late-stage diagnosis were male sex (adjusted odds ratio [AOR] = 1.72; 95% confidence interval [CI] = 1.40-2.13), older age (every 10-year increase: AOR = 1.48; 95% CI = 1.34-1.62), being born in Africa (AOR = 2.21; 95% CI = 1.70-2.88), and Asia (AOR = 2.93; 95% CI = 1.88-4.65). People born in eastern Europe approached significance (AOR = 1.70; 95% CI = 0.97-3.05). Most late-stage diagnoses occurred in hospitals. The proportion of late-stage HIV diagnoses remains high among heterosexuals in the Netherlands. Men; older people; and those born in Africa, Asia, and eastern Europe were associated with late-stage diagnosis.

Conventional assessment and treatment approaches targeting justice-involved youth have typically yielded low engagement and modest long-term impact on recidivism and psychosocial functioning. Technologies such as virtual reality, smartphone applications, and wearable devices, offer promising opportunities to address such limitations by providing scalable, engaging and ecologically valid approaches that align well with the often complex needs of this population. The contributions in the special issue aim to showcase some of the potential of these technologies. The special issue originated from a 5-day international Lorentz workshop that brought together researchers and professionals working in clinical practice to explore opportunities, needs, and barriers related to technology implementation in this context. The included contributions comprise empirical case studies illustrating efficiency gains through technological support of existing practices; papers detailing innovative methods that leverage unique capabilities of specific technologies, such as enhanced accessibility and immersive experiences; state-of-the-art reviews; and a viewpoint paper addressing ethical considerations. Collectively, the contributions highlight the promise of technology as well as the need for methodologically robust research to ensure effective and ethical implementation.

Increasing population-level physical activity (PA) requires system-level policy action. However, public policies targeting the general population, without addressing socially disadvantaged populations, might unintentionally increase socioeconomic inequities in PA. This is particularly concerning since disadvantaged groups are less likely to meet PA recommendations to begin with. This systematic review assesses evidence on the effects of public policies on equity in PA. A literature search was performed in seven bibliographic databases on May 7, 2024, in collaboration with a librarian. Studies were included if they a) focused on changes in PA behaviour, PA proxies, or the PA environment as outcomes, b) examined public policy as the independent variable, and c) included a low socioeconomic status (SES) (sub)population. Screening was done in duplicate. Key data extracted included: public policy information, target population and/or SES subgroup measures, PA outcomes, and equity-related findings. Policies were grouped into domains aligned with the eight investments of the International Society for Physical Activity and Health and categorized based on their impact on inequities: reduction, increase, no effect, or mixed effects. Out of 10,350 records screened, 81 studies were included. Results showed that 27% of the public policies reduced inequities, 38% had no effect, 10% increased them, and 25% had mixed effects. The fewest PA policies were identified in the healthcare (n = 2) and workplace (n = 0) domains, the most in the community-wide domain (n = 22). Based on the available evidence, the school, transport, community-wide, and mass media policy domains most frequently demonstrated potential to reduce inequities in PA and/or to benefit high and low SES populations equally. Policies that most consistently reduced inequities or had a neutral equity effect included a) infrastructure policies, b) financial incentives supporting active transport, c) multi-component school-based PA and health policy programmes, d) school physical education policies, and e) policies supporting mass media campaigns. Conversely, urban design and sport for all policies varied in their effects on inequities. Most policies do not appear to exacerbate inequities. Policies in the school, transport, community-wide, and mass media domains show particular promise for promoting PA in an equitable way. These findings offer valuable insights for future policymaking.