GGD Rotterdam-Rijnmond

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.

ABSTRACT An ongoing shift from indoor sex work venues to home-based sex work has resulted in challenges in the provision of sexual healthcare services (SHS) for female sex workers (FSW), such as sexually transmitted infection (STI) testing. The study aimed to explore self-identified characteristics of the home-based FSW population and barriers and facilitators to access and utilise the STI clinic’s SHS. For this qualitative study, semi-structured in-depth interviews were conducted with 29 home-based FSW in the Netherlands and thematically analysed using a hybrid of inductive and deductive coding using Atlas.ti 8. Home-based FSW valued autonomy and financial benefits but faced societal stigma, with experiences varying across clients. Main barriers to accessing and utilising SHS were mistrust due to legal concerns and fear of repercussions from authorities, fear of STI test results and concerns about cost, confidentiality, and anonymity of SHS. Main facilitators were direct telephone contact and building trust with STI clinic nurses, and increasing awareness of available SHS. Results highlight the importance of understanding FSW’s lived experiences and creating a supportive environment at SHS providers by building trust and offering non-stigmatising SHS. Addressing the identified barriers and facilitators is essential to improve access to and utilisation of SHS by home-based FSW.

Compared to conservative treatment, low-certainty evidence showed that nucleoplasty may result in a large reduction in pain and no difference in neck-related function at short-term follow-up. For the other comparisons (pulsed radiofrequency of the dorsal root ganglion, discectomy), there was low to very low-certainty evidence for little to no effect of nucleoplasty on pain, neck-related function, recovery or adverse events. No serious complications occurred in the nucleoplasty or comparison groups. There is insufficient evidence to support the use of nucleoplasty for people with radicular pain due to disc herniation. There is a need for sufficiently powered, well-designed RCTs.

Abstract Background Informal carers with a migration background supporting a relative with a mental illness face barriers like stigma and cultural misunderstandings. The They Aren't Mental?! (TANM) intervention uses community-based peer education via ambassadors to reduce taboos, improve access to care, and enhance social support in informal carers. TANM consists of three peer education sessions about mental health and informal care and optional follow-up support: either 1-on-1 sessions with a family expert-by-experience (FEE) or group-based training on coping with mental illness in the family. This realist evaluation (RE) explored mechanisms through which these outcomes are achieved, and under what conditions. Methods This RE had two phases: Phase 1 developed an Initial Program Theory (IPT) through interviews and a focus group. Phase 2 refined the IPT using data from observations, questionnaires and interviews with target group and ambassadors, and was validated in a focus group with members of the coordinating organizations. We expected the intervention to reduce stigma and improve help-seeking by providing culturally sensitive support in a trusted setting. Results TANM was implemented in communities where stigma on mental health, shame, and mistrust of formal institutions were common. Participants reported reduced taboos, greater awareness of support options, and stronger social support. Expressed needs included cultural sensitivity and emotional support. These outcomes were achieved with mechanisms such as trust-building, personal storytelling, and by creating safe group environments. Ambassadors and the FEE played key roles in translating information, modelling help-seeking behaviors, and guiding participants to appropriate support. Conclusions TANM's strength lies in its cultural embedded peer-led structure and in continuity through trusted community figures. Selecting ambassadors with firm connections with target groups will strengthen trust and improve outcomes. Key messages • Stigma, distrust, and cultural barriers limit access to mental health support for migrant informal carers. • Peer-led, culturally embedded outreach to migrant informal care givers builds trust and enhances access to mental health care.

Abstract Background We assessed whether participants in the EZI-PrEP study, a non-inferiority trial evaluating online and six-monthly monitoring of oral HIV pre-exposure prophylaxis (PrEP), represent the broader population of PrEP users in the Netherlands. Methods We conducted a cross-sectional study using routinely collected data from September 2021 to August 2022 at four sexual health centres (SHCs) in the Netherlands. Socio-demographic characteristics, sexual behaviour, and prevalence of bacterial STIs were compared between EZI-PrEP participants at baseline and other PrEP users during their first PrEP monitoring visit in said time period. Results The analysis included 469 EZI-PrEP participants and 5196 other PrEP users; respectively 99% and 96% were men who have sex with men (MSM). EZI-PrEP participants were less often transgender or gender divers persons (TGDP) (1% vs. 4%, p<0.001), older (median age=36 vs. 34 years, p=0.004), more often born in the Netherlands (68% vs. 58%, p<0.001), and more often completed a university/college degree (81% vs. 76%, p=0.01). They reported more group sex (38% vs. 33%, p=0.023) and condomless anal sex (95% vs. 92%, p=0.004), but less often sex work (1% vs. 6%, p<0.001). Prevalence of bacterial STIs was similar between groups (19% vs 18%, p=0.766). Conclusions The similar STI prevalence suggests comparable risk for HIV acquisition among EZI-PrEP participants and other PrEP users, making EZI-PrEP study outcomes applicable to a broader population of PrEP users. However, under-representation of TGDPs, sex workers, individuals not born in the Netherlands, and individuals without university or college degree may limit generalizability.

BackgroundThe adoption of high-quality health apps has been slow, despite the myriad benefits associated with their use. This is partly due to concerns regarding the effectiveness, safety, and data privacy of such apps. Quality assessments with robust and transparent criteria can address these concerns and, thereby, encourage the use of high-quality apps. However, a major challenge for such assessments is reaching a scale at which a substantial proportion of the more than 350,000 available health apps can be evaluated.ObjectiveTo support the scaling of health app quality assessments, this study aimed to examine the preferences and willingness to pay for assessments with different value propositions among potential customers.MethodsWe conducted 2 discrete choice experiments: one with 41 health app developers and another with 46 health system representatives (from health care institutions, authorities, and insurers) from across Europe. Mixed logit models were applied to examine the impact of assessment attributes on participants’ choices as well as to calculate marginal willingness to pay and predicted assessment uptake.ResultsAmong health app developers, the attributes with the largest impact on assessment choices were the associated clinical care uptake (integration into clinical guidelines and reimbursement or procurement) and cost (purchase price). Increased willingness to use assessed apps and app store integration of assessment results had a moderate impact on choices, while required developer time investment and time until assessment results become available made the smallest contribution. Among health system representatives, increased willingness of clinicians and patients to use evaluated apps had the greatest impact on assessment choices, followed by cost. Time until assessment result availability and the percentage of peers recommending the assessment made a moderate contribution, while reassessment frequency had the smallest impact on choices. On average, health app developers were willing to pay an additional €9020 (95% CI €4968-€13,072) if an assessment facilitates guideline integration and procurement or reimbursement (at the time of data collection, €1=US $1.11), while health system representatives were, on average, willing to pay €7037 (95% CI €4267-€9806) more if an assessment results in a large, rather than a small, increase in willingness to use the evaluated app. The predicted uptake of assessments that offer the preferred values for all attributes was 88.6% among app developers and 91.1% among health system representatives.ConclusionsThese findings indicate that, to maximize uptake and willingness to pay among health app developers, it is advisable for assessments to facilitate or enable clinical guideline integration and reimbursement or procurement for high-scoring apps. Assessment scaling thus requires close collaboration with health authorities, health care institutions, and insurers. Furthermore, if health system organizations are targeted as customers, it is essential to provide evidence for the assessment’s impact on patients’ and clinicians’ willingness to use health apps.

The Heat Neighborhood Approach (De Wijkaanpak Hitte) is a collaborative initiative involving the municipality of Rotterdam, Rotterdam University of Applied Sciences, GGD Rotterdam-Rijnmond, local organizations, and residents. This initiative aims to understand the impact of heatwaves on urban neighborhoods and develop practical measures to enhance community resilience to heat stress. The research explores interventions in both the physical environment (urban and building design) and behavioral dimensions, focusing on how residents perceive and respond to heat.Data collection included focus group discussions, interviews in three Rotterdam neighborhoods, and indoor temperature monitoring. In-depth interviews revealed that many residents underestimate their personal vulnerability to heat-related risks compared to actual risk levels. For most, heat is not seen as a threat but rather welcomed as a temporary change in weather. Residents with experience in warmer climates demonstrated more adaptive behaviors during heatwaves than those less accustomed to high temperatures. The Behaviour Change Wheel Framework (Mitchie et al., 2018) was applied to identify behavioral barriers and interventions. To address gaps in risk awareness, a serious game was developed for older adults living independently in the Ommoord district. The game aimed to improve understanding of heat-related risks and promote adaptive behaviors. Preliminary results indicate that it successfully increased risk perception and encouraged behavioral changes among elderly participants.This study highlights the need to integrate both physical and behavioral interventions in urban heat adaptation strategies. The findings provide valuable insights for cities developing community-based approaches to address the increasing challenge of urban heat stress.

BackgroundSocial recovery (SR) in people with psychotic disorders involves taking on social roles and completing daily tasks. Functional recovery (FR), particularly executive functions, is critical for these roles. Psychotic disorder patients often experience severe cognitive impairments, especially in executive functions. This study investigates the relationship between functional and social recovery in individuals with psychotic disorders and examines the effect of employment status on this association.MethodThis cross-sectional study involved people with a psychotic disorder. SR was measured using the WHO-DAS, divided into Daily Functioning (DF) and Social Functioning (SF) scales. FR was measured using the BRIEF-A and the TOL. Employment status was categorized into Non-active, Otherwise Active, and Active. The Likelihood-ratio Test (LRT) was used for model selection.ResultsData from 251 participants (mean age 41.5) showed that the BRIEF-A affected both DF and SF, while the TOL only affected DF. Only being Otherwise Active influenced DF. Employment status had no influence on SF. Being Otherwise Active positively influenced perceived disabilities in Daily Functioning.ConclusionMeasuring executive functions using both performance-based and self-report measures is important. Both measures are associated differently with perceived disabilities in daily and social functioning. Being a volunteer or looking for a job positively influences perceived disabilities in Daily Functioning.

BackgroundAltered gaze in social settings is a hallmark of social anxiety; however, little research directly examines gaze in anxiety-provoking contexts among youth with anxiety disorders, limiting mechanistic insight into pediatric anxiety. The present study leveraged mobile eye-tracking technology to examine gaze behavior during a naturalistic stressor in a clinical developmental sample. MethodsSixty-one youth (ages 8–17 years; 28 with anxiety disorders, 33 non-anxious controls) completed a naturalistic social stress task (public speaking in front of a videotaped classroom audience) while wearing eye-tracking glasses. Gaze behavior and state anxiety were quantified in each group during two task conditions: while giving a speech and while passively viewing the audience. ResultsAnxiety-related differences emerged in state anxiety and gaze behavior. First, a significant interaction between diagnostic group and task condition on state anxiety indicated that while anxiety increased among non-anxious controls following the speech, youth with anxiety disorders reported persistently elevated anxiety across all assessments. Second, a significant interaction emerged between social anxiety symptom severity and task condition on gaze time on the audience. While youth overall showed low dwell time on the audience during speech delivery, individuals with greater social anxiety showed longer gaze on the audience during the passive viewing condition. This pattern was specific to dimensional analyses of social anxiety symptom severity. LimitationsThe current study was not sufficiently powered to examine age-related differences. ConclusionsThese findings highlight anxiety-related differences in gaze behavior in youth, providing new mechanistic insight into pediatric anxiety using mobile eye-tracking.