Public Health Service of Amsterdam

In 2017, the Netherlands introduced primary human papillomavirus (HPV)-based screening with cytology triage, which increased colposcopy referrals and low-grade lesions detected. In 2022, HPV16/18 genotyping was added for women with borderline/low-grade cytology. Triage with HPV genotyping may better balance screening benefits, harms, and costs. Therefore, we evaluated the cost-effectiveness of 19 triage strategies based on net monetary benefit (NMB) at cost-effectiveness thresholds of €20,000 and €50,000/quality-adjusted life-year (QALY), with the highest NMB indicating the most cost-effective strategy. Triage tests included 16/18 genotyping, 7-type (16/18/31/33/45/52/58) genotyping, and cytology (high-grade squamous intraepithelial lesions [HSIL]: moderate/severe, atypical squamous cells of undetermined significance [ASC-US]/low-grade squamous intraepithelial lesions [LSIL]: borderline/low-grade, negative for intraepithelial lesion or malignancy [NILM]: normal). Effects on cancer incidence and mortality were obtained by combining POBASCAM trial data with nationwide screening and cancer registries. Time since the onset of high-grade lesion (cervical intraepithelial neoplasia [grade 2/3] [CIN2/3]) at baseline of the Population-based Screening Study Amsterdam trial cannot be estimated from the data and was varied between 0 and 10 years. At a €20,000/QALY threshold, immediate referral for HSIL and 16/18-positive ASC-US/LSIL, and repeat cytology for 16/18-negative ASC-US/LSIL and 7-types positive NILM had the highest NMB (€214.1 to €309.3/woman gained compared to referring all HPV-positive women). At a €50,000/QALY threshold, immediate referral for all 16/18-positives and/or HSIL, and repeat cytology for 16/18-negative ASC-US/LSIL and 7-types positive NILM had the highest NMB if time since onset of CIN2/3 was greater than 2 years. Cytology combined with HPV16/18 and extended genotyping is cost-effective for triage of HPV-positives. Immediate colposcopy referral of all HPV16/18-positives is cost-effective at a €50,000/QALY threshold.

The objective of this study was to evaluate the Diabetes Eating Problems Survey-Revised (DEPS-R) against the Eating Disorder Diagnostic Interview (EDDI). Specific aims were to (1) assess the ability of the DEPS-R to identify Diagnostic and Statistical Manual-5 (DSM-5) eating disorders, including sensitivity and specificity of the current DEPS-R cutoff ≥20 and (2) report the correlation of each item to the presence of any eating disorder. Baseline data from 293 women (14-35 years) with type 1 diabetes (T1D) and body image concerns enrolled in a multinational randomized controlled trial were examined. Receiver operating characteristic (ROC) analysis, univariate logistic regression and two-sample t-test were performed. The ROC analysis demonstrated good accuracy of the DEPS-R with an area under the curve (AUC) of 0.82 (95% CI 0.79-0.94). The cutoff of ≥20 yielded a sensitivity of 87.5% (95% CI 83.6%-91.3%) and a specificity of 60.4% (95% CI 54.8%-66.0%). Univariate logistic regression identified 12 items as significantly correlated with the presence of any eating disorder. The highest odds ratios (OR) were observed for items 9 (OR = 3.64), 8 (OR = 2.85), 13 (OR = 2.36), 14 (OR = 2.23), 15 (OR = 1.99) and 5 (OR = 1.99). This is the first study to investigate the ability of the DEPS-R to identify DSM-5 eating disorder diagnosis established via a diagnostic interview using a ROC-analysis. DEPS-R cutoff ≥20 correctly identified most cases with eating disorders but showed moderate specificity, considered acceptable as an initial screening tool for disordered eating. In clinical care, specific DEPS-R items may be emphasized to explore the presence of disordered eating behaviours and eating disorders.

This study explores whether Large Language Models (LLMs) can analyze brief trauma narratives in ways that align with self-reported trauma-related symptoms and probable Post-Traumatic Stress Disorder (PTSD) based on a recommended cut-off. We investigate Gemini 1.5 Pro and GPT-4o's ability to score 1000 trauma narratives for severity of PTSD symptoms comparing various prompting strategies. Prompts ranged from basic instructions requesting a binary or graded (5-point) inference based solely on the narrative, to more complex prompts incorporating demographic information (age, gender), time since the traumatic event, and extended instructions detailing PTSD symptomatology. Accuracy of inferences was evaluated using Pearson correlations and Area Under the Curve (AUC) metrics computed between LLM inferences and self-reported measures. Results showed small-to-moderate positive correlations across all prompting strategies, with correlations as high as r = .42 with self-report symptoms. Graded inferences yielded stronger correlations with self-reported symptoms than binary inferences. The AUC for probable PTSD peaked at 0.713 using Gemini 1.5 Pro, with a sensitivity of 0.712 and a specificity of 0.662 in detecting PTSD symptoms. Of note, providing extended instructions on PTSD symptoms did not reliably improve performance beyond basic demographic and temporal context. The performance of LLMs was comparable to that achieved by traditional machine learning methods trained on large datasets but without requiring extensive training data; however, the emerging moderate associations underscore the need for continued refinement. Findings are limited by brief, self-selected English-language web narratives and self-reported symptoms and should be considered preliminary pending validation in clinically verified samples.

Metacarpal fractures are common injuries that are frequently managed with repeated radiological follow-up, although the clinical value of routine imaging is uncertain. The aim of this study was to evaluate the frequency and clinical impact of follow-up imaging in patients with metacarpal fractures treated operatively or non-operatively, and to quantify the associated financial and environmental impact. This retrospective study evaluated adult patients with metacarpal fractures treated non-operatively or operatively at a Dutch level 2 trauma center between 2017 and 2022. Radiology reports and medical records were reviewed to assess whether follow-up imaging led to treatment modification. Additionally, the corresponding financial and environmental impact was calculated. A total of 2342 patients were included (median age 32years; 28% female). Among initially non-operatively treated patients (n = 1978), 1.1% (n = 22) required conversion to surgery. The overall cost associated with this 1% conversion amounted to €230,000, with an estimated environmental impact of 2711kg CO₂-eq. Among operatively treated patients (n = 386), postoperative imaging rarely prompted re-operation (0.3%, n = 1). The total costs associated with 0.3% re-operation were €171,000 and an associated environmental impact of 1801kg CO₂-eq. Together, the impact equals almost one trip around the world by car. Routine radiological follow-up after the initial decision for operative or non-operative treatment in metacarpal fractures provided minimal clinical benefit. A symptom-driven approach may optimize care while reducing unnecessary financial and environmental burden. Level IV.

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.

To explore how cancer survivors experience work-related well-being and aspects influencing their experience of it, one year after cancer treatment. During the development of a work-related intervention, cancer survivors (n = 22, 67% was female, age md 56years) were interviewed using purposive sampling one year post chemo-/radiotherapy for breast, prostate or colorectal cancer. Inductive content analysis was applied. The first year after treatment was described as a transition period in which cancer survivors strove to regain their general well-being but were able to experience work-related well-being even when their general well-being was limited. Their work-related experiences were characterised by a balance between personal readiness for work participation and workload. Daily life and working life were described as interdependent, requiring strategies to maintain balance. There was a vulnerability in handling the demands of work. Both general well-being and work-related well-being were promoted by the absence of side effects and the availability of guidance and responsiveness from caregivers and employers. One year after treatment, cancer survivors considered participation in work life to be important for their well-being. At the same time, the need for enhanced preparation was expressed for balancing work and private life, managing remaining side effects, and navigating ongoing rehabilitation. Our results suggest that the interplay between personal preparedness and work-related stress is central to work-related well-being, highlighting the importance of addressing work-related aspects early in treatment. The findings also indicate that available resources in cancer rehabilitation are underused relative to patients' individual needs. Cancer survivors desired a more holistic rehabilitation, as both general well-being and work-related well-being encompass life after illness as well as the process of returning to work. Strengthening and clearly defining the role of contact nurses regarding work-related issues, and establishing early collaboration between thecancer survivor, employer, and rehabilitation coordinators, can improve support for return to work. Further research is needed to investigate how these discussions and support efforts can be structured and how models and theories can be applied to contribute to increased focus on issues related to work-related well-being after cancer.

ObjectivesTo explore how former breast cancer patients (BCPs) experience the daily-life impact of radiotherapy (RT) side effects and to examine how these narratives can inform the selection of patient stories for the BRASA patient decision aid (BRASA-PtDA).MethodsSemi-structured interviews were conducted with fourteen former BCPs who completed adjuvant RT 6 months–5 years earlier. Thematic analysis identified locoregional, general, and overarching impacts on quality of life (QoL). Narrative excerpts were classified by type, purpose, and evaluative valence.ResultsParticipants described locoregional side effects (pain, reduced arm function, changes in breast appearance, skin irritation) and general effects (fatigue, concentration difficulties) affecting daily activities and self-perception. Three overarching themes—comparisons to the pre-treatment self, acceptance, and work—captured broader QoL impacts. All narratives were experiential or outcome-focused, mostly negative in valence. Thirteen balanced narratives were selected for potential inclusion in the BRASA-PtDA.ConclusionsNarratives from BCPs illustrate how RT side effects shape daily life and overall QoL. Structured narrative classification provided a transparent method for selecting stories for a decision aid. Future research should examine how different narrative types influence patient engagement and decision outcomes.InnovationTo our knowledge, this is the first qualitative study to examine how BCPs live with RT side effects, highlighting impacts on daily life that are under-communicated in current practice in the Netherlands and internationally. Findings provide rich insights for improving risk communication and shared decision making by moving beyond symptom-focused information to incorporate patients' lived experiences.

Patients with an osteochondral lesion of the talus (OLT) often present with deep ankle pain, but the direct relationship between structural damage and the perceived pain remains unclear. The aim of this study was therefore to determine whether pain is associated with demographic and radiologic (computed tomography [CT]-only) lesion characteristics. This cross-sectional study was conducted in patients with symptomatic OLTs at a tertiary referral academic hospital. The primary outcome was the Pain subscale of the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the Numeric Rating Scale (NRS) for pain at rest and during walking, as well as the other FAOS subscales. Associations with patient demographics, lesion size, morphology, and location were assessed using univariate linear regression, followed by multivariate linear regression with backward selection. A total of 310 patients were included. In the final multivariate model for the FAOS Pain subscale, higher age (β = -0.18, P = .04) and smoking (β = -8.70, P < .001) were significantly associated with worse pain scores. Lesion morphology characterized by the presence of an osteochondral fragment was associated with lower NRS pain scores during walking. For NRS pain at rest, worse scores were significantly associated with female sex, higher body mass index, smoking, non-primary lesion nature, and greater lesion depth. No association was found between CT-based radiologic lesion characteristics and patient-reported pain as measured by the FAOS Pain subscale. In secondary analyses, some lesion characteristics showed associations, but these were limited and directionally inconsistent. These findings suggest structural damage alone does not seem to fully explain the patient's pain. Given the CT‑only approach and other design constraints, further research is warranted.

Throughout the COVID-19 pandemic, public debate arose regarding the proportionality of infection prevention and control (IPC) measures in nursing homes (NHs), as these measures negatively impacted residents' well-being. To be better prepared for future outbreaks and pandemics, we need a deeper understanding of how NHs manage COVID-19 or influenza outbreaks, and which considerations are being made to balance IPC and well-being. Mixed-methods study. Fourteen Dutch NH organizations (176 NH locations) where COVID-19 or influenza outbreaks occurred during winter 2022-2023 were included. We monitored the progression and management of 24 outbreaks by administering weekly questionnaires. Heterogeneous sampling was used to select 7 outbreaks for extensive monitoring, including epidemiologic data collection on the resident level and outbreak management evaluation through qualitative interviews (n = 7). Quantitative data were used for descriptive analysis (all outbreaks) and the generation of epidemiologic curves (extensively monitored outbreaks). Qualitative interview data were used to deepen our understanding of the considerations and adjustments made to IPC strategies by NH staff. We observed differences in IPC measures taken between NH organizations, but also within NH organizations, as IPC protocols were often customized to fit specific units, residents, or situations during outbreaks. Staff consistently considered the impact of IPC measures on residents against their beliefs about the effectiveness of measures, which occasionally led them to deviate from their IPC strategy in favor of residents' well-being. The current study provides an understanding of how COVID-19 and influenza outbreaks were managed, how NH staff considered the impact and effectiveness of measures, and consequently, how IPC strategies were gradually adjusted during outbreaks. Acknowledging that although the majority of NH staff consistently recognize the need to tailor IPC measures, they inconsistently apply such customization in practice, which may help NH organizations better prepare for future outbreaks.