Search

BackgroundVaccine uptake differs between social groups. Mobile vaccination units (MV-units) were deployed in the Netherlands by municipal health services in neighbourhoods with low uptake of COVID-19 vaccines.AimWe aimed to evaluate the impact of MV-units on vaccine uptake in neighbourhoods with low vaccine uptake.MethodsWe used the Dutch national-level registry of COVID-19 vaccinations (CIMS) and MV-unit deployment registrations containing observations in 253 neighbourhoods where MV-units were deployed and 890 contiguous neighbourhoods (total observations: 88,543 neighbourhood-days). A negative binomial regression with neighbourhood-specific temporal effects using splines was used to study the effect.ResultsDuring deployment, the increase in daily vaccination rate in targeted neighbourhoods ranged from a factor 2.0 (95% confidence interval (CI): 1.8-2.2) in urbanised neighbourhoods to 14.5 (95% CI: 11.6-18.0) in rural neighbourhoods. The effects were larger in neighbourhoods with more voters for the Dutch conservative Reformed Christian party but smaller in neighbourhoods with a higher proportion of people with non-western migration backgrounds. The absolute increase in uptake over the complete intervention period ranged from 0.22 percentage points (95% CI: 0.18-0.26) in the most urbanised neighbourhoods to 0.33 percentage point (95% CI: 0.28-0.37) in rural neighbourhoods.ConclusionDeployment of MV-units increased daily vaccination rate, particularly in rural neighbourhoods, with longer travel distance to permanent vaccination locations. This public health intervention shows promise to reduce geographic and social health inequalities, but more proactive and long-term deployment is required to identify its potential to substantially contribute to overall vaccination rates at country level.

Background: A booster with bivalent COVID-19 vaccine was offered in the Netherlands in autumn, 2022. We aimed to investigate vaccine uptake during the autumn 2022 booster round among the population subgroups at risk for severe COVID-19 that were specifically targeted by this campaign: the medical risk group aged 18-59 years and individuals ≥ 60 years. We calculated booster uptake in both populations and analyzed determinants of booster uptake among those who had received at least one prior COVID-19 vaccination., Methods: Having had an autumn 2022 booster dose was defined as having received a COVID-19 vaccination between 19 September 2022 and 7 March 2023. The study population included individuals who received at least one previous COVID-19 vaccination. National registries of sociodemographic determinants and COVID-19 vaccination were linked by a unique person identifier. Voting proportions for political parties were included at neighborhood level. Determinants of COVID-19 vaccine autumn booster uptake were ranked by importance by random forest analyses., Results: Booster uptake was 68 % among those aged ≥ 60 and 30 % among those aged 18-59 years with a medical risk factor for severe disease. For both target groups the most important determinant for booster uptake was age (15 % in 18-29 years to 72 % in 80 + years). Voting proportions for progressive liberal political parties ranked second in the random forest analysis in both groups, with an increasing proportion of votes associated with higher uptake. In the 60 + group, household type ranked third, with highest vaccine uptake among married couples without children (72 %) and the lowest uptake among unmarried couples with children (47 %). In the medical risk group, migration status ranked third. Migrants with two parents born abroad had the lowest uptake (18 %), whereas migrants with both parents born in the Netherlands had the highest uptake (35 %)., Conclusion: The target group of people aged ≥ 60 years was much better reached than the target group of people with a medical risk aged 18-59 years. Uptake varied considerably among subgroups in both target groups. The findings of this study can be used in future vaccination strategies as well as for further research to better understand the drivers and barriers of vaccine uptake among the subgroups with notably low uptake., 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 Elsevier Ltd. All rights reserved.)

By September 2022, the uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies have indicated a lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination program and generate hypotheses for research on drivers of, and barriers to, vaccination. A retrospective database study was performed including the entire Dutch population ≥ 18. Vaccination data (5 January 2021-18 November 2021) were at individual levels linked to sociodemographic data. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. The most important determinant was age; uptake increased until the age of 80 (67% in 18-35 years, 92% in 67-79 years, and 88% in those > 80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower among individuals in the lowest income group (69%), those receiving social benefits (56%), and individuals with two parents born abroad (59%). Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. How to best address this inequity in future vaccination campaigns requires further research.

Background: We aimed to estimate vaccine effectiveness (VE) against COVID-19 mortality, and to explore whether an increased risk of non-COVID-19 mortality exists in the weeks following a COVID-19 vaccine dose., Methods: National registries of causes of death, COVID-19 vaccination, specialized health care and long-term care reimbursements were linked by a unique person identifier using data from 1 January 2021 to 31 January 2022. We used Cox regression with calendar time as underlying time scale to, firstly, estimate VE against COVID-19 mortality after primary and first booster vaccination, per month since vaccination and, secondly, estimate risk of non-COVID-19 mortality in the 5 or 8 weeks following a first, second or first booster dose, adjusting for birth year, sex, medical risk group and country of origin., Results: VE against COVID-19 mortality was > 90 % for all age groups two months after completion of the primary series. VE gradually decreased thereafter, to around 80 % at 7-8 months post-primary series for most groups, and around 60 % for elderly receiving a high level of long-term care and for people aged 90+ years. Following a first booster dose, the VE increased to > 85 % in all groups. The risk of non-COVID-19 mortality was lower or similar in the 5 or 8 weeks following a first dose compared to no vaccination, as well as following a second dose compared to one dose and a booster compared to two doses, for all age and long-term care groups., Conclusion: At the population level, COVID-19 vaccination greatly reduced the risk of COVID-19 mortality and no increased risk of death from other causes was observed., 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 Elsevier Ltd. All rights reserved.)

Introduction: Since the definition of chronic migraine as a new disease entity in 2004, numerous clinical trials have examined the efficacy of preventive treatments in chronic migraine. Our aim was to assess the adherence of these trials to the Guidelines of the International Headache Society published in 2008., Methods: We searched PubMed for controlled clinical trials investigating preventive treatment for chronic migraine in adults designed after the release of the Guidelines and published until December 2017. Trial quality was evaluated with a 13-item scoring system enlisting essential recommendations adapted from the Guidelines., Results: Out of 3352 retrieved records, we included 16 papers in the analysis dealing with pharmacological treatment of chronic migraine. The median score was 6.5 (range 2-13). All trials were randomized, the large majority (81.25%) were placebo-controlled and double-blinded (87.5%). Adherence was lowest on i) a priori definition of outcomes (31.25%), ii) primary endpoint definition (37.5%%) and iii) trial registration (37.5%)., Discussion: Most clinical trials adhered to the recommendations of the IHS, whereas adherence to migraine-specific recommendations was lower. Greater awareness and adherence to the guidelines are essential to improve the quality of clinical trials, validity of publications and the generalizability of the results.

Background: Miltefosine (MF) is the only oral drug available for treatment of visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL). Although the drug is effective and well tolerated in treatment of VL, the efficacy and safety of MF for longer treatment durations (>28 days) in PKDL remains unclear. This study provides an overview of the current knowledge about safety and efficacy of long treatment courses with MF in PKDL, as a strategy in the VL elimination in South Asia., Methodology/principal Findings: Literature was searched systematically for articles investigating MF treatment in PKDL. A meta-analysis included eight studies (total 324 PKDL patients) to estimate the efficacy of MF in longer treatment regimens (range 6-16 weeks). We found a per-protocol (PP) initial cure rate of 95.2% (95%CI 89.6-100.8) and a PP definite cure rate of 90% (95%CI 81.6-96.3). Descriptive analysis showed that 20% of patients experienced adverse events, which mostly had an onset in the first week of treatment and were likely to get more severe after four weeks of treatment. Gastrointestinal (GI) side effects such as vomiting, nausea, diarrhoea, and abdominal pain were most common., Conclusions/significance: Longer treatment regimens with MF are effective in PKDL patients in India, however with the caveat that the efficacy has recently been observed to decline. GI side effects are frequent, although mostly mild or moderate. However, on the basis of limited data, we cannot conclude that longer MF treatment regimens are safe. Moreover, VL and PKDL pharmacovigilance studies indicate a risk for serious adverse events, questioning the safety of MF. The provision of safer treatment regimens for PKDL patients are therefore recommended. Until these regimens are identified, it should be considered to halt the use of MF monotherapy for PKDL in order to preserve the drug's efficacy., Competing Interests: The authors have declared that no competing interests exist.

- Medication-overuse headache is a highly prevalent disorder with a major impact on the quality of life.- Medication-overuse headache is defined as headache on ≥ 15 days per month with overuse of acute headache medication for ≥ 3 months. We talk about overuse in case of intake of simple analgesics on ≥ 15 days per month or triptans or combinations of analgesics on ≥ 10 days per month.- The underlying type of headache is usually migraine or tension-type headache.- One of the possible underlying mechanisms of medication-overuse headache is changed sensitivity as a consequence of central sensitisation.- The initial treatment is detoxification of the headache medication. The preferred detoxification method is outpatient, abrupt withdrawal of all acute-headache medication and caffeine-containing products. Essential for successful detoxification is education about the reasons for detoxification, the expected course and the subsequent treatment.

Background: Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce., Methods: Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors., Results: Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5-S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days. Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2., Conclusion: This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.

Aim: J.A.P. and M.A.L. contributed equally to this manuscript.The aim of this article is to determine whether support by a headache nurse in the treatment of medication-overuse headache (MOH) increases successful withdrawal, and to study determinants of response to withdrawal therapy., Methods: A retrospective, controlled follow-up study was performed with 416 MOH patients. All patients were treated with outpatient withdrawal therapy, with two treatment arms: with or without the support of a specialised headache nurse. The outcome measures were: i) successful withdrawal, defined as discontinuation of all headache medication according to the study protocol; and ii) the responder rate, defined as the percentage of patients with ≥ 50% reduction in headache days after successful withdrawal and iii) relative reduction in headache days after successful withdrawal., Results: Successful withdrawal percentages were significantly higher in the group supported by the headache nurse than in the group without support (73.1% vs. 60.7%; p = 0.008), which was confirmed in multivariate analysis (OR 1.73, 95% CI 1.11-2.71, p = 0.016). Support by a headache nurse was not associated with response. The underlying primary headache diagnosis, determined after withdrawal, was significantly correlated with response., Conclusion: The support by a headache nurse results in an increased adherence to detoxification., (© International Headache Society 2015.)

Objective: A strong association has been established between migraine and depression. However, this is the first study to differentiate in a large sample of migraine patients for symptom dimensions of the affective disorder spectrum., Methods: Migraine patients (n=3174) from the LUMINA (Leiden University Medical Centre Migraine Neuro-analysis Program) study and patients with current psychopathology (n=1129), past psychopathology (n=477), and healthy controls (n=561) from the NESDA (Netherlands Study of Depression and Anxiety) study, were compared for three symptom dimensions of depression and anxiety. The dimensions -lack of positive affect (depression specific); negative affect (nonspecific); and somatic arousal (anxiety specific)- were assessed by a shortened adaptation of the Mood and Anxiety Symptom Questionnaire (MASQ-D30). Within the migraine group, the association with migraine specific determinants was established. Multivariate regression analyses were conducted., Results: Migraine patients differed significantly (p<0.001) from healthy controls for all three dimensions: Cohen's d effect sizes were 0.37 for lack of positive affect, 0.68 for negative affect, and 0.75 for somatic arousal. For the lack of positive affect and negative affect dimensions, migraine patients were predominantly similar to the past psychopathology group. For the somatic arousal dimension, migraine patients scores were more comparable with the current psychopathology group. Migraine specific determinants for high scores on all dimensions were high frequency of attacks and cutaneous allodynia during attacks., Conclusion: This study shows that affective symptoms in migraine patients are especially associated with the somatic arousal component., (Copyright © 2015 Elsevier Inc. All rights reserved.)

In baseball batting, golf putting, and dart throwing, successful players estimate the size of the target object to be bigger than their less successful counterparts. While more and more empirical evidence is accumulated supporting the existence of this intriguing phenomenon, an explanation of the processes underpinning this effect remains to be provided. Here, we re-analysed data from a dart throwing experiment to examine the proposal--recently put forward by Proffitt and Linkenauger (in press)--that the variability in target-related performance may serve as a scaling metric for perceived target size which may explain why actors who perform consistently close to the target perceive the target to be bigger. Our results confirm that less variability in target-related performance in darts relates to perceiving the target as being bigger, thereby providing initial support for Proffitt and Linkenauger's proposal.

Recent empirical research suggests that performance modulates perception. For example, baseball players judge the ball to be bigger when performing well as compared to when performing less successfully. Yet, the underlying processes that mediate the emergence of action-specific effects on perception are still largely unknown. To this end, we aimed to examine the impact of anxiety on the action-specific influence on perception as anxiety has been shown to affect both performance and perception. Thirty participants threw darts at a circle-shaped target and were then asked to judge the size of the target. The task was performed under conditions of low and high anxiety. Results replicated previously reported action-specific effects on perception under levels of low anxiety. However, these effects vanished in the high anxiety condition. Results seem to suggest that anxiety has a direct influence on the relation between performance and perception. Attentional control theory is discussed to explain the current findings.

In two experiments, we examined whether training with anxiety can prevent choking in experts performing perceptual-motor tasks. In Experiment 1, 17 expert basketball players practised free throws over a 5-week period with or without induced anxiety. Only after training with anxiety did performance no longer deteriorate during the anxiety posttest. In Experiment 2, 17 expert dart players practised dart throwing from a position high or low on a climbing wall, thus with or without anxiety. Again, only after training with anxiety was performance maintained during the anxiety posttest, despite higher levels of anxiety, heart rate, and perceived effort. It is concluded that practising under anxiety can prevent choking in expert perceptual-motor performance, as one acclimatizes to the specific processes accompanying anxiety.

The object of the current study was to investigate anxiety-induced changes in movement and gaze behavior in novices on a climbing wall. Identical traverses were situated at high and low levels on a climbing wall to manipulate anxiety. In line with earlier studies, climbing times and movement times increased under anxiety. These changes were accompanied by similar changes in total and average fixation duration and the number of fixations, which were primarily aimed at the holds used for climbing. In combination with these findings, a decrease in search rate provided evidence for a decrease in processing efficiency as anxiety increased.

In two experiments we examined changes in the perception of action possibilities as a function of exertion. In Experiment 1, participants repeatedly climbed on a climbing wall in a series of trials that progressively increased in number to 10 trials, resulting in increased exertion. Before and during climbing, the participants judged their maximum reaching height and perceived exertion. On a separate day, participants climbed another 10 trials while performing actual maximum reaches. Higher perceived exertion was associated with decreases in perceived maximum reach while the actual reaches did not decrease. However, the perceptual changes occurred early during task execution when the participants were not yet fatigued. When exertion set in, neither perceived nor actual maximum reaching appeared to be affected. In Experiment 2, we included exhaustion trials. The findings replicated the early changes in perception observed in Experiment 1, which may be explained by hands-on experience with the task. Furthermore, while climbing to exhaustion, perceptual judgements largely changed in keeping with changes in the actual maximum reach. Thus, there appeared to be a functional relationship between participants' actual action capabilities, rather than their state of physical fatigue per se, and perceived action possibilities.

We investigated the impact of anxiety on movement behaviour during the execution of a complex perceptual-motor task. Masters' (1992) conscious processing hypothesis suggests that under pressure an inward focus of attention occurs, resulting in more conscious control of the movement execution of well-learned skills. The conscious processes interfere with automatic task execution hereby inducing performance decrements. Recent empirical support for the hypothesis has focused on the effects of pressure on end performance. It has not been tested so far whether the changes in performance are also accompanied by changes in movement execution that would be expected following Masters' hypothesis. In the current study we tested the effects of anxiety on climbing movements on a climbing wall. Two identical traverses at different heights on a climbing wall provided different anxiety conditions. In line with the conscious processing hypothesis we found that anxiety had a significant effect on participants' movement behaviour evidenced by increases in climbing time and the number of explorative movements (Experiments 1 and 2) and by longer grasping of the holds and slower movements (Experiment 2). These results provide additional support for the conscious processing hypothesis and insight into the relation between anxiety, performance, and movement behaviour.

In order to explore the nature and amount of information in the optic array used by subjects required to carry out one-handed catching actions, the optical expansion pattern (using a deflating ball) and the duration of viewing time (using liquid crystal spectacles) of the ball were varied. Subjects were required to catch luminous balls (two of constant physical size and one of changing physical size during approach) attached to a pendulum in a totally dark room, while the liquid spectacles were closed at 0, 100, 200 or 300 ms before hand-ball contact. The results confirmed previous findings that the timing of the catching action is based on retinal expansion information and that conclusion was strengthened when an additional dependent variable (time of the maximal opening velocity of the grasp) was used. Further, for the viewing time duration manipulations, the time of the maximal closing velocity of the hand was later, while no effect was found on the time of the maximal opening velocity, when the last 300 ms of the trajectory of the ball was occluded. Adjustments to the catching action in response to the different ball sizes under the 0 ms condition differed significantly from the adjustments under the 300 ms condition. Both findings point to the importance of relative optical expansion information, available between 300 and 200 ms before ball-hand contact, in maintaining a (relatively) continuous perception-action coupling in the act of catching.