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Indoor sporting locations have been forced to stay closed longer than outdoor sporting locations during the lockdowns introduced during the COVID-19 pandemic. This research addresses the question whether exercising indoors does raise one's risk of infection with SARS-CoV‑2. This analysis was performed using data from the COVID RADAR app and accounted for user differences in age, vaccine status, sex, other risky behavior, SARS-CoV‑2 prevalence and quality of living environment. Analyzing data from 1,353 users, 13.1% of which reported a positive SARS-CoV‑2 test, we found that exercising indoors leads to an odds ratio of 1.8 with a positive SARS-CoV‑2 test (95%-confidence interval 1.2-2.6, p  = 0.003), as compared to users who exercise outdoors. This confirms the justification used in longer closing indoor sporting locations to reduce the number of infections., (© The Author(s) 2022.)

After the second corona vaccination, a number of GPs in Utrecht dropped out for 2-3 days due to the side effects. Through a simple email survey, we arrived at a 14% dropout rate during the days following vaccination. We explored options to anticipate dropout during following vaccination rounds and advocate transparency with regard to the side effects.

In this study we describe changes in perceived food insecurity and eating habits in the Netherlands since the start of the COVID-19-crisis, how these changes were experienced, and which options were indicated for a healthier diet. The study was conducted through online questionnaires among adults with a relatively low socioeconomic position living in the Netherlands. We included 1033 participants. The results show changes in perceived food insecurity in the Netherlands since the start of the COVID-19 crisis, with some participants experiencing lower food security and others experiencing higher food security. About one-fifth of the participants reported that their eating pattern had changed since the start of the COVID-19-crisis, while more than half of the food insecure participants reported a changed eating pattern: in particular, they reported eating less healthily and fewer fruits and vegetables. Participants experiencing food insecurity more often reported to want help for a healthier diet. A cheaper food supply was seen as a promising solution, while food bank use was rarely mentioned in this regard. The COVID-19-crisis can lead to financial insecurity and changes in food availability/accessibility, known risk factors for food insecurity. Therefore, these findings highlight the urgency of reducing food insecurity and providing appropriate support for healthy eating, particularly for people experiencing food insecurity., (© The Author(s) 2021, corrected publication 2021.)

Healthcare professionals can play a significant role in the prevention of lifestyle-related diseases. Yet there is still relatively little attention to lifestyle counseling, partly because of limited available time and doubts about its effectiveness. During so-called 'teachable moments', patients may be more receptive towards lifestyle advices and more motivated to change their lifestyle. For example during pregnancy, disease diagnoses, abnormal test results or even the corona crisis, patients may suddenly face lifestyle change differently. In this paper, we provide guidelines to healthcare professionals regarding utilization of these situations. General practitioners or specialists can create a potential teachable moment by discussing risk perception, emotions and self-image with the patient. Subsequently, paramedics can encourage patients to change health behaviors by increasing their motivation, self-efficacy and lifestyle-related skills. Recognizing and making optimal use of potential teachable moments can contribute to desired behavior change of patients with relatively little time investment.

Objective: To investigate how general practitioners and preventive youth health physicians experience their collaboration and to analyse factors involved., Design: Qualitative research., Method: 14 general practitioners and 11 preventive youth health physicians from the Leiden and The Hague areas were interviewed in a semistructured manner. Data were analysed by thematic analysis using the 'Framework method', to identify important themes for collaboration., Results: Contact frequency between general practitioners and preventive youth health physicians varied from biannually to weekly. Important conditions for good collaboration were not met by most participants. General practitioners were not always aware of competencies and tasks of preventive youth health physicians and had little trust in them. They also reported less often than preventive youth health physicians that there were mutual agreements or guidelines. Both parties experienced little support from municipalities or their own organisations. For both, exchange of information mainly took place in case of medical necessity or when the other party requested it. Accessibility of the other party was experienced as inconsistent. Better information exchange was mentioned as the most important point for improvement of collaboration., Conclusion: Current collaboration between general practitioners and preventive youth health physicians is suboptimal. There is room for improvement with respect to knowledge of each other's competencies and tasks, trust, information exchange and support from within their own organisations and municipalities. These insights could help to shape and improve interprofessional collaboration in primary care for children, also regarding the youth teams created recently.

Objective: To determine how often press releases and news articles contain exaggeration and to locate its origin in the trajectory from research paper to news article., Design: Retrospective quantitative content analysis., Method: We analysed press releases on health-related research published by Dutch universities and university medical centres in 2015 (n = 129) as well as news media articles related to those press releases (n = 185)., Results: 20% of press releases and 29% of news articles exaggerated the conclusion or causal claim. Explicit health advice was, when present, exaggerated in 7% of press releases and 10% of news articles. When press releases exaggerated the conclusion or causal claim, 92% of associated news articles contained the same exaggeration. When the conclusion was not exaggerated in the press release, 6% of the news articles was exaggerated. The relative chance for exaggerated news associated with exaggerated press releases was 16.08 (95% CI: 7.35-35.18). Exaggerated press releases were associated with news articles more frequently. The relative chance for news articles to be associated with exaggerated press releases vs. a non-exaggerated press release was 1.45 (95% CI: 1.02-2.04)., Conclusion: Exaggeration in health-related news is strongly correlated with exaggeration in the original press release and occurs in more than 1 in 5 articles. Monitoring and, if necessary, improving the accuracy and correctness of academic press releases seem to be important measures to improve the quality of health related news., Conflict of interest and financial support: I. Smeets is a columnist with one of the newspapers investigated. She was not involved in collecting, coding and analysing the relevant data. Additional potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.

Large population studies published recently have revealed additional risks of chronic use of proton pump inhibitors (PPIs). Dementia and renal failure were reported as long-term follow-up side effects of chronic use, in addition to the previously known increased risk for various infections, osteoporosis and metabolic disturbances. In the light of ongoing over-prescription of PPIs, this should lead to reconsideration of individual indications.

Early and routine screening of older people for cognitive impairment is widely advocated as it is thought to support proactive interventions and improve treatment results. However, scientific evidence to support this strategy is lacking. The recent systematic review of screening instruments and interventions discussed in this commentary shows that the widely implemented Mini-mental state examination questionnaire (MMSE) is indeed adequate to confirm the diagnosis of dementia, and to a lesser extent also mild cognitive impairment. However, no pharmacological interventions have shown any convincing evidence of a positive effect in the groups selected by screening. Pharmacological treatment is often discontinued because of its side effects. No convincing evidence could be found to support the effect of any other caregiver-oriented intervention either. This commentary concludes that the MMSE can be used for diagnosing dementia in primary care, but should not be used for screening otherwise healthy older patients.

Background: Currently, primary care for the older, vulnerable patient is reactive, fragmented and does not meet patients needs. Given the expected increase of home-dwelling frail elderly people a transition is needed to proactive and integrated care., Methods: In the described study, we explore two innovative interventions in primary care. First we describe a newly developed screening and monitoring program for frail elderly patients based on routine care information in general practice. Second, we describe a multidisciplinary intervention program by trained nurses for frail elderly patients in general practice. The effectiveness of the interventions is examined in a three-armed, cluster randomized trial, taking place in 58 primary care practices in Utrecht, the Bilt and Maarsenbroek., Results: Three thousand eight patients are included. Primary outcome measure is the impact of the interventions on the daily activities, measured with the Katz questionnaire. Secondary outcomes measures are the quality of life, mortality, recording in a care or nursing home, visit to an emergency room or outpatient unit, recording in the hospital and volunteer caregivers tax.

The guideline 'Gastric symptoms' covers the diagnosis and management of adults with dyspepsia in general practice, the prevention of unnecessary proton pump inhibitor use, and gastric protection during treatment with non-steroidal anti-inflammatory drugs (NSAIDs), including low-dose acetylsalicylic acid derivatives. During an initial episode of dyspepsia no distinction is made between reflux and ulcus symptoms because management is the same: start by prescribing an antacid and, if these provide insufficient effect, progress to a H₂-receptor antagonist and subsequently to a proton pump inhibitor (PPI). Testing for Helicobacter pylori should be performed in all patients with persistent or recurrent symptoms, preferably by using the monoclonal stool test. Gastroscopy should be performed with restraint in an H. pylori negative patient < 50 years with persistent or recurrent symptoms but no acute symptoms as there is only a very slight risk of malignancy. - Chronic PPI use is seen in 7% of the population and is associated with infections and osteoporosis. Phasing out of PPI use without good indication seems to be possible in 70% of patients.

The new guideline on rectal bleeding presents a clear view on what can and should be done in primary care in cases of visible rectal blood loss. However, it does not elaborate on approaches that can be taken to verify that 'rectal bleeding' really is caused by blood loss from the gastrointestinal tract, notably by use of a faecal occult blood test. Nevertheless, the guideline presents practical risk factors that require further diagnostic testing by colonoscopy. More importantly however, plenty of attention is given to the diagnostics and possible interventions that apply to benign causes of rectal bleeding: haemorrhoids, fissures and proctitis. This guideline should stimulate further broadening of proctological skills among general practitioners.

The revised Dutch College of General Practitioners' practice guideline 'Viral hepatitis and other liver diseases' offers advice in the diagnosis and management of viral hepatitis A, B and C and other liver diseases. The guideline is important for general practitioners as well as specialists in internal medicine and gastroenterology. The emphasis is on the management of chronic hepatitis B en C, because the prevalence of these diseases has increased in the Netherlands and, in addition, the treatment options for chronic hepatitis have improved. Consequently, timely recognition and adequate referral of patients with chronic hepatitis B or hepatitis C have become more important. However, many patients with a chronic liver disease have no symptoms. Therefore, the general practitioner should be aware that a patient visiting the practice with fatigue and malaise could have a liver disease if he or she belongs to a high-risk group or has had high-risk contacts. If the general practitioner repeatedly finds increased liver transaminase values during routine examination of asymptomatic patients, additional diagnostic tests should be performed. Further tests should focus on viral hepatitis as well as on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis or, depending on the history-taking, liver damage due to excessive alcohol, medication or drug use.

Objective: To determine the association between overweight, physical and mental health conditions and health-related quality of life in an adult community population upon entering a new primary care practice., Design: Cross-sectional study., Method: Baseline data from 4825 participants (mean age: 39 years; 55% women) in the Utrecht Health Project; a dynamic primary care population study with a response rate of over 50%, were used to determine and compare the prevalence of diagnosed medical conditions, complaints and quality of life between individuals of normal weight (BMI 18.5-< 25 kg/m2) and those who were overweight (BMI 25-< 30 kg/m2) or obese (BMI > or = 30 kg/m2). Normal weight was used as the reference category., Results: Overweight individuals were approximately twice as likely to have cardiovascular risk factors and had a 20-60% increased risk of back pain, arthrosis, migraine, dyspepsia and respiratory symptoms than those of normal weight. Obese individuals were almost twice to four times more likely to have these conditions and were additionally at increased risk of obstructive pulmonary disease, cardiovascular disease and arthritis (range of odds ratios (ORs): 1.9-3.3). Somatization and reduced physical well-being were more common among both overweight (ORs: 1.2-1.5) and obese (ORs: 1.7-3.7) individuals, whereas only obese individuals demonstrated a 30-50% increased risk of mental health conditions and reduced mental well-being., Conclusion: Overweight was associated with a broad range of physical and mental health conditions and a reduced health-related quality of life. Routine measurement of BMI upon entering a primary care practice is relatively simple and may contribute to the identification of individuals at high risk of comorbidity.

For the management of patients with dyspepsia a multidisciplinary working party has made recommendations, i.e. about indications for prompt endoscopy, the management of dyspeptic complaints of recent onset, the application of diagnostic tests and treatment of recurrent dyspepsia and the indications for long term use of acid suppressants. Endoscopy is indicated in every patient with alarm symptoms, i.e. blood loss, dysphagia, weight loss or anemia in combination with dyspepsia. Age alone is not a decisive factor in this. Given the good prognosis of recent onset dyspepsia, the application of diagnostic tests is generally not required. Treatment should be restricted to antacids or H2 receptor antagonists. Only in case of persistent or recurring complaints, diagnostic tests or another treatment (Helitobacter pylori diagnostic tests, empirical treatment or endoscopy) should be considered. Testing for H. pylori is especially effective in patients at risk for peptic ulcer disease: those with recurrent complaints, and those with a history of peptic ulcer, without typical reflux symptoms or those with a history ofpeptic ulcer. Short term empirical treatment with a proton pump inhibitor is especially effective in patients with typical reflux symptoms. Endoscopy is the only way to rule out malignancy, and should be used to solve serious diagnostic uncertainty in patient or physician. The only indication for continuous proton pump inhibitor treatment is severe oesophagitis. All other patients with less severe reflux disease should preferably be treated on either on demand or intermittent basis. Long term proton pump inhibitor treatment is not indicated for patients with peptic ulcer disease or functional dyspepsia.

Objective: To determine the value of successful trial therapy with proton-pump inhibitors (PPIs) as a diagnostic test for gastro-oesophageal reflux disease (GERD)., Design: Systematic review and meta-analysis., Method: Studies were included in which the clinical response to a short course (1-4 weeks) of PPI therapy could be related to abnormal results of 24-hr pH monitoring, gastroscopy, and/or diagnostic questionnaires. The sensitivity and specificity of the trial therapy were calculated. The ROC method was used to summarize the test characteristics across studies., Results: With 24-hr pH monitoring as the reference standard, the positive likelihood ratio of the diagnosis 'reflux disease' ranged from 1.63 to 1.87 and the combined estimates of sensitivity and specificity in the various studies were 0.78 (95% CI: 0.66-0.86) and 0.54 (0.44-0.65), respectively. These values were lower with the other reference standards., Conclusion: Although there were insufficient data to determine the effect of varying dosages of PPIs and duration of therapy on the test characteristics, successful short-term treatment with PPIs in patients suspected of having GERD provides insufficient certainty as to the diagnosis.

Supported by the Dutch Institute for Health Care Improvement (CBO), a committee consisting of rheumatologists, general practitioners, gastroenterohepatologists, hospital pharmacists and a health-economist have developed a national evidence-based guideline for the prevention of gastric damage by non-steroidal anti-inflammatory drugs (NSAIDs). The goal of the guideline is to reduce the number of gastric ulcers with perforation or bleeding as a consequence of NSAID use. It is estimated that 165 patients died as a result of these complications in the year 2000. The guideline comprises chapters on the risk factors for ulceration during NSAID use, the effectiveness and relative toxicity of different NSAIDs for the stomach, the effectiveness of various treatments meant to reduce the risk of gastro-duodenal damage, and the management of dyspeptic symptoms during NSAID use. A strategy is recommended in which prescription of NSAIDs is always preceded by an assessment of the degree to which the risk of gastric damage is increased: the most important risk factors that need to be identified are previous peptic ulcer disease, age over 70 years, and an untreated Helicobacter pylori infection associated with peptic ulcer disease. Whenever an increased risk of gastro-duodenal damage is present, the prescribing physician can choose one of three preventive strategies: addition of misoprostol, addition of a proton-pump inhibitor, or the prescription of a COX-2-selective NSAID. Provided that adequate risk assessment has been carried out, the guideline leaves it to the patient and physician to choose which of these preventive measures, all of which result in roughly equal risk reduction and costs, is the most suitable for individual situations. The use of aspirin or a coumarin derivative increases the risk; several preventive strategies are possible; the guideline discusses the situation that arises when NSAIDs are added to the treatment.