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The Lifestyle Monitor (LSM) was launched in 2013 on behalf of the Ministry of Health, Welfare and Sports to reorganize the multiple data collections in the field of lifestyle and health in the Netherlands. The reorganization should enhance the efficiency and coherence of the lifestyle and health data collections and should provide unambiguous figures for policymakers. This article describes the background and content (including the lifestyle-themes) of the LSM and the tasks and roles of the collaborating parties involved. The measurement methods used and requirements for data requests are described as well. Finally, some examples of figures and trends over the period 2014-2020 to underpin the health policy are described.

Background Since its formal introduction in 2019, PrEP uptake in the Netherlands is growing, but remains at suboptimal levels. Hence, the analysis of determinants is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called ‘Randstad’, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional discrepancies is necessary. We seek to unravel regional differences jointly with known predictors of PrEP use, intention and awareness. Method This cross-sectional study included 3,232 HIV-negative Dutch MSM recruited via the EMIS survey in late 2017. Prevalence and standardized prevalence ratio (SPR) of PrEP use, awareness and intention were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modeling was conducted to identify the association of PrEP use with PrEP awareness and intention, sociodemographic, behavioral, psychological/cognitive determinants, and random effects from regional differences. Results MSM from Randstad used more PrEP (SPR=1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance (adjusted ICC=0.046). Greater influence from intention to use (OR=4.5, 95%CI 2.0–10.1) and knowledge of PrEP (OR=7.0, 95%CI 4.1–12.0), while limited influence from the awareness of PrEP was observed (OR=0.4, 95%CI 0.04–4.4). Lower education (OR=0.4, 95%CI 0.2–0.9) was negatively associated with PrEP use, however, no significant difference was found between middle and high education (OR=1.2, 95%CI 0.7- 2.0). Conclusion We showed that regional differences – MSM in non-urban regions – and with a low educational background account for lower PrEP use and intention. Based on these findings more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

This systematic review and meta-analysis determined the association between aspirated after ovarian stimulation and top/good quality embryos obtained in women undergoing ovarian stimulation for IVF/intracytoplasmic sperm injection (ICSI). MEDLINE, EMBASE, Scopus, CINAHL and Web of Science were searched for English-language publications on top/good-quality embryos at cleavage (day 2/3) and/or blastocyst (day 5/6) developmental stages, up to 18 November 2017. Twenty-eight studies (three prospective and 25 retrospective) reporting data on 291,752 assisted reproductive technology (ART) cycles were considered eligible. We confirmed a strong positive association between oocytes retrieved and top/good-quality day 2/3 embryos (weighted correlation coefficient [rw] = 0.791), day 5/6 embryos (rw = 0.901), metaphase II oocytes (rw = 0.988), oocytes exhibiting two pronuclei (rw = 0.987) and euploid embryos (rw = 0.851); P < 0.001 for all correlations (evaluated in subsets of the 17 studies). Data from 5657 cycles showed that the group with the most oocytes aspirated had the most top/good-quality day 2/3 embryos (pooled standardized mean differences (high [>15] versus low [

PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called “Randstad”, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0–10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04–4.4). Lower education (aOR = 0.4, 95% CI 0.2–0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7–2.0) and high education. We showed that regional differences—MSM in non-urban regions—and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

Background Reducing the number of new acute hepatitis B virus (HBV) infections to zero by 2022 is an important goal in the Netherlands. Free HBV vaccination is available for population groups at higher risk of infection, including men who have sex with men (MSM). Identifying correlates of HBV vaccination among MSM can guide the development of health promotion interventions to increase coverage of HBV vaccination. Methods: We assessed factors associated with the HBV vaccination status of 4270 MSM in the Netherlands. Data were collected through the 2018 online Men & Sexuality survey. Results: Multinomial regression analysis showed that lower education level, having never tested for HIV, not recently diagnosed with a sexually transmissible infection, recently having had sex abroad and unknown HBV testing status were associated with higher odds of being unvaccinated as opposed to fully vaccinated. Living in Amsterdam and testing HBV negative were associated with lower odds of being unvaccinated as opposed to fully vaccinated. Age (25–39 years vs younger ages), living in Amsterdam and using pre-exposure prophylaxis decreased the odds to be partly vaccinated as opposed to fully vaccinated; having a migration background increased these odds. Conclusions: HBV vaccination rates among MSM will not reduce HBV transmission to zero. HBV promotion should focus on MSM outside of Amsterdam who are likely less connected with sexual health services and may be at lower (perceived) risk. The factors identified related to HBV vaccination status provide guidance for health promotion interventions to increase uptake and vaccination completion among MSM.

Background Of newly diagnosed HIV positive men who have sex with men (MSM) in the Netherlands, 29% have a non-Western migration background (MSM-NW). Among MSM-NW, HIV positivity rates are high (0.8%-2.0%), as is the proportion of late stage infections (39%). Factors such as HIV and sexual orientation–related stigma may form barriers for timely testing. Innovative approaches for HIV testing are needed to better reach MSM-NW. Social network testing (SNT) for HIV is an evidence-supported approach where peer recruiters identify persons (network associates) who could benefit from testing in their social or sexual networks. Web-supported SNT might be particularly promising for reaching people who may not be reached by regular care. Objective The purpose of this paper is to describe the design of our pilot PREVENT (Peer-Empowered Voluntary Extended Network Testing). In this pilot, we will explore whether SNT using HIV self-tests is feasible and acceptable among MSM-NW in the Netherlands and whether it reaches those who were never or not recently tested for HIV (>1 year ago). Methods The project aims to include 50 to 60 MSM and MSM-NW peers who will distribute 4 to 5 oral HIV self-tests each aiming to reach 200 network associates (NAs). Enrollment of peers includes 4 steps: (1) fostering interest in becoming a peer by health care professionals at sexual health clinics, HIV treatment clinics, and community settings; (2) sending peer contact information to the peer coordinator; (3) registering peers and giving program instructions by the peer coordinator and referring to the Web-based training at time2test; and (4) receiving precoded HIV self-tests for distribution in the peers’ networks. NAs who receive the self-test will log in with their test package code in the time2test application for step-by-step test instructions. After testing is complete, NAs receive tailored follow-up information depending on their test result. Results Between January and May 2019, 10 STI clinics and 7 HIV treatment clinics started recruiting peers. Results of the PREVENT pilot are expected in December 2020. Conclusions This is the first Web-supported peer-driven SNT pilot using HIV self-tests in the Netherlands and one of the first in Europe. Implementation is considered successful if it reaches MSM-NW who were never or not recently tested for HIV. Additionally, it may encourage conversations within the networks about risk behavior and barriers to HIV testing, potentially contributing to the Joint United Nations Programme on HIV/AIDS goal of zero HIV infections. Trial Registration Netherlands Trial Registry NL7424; https://www.trialregister.nl/trial/7424 International Registered Report Identifier (IRRID) DERR1-10.2196/14743

Background Placental anomalies (placenta praevia, placental abruption, morbidly adherent placenta and cord insertion anomalies) are associated with maternal and fetal morbidity and mortality. It has been suggested these might be more prevalent in pregnancies after assisted reproduction technology (ART). Objectives To determine whether ART singleton pregnancies are associated with an increased risk of placental anomalies compared with non-ART singleton pregnancies. Search strategy MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus (January 2018). Selection criteria Cohort studies reporting placental anomalies in ART and non-ART singleton pregnancies. Data collection and analysis We report pooled odds ratios (OR) for the comparisons: (1) ART versus SC (spontaneously conceived), (2) ART versus non-ART (unspecified), (3) FET-ART (frozen-embryo transfer) versus SC, (4) ART versus non-ART (subfertile patients). Study quality was assessed using a modified Newcastle -Ottawa scale. Main results 33 low/moderate quality studies evaluated 124 215 ART and 6 054 729 non-ART singleton pregnancies. Risk of placenta praevia, placental abruption and morbidly adherent placenta was higher in ART than SC pregnancies: odds ratio (OR) (OR 3.76, 95% CI 3.09-4.59); (OR 1.87, 95% CI 1.70-2.06) and (OR 2.27, 95% CI 1.79-2.87) respectively. Risk of placenta praevia and placental abruption was higher in ART than in non-ART (subfertile patients): (OR 2.51, 95% CI 2.12-2.98) and (OR 1.61, 95% CI 1.33-1.95) respectively. Results were similar when comparing ART with unspecified non-ART pregnancies. Risk of placenta praevia was higher, but not significantly so, in FET-ART than in SC pregnancies (OR 2.42, 95% CI 0.63-9.30). Conclusions Singleton ART pregnancies are associated with an increased risk of placental anomalies compared with non-ART singleton pregnancies. Tweetable abstract A review of over 6 million singleton pregnancies finds increased risk of placental anomalies after ART.

Background The number of private and online providers of STI tests is increasing in the Netherlands. The autonomy and accessibility of online self-testing may contribute to timely diagnosis, lower healthcare costs and shorter waiting lists at STI clinics. But ill-informed self-testing can also lead to underdiagnosis and insufficient partnermanagement of STIs. To improve linkage to high quality private testing providers the online advice application Advies.chat was launched in 2017. We assessed process indicators for the successful implementation of this online advice instrument in 2018. Methods The application generates tailored advices based on clinical guidelines. The questionnaire takes into account personal characteristics, sexual behaviour, sexual risks and symptoms. The advice refers to STI testing providers if testing is indicated and explains which specific STIs need to be tested for. All test advices refer to GP’s and the specific diagnostic tests offered by selected online testing providers. Key populations (MSM, sex workers and young people Results Advies. chat was visited 337,736 times in 2018; 113,257 visitors started the questionnaire, 17,449 the chatbot. Visits increased on Sundays, peaked on Mondays and decreased during the week. The most indicated reason for using Advies.chat was the ‘possibility of being STI or HIV infected’ (75%). Around 60% finished the questionnaire, leading to 65,736 advices and 8,700 clicks to online self-test providers. Conclusion Online self-management tools can play a keyrole in improving the quality of the growing online STI testing market. Advies.chat shows that online triage and tailored advice is feasible and increases traffic to quality testing providers. The contribution of Advies.chat to the estimated 430,000 consultations at GP’s and STI clinics in the Netherlands is sizable. Methods need to be developed to assess the impact of online self-management and self-testing on STI control. Disclosure No significant relationships.

Placental anomalies (placenta praevia, placental abruption, morbidly adherent placenta and cord insertion anomalies) are associated with maternal and fetal morbidity and mortality. It has been suggested these might be more prevalent in pregnancies after assisted reproduction technology (ART).To determine whether ART singleton pregnancies are associated with an increased risk of placental anomalies compared with non-ART singleton pregnancies.MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus (January 2018).Cohort studies reporting placental anomalies in ART and non-ART singleton pregnancies.We report pooled odds ratios (OR) for the comparisons: (1) ART versus SC (spontaneously conceived), (2) ART versus non-ART (unspecified), (3) FET-ART (frozen-embryo transfer) versus SC, (4) ART versus non-ART (subfertile patients). Study quality was assessed using a modified Newcastle -Ottawa scale.33 low/moderate quality studies evaluated 124 215 ART and 6 054 729 non-ART singleton pregnancies. Risk of placenta praevia, placental abruption and morbidly adherent placenta was higher in ART than SC pregnancies: odds ratio (OR) (OR 3.76, 95% CI 3.09-4.59); (OR 1.87, 95% CI 1.70-2.06) and (OR 2.27, 95% CI 1.79-2.87) respectively. Risk of placenta praevia and placental abruption was higher in ART than in non-ART (subfertile patients): (OR 2.51, 95% CI 2.12-2.98) and (OR 1.61, 95% CI 1.33-1.95) respectively. Results were similar when comparing ART with unspecified non-ART pregnancies. Risk of placenta praevia was higher, but not significantly so, in FET-ART than in SC pregnancies (OR 2.42, 95% CI 0.63-9.30).Singleton ART pregnancies are associated with an increased risk of placental anomalies compared with non-ART singleton pregnancies.A review of over 6 million singleton pregnancies finds increased risk of placental anomalies after ART.

Samenvatting Dit onderzoek beschrijft verschillen naar seksuele oriëntatie in de mate waarin jongeren zich wenden tot ouders, vrienden en internet bij vragen of problemen over seks en in het zoeken van seksueel expliciete beelden en seksuele contacten via internet. Daartoe vulden 4707 jongeren van 17 tot en met 24 jaar een digitale vragenlijst in met vragen over seksuele communicatie en aan seksualiteit gerelateerd internetgebruik. Ouders en vrienden spelen voor homo-, bi- en heteroseksuele jongeren een vergelijkbare rol. Er bestaan wel verschillen in het geslacht van de ouder of vriend die wordt geraadpleegd en de onderwerpen die worden besproken. Internet speelt een belangrijke rol voor homo- en biseksuele jongeren, bijvoorbeeld voor het praten over problemen en voor het zoeken van relatie- en sekspartners. In de hulpverlening en preventie dient rekening te worden gehouden met deze belangrijke en tweezijdige rol van internet voor homo- en biseksuele jongeren. De mogelijkheden van internet moeten worden versterkt en benut, waarbij jongeren ook bewust gemaakt moeten worden van de risico’s.