Comparing antibiotic prescriptions in primary care between SARS-CoV-2 and influenza: a retrospective observational study.

BACKGROUND: Antibiotics are frequently prescribed during viral respiratory infection episodes in primary care. There is limited information about antibiotic prescription during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in primary care and its association with risk factors for an adverse course. AIM: To compare the proportion of antibiotic prescriptions between patients with COVID-19 and influenza or influenza-like symptoms, and to assess the association between antibiotic prescriptions and risk factors for an adverse course of COVID-19. DESIGN & SETTING: An observational cohort study using pseudonymised and coded routine healthcare data extracted from 85 primary care practices in the Netherlands. METHOD: Adult patients with influenza and influenza-like symptoms were included from the 2017 influenza season to the 2020 season. Adult patients with suspected or confirmed COVID-19 were included from the first (15 February 2020-1 August 2020) and second (1 August 2020-1 January 2021) SARS-CoV-2 waves. Proportions of antibiotic prescriptions were calculated for influenza and COVID-19 patients. Odds ratios (ORs) were used to compare the associations of antibiotic prescriptions in COVID-19 patients with risk factors, hospital admission, intensive care unit (ICU) admission, and mortality. RESULTS: The proportion of antibiotic prescriptions during the first SARS-CoV-2 wave was lower than during the 2020 influenza season (9.6% versus 20.7%), difference 11.1% (95% confidence interval [CI] = 8.7 to 13.5). During the second SARS-CoV-2 wave, antibiotic prescriptions were associated with being aged ≥70 years (OR 2.05; 95% CI = 1.43 to 2.93), the number of comorbidities (OR 1.46; 95% CI = 1.18 to 1.82), and admission to hospital (OR 3.19; 95% CI = 2.02 to 5.03) or ICU (OR 4.64; 95% CI = 2.02 to 10.62). CONCLUSION: Antibiotic prescription was less common during the SARS-CoV-2 pandemic than during influenza seasons, and was associated with an adverse course and its risk factors. The findings suggest a relatively targeted prescription policy of antibiotics in primary care during COVID-19.

Binnensporten tijdens de COVID-19-pandemie: analyse met behulp van data uit de COVID RADAR app Indoor sporting during the COVID-19 pandemic: analysis with data from the COVID RADAR app

Samenvatting Binnensportaccommodaties werden langer gesloten gehouden dan buitensportaccommodaties gedurende de lockdowns tijdens de COVID-19-pandemie. Dit onderzoek beantwoordt de vraag of binnen sporten het risico op besmetting met SARS-CoV‑2 vergroot. Hiervoor werden gegevens gebruikt van de COVID RADAR-app. Er werd gecorrigeerd voor leeftijd, vaccinatiestatus, geslacht, ander risicogedrag, prevalentie van SARS-CoV‑2 en kwaliteit van de leefomgeving. Uit analyses van 1.353 gebruikers, van wie 13,0% een positieve testuitslag rapporteerde, blijkt dat binnensporters significant vaker een positieve test hadden (oddsratio 1,8;95%-betrouwbaarheidsinterval 1,2–2,6;p = 0,003) ten opzichte van gebruikers die buiten sporten. Dit bevestigt de rationale achter het eerdere beleid ten aanzien van het langer gesloten houden van binnensportaccommodaties om het aantal besmettingen te reduceren. Digitaal aanvullende content De online versie van dit artikel (10.1007/s12508-022-00351-0) bevat aanvullend materiaal, toegankelijk voor daartoe geautoriseerde gebruikers.

[Indoor sporting during the COVID-19 pandemic: analysis with data from the COVID RADAR app]. / Binnensporten tijdens de COVID-19-pandemie: analyse met behulp van data uit de COVID RADAR app.

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-CoV­2. 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-CoV­2 prevalence and quality of living environment. Analyzing data from 1,353 users, 13.1% of which reported a positive SARS-CoV­2 test, we found that exercising indoors leads to an odds ratio of 1.8 with a positive SARS-CoV­2 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.

[Changes in perceived food insecurity and eating behavior in the Netherlands since the COVID-19-crisis]. / Veranderingen in ervaren voedselzekerheid en eetgedrag in Nederland sinds de COVID-19-uitbraak.

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 COVID-19 Crisis as a Teachable Moment for Lifestyle Change in Dutch Cardiovascular Disease Patients.

Objective: When lifestyle changes are needed, life events or crises such as COVID-19 may function as "teachable moments". This study aimed to explore whether the pandemic can provoke a teachable moment regarding lifestyle change in cardiovascular disease patients. Method: In this cross-sectional survey study, 830 cardiovascular disease patients reported their intentions to change lifestyle, instigated by the corona crisis, together with risk perception, affective impact, and changed self-concept, based on a "teachable moments" framework. Results: Between 8 and 28% of the sample reported increased intentions to optimize lifestyle behaviors, particularly related to general lifestyle (28%), physical activity (25%), and diet (21%). Multivariate regression analyses revealed that changed self-concept was associated with higher intentions to improve general lifestyle (B = 0.26; CI = 0.19-0.33), physical activity (B = 0.23; CI = 0.16-0.30), and smoking (B = 0.29; CI = 0.01-0.57). In addition, changed self-concept and affective impact were both significantly associated with higher intentions to improve diet (resp. B = 0.29; CI = 0.21-0.36 and B = 0.12; CI = 0.04-0.21) and to limit alcohol consumption (resp. B = 0.22; CI = 0.13-0.30 and B = 0.11; CI = 0.01-0.20). We did not find evidence for an important role of risk perception on behavior change intentions. Conclusion: The COVID-19 crisis evoked a potential teachable moment for lifestyle change in cardiovascular disease patients, driven by a change in a patient's self-concept and to a lesser extent by an affective impact of the COVID-19 crisis. These results suggest an important window of opportunity for healthcare professionals to utilize the pandemic to promote a healthy lifestyle to their patients.

COVID RADAR app: Description and validation of population surveillance of symptoms and behavior in relation to COVID-19.

BACKGROUND: Monitoring of symptoms and behavior may enable prediction of emerging COVID-19 hotspots. The COVID Radar smartphone app, active in the Netherlands, allows users to self-report symptoms, social distancing behaviors, and COVID-19 status daily. The objective of this study is to describe the validation of the COVID Radar. METHODS: COVID Radar users are asked to complete a daily questionnaire consisting of 20 questions assessing their symptoms, social distancing behavior, and COVID-19 status. We describe the internal and external validation of symptoms, behavior, and both user-reported COVID-19 status and state-reported COVID-19 case numbers. RESULTS: Since April 2nd, 2020, over 6 million observations from over 250,000 users have been collected using the COVID Radar app. Almost 2,000 users reported having tested positive for SARS-CoV-2. Amongst users testing positive for SARS-CoV-2, the proportion of observations reporting symptoms was higher than that of the cohort as a whole in the week prior to a positive SARS-CoV-2 test. Likewise, users who tested positive for SARS-CoV-2 showed above average risk social-distancing behavior. Per-capita user-reported SARS-CoV-2 positive tests closely matched government-reported per-capita case counts in provinces with high user engagement. DISCUSSION: The COVID Radar app allows voluntarily self-reporting of COVID-19 related symptoms and social distancing behaviors. Symptoms and risk behavior increase prior to a positive SARS-CoV-2 test, and user-reported case counts match closely with nationally-reported case counts in regions with high user engagement. These results suggest the COVID Radar may be a valid instrument for future surveillance and potential predictive analytics to identify emerging hotspots.

Effect of COVID-19 on health system integration in the Netherlands: a mixed-methods study.

OBJECTIVES: Overcrowding in acute care services gives rise to major problems, such as reduced accessibility and delay in treatment. In order to be able to continue providing high-quality health care, it is important that organizations are well integrated at all organizational levels. The objective of this study was to to gain an understanding in which extent cooperation within an urban acute care network in the Netherlands (The Hague) improved because of the COVID-19 crisis. METHODS: Exploratory mixed-methods questionnaire and qualitative interview study. Semistructured interviews with stakeholders in the acute care network at micro (n = 10), meso (n = 9), and macro (n = 3) levels of organization. Thematic analysis took place along the lines of the 6 dimensions of the Rainbow Model of Integrated Care. RESULTS: In this study we identified themes that may act as barriers or facilitators to cooperation: communication, interaction, trust, leadership, interests, distribution of care, and funding. During the crisis many facilitators were identified at clinical, professional, and system level such as clear agreements about work processes, trust in each other's work, and different stakeholders growing closer together. However, at an organizational and communicative level there were many barriers such as interference in each other's work and a lack of clear policies. CONCLUSION: The driving force behind all changes in integration of acute care organizations in an urban context during the COVID-19 crisis seemed to be a great sense of urgency to cooperate in the shared interest of providing the best patient care. We recommend shifting the postcrisis focus from overcoming the crisis to overcoming cooperative challenges.