Predicting the spread of covid-19 and the impact of government measures at the early stage of the pandemic: The Dutch case-Stricter but short-term measures are better.

In this paper, we investigate the spread of COVID-19 and the impact of government measures at the early stage of the pandemic (before the introduction of the vaccines) in the Netherlands. We build a multiple linear regression model to predict the effective reproduction rate using key factors and measures and integrate it with a system dynamics model to predict the spread and the impact of measures against COVID-19. Data from February to November 2020 is used to train the model and data until December 2020 is used to validate the model. We use data about the key factors, e.g., disease specific such as basic reproduction rate and incubation period, weather related factors such as temperature, and controllable factors such as testing capacity. We consider particularly the following measures taken by the government: wearing facemasks, event allowance, school closure, catering services closure, and self-quarantine. Studying the strategy of the Dutch government, we control these measures by following four main policies: doing nothing, mitigation, curbing, elimination. We develop a systems dynamic model to simulate the effect of policies. Based on our numerical experiments, we develop the following main insights: It is more effective to implement strict, sharp measures earlier but for a shorter duration than to introduce measures gradually for a longer duration. This way, we can prevent a quick rise in the number of infected cases but also to reduce the number of days under measures. Combining the measures with a high testing capacity and with effective self-quarantine can significantly reduce the spread of COVID-19.

A randomised cross-over trial investigating the ease of use and preference of two dry powder inhalers in patients with asthma or chronic obstructive pulmonary disease.

OBJECTIVES: The objective of this randomised, cross-over study was to compare a new single-dose dry powder inhaler (Elpenhaler (EH)), with a widely used, multi-dose dry powder inhaler (Diskus (DK)) on critical errors, patient preference, and satisfaction with the inhalers. METHODS: First, patients read the instructions of one device, followed by a first inhalation attempt. Inhalation errors were assessed and if mistakes were made, correct inhaler use was demonstrated. Then patients had to demonstrate again and mistakes were registered. This was repeated up to four times. After completing the first device, the same procedure was started with the second inhaler. Primary outcome was the percentage of patients making at least one critical error after reading the insert. Secondary outcomes were inhaler preference and satisfaction with the inhalers. RESULTS: After reading the insert, 19 of 113 patients (17%) made at least one critical error with DK and 40 (35%) with EH (p = 0.001); 73% preferred the DK and 27% the EH (p < 0.001). The mean overall satisfaction score (1 = very satisfied; 5 = very dissatisfied) for DK was 1.59 and for EH 2.48 (p < 0.001). CONCLUSION: With DK fewer errors were made, more patients preferred DK over EH and patients were more satisfied with DK. This may enable DK to improve treatment outcomes more than EH.

The use of video clips in teleconsultation for preschool children with movement disorders.

PURPOSE: To investigate the reliability and validity of video clips in assessing movement disorders in preschool children. METHODS: The study group included 27 children with neuromotor concerns. The explorative validity group included children with motor problems (n = 21) or with typical development (n = 9). Hempel screening was used for live observation of the child, full recording, and short video clips. The explorative study tested the validity of the clinical classifications "typical" or "suspect." RESULTS: Agreement between live observation and the full recording was almost perfect; Agreement for the clinical classification "typical" or "suspect" was substantial. Agreement between the full recording and short video clips was substantial to moderate. The explorative validity study, based on short video clips and the presence of a neuromotor developmental disorder, showed substantial agreement. CONCLUSION: Hempel screening enables reliable and valid observation of video clips, but further research is necessary to demonstrate the predictive value.

A systematic and critical review of the evolving methods and applications of value of information in academia and practice.

OBJECTIVE: This article provides a systematic and critical review of the evolving methods and applications of value of information (VOI) in academia and practice and discusses where future research needs to be directed. METHODS: Published VOI studies were identified by conducting a computerized search on Scopus and ISI Web of Science from 1980 until December 2011 using pre-specified search terms. Only full-text papers that outlined and discussed VOI methods for medical decision making, and studies that applied VOI and explicitly discussed the results with a view to informing healthcare decision makers, were included. The included papers were divided into methodological and applied papers, based on the aim of the study. RESULTS: A total of 118 papers were included of which 50 % (n = 59) are methodological. A rapidly accumulating literature base on VOI from 1999 onwards for methodological papers and from 2005 onwards for applied papers is observed. Expected value of sample information (EVSI) is the preferred method of VOI to inform decision making regarding specific future studies, but real-life applications of EVSI remain scarce. Methodological challenges to VOI are numerous and include the high computational demands, dealing with non-linear models and interdependency between parameters, estimations of effective time horizons and patient populations, and structural uncertainties. CONCLUSION: VOI analysis receives increasing attention in both the methodological and the applied literature bases, but challenges to applying VOI in real-life decision making remain. For many technical and methodological challenges to VOI analytic solutions have been proposed in the literature, including leaner methods for VOI. Further research should also focus on the needs of decision makers regarding VOI.

Histological type is not an independent prognostic factor for the risk pattern of breast cancer recurrences.

Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC) and appears to have a distinct biology. Inconsistent findings regarding disease-free survival (DFS) are probably due to the fact that histologic type is related to hormone receptor status. This study aims to determine whether the type of the primary breast cancer histology is an independent prognostic factor for DFS, the risk pattern of loco-regional recurrences and distant metastases (DM), and whether it is a prognostic factor for the site of DM. All Dutch women diagnosed between 2003 and 2005 with ILC (n = 2,949) or IDC (n = 22,378) were selected from the Netherlands Cancer Registry. DFS was assessed using proportional hazard regression analysis. Compared to patients with IDC, those with ILC were significantly older and more likely to have more than three positive lymph nodes and have larger, better differentiated, more multifocal, and hormone receptor positive tumors (all P < 0.001). ILC was more likely to metastasize to the gastrointestinal organs and bones and less likely to the lung, central nervous system, and lymph nodes. Within the ER+PR+ and ER+PR- subgroups ILC was still more likely to metastasize to gastrointestinal organs and less likely to the lung. The timing of recurrence was correlated to hormone receptor status, independent of histological type. Highest risks were observed among ER-PR- patients within 2 years of surgery. Multivariable analysis showed that histological type is not an independent significant prognostic factor of DFS for the first 3 years post-surgery and thereafter (<3 years HR 0.91, 95 % CI 0.78-1.06, >3 years HR 1.07, 95 % CI 0.88-1.30). Histological type should not be considered an important prognostic factor for the risk and risk pattern of recurrences.

Daily physical activity of patients with the chronic fatigue syndrome: a systematic review.

OBJECTIVE: To give an overview of the physical activity level of patients with chronic fatigue syndrome in comparison with asymptomatic controls. DATA SOURCES: MEDLINE, Web of Science, EMBASE, PsycINFO, Picarta, the Cochrane Controlled Trial Register that is included in the Cochrane Library and reference tracking. REVIEW METHODS: A systematic literature search was conducted focusing on studies concerning physical activity levels of patients with chronic fatigue syndrome compared to controls. A meta-analysis was performed to pool data of the studies. RESULTS: Seventeen studies were included with 22 different comparisons between patients with chronic fatigue syndrome and controls. Fourteen studies, including 18 comparisons, showed lower physical activity levels in patients with chronic fatigue syndrome as compared to controls. Four studies, including four comparisons, showed no differences between both groups. The meta-analysis included seven studies and showed a daily physical activity level in patients with chronic fatigue syndrome of only 68% of the physical activity level observed in control subjects. The pooled mean coefficient of variation in patients with chronic fatigue syndrome was higher as compared to control subjects (34.3% versus 31.5%), but this difference did not reach significance. CONCLUSION: Patients with chronic fatigue syndrome appear to be less physically active compared with asymptomatic controls. There is no difference in variation of physical activity levels between patients with chronic fatigue syndrome and healthy control subjects, but the validity and reliability of some methods of measuring physical activity is questionable or unknown.

Back muscle activation patterns in chronic low back pain during walking: a "guarding" hypothesis.

OBJECTIVES: To investigate whether patients with chronic low back pain (CLBP) show "guarded" movements during walking. It is hypothesized that guarding will be reflected by increased lumbar muscle activity during all periods of stride and secondary, relatively lesser relaxation during periods of swing compared with double support. Furthermore, it is hypothesized that higher levels of perceived fear and disability are related to increased muscle activity and less relative relaxation. MATERIALS AND METHODS: In a cross-sectional study 63 patients with CLBP and 33 healthy controls walked on a treadmill at 3.8 km/h. Surface electromyography (sEMG) data of the erector spinae were obtained and smoothed rectified sEMG (SRE) values were calculated per period of swing and double support. The ratio of SRE values in swing to double support was used as a measure of relative relaxation (SRE ratio). In addition, the relationship between SRE values, the Roland Morris Disability Questionnaire, and the Tampa Scale for Kinesiophobia was analyzed in patients with CLBP. RESULTS: Mean SRE values were significantly higher in patients with CLBP than in controls both during periods of double support and swing. SRE ratios were not significantly different between groups. Results showed no influence of disability or fear of movement on either SRE values or ratios. DISCUSSION: In patients with CLBP, increased lumbar muscle activity during all periods of stride, with comparable alteration between swing and double support, suggests difficulties with total muscle relaxation. On the basis of this evaluation, it is concluded that patients with CLBP show a guarding mechanism during walking. No relationship is found between perceived fear, disability, and muscle activity.

Multidisciplinary rehabilitation treatment of patients with chronic low back pain: a prognostic model for its outcome.

OBJECTIVES: (1) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and (2) to explore the value of potentially prognostic factors further. METHODS: Data were derived from a randomized controlled trial on the effect of a multidisciplinary rehabilitation program for chronic low back pain compared with usual care. The primary outcome measure was the Roland and Morris Disability Questionnaire and secondary outcomes were the Physical and Mental Component Summary Scales, derived from the Short Form Health Survey. Outcomes were expressed as the differences between baseline and follow-up (8 wk and 6 mo) values. A confirmatory and an exploratory model were defined. Baseline predictors included in the confirmatory model were pain intensity, work status, and Multidimensional Pain Inventory subgroup membership. The exploratory model included sick leave, compensation, depression, and fear-avoidance beliefs. Statistical analysis was performed using multiple linear regression analysis. RESULTS: One hundred and sixty-three patients participated in the study. More pain was prognostic for more improvement in the rehabilitation group. No value was found for work status or the Multidimensional Pain Inventory subgroups. For the exploratory model, more depression and fear-avoidance beliefs predicted more improvement after rehabilitation. The explained variance ranged from 18.5% to 43.8% depending on the length of follow-up evaluation, the treatment group, and the outcome variable of interest. DISCUSSION: The results of this study do not support the construction of a clinical prediction model. Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors.

Preference-based measure of social participation from the Handicap Scale for Children.

OBJECTIVE: To establish a model that estimates a preference-based measure (valuation) of social participation for children between 8 and 18 years of age from the Handicap Scale for Children (HSC), a validated questionnaire for children with a chronic illness. METHODS: Vignettes of the HSC classification system were valued by a representative sample of 249 persons aged 18 years onwards. Linear and nominal scale (mixed-effects) models were used to analyze the valuations of the vignettes. RESULTS: We established a model that performed better than a model that simply sums up the levels of each dimension. CONCLUSION: We obtained a measure that can be used for assessing need, for quality assurance and for evaluating interventions on a group level aiming to increase social participation in children with chronic illnesses.

The role of the fear-avoidance model in female workers with neck-shoulder pain related to computer work.

OBJECTIVE: This study explores the fear-avoidance model in a sample of women with neck-shoulder pain related to computer work who were still functioning at the workplace. Exploring this model in this population could produce starting points for new treatment approaches in occupational health. METHODS: Fifty-eight women with work-related neck-shoulder pain and 45 healthy controls were included. Differences in components of the fear-avoidance model between cases and controls were computed using t tests. In addition, correlations were calculated and structural equation modeling techniques were performed to investigate the fear-avoidance model in the case group. RESULTS: In line with the fear-avoidance model, cases had lower performance levels and felt significantly more disabled compared with their controls but showed, in contrast to the model, significantly lower levels of catastrophizing thoughts. Of the fear-avoidance beliefs measures, all correlations were significant except, between catastrophizing and fear of movement. Fear-avoidance beliefs about work seem to play an important role in disability levels of work-related neck-shoulder pain patients as illustrated by the high(est) association with disabilities. The results of the present study also showed that the original fear-avoidance model proposed in people with work-related neck-shoulder pain who are still functioning at the workplace could only be confirmed by 1 of the 3 fit indices. Interestingly, adding an extrapath between fear-avoidance beliefs and disability in the original model approached good model fit as shown by all 3 fit indices. DISCUSSION: In line with the fear-avoidance model, the current results addressed the importance of pain-related fear in people with neck-shoulder pain disability related to computer work. Interestingly, and not in accordance with the fear-avoidance model, fear-avoidance beliefs directly influence disability levels in the current sample; regardless of lower levels of performance that is, physical impairment.

Comparison of electric stimulation methods for reduction of triceps surae spasticity in spinal cord injury.

OBJECTIVES: To compare the effect of 3 methods of electric stimulation to reduce spasticity of the triceps surae in patients with complete spinal cord injury (SCI) and to investigate the carryover effect. DESIGN: Placebo-controlled study with repeated measurements after the interventions. SETTING: Research department affiliated with a rehabilitation hospital in the Netherlands. PARTICIPANTS: Ten patients with a complete SCI were recruited from the outpatient population of the rehabilitation hospital. All subjects had American Spinal Injury Association grade A impairment scores, except for one, who had grade C. The patients had no voluntary triceps surae contractibility. INTERVENTIONS: Forty-five minutes of cyclic electric stimulation of the agonist, antagonist, or dermatome of the triceps surae or a placebo approach. MAIN OUTCOME MEASURES: Outcome measures were the Modified Ashworth Scale (MAS), clonus score, and the H-reflex and M wave (H/M) ratio. The electromyographic response to a stretch of the soleus over the whole range of motion was also determined. The magnitude and ankle angle at which the electromyographic response started were calculated. RESULTS: Stimulation of the agonist provided a significant reduction in the MAS compared with the placebo approach (P<.001). There was no significant change in the H/M ratio or the electromyographic response amplitude after any of the stimulation methods, whereas stimulation of the antagonist muscle resulted in a significant reduction in the ankle angle at which the electromyographic response started, compared with the placebo approach (P<.037). CONCLUSIONS: Triceps surae stimulation reduces the MAS for that specific muscle, whereas the angle at which the reflex starts changes after antagonist stimulation.

Use of orthopedic shoes in patients with degenerative disorders of the foot.

OBJECTIVES: To study the actual use of orthopedic shoes by patients with degenerative foot disorders and to identify factors associated with use and nonuse, based on the parameters of the International Organization for Standardization definition of usability: effectiveness, efficiency, satisfaction, and context of use. DESIGN: Multicenter, prospective cohort study. SETTING: Outpatient clinics of 7 rehabilitation centers in the Netherlands. PARTICIPANTS: One hundred consecutive patients with degenerative foot disorders. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Usability was assessed by means of the Questionnaire for Usability Evaluation of orthopedic shoes. RESULTS: Seventy of 93 patients with degenerative foot disorders wore their orthopedic shoes for more than 3 days a week after 3 months of follow-up. Factors significantly associated with the actual use of orthopedic shoes were (1) increase in stance duration (effectiveness odds ratio [OR]=2.14; 95% confidence interval [CI], 1.19-3.85), (2) decrease in skin abnormalities (effectiveness OR=1.35; 95% CI, 1.02-1.8]), (3) problems experienced with putting on and taking off orthopedic shoes (efficiency OR=.46; 95% CI, .26-.82), and (4) cosmetic appearance of orthopedic shoes (satisfaction OR=1.54; 95% CI, 1.1-2.15). The overall fit of the multiple logistic regression model ( R 2 ) was 56.3%. CONCLUSIONS: By adding efficiency and satisfaction factors and not focusing only on the effectiveness factors, the amount of explained variance increases, and it becomes possible to evaluate and design products for people with special needs more comprehensively.