Background Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app.

Background: This study aims to quantify medication costs in juvenile idiopathic arthritis (JIA), based on subtype. Research design and methods:This study is a single-center, retrospective analysis of prospective data from electronic medical records of JIA patients, aged 0-18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, subtype) and medication use were extracted. Medication use and costs were reported as: 1) mean total annual costs; 2) between-patient heterogeneity in these costs; 3) duration of medication use; and, 4) costs over the treatment course. Results: The analysis included 691 patients. Mean total medication costs were €2,103/patient/year, including €1,930/patient/year (91.8%) spent on biologicals. Costs varied considerably between subtypes, with polyarticular rheumatoid-factor positive and systemic JIA patients having the highest mean costs (€5,020/patient/year and €4,790/patient/year, respectively). Mean annual medication costs over the patient's treatment course ranged from <€1,000/year (71.1% of patients) to >€11,000/year (2.5% of patients). Etanercept and adalimumab were the most commonly used biologicals. Cost fluctuations over the treatment course were primarily attributable to biological use. Conclusions: Polyarticular rheumatoid-factor positive and systemic JIA patients had the highest mean total annual medication costs, primarily attributable to biologicals. Costs varied considerably between subtypes, individuals, and over the treatment course.

A Digital electronic Coach (eCoach) app was built and evaluated during the Covid-19 pandemic in The Netherlands. Its aim was to provide support for AQ1 individuals that had to either quarantine or self-isolate after a positive corona test or an indication of a heightened risk of infection. The coach ("IsolationCoach"), AQ2 its value and uses were evaluated in 29 semi-structured interviews with individuals who had quarantined or isolated themselves or were part of the general Dutch public. Three main findings emerge. First, participants found value in a digital coach that would help them comply with quarantine or isolation instructions and provided information on the practical challenges of organizing their quarantine or isolation. Second, the usage of the app, which gradually and conditionally provides relevant information as opposed to conventional paper pamphlets/email, was greatly appreciated. Third, participants experienced a need for mental support during their period of isolation or quarantine, and this could at least partially be filled by the eCoach, which provided emotional support through a Socratic method styled form of self-reflection. It was beneficial that the app was implemented rapidly within weeks using a ready-to-use platform and that its content was assessed by experts from various health-related disciplines prior to rollout. Yet, for large-scale implementation, an integrated vision and digital strategy is needed to align forms of support by the health authorities.

BACKGROUND Adoption and evaluation of ICT-based contact tracing tools may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports (HWS) initiated and developed a COVID-19 contact tracing app: CoronaMelder. This app is based on Google/Apple exposure notification approach and aims to combat the spread of the COVID-19 virus among citizens, by notifying citizens who were at increased risk of infection because they were close by someone who was later tested positive for COVID-19. The app should support the traditional contact tracing by quicker tracing and reaching more people than regular contact tracing procedures. OBJECTIVE The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing of Public Health Authorities (PHAs). To achieve this, usability tests were conducted aimed at answering the following question: Is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? METHODS Participants (n=44) with different backgrounds were recruited: young people with a lower or higher level of education, young people with an intellectual disability, migrants, adults (40-64 years) and elderly (65> years) via convenience sampling in the CoronaMelder test region Twente, The Netherlands. The app was evaluated with scenario-based think-aloud usability tests with additional interviews. Findings were recorded via voice recordings, observation notes, the Dutch User Experience Questionnaire (UEQ-Dutch) and some participants wore eye trackers to measure gaze behavior. RESULTS Our results show that the app is easy to use. Yet, problems occurred with understandability and accessibility. Elderly and young people with a lower level of education do not understand why or when they receive notifications, or why they must share the key, and what happens after sharing. Especially young people with a lower level of education did not trust and understand the Bluetooth signals, timing and follow-up activities after risk exposure notification and elderly had difficulties in multitasking (contact with PHAs simultaneously with sharing key in app). PHAs appeared unprepared to be supported by the app in traditional contact tracing, because their telephone conversation protocol lacks guidance, explanation, and empathy. CONCLUSIONS The study indicated that the app is easy to use, but participants have misconceptions about its functioning. The perceived lack of clarity led to misconceptions of the app, mostly regarding its usefulness or privacy-preserving mechanisms. Tailored and target group specified communication, in forms of public campaigns or social media, is necessary to provide correct information about the app to Dutch citizens. Additionally, the app should be presented as part of the package of national corona measures, instead of just as a stand-alone app provided to the public. To succeed, PHA workers should be trained to effectively and empathically instruct users to warn others by using the CoronaMelder app.

polyhydramnion (p=0.0123) is found in PCOS pregnancies, but macrosomy (p=0.110) does not occur more frequently in this group. Conclusions: In view of the results obtained, the presence of PCOS diagnosis affects BMI values, blood pressure, cholesterol and triglyceride levels, and polyhydramnion occurs more frequently. It does not affect the prevalence of GDM, preeclampsia and macrosomia.