BackgroundThis study assesses the incidence of gastrointestinal symptoms in the first year after resection of esophageal or gastric cancer and its association with health-related quality of life ... Show moreBackgroundThis study assesses the incidence of gastrointestinal symptoms in the first year after resection of esophageal or gastric cancer and its association with health-related quality of life (HRQoL), functioning, work productivity, and daily activities.Patients and MethodsPatients diagnosed with esophageal or gastric cancer between 2015 and 2021, who underwent a resection, and completed & GE; 2 questionnaires from the time intervals prior to resection and 0-3, 3-6, 6-9, and 9-12 months after resection were included. Multivariable generalized linear mixed models were used to assess changes in gastrointestinal symptoms over time and the impact of the number of gastrointestinal symptoms on HRQoL, functioning, work productivity, and daily activities for patients who underwent an esophagectomy or gastrectomy separately.ResultsThe study population consisted of 961 (78.8%) and 259 (21.2%) patients who underwent an esophagectomy and gastrectomy, respectively. For both groups, the majority of gastrointestinal symptoms changed significantly over time. Most clinically relevant differences were observed 0-3 after resection compared with prior to resection and included increased diarrhea, appetite loss, and eating restrictions, and specifically after esophagectomy dry mouth, trouble with coughing, and trouble talking. At 9-12 after resection one or more severe gastrointestinal symptoms were reported by 38.9% after esophagectomy and 33.7% after gastrectomy. A higher number of gastrointestinal symptoms was associated with poorer functioning, lower HRQoL, higher impairment in daily activities, and lower work productivity.ConclusionsThis study shows that gastrointestinal symptoms are frequently observed and burdensome after esophagectomy or gastrectomy, highlighting the importance to address these sequelae for high quality survivorship. Show less
Background: It is unclear to what extent mental health and negative life events (NLEs) contribute to weight change in patients with overweight. This study aimed to evaluate the association of... Show moreBackground: It is unclear to what extent mental health and negative life events (NLEs) contribute to weight change in patients with overweight. This study aimed to evaluate the association of anxiety, depression, NLEs and quality of life (QoL) with weight change over ten years in middle-aged individuals with overweight.Methods: Population-based cohort study of 2889 middle-aged men and women with a body mass index ≥27 kg/m2. Relative weight change over ten years was defined as weight loss (≤- 5 %), stable weight (between >- 5 % and <5 %) or weight gain (≥5 %). At baseline, participants reported anxiety symptoms, depressive symptoms, recent (last year) and distant (lifetime) NLEs, and a mental component summary of QoL. With multinomial logistic regression adjusting for potential confounding, we examined the association of mental health and NLEs with weight change after a median (25th, 75th percentiles) follow-up of 9.7 (9.0-10.5) years.Results: In 51 % participants weight was stable, 33 % participants lost weight and 17 % gained weight. Mild (odds ratio 1.36; 95 % confidence interval 1.05-1.75), and moderate to very severe depressive symptoms (1.43; 0.97-2.12) and four or more distant NLEs (1.35; 1.10-1.67) were associated with weight gain. Anxiety symptoms, the mental component summary of QoL were not associated with either weight gain or weight loss.Limitations: Due to the observational design residual confounding cannot be excluded.Conclusion: Our study suggests that depressive symptoms or having experienced distant NLEs are associated with weight gain over time in middle-aged individuals with overweight. These subgroups might benefit from proactive attention from their health care providers.Keywords: Body weight changes; Life change events; Longitudinal study; Mental health; Overweight. Show less
BackgroundIt is unclear to what extent mental health and negative life events (NLEs) contribute to weight changein patients with overweight. This study aimed to evaluate the association of anxiety... Show moreBackgroundIt is unclear to what extent mental health and negative life events (NLEs) contribute to weight changein patients with overweight. This study aimed to evaluate the association of anxiety, depression, NLEs and quality of life (QoL) with weight change over ten years in middle-aged individuals with overweight.MethodsPopulation-based cohort study of 2889 middle-aged men and women with a body mass index ≥27 kg/m2. Relative weight change over ten years was defined as weight loss (≤− 5 %), stable weight (between >− 5 % and <5 %) or weight gain (≥5 %). At baseline, participants reported anxiety symptoms, depressive symptoms, recent (last year) and distant (lifetime) NLEs, and a mental component summary of QoL. With multinomial logistic regression adjusting for potential confounding, we examined the association of mental health and NLEs with weight change after a median (25th, 75th percentiles) follow-up of 9.7 (9.0–10.5) years.ResultsIn 51 % participants weight was stable, 33 % participants lost weight and 17 % gained weight. Mild (odds ratio 1.36; 95 % confidence interval 1.05–1.75), and moderate to very severe depressive symptoms (1.43; 0.97–2.12) and four or more distant NLEs (1.35; 1.10–1.67) were associated with weight gain. Anxiety symptoms, the mental component summary of QoL were not associated with either weight gain or weight loss.LimitationsDue to the observational design residual confounding cannot be excluded.ConclusionOur study suggests that depressive symptoms or having experienced distant NLEs are associated with weight gain over time in middle-aged individuals with overweight. These subgroups might benefit from proactive attention from their health care providers. Show less
Zhang, C.; Adriaanse, M.A.; Potgieter, R.; Tummers, L.; Wit, J. de; Broersen, J.; ... ; Aarts, H. 2022
Background: Since the outbreak of the COVID-19 pandemic, physical distancing and hand washing have been used as effective means to reduce virus transmission in the Netherlands. However, these... Show moreBackground: Since the outbreak of the COVID-19 pandemic, physical distancing and hand washing have been used as effective means to reduce virus transmission in the Netherlands. However, these measures pose a societal challenge as they require people to change their customary behaviours in various contexts. The science of habit formation is potentially useful for informing policy-making in public health, but the current literature largely overlooked the role of habit in predicting and explaining these preventive behaviours. Our research aimed to describe habit formation processes of physical distancing and hand washing and to estimate the influences of habit strength and intention on behavioural adherence. Methods: A longitudinal survey was conducted between July and November 2020 on a representative Dutch sample (n = 800). Respondents reported their intentions, habit strengths, and adherence regarding six context-specific preventive behaviours on a weekly basis. Temporal developments of the measured variables were visualized, quantified, and mapped onto five distinct phases of the pandemic. Regression models were used to test the effects of intention, habit strength, and their interaction on behavioural adherence. Results: Dutch respondents generally had strong intentions to adhere to all preventive measures and their adherence rates were between 70% and 90%. They also self-reported to experience their behaviours as more automatic over time, and this increasing trend in habit strength was more evident for physical-distancing than for hand washing behaviours. For all six behaviours, both intention and habit strength predicted subsequent adherence (all ps < 2e-16). In addition, the predictive power of intention decreased over time and was weaker for respondents with strong habits for physical distancing when visiting supermarkets (B = -0.63, p <.0001) and having guests at home (B = -0.54, p <.0001) in the later phases of the study, but not for hand washing. Conclusions: People's adaptations to physical-distancing and hand washing measures involve both intentional and habitual processes. For public health management, our findings highlight the importance of using contextual cues to promote habit formation, especially for maintaining physical-distancing practices. For habit theories, our study provides a unique dataset that covers multiple health behaviours in a critical real-world setting. Show less
Background: Mismatch between need and mental healthcare (MHC) use (under-and overuse) has mainly been studied with cross-sectional designs, not accurately capturing patterns of persistence or... Show moreBackground: Mismatch between need and mental healthcare (MHC) use (under-and overuse) has mainly been studied with cross-sectional designs, not accurately capturing patterns of persistence or change in clinical burden and MHC-use among persons with depressive and/or anxiety disorders. Aims: Determining and describing [mis]match of longitudinal trajectories of clinical burden and MHC-use. Methods: Six-year longitudinal burden and MHC-use data came from the Netherlands Study of Depression and Anxiety (n=2981). The sample was split into four subgroups: I) no clinical burden but constant MHC use, II) constant clinical burden but no MHC-use, III) changing clinical burden and MHC-use, and IV) healthy non-users. Within subgroups I)-III), specific clinical burden and MHC trajectories were identified (growth mixture modeling). The resulting classes' associations with predisposing, enabling, and need factors were investigated (regression analysis). Results: Subgroups I-III revealed different trajectories. I) increasing MHC without burden (4.1%). II) slightly increasing (1.9%), strongly increasing (2.4%), and decreasing (9.5%) burden without MHC. III) increasing (41.4%) or decreasing (19.4%) burden and concurrently increasing MHC use (first underuse, then matched care), thus revealing delayed MHC-use. Only having suicidal ideation (p<.001, Cohen's d=.6-1.5) was a significant determinant of being in latter classes compared to underusers (strongly increasing burden without MHC-use). Limitations: More explanatory factors are needed to explain [mis]match. Conclusion: Mismatch occurred as constant underuse or as delayed MHC-use in a high-income country (Netherlands). Additionally, no meaningful class revealed constantly matched care on average. Presence of suicidal ideation could influence the probability of symptomatic individuals receiving matched MHC or not. Show less
This dissertation focuses on the overall study, as well as the nuances, of bullying behaviours among school-going youth in India. A systematic review of past literature from India is presented by... Show moreThis dissertation focuses on the overall study, as well as the nuances, of bullying behaviours among school-going youth in India. A systematic review of past literature from India is presented by synthesizing 37 empirical studies examining psychometric properties of the instruments adopted, methodological characteristics, sample size and procedures, and characteristics of bullying behaviour. Results show that bullying is widely spread, and certain factors, like caste and religion, and their association with bullying behaviours are typical to the Indian culture. This dissertation also examines if dimensions of psychopathy, namely callous-unemotional traits, narcissism, and impulsivity, can differentiate between, bullies, victims, and bully-victims in a longitudinal capacity. Using a multi-informant approach and multinomial logistic regression analyses, it was found that psychopathy dimensions taken together provide a better fit in predicting bullying than the independent psychopathic subscales. The dissertation further investigates the structure and context of the relationship between victimization and Body Mass Index through a transactional model. Key results of structural equation modeling analyses yielded mainly concurrent relations between BMI and victimization, emphasizing that results from western countries may not generalize to India. Finally, bullying behaviours among youth as a function of their socio-economic status (SES) in classroom and self-perceptions of minority status are examined using a moderated-mediation growth model. Results show classroom level SES plays a significant role in predicting victimization cross-sectionally, and is mediated through perceptions of self. However, in the long run, being part of a minority, and perceiving self as such, leads to decreased victimization among youth in India. Show less
Self-regulation refers to the ability to deliberately control one’s affect and behavior to meet certain standards such as customs, norms and social expectations, and to pursue long-term goals (Kopp... Show moreSelf-regulation refers to the ability to deliberately control one’s affect and behavior to meet certain standards such as customs, norms and social expectations, and to pursue long-term goals (Kopp, 1982). Problems with self-regulation can result in significant personal as well as social problems such as substance addiction (e.g., drugs, alcohol and cigarettes), health problems (e.g., obesity and eating disorders), violence and crime (e.g., Baumeister et al., 2015; Hirschi, 2004; Johnson et al., 2012). Self-regulation emerges in early infancy and increases dramatically in later infancy and toddlerhood. This process has been described as the development from external regulation depending on caregivers to independent self-regulation (Calkins, 2002). During this transition, both infant factors (e.g., infant attention) and social factors (e.g., parental behaviors) contribute to the development of self-regulation (e.g., Bernier et al., 2010; Miyake et al., 2000). As mother-infant and father-infant relationships provide different experiences for infants, the parental impact on self-regulation may also differ between mothers and fathers (e.g., Braungart‐Rieker et al., 1998; Feldman et al., 2003). Yet, most parenting and infant research has focused on mothers, whereas fathers – and other family members with a caregiving role – are rarely investigated. Moreover, empirical studies of parenting and infant development have largely been restricted to North America and Western Europe (e.g., Bornstein, 2015; Tomlinson et al., 2014). As some evidence shows that the association between parental behaviors and the process of infant development is dependent on country and the associated cultural context (e.g., Deater- Deckard et al., 2011; Landford et al., 2016), it is also important to carry out research in non-Western countries to understand the generalizability of theories built in Western contexts and primarily rooted in Western tradition to non-Western populations. China—a non-Western country—has the world’s largest population, with traditions of multigenerational co-residence (including grandparents). However, few empirical studies have focused on grandparenting, parenting and child development. The current dissertation longitudinally investigated the parental role in infant self-regulation during the first two years of life in the Netherlands and China, and also specifically focused on the role of grandparents in China. Show less
Empathy enables people to share, understand, and show concern for others' emotions. However, this capacity may be more difficult to acquire for children with hearing loss, due to limited social... Show moreEmpathy enables people to share, understand, and show concern for others' emotions. However, this capacity may be more difficult to acquire for children with hearing loss, due to limited social access, and the effect of hearing on empathic maturation has been unexplored. This four-wave longitudinal study investigated the development of empathy in children with and without hearing loss, and how this development is associated with early symptoms of psychopathology. Seventy-one children with hearing loss and cochlear implants (CI), and 272 typically-hearing (TH) children, participated (aged 1-5 years at Time 1). Parents rated their children's empathic skills (affective empathy, attention to others' emotions, prosocial actions, and emotion acknowledgment) and psychopathological symptoms (internalizing and externalizing behaviors). Children with CI and TH children were rated similarly on most of the empathic skills. Yet, fewer prosocial actions were reported in children with CI than in TH children. In both groups, affective empathy decreased with age, while prosocial actions and emotion acknowledgment increased with age and stabilized when children entered primary schools. Attention to emotions increased with age in children with CI, yet remained stable in TH children. Moreover, higher levels of affective empathy, lower levels of emotion acknowledgment, and a larger increase in attention to emotions over time were associated with more psychopathological symptoms in both groups. These findings highlight the importance of social access from which children with CI can learn to process others' emotions more adaptively. Notably, interventions for psychopathology that tackle empathic responses may be beneficial for both groups, alike. Show less
Souwer, E.T.D.; Oerlemans, S.; Poll-Franse, L.V. van de; Erning, F.N. van; Bos, F. van den; Schuijtemaker, J.S.; ... ; Maas, H.A.A. 2019
The aim of this thesis was to explore the neuromechanics of recovery of arm-hand function after stroke. A literature review revealed six articles that measured biomechanical and electromyographical... Show moreThe aim of this thesis was to explore the neuromechanics of recovery of arm-hand function after stroke. A literature review revealed six articles that measured biomechanical and electromyographical outcome measures simultaneously, while applying active and passive tasks and multiple movement velocities to separate neural and non-neural contributors to movement disorders after stroke. Therefore, a neuromechanic assessment protocol was developed. Parameters were responsive to clinical status and had good to excellent test-retest reliability. Selective muscle activation was assessed with high measurement reliability and was significantly lower in chronic stroke patients compared to healthy participants. Longitudinally, neuromechanical parameters were combined with data on arm-hand function at six months after stroke. Paresis and diminished modulation of reflexes were associated with poor functional outcome. Changes in tissue properties were represented by a shift in wrist rest angle towards flexion and decline in passive range of motion. Increase in active range of motion and steady rest angle contributed most to prediction of functional outcome. The precision diagnostics provided by a neuromechanical assessment protocol could support clinical decision making and should be used in prediction models and as biomarkers in recovery of arm-hand function after stroke, for example by improving the selection of time-window and patients. Show less
Children and adolescents with Autism Spectrum Disorder (ASD) often show comorbid emotional and behavior problems. The aim of this longitudinal study is to examine the relation between emotion... Show moreChildren and adolescents with Autism Spectrum Disorder (ASD) often show comorbid emotional and behavior problems. The aim of this longitudinal study is to examine the relation between emotion control (i.e., negative emotionality, emotion awareness, and worry/rumination) and the development of internalizing and externalizing problems. Boys with and without ASD (N = 157; age 9–15) were followed over a period of 1.5 years (3 waves). We found that baseline levels of worry/rumination was a specific predictor of later externalizing problems for boys with ASD. Furthermore, the developmental trajectory of worry/rumination predicted the development of internalizing and externalizing problems in both groups. Our findings suggest that worry/rumination may constitute a transdiagnostic factor underlying both internalizing and externalizing problems in boys with and without ASD. Show less
Recently, infants younger than 2 years have been shown to display correct expectations of the actions of an agent with a false belief. The developmental trajectory of these early-developing... Show moreRecently, infants younger than 2 years have been shown to display correct expectations of the actions of an agent with a false belief. The developmental trajectory of these early-developing abilities and their robustness, however, remain a matter of debate. Here, we tested children longitudinally from 2 to 4 years of age with an established anticipatory looking false belief task, and found a significant developmental change between the ages of 3 and 4 years. Children anticipated correctly only by the age of 4 years, and performed at chance at the ages of 2 and 3 years. Moreover, we found correct anticipation only when the agent falsely believed an object to be in its last rather than a previous location. These findings point towards the fragility of early belief-related action anticipation before the age of 4 years, when children start passing traditional false belief tasks. Show less
In a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments... Show moreIn a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments at base-line, after three months, and at one-year follow-up were performed with the Anxiety Disorders Interview Schedule. When we compared cortisol levels at baseline and one-year follow-up, persistence of the anxiety disorder was associated with both increased daytime cortisol production (F = 3.2, p = 0.04) and a trend towards a decreased cortisol morning rise (F = 2.4, p = 0.09). At one-year follow-up daytime cor-tisol production was lowest in the early remitters (109.7 ± 29.2 h mmol/l), higher in the late remitters (121.0 ± 40.0 h mmol/l) and highest in the non-remitters (131.1 ± 48.9 h mmol/l). Early remitters had the highest cortisol morning rise (1.1 ± 1.5 h mmol/l), followed by the late remitters (0.8 ± 1.8 h mmol/l), the non-remitters had the lowest cortisol morning rise (0.07 ± 1.7 h mmol/l). Persistence of an anxiety disorder may thus lead to changes in HPA-axis functioning, underscoring the importance adequate treatment of anxiety disorders. Show less
The aim of the present PhD thesis was: (a) to test the statistical properties and the generalizability of two rating systems that combine both the categorical and dimensional approach, measuring... Show moreThe aim of the present PhD thesis was: (a) to test the statistical properties and the generalizability of two rating systems that combine both the categorical and dimensional approach, measuring some of the major childhood psychiatric disorders and a two dimensional non-disruptive construct of the psychopathic syndrome respectively, and (b) to apply this approach in the daily clinical and educational practice. For that reason two studies were carried out: a cross-sectional study, where 2.132 parents/caregivers of pre-pubertal children aged 4-12 years old were recruited randomly from the general population of the Netherlands and Greece and a longitudinal study, in which the parents and teachers of 89 children attending a special education school in the Netherlands were followed up for two years. The findings of the present thesis are relevant for the discussion regarding the development of the DSM-V system, as well as they add to the evidence base of the treatment of developmental disorders and specifically for autism. A rating scale combining both approaches can promote early assessment of children at high risk in the general population as well as it can give a better understanding regarding the development of several disorders among clinical populations, so that optimal treatment strategies are planned. Show less
