Introduction: In addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important... Show moreIntroduction: In addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important endpoints, especially for elderly patients. However, little is known about the long-term effect of surgery with regard to these other outcomes. Our aim is to investigate the functional status and self-reported health status of patients > 70 years one year after surgery for head and neck cancer. Methods: We present one-year follow-up data of patients > 70 year who underwent surgery for HNC. During an interview by telephone, functional status was evaluated by using the Katz-15 Index of Independence questionnaire including six items covering basic Activities of Daily Living (ADL) and nine items covering Instrumental Activities of Daily Living (IADL). Measurements were compared with those obtained preoperatively. Results: In total, 126 patients were included and eventually we collected follow-up data of 68 patients. There was a statistically significant decrease in functional status on the total Katz-15 and on the IADL questionnaire scores one year after surgery (mean 1.34 versus 2.42, p -value 0.00 and mean 1.21 versus 1.94, p- value 0.00). There was no significant change concerning ADL dependence ( p -value 0.18) and cognitive status ( p -value 0.11). The self-reported health status improved postoperatively, although not statistically significantly so (mean 67.36 versus 71.25, p -value 0.12). Conclusion: Approximately-one year after surgery for HNC, there is a significant decline in functional status indicating a higher level of dependency. Show less
Hulst, A.M. van; Verwaaijen, E.J.; Fiocco, M.F.; Pluijm, S.M.F.; Grootenhuis, M.A.; Pieters, R.; ... ; Heuvel-Eibrink, M.M. van den 2021
Background: Dexamethasone, a highly effective drug in treating pediatric acute lymphoblastic leukemia (ALL), can induce serious neurobehavioral side effects. These side effects are experienced by... Show moreBackground: Dexamethasone, a highly effective drug in treating pediatric acute lymphoblastic leukemia (ALL), can induce serious neurobehavioral side effects. These side effects are experienced by patients and parents as detrimental with respect to health related quality of life (HRQoL). Based on previous studies, it has been suggested that neurobehavioral side effects are associated to cortisol depletion of the mineralocorticoid receptor in the brain. Our previously reported randomized controlled trial, the Dexadagen study (NTR3280), suggests that physiological hydrocortisone addition during dexamethasone treatment may overcome clinically relevant neurobehavioral problems in patients who experience these problems during dexamethasone treatment. With our current study, we aim to replicate these results in a targeted larger sample before further implementing this intervention into standard of care.Methods: In a national center setting, pediatric ALL patients between 3 and 18 years are enrolled in an Identification study, which identifies patients with clinically relevant dexamethasone-induced neurobehavioral side effects using the Strengths and Difficulties Questionnaire (SDQ). Contributing factors, such as genetic susceptibility, dexamethasone pharmacokinetics as well as psychosocial and family factors are studied to determine their influence in the inter-patient variability for developing dexamethasone-induced neurobehavioral side effects.Patients with clinically relevant problems (i.e. a rise of >= 5 points on the SDQ Total Difficulties Score after 5 days of dexamethasone) are subsequently included in a randomized double-blind placebo-controlled trial with a cross-over design. They receive two courses placebo followed by two courses hydrocortisone during dexamethasone treatment, or vice versa, each time at least 16 days without study medication in between. The primary endpoint is change in SDQ score. The secondary endpoints are sleep (measured with actigraphy and the Sleep Disturbance Scale for Children) and HRQoL (Pediatric Quality of Life Questionnaire).Discussion: The results of our current study may contribute to the management of future ALL patients who experience dexamethasone-induced neuropsychological problems as it may improve HRQoL for patients who suffer most from dexamethasone-induced neurobehavioral side effects. Furthermore, by investigating multiple risk factors that could be related to inter-patient variability in developing these side effects, we might be able to identify and treat patients who are at risk earlier during treatment. Show less
Hiele, K. van der; Gorp, D.A.M. van; Egmond, E.E.A. van; Jongen, P.J.; Reneman, M.F.; Klink, J.J.L. van der; ... ; Visser, L.H. 2021
Background: Multiple sclerosis (MS) poses a major threat to sustainable employability. Identifying conditions and factors that promote work participation is of great importance. Our objective was... Show moreBackground: Multiple sclerosis (MS) poses a major threat to sustainable employability. Identifying conditions and factors that promote work participation is of great importance. Our objective was to explore the contribution of personality traits in explaining occupational functioning in MS. Methods: 241 participants with relapsing-remitting MS (78% female, median age: 42.0 years, median EDSS: 2.0) and 60 healthy controls (70% female, median age: 45.0 years) underwent neuropsychological and neurological examinations and completed questionnaires. Multivariate logistic and linear regression analyses were conducted to examine relations between personality traits and self-reported occupational functioning, while accounting for known correlates. Results: Personality traits were not associated with self-reported occupational functioning when correcting for known correlates. A higher impact of fatigue (B = -0.05, p = .005 and B = -0.04, p = .009) and depression (B = -0.22, p = .008 and B = -0.21, p = .01) were associated with no paid job (R2 = 0.13) and considering to reduce work hours (R2 = 0.12). A higher impact of fatigue (B = -0.05, p = .008, beta = 0.46, p = .001 and beta = -0.36, p = .001) was associated with absenteeism from work (R2 = 0.15), more presenteeism (R2 = 0.35) and lower work ability (R2 = 0.25). A higher impact of fatigue (beta = 0.46, p = .001) and anxiety (beta = 0.25, p = .001) were associated with more work difficulties (R2 = 0.54). Conclusion: Personality traits did not explain additional variance in self-reported occupational functioning in persons with relapsing-remitting MS with mild disability. The impact of fatigue was the main and most consistent correlate of occupational functioning, often combined with depression or anxiety. Total explained variance of the Show less
The idea that perception is a direct reflection of the outer world has been challenged by the notion that information is integrated at all levels of processing, including perceptual levels. Affect... Show moreThe idea that perception is a direct reflection of the outer world has been challenged by the notion that information is integrated at all levels of processing, including perceptual levels. Affect has been suggested to be a powerful source of information. This thesis explored affective influences on auditory perception and processing and what such influences may imply about penetrability of perception. The presented studies found that listeners in a sad mood more frequently judged ambiguous pitch changes as going downwards than in a happy mood. Furthermore, auditory sensitivity in noise was related to the affective reactivity of the listener, but its relation with mood remained inconclusive and should be further explored. Finally, this thesis demonstrated that evaluative conditioning changed affective quality of sounds without changing low-level stimulus features, which future studies into auditory processing of affective sounds can utilize. Together the findings suggest that aspects of auditory perception are subject to affective influence. This is consistent with the notion that perceptual and non-perceptual information is integrated, allowing listeners to form percepts from often noisy, incomplete, or ambiguous auditory input. The findings provide a basis and stimulation to further investigate where in the brain and through which mechanisms this integration occurs. Show less
Adaptive behavioral control involves a balance between top-down persistence and flexible updating of goals under changing demands. According to the metacontrol state model (MSM), this balance... Show moreAdaptive behavioral control involves a balance between top-down persistence and flexible updating of goals under changing demands. According to the metacontrol state model (MSM), this balance emerges from the interaction between the frontal and the striatal dopaminergic system. The attentional blink (AB) task has been argued to tap into the interaction between persistence and flexibility, as it reflects overpersistence—the too-exclusive allocation of attentional resources to the processing of the first of two consecutive targets. Notably, previous studies are inconclusive about the association between the AB and noninvasive proxies of dopamine including the spontaneous eye blink rate (sEBR), which allegedly assesses striatal dopamine levels. We aimed to substantiate and extend previous attempts to predict individual sizes of the AB in two separate experiments with larger sample sizes (N = 71 & N = 65) by means of noninvasive behavioral and physiological proxies of dopamine (DA), such as sEBR and mood measures, which are likely to reflect striatal dopamine levels, and color discrimination, which has been argued to tap into the frontal dopamine levels. Our findings did not confirm the prediction that AB size covaries with sEBR, mood, or color discrimination. The implications of this inconsistency with previous observations are discussed. Show less
To assess (feasibility) of adherence to treatment guidelines among outpatients with common mental disorders in a routine Dutch clinical outpatient setting for common mental disorders with clinical... Show moreTo assess (feasibility) of adherence to treatment guidelines among outpatients with common mental disorders in a routine Dutch clinical outpatient setting for common mental disorders with clinical treatment data. Also,we studied patient- and therapistfactors influencing guideline-adherence in clinical practice.We established certain characteristics that might hamper tretamnet according to guidelines and more research is needed to assess whether patient in clinical practice do benefit from guidelines. Show less
The studies described in this thesis aimed to investigate how affect and motivation impact cognitive control, in terms of both behavior and brain activation. Six out of the eight empirical studies... Show moreThe studies described in this thesis aimed to investigate how affect and motivation impact cognitive control, in terms of both behavior and brain activation. Six out of the eight empirical studies found support for indirect effects on cognitive control, as measured with sequential trial-to-trial adaptations in cognitive control tasks. Only two studies resulted in evidence for a direct modulation of cognitive control (Chapter 4 and 9). Indirect effects occurred on trial-to-trial adaptation in cognitive control tasks involving a random presentation of compatible and incompatible trials. We found that conflict adaptation, the transient improvement of behavioral control after incompatible in comparison to compatible trials, was subject to affective regulation. In particular, we found that after incompatible trials, positive emotional states reduced and negative emotional states increased adaptation. These effects occurred for both short-term (Chapters 2 and 3) and long-term affect manipulations (Chapters 5, 6, and 7). Motivation and task difficulty also interacted with conflict adaptation (Chapter 8). The neuroimaging studies described in Chapter 3 and 6 demonstrate the role of fronto-striatal interactions in this affective regulation of cognitive control. Taken together, this thesis demonstrates the role that positive and negative emotions play in the adaptation of behavior and mental effort. Show less
