Background: Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital... Show moreBackground: Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA.Methods: Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as >= 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain).Results: In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT >= 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with >= 12 weeks of postoperative PT (range Odds Ratios 0.97-0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01-1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations.Conclusion: Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients' needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities. Show less
Multigenerational toxicity tests provide more sensitive measures of population-level effects than conventional single-generation tests. Particularly for stressors which exhibit slow uptake rates (e... Show moreMultigenerational toxicity tests provide more sensitive measures of population-level effects than conventional single-generation tests. Particularly for stressors which exhibit slow uptake rates (e.g. nanomaterials), multigenerational tests may also provide a more realistic representation of natural exposure scenarios. To date, the inherently high costs and labor intensity have however limited the use of multigenerational toxicity tests and thereby their incorporation in environmental risk assessment. The aim of the present study was therefore to determine to what extent short(er) term endpoints which are conventionally measured in Daphnia magna toxicity tests hold predictive capacity towards reproduction measured over longer timescales, including multiple generations. To assess this, a case-study was performed in which effects of TiO2 nanoparticles (0, 0.02, 0.2, 2 and 5 mg L−1) on D. magna life-history traits were assessed over five generations. Additionally, it was determined whether offspring derived from exposed parents exhibited sustained adverse effects when rearing them in clean (non-exposed) media after each generation of exposure. The present study showed that although various life-history traits correlate with the total reproductive output in the same- and subsequent generation under non-exposed conditions, these correlations were decoupled in presence of exposure to nTiO2. In addition, it was found that nTiO2 can induce adverse effects on population relevant endpoints at concentrations 1–2 orders of magnitude lower than previously found (i.e. 0.02 mg L−1), and close to the range of concentrations occurring in natural freshwater ecosystems. Show less
The current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall... Show moreThe current dissertation aims to assess the well-being of Emergency Department (ED) nurses and identify (combinations of) job factors related to this. Second, it aims to evaluate the overall effectiveness and effective elements of an intervention implementation project conducted in multiple EDs in the Netherlands. Findings show a high prevalence of stress-related outcomes in ED nurses, but also high levels of work engagement and job satisfaction. Worktime demands and aggression/conflict situations have the strongest relationship with exhaustion, whilst work engagement is mostly related to developmental opportunities. Recovery during and outside of work can buffer the impact of patient-related stressful situations. According to a literature review, interventions can effectively prevent/reduce stress-related outcomes in nurses, with person-directed interventions reaching greater short-term effects. Little is known about their longevity and only a limited number of organization-directed studies exist. The current 2,5-year (mostly organization-directed) intervention project, led to improved working conditions but not (yet) to better well-being. Greater effects were found in hospitals with more fitting interventions and were employees felt more informed about and involved in the project. Psychosocial safety climate was positively related to communication, participation and the fit of actions to the risk factors, and as such provides a good starting point for a successful intervention project. Show less
Background: Factors such as age, pre-injury health, and injury severity, account for less than 35% of outcome variability in traumatic brain injury (TBI). While some residual outcome variability... Show moreBackground: Factors such as age, pre-injury health, and injury severity, account for less than 35% of outcome variability in traumatic brain injury (TBI). While some residual outcome variability may be attributable to genetic factors, published candidate gene association studies have often been underpowered and subject to publication bias. Methods: We performed the first genome-and transcriptome-wide association studies (GWAS, TWAS) of genetic effects on outcome in TBI. The study population consisted of 5268 patients from prospective European and US studies, who attended hospital within 24 h of TBI, and satisfied local protocols for computed tomography. Findings: The estimated heritability of TBI outcome was 0.26. GWAS revealed no genetic variants with genome-wide significance (p < 5 x 10(-8)), but identified 83 variants in 13 independent loci which met a lower pre-specified sub-genomic statistical threshold (p < 10(-5)). Similarly, none of the genes tested in TWAS met tissue-wide significance. An exploratory analysis of 75 published candidate variants associated with 28 genes revealed one replicable variant (rs1800450 in the MBL2 gene) which retained significance after correction for multiple comparison (p = 5.24 x 10(-4). Interpretation: While multiple novel loci reached less stringent thresholds, none achieved genome-wide significance. The overall heritability estimate, however, is consistent with the hypothesis that common genetic variation substantially contributes to inter-individual variability in TBI outcome. The meta-analytic approach to the GWAS and the availability of summary data allows for a continuous extension with additional cohorts as data becomes available. Show less
Dalmaijer, E.; Leeuwen, M. van; Putte, E. van de 2021
The aim of this article is to show what a linguistic-stylistic approach can offer for the study of correlations between language use and well-being, in which quantitative and qualitative analysis... Show moreThe aim of this article is to show what a linguistic-stylistic approach can offer for the study of correlations between language use and well-being, in which quantitative and qualitative analysis go hand in hand. As a case study, we investigate whether there are differences in the language used by recovered and non-recovered adolescents who followed the online FitNet treatment for chronic fatique syndrome (CFS). More specifically, we analyzed whether there are differences between both groups in their use of five linguistic means that hide agency. Our results indicate that this is the case indeed: non-recovered patients used these linguistic means more often than recovered patients. In addition, both patient groups show a different development during the therapy: while non-recovered patients increased their use of these stylistic phenomena during the treatment, recovered patients decreased their use of these same phenomena. As such, our study shows that there is indeed a correlation between the use of certain formulations in the language used by patients with CFS and (a change in) their well-being. It is argued that the linguistic means that we investigated, could not have been analysed with a purely computational approach, and that a linguistic-stylistic approach is thus of added value for studying correlations between language use and recovery. Show less
Purpose This study aims to explore the perspectives of mental health professionals who are in a process of integrating their own experiential knowledge in their professional role. This study... Show morePurpose This study aims to explore the perspectives of mental health professionals who are in a process of integrating their own experiential knowledge in their professional role. This study considers implications for identity, dilemmas and challenges within the broader organization, when bringing experiential knowledge to practice. Design/methodology/approach As part of a participatory action research approach, qualitative methods have been used, such as in-depth interviews, discussions and observations during training and project team. Findings The actual use of experiential knowledge by mental health care professionals in their work affected four levels: their personal-professional development; the relation with service users; the relation with colleagues; and their position in the organization. Research limitations/implications Because of its limited context, this study may lack generalisability and further research with regard to psychologists and psychiatrists, as well as perceptions from users, is desirable. Social implications According to this study, social change starts from a bottom-up movement and synchronously should be facilitated by top-down policy. A dialogue with academic mental health professionals seems crucial to integrate this source of knowledge. Active collaboration with peer workers and supervisors is desired as well. Originality/value Professionals with lived experiences play an important role in working recovery-oriented, demonstrating bravery and resilience. Having dealt with mental health distress, they risked stigma and rejections when introducing this as a type of knowledge in current mental health service culture. Next to trainings to facilitate the personal-professional process, investments in the entire organization are needed to transform governance, policy and ethics. Show less
When disaster strikes, urban planners often rely on feedback and guidance from committees of officials, residents, and interest groups when crafting reconstruction policy. Focusing on recovery... Show moreWhen disaster strikes, urban planners often rely on feedback and guidance from committees of officials, residents, and interest groups when crafting reconstruction policy. Focusing on recovery planning committees after Japan's 2011 earthquake, tsunami, and nuclear disasters, we compile and analyze a dataset on committee membership patterns across 39 committees with 657 members. Using descriptive statistics and social network analysis, we examine 1) how community representation through membership varied among committees, and 2) in what ways did committees share members, interlinking members from certain interests groups. This study finds that community representation varies considerably among committees, negatively related to the prevalence of experts, bureaucrats, and business interests. Committee membership overlap occurred heavily along geographic boundaries, bridged by engineers and government officials. Engineers and government bureaucrats also tend to be connected to more members of the committee network than community representatives, giving them prized positions to disseminate ideas about best practices in recovery. This study underscores the importance of diversity and community representation in disaster recovery planning to facilitate equal participation, information access, and policy implementation across communities. Show less
Sijp, M.P.L. van der; Moonen, L.; Schipper, I.B.; Krijnen, P.; Pre, K.J. du; Niggebrugge, A.H.P. 2020
Introduction: Hip fractures are the most common fractures amongst frail older patients. Earlier studies have indicated an impaired hip flexion strength in patients with fractures that include... Show moreIntroduction: Hip fractures are the most common fractures amongst frail older patients. Earlier studies have indicated an impaired hip flexion strength in patients with fractures that include detachment of the lesser trochanter. These patients may experience protracted functional impairment and longer recovery time, causing prolonged rehabilitation journeys. This study aimed to evaluate the effects of a detached lesser trochanter in trochanteric fractures on the recovery of hip function.Method: A prospective observational cohort study was performed between 2016 and 2019. Community dwelling patients aged 70 years or older with AO 31A1-A3 trochanteric fractures were included. Patients followed routine care and were treated with a DHS or PFNA. The groups with and without involvement of the lesser trochanter were analysed. The primary outcome was hip function assessed at 6 weeks, 3 months and 1 year after surgery with the Harris Hip Score. Secondary outcomes included the Ludloff's test, complications, rehabilitation time, and pain-, independence-, and quality of life scores. A propensity score was used to adjust for any baseline differences between the two groups.Results: A total of 114 patients were included, 51 (44.7%) with involvement of the lesser trochanter and 63 (55.3%) without. Minor differences were observed in the baseline characteristics. No significant difference was observed for the Harris Hip Score (coefficient estimate: 3.31; 95% CI, -5.09-11.72; P = 0.43). The flexion function of the iliopsoas muscle was more often normal with the Ludloff's test in patients without involvement of the lesser trochanter (OR, 2.33; 95% CI, 1.241-4.387; P = 0.009). However, no differences were observed for any of the other secondary outcomes.Conclusion: Although no differences in overall hip function were found, more hip fracture patients with involvement of the lesser trochanter showed prolonged impaired flexion of the hip. The absence of longterm, clinically relevant disadvantages however, proves fixing the lesser trochanter to be redundant. (C) 2020 Elsevier Ltd. All rights reserved. Show less
The main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: 1. The clinical course of acute abdominal pain and risks of pain... Show moreThe main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: 1. The clinical course of acute abdominal pain and risks of pain persistence. 2. The clinical course of chronic pelvic pain (CPP) and predictors of recovery. 3. The moderating and /or mediating factors of sexual functioning. 4. The reliability of videotaped compared to real-time laparoscopic findings. Results show that pain persisted in 30% of women after an acute episode of abdominal pain. A low education level and an abuse history at a younger age were risks for chronicity. Recovery from pain was observed in 20% to 25% of women with CPP. Only a decrease in catastrophizing pain was associated with an improvement in pain and adjustment. Women with CPP reported more sexual problems than pain free controls. Anxiety and depression moderated sexual problems, while sexual abuse was a non-specific predictor. Finally, the evaluations of videotaped laparoscopies to score endometriosis were reliable, apart from ovarian lesions. In case of adhesions such evaluations were inconsistent. Main conclusion: CPP in women has to be considered as a chronic pain condition in general. A model to assess women with CPP and facilitate pain management is suggested. Show less
The elucidation of the molecular and cellular mechanisms of ischemic ARF very important in finding new strategies to reduce or prevent renal injury. FAK is an important FA protein with tyrosine... Show moreThe elucidation of the molecular and cellular mechanisms of ischemic ARF very important in finding new strategies to reduce or prevent renal injury. FAK is an important FA protein with tyrosine kinase and scaffolding function. The general goal of this thesis was to investigate the role of FAK during I/R. Using a unilateral renal I/R rat model, we show the presence of tyrosine phosphorylated FAs in vivo and disruption of FAs and the F-actin network after ischemia and rebuild during reperfusion. FAK phosphorylation occured on different tyrosine residues during the reperfusion implicating a role of FAK. ERK is known to be involved in FA signaling. We studied the role of ERK signaling pathway during I/R in vivo using the inhibitor U0126. Inhibition prevented the changes in FA protein phosphorylation after ischemia and diminished injury. We used an inducible proximal tubule cell specific FAK knockout model to investigate the role of FAK in I/R. We show that FAK knockout mice are less susceptible to I/R injury compared to their wildtype littermates. Furthermore we studied FAK signaling under normal and ATP depletion in vitro. FAK deleted renal cells show no differences in morphology. However FAK knockout cells have increased FAs, aberrant stress fibers and impaired spreading. During recovery from ATP depletion, FAK deleted cells show impaired recovery of FAs and stress fibers. Show less
De relatie tussen psychosociale stress en hart- en vaatziekten is intensief onderzocht. In de afgelopen decennia was het ‘reactivity model’ het belangrijkste theoretische uitgangspunt in de meeste... Show moreDe relatie tussen psychosociale stress en hart- en vaatziekten is intensief onderzocht. In de afgelopen decennia was het ‘reactivity model’ het belangrijkste theoretische uitgangspunt in de meeste onderzoeken. In dit model wordt verondersteld dat een heftige reactie van hart- en vaatstelsel tijdens stress een risicofactor zou zijn voor het ontwikkelen van hart- en vaatziekten. Hoewel het ‘reactivity model’ in het dieronderzoek veelbelovende resultaten boekte, ondervond vanwege resultaten uit humaan onderzoek een aantal fundamentele kritieken. Het brandpunt ligt bij momenten waarop een stressvolle gebeurtenis plaatsvindt, terwijl de periode daarvoor of daarna over het hoofd wordt gezien. Stressoren zijn gewoonlijk kort van duur en doen zich bij de meeste mensen niet frequent genoeg voor om consequenties voor de gezondheid te hebben. Deze factoren kunnen dus niet verklaren waarom chronische veranderingen in de balans van het hart- en vaatsysteem optreden. Een alternatief model dat wij voorstellen in dit proefschrift - het ‘prolonged activation model’- gaat er vanuit dat stressoren alleen kunnen leiden tot hart- en vaatziekten als ze in staat zijn verlengde fysiologische effecten te veroorzaken. Daarnaast is het onduidelijk waarom sommige stressoren wel verlengde effecten tot gevolg hebben en anderen niet. Tot nu toe verklaart het ‘perseverative cognition model’, als enige waarom sommige stressoren leiden tot verlengde effecten en anderen niet. Perseveratieve cognitie is het voortdurend denken aan negatieve gebeurtenissen en omvat fenomenen zoals piekeren of zich zorgen maken. Perseveratieve cognitie zorgt voor het ‘vers’ houden van het mentale beeld van een stressor alsmede de negatieve fysiologische effecten ervan, of deze stressor nu wel of niet plaatsvindt. Daarom bestaat een groot deel van dit proefschrift uit onderzoek naar de effecten van perseveratieve cognitie op hartactiviteit. We concluderen dat de resultaten van dit proefschrift aangeven dat perseveratieve cognitie, een belangrijke factor is in het ‘prolonged activation model’. Het verklaart niet alle verlengde effecten van stressoren, maar heeft daarentegen zelf een verlengd fysiologisch effect, dat zelfs langer lijkt dan dat van stressoren. Deze vondst en de effecten van 'piekergeneigdheid' op hartactiviteit gedurende de slaap suggereren dat onderzoek in de toekomst gericht zou moeten worden op de rol van onbewuste perseveratieve cognitie. Show less
