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Understanding Why Certain Patients With Hand and Wrist Conditions Are Dissatisfied Despite Achieving Their Expressed Personal Improvement Goals Anchored at Satisfaction:A Qualitative Study
No full textPURPOSE: The Personal Meaningful Gain (PMG) is a construct identifying a patient's self-defined improvement goal, capturing the individual's threshold to be satisfied with treatment results. Previous research shows that patients who achieve their expressed PMG should be satisfied with their treatment results, but this is not always the case. This study explored the lived experiences of patients who were dissatisfied with their treatment results despite having achieved their expressed PMG.METHODS: We conducted a qualitative study comprising semistructured interviews using Interpretative Phenomenological Analysis. Data were collected in a specialized hand surgery and therapy clinic in the Netherlands. The validated PMG was identified before the initial surgeon consultation and treatment. We interviewed patients who had met their expressed PMG (ie, their goal to become satisfied) but responded as being "very" or "extremely" dissatisfied with their treatment results on a validated questionnaire.RESULTS: We included six patients and identified four main themes. Three themes were directly related to satisfaction with treatment results: (1) the expressed goal was a means to an end (eg, elimination of pain) instead of the true goal (eg, feeling capable to perform activities); (2) disappointment resulting from unexpected, undesirable events; and (3) positive care experiences ameliorate, but do not resolve, dissatisfaction. The fourth theme reflected patients' attempts to cope with dissatisfaction.CONCLUSIONS: Our study shows that, although the PMG is valid and predicts satisfaction, some dissatisfied patients may have expressed a PMG that was only a means to an end. Positive care experiences could ameliorate dissatisfaction, but they rarely resolve it completely. Unexpected and undesirable events, as well as the patient's coping style, influenced satisfaction with treatment results.CLINICAL RELEVANCE: Clinicians should prioritize understanding the patients' actual goals and target factors such as coping and care experiences to improve satisfaction in patients who remain dissatisfied despite achieving their expressed PMG.</p
Deeper into dissociative Amnesia:A perspective from Higher-Order theories of consciousness
No full textMemory is a fundamental brain function relying on complex neurological mechanisms that involve the processes of experiencing, encoding, consolidating and retrieving. A disorder primarily characterized by the loss of (autobiographical) memory owing to stressful or traumatic events is dissociative amnesia, the underlying mechanisms of which are poorly understood and further research is warranted. In this review, we first outline the memory systems and associated brain areas, then introduce the neural suppression pathways of memory retrieval and discuss the neural correlates and influential theoretical models of dissociative amnesia. After reviewing notable consciousness theories, we finally examine dissociative amnesia through the lens of higher-order theories of consciousness. We propose a theoretical model, the metarepresentational system of memory suppression which learns, through self-organizing processes, to downregulate or block access to a negatively colored autobiographical content. More specifically, we hypothesize that dissociative amnesia, primarily addressing some of its selective forms, may emerge from a functional disconnect between first-order representations, located in the neocortex and hippocampus and higher-order representations, the metarepresentations, located in the dorsal anterior cingulate cortex (dACC) and dorsolateral prefrontal cortex (DLPFC) which evaluate and regulate conscious access. Additionally, we discuss that the inhibitory mechanisms in the metarepresentational system are flexible and dynamic and can reverse the suppression given the appropriate conditions, as seen in actual dissociative amnesia cases. Although empirical evidence is needed to support our theory, we suggest that disruptions in conscious access, such as those seen in dissociative amnesia, offer a powerful window into the broader mechanisms of consciousness.</p
Reducing social disparities in child emotional and behavioral problems by hypothetical physical activity and screen time interventions
No full textPurpose: To estimate how social disparities in child psychiatric symptoms might change following hypothetical interventions targeting sports, outdoor play, and screen time at age 10. Methods: We used data from 9,778 children of the Generation R Study, a prospective population-based cohort in Rotterdam, the Netherlands. Social inequality variables included sex, maternal education, and migration background. Primary caregivers filled out the validated Child Behavior Checklist to report on children’s internalizing and externalizing symptoms at the age of 13. The hypothetical interventions (i.e., outdoor play, sports participation, and screen time) were parent-reported at age 10. We used sequential G-estimation to estimate the inequality with and without the hypothetical intervention. Results: Children with migration backgrounds (46.3%) and low maternal education (53.3%) were associated with relatively more internalizing and externalizing symptoms than peers, with disparities of 0.125 and 0.177 standard deviations, respectively. Girls had more internalizing symptoms (0.106 SD), while boys had more externalizing symptoms (0.154 SD). Increasing sports participation reduced disparities in internalizing symptoms linked to maternal education (β = -0.014; 95% CI: -0.024, -0.003), while outdoor play and screen time interventions showed limited effects. None of the hypothetical interventions led to a statistically significant reduction in social disparities in externalizing symptoms. Conclusions: This study underscores the persistence of sex, cultural, and socioeconomic disparities in youth mental health. While sports participation showed a potential effect in reducing disparities in internalizing symptoms, its impact on externalizing symptoms and other interventions was negligible. Future efforts should focus on identifying more effective strategies for addressing these disparities.</p
Serum neurofilament light chain and glial fibrillary acidic protein predicting multiple sclerosis after clinically isolated syndrome
No full textINTRODUCTION: Serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) may synergistically enhance early risk stratification of multiple sclerosis (MS) diagnosis after clinically isolated syndromes (CIS). We investigated the prognostic value of combined NfL and GFAP for McDonald 2024 MS diagnosis after CIS and associations with key genetic and environmental risk factors.METHODS: CIS participants, within six months after symptom onset, were included in a prospective cohort. We measured baseline serum NfL and GFAP levels and calculated z-scores. We evaluated weighted genetic risk scores for MS susceptibility, HLA-DRB1*15:01 risk and measured Anti-Epstein Barr virus Nuclear Antigen-1 (anti-EBNA1) immunoglobulin G (IgG) antibodies. Associations with MS diagnosis were evaluated using Cox proportional hazards models and time-dependent receiver operating characteristic (ROC) analyses.RESULTS: During follow-up, 162/221 CIS participants were diagnosed with McDonald 2024 MS. Separately, high NfL and GFAP associated with earlier MS diagnoses (hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.12-1.66, p = 0.002, HR 1.12, 95% CI 1.02-1.42, p = 0.01, respectively). In combined models, only NfL remained independently predictive (HR 1.30, 95% CI 1.02-1.60, p = 0.01). Time-dependent ROC analyses showed similar results for NfL alone and combined with GFAP. HLA-DRB1*15:01-risk, but not GFAP or anti-EBNA1 IgG, improved predictive value.CONCLUSION: Our study found that serum NfL outperformed GFAP in predicting early MS diagnoses after CIS. Baseline NfL, together with HLA-DRB1*15:01 status, provides robust early risk stratification for MS after CIS, whereas GFAP and anti-EBNA1 titres add limited prognostic value. Additional immunological and imaging markers are essential to further refine predictive models.</p
How can incumbents innovate?:A Study on the Microfoundations of Absorptive Capacity
No full textLarge traditional organizations are often slow to adapt when disruptive innovations reshape their industries. Although they rely on established strengths, they struggle to renew themselves when technological shifts challenge existing organizational forms. This dissertation addresses the fundamental question of how incumbents can innovate by examining the microfoundations of absorptive capacity (AC), the individual and collective behaviors through which firms identify, assimilate, and exploit new knowledge.Drawing on three empirical studies, the dissertation unpacks how employees and leaders interact to shape innovation in established firms. The first study highlights the role of speed in technology adoption, emphasizing constructive tensions, open innovation, and knowledge standardization as key accelerators. The second study investigates how frontline employees navigate goal conflicts, showing that tensions between safety and innovation can stimulate exploratory innovation, whereas conflicts with revenue goals do not. The third study investigates how different forms of power among leaders and employees influence AC, creating either virtuous or vicious cycles of innovation.Together, these studies contribute to a more fine-grained understanding of AC’s microfoundations, demonstrating that innovation in incumbents depends not only on strategy and structure, but also on the daily interactions, goals, and power relations among organizational members. The findings offer both theoretical insights for scholars and practical guidance for managers seeking to strengthen their firms’ AC in the face of disruption.<br/
Trends in use of Attention-Deficit Hyperactivity Disorder medications among children and adults in five European countries, 2010 to 2023:a population-based observational study
No full textBackground: An increase in the use of medications for Attention-Deficit Hyperactivity Disorder (ADHD) has been reported globally. This study aims to estimate the trends of ADHD medications use among children and adults across Europe from 2010 to 2023. Methods: We conducted a population-level observational study using electronic health records from five European countries: Belgium, Germany, the Netherlands, Spain, and the UK. We estimated the prevalence and incidence of methylphenidate, dexamphetamine, lisdexamfetamine, atomoxetine and guanfacine use among individuals aged 3 years and older. We used the proportion of patients covered to measure treatment adherence. All analyses were reported by country and stratified by age group and sex. Findings: The prevalence of ADHD medication use increased across all five countries during the study period. Between 2010 and 2023, prevalence rose more than threefold in the UK (from 0.12% to 0.39%) and more than doubled in the Netherlands (from 0.67% to 1.56%). Adult use increased substantially in all countries, particularly among females. In the UK, prevalence among adults aged over 25 increased from 0.01% in 2010 to approximately 0.20% in 2023, representing a more than twenty-fold increase in females and fifteen-fold in males. Although ADHD medication use remained higher among males, the sex gap in treatment narrowed over time and with increasing age. After 1-year of medication initiation, 14.9%, 16.0%, 43.9%, and 30.8% of participants were covered by treatment in Germany, the Netherlands, Spain, and the UK respectively. Among initiators, the prevalence of psychiatric conditions and prior use of psycholeptic medications was higher in females and in older age groups. Interpretation: Over 14 years, ADHD medication prevalence increased across Europe, with varying incidence trends by country, age, and sex. Understanding the utilisation of ADHD medications can provide useful information in monitoring use, as well as for anticipation and planning to minimise potential shortages. Funding: European Medicines Agency.</p
Natriuretic response to an acute oral potassium load in healthy individuals and patients with chronic kidney disease:a randomized controlled trial
No full textBackground:The health benefits of dietary potassium have been linked to potassium-induced natriuresis. However, it is unknown whether potassium loading in patients with chronic kidney disease (CKD) induces natriuresis and to what degree it increases plasma potassium. We hypothesize that potassium-induced natriuresis remains intact and that potassium loading is safe in patients with CKD. Methods:In this placebo-controlled crossover study, 18 healthy individuals and 9 patients with non-diabetic CKD stage G3b–G4 received an acute oral load of potassium chloride (KCl), potassium citrate (K-cit) (40 mmol each) or placebo, either with or without 6 weeks of lisinopril (10 mg/day) pretreatment. Differences in placebo-subtracted plasma potassium and natriuresis between groups during 4-h follow-up were analysed using linear mixed models. Results:In healthy individuals, but not in patients with CKD, urinary sodium excretion increased 2 h after potassium supplementation, independent of lisinopril pretreatment. Compared with patients with CKD, mean urinary sodium excretion in healthy individuals was 13 mmol [95% confidence interval (CI) 4–22; P =.005] and 13 mmol (95% CI 4–22; P =.006) higher 2 h after KCl and K-cit, respectively. Estimated glomerular filtration rate positively correlated with urinary sodium excretion 2 h after KCl and K-cit, both with and without lisinopril pretreatment. Plasma potassium after potassium supplementation was higher in patients with CKD than in healthy individuals independent of lisinopril pretreatment. Conclusions:These findings indicate that in CKD, potassium-induced natriuresis does not occur and oral potassium loading is accompanied by an increased risk of hyperkalaemia.</p
Determinants for the implementation of a combined lifestyle intervention for patients with knee osteoarthritis and overweight:a qualitative study
No full textObjectives:Lifestyle changes—such as adopting healthy nutrition and increasing physical activity—are essential for alleviating symptoms in patients with knee osteoarthritis (OA) and overweight, with weight loss being a key outcome of these changes. Since 2019, healthcare professionals (HCPs) in the Netherlands have been able to refer these patients to a reimbursed combined lifestyle intervention (CLI). This study aims to identify determinants affecting CLI implementation for individuals with knee OA and overweight from both patient and HCP perspectives. Design:Semistructured interviews were conducted in a qualitative study with 23 individuals with knee OA and overweight and 16 HCPs (general practitioners (GPs) and lifestyle coaches). Interviews were transcribed verbatim and coded independently by two researchers using the updated Consolidated Framework for Implementation Research (CFIR). Setting:Primary care, including GPs and lifestyle coaches from the Greater Rotterdam region in the Netherlands.Participants:23 individuals with knee OA and overweight and 16 HCPs (GPs and lifestyle coaches). Results:Determinants were explored within four CFIR domains: innovation, outer setting, inner setting and individuals. Key facilitators included recognition of the programme’s potential, strong social support and positive participant–coach relationships. Major barriers involved the absence of an exercise component, financial constraints limiting its inclusion, scepticism among GPs about care quality, limited expertise of lifestyle coaches addressing OA-specific needs and difficulties adapting the programme to participants’ diverse knowledge levels and health literacy. Conclusions:To improve the implementation of the CLI for patients with knee OA, it is essential to incorporate a tailored exercise component, strengthen lifestyle coaches’ expertise, address financial barriers and build trust among GPs through education and clear communication of programme outcomes. Tailoring the CLI to better meet participant needs is crucial to ensure its long-term effectiveness and sustainability as a treatment for individuals with knee OA and overweight.</p
Between active citizenship and exploitation:understanding exhaustion and disposability in un(der)paid and low-paid labor by refugees in the Netherlands
No full textDutch refugee integration and labor policies promote un(der)paid and low-paid labor by refugees a key pathway for participation. This article draws on an extensive number of interviews with public, non-public and private actors as well as refugees to examine refugees’ experiences with such forms of labor. We find that refugees are often pushed by frontline workers into protracted forms of un(der)paid labor and short-term, low-paid roles that disregard prior experience and derail personal aspirations. These potentially exploitative positions rarely deliver on promises of language acquisition or future employment, leaving many refugees feeling trapped in unfulfilling and alienating jobs. Our findings challenge dominant narratives of active citizenship that repackage un(der)paid labor as “volunteering” and celebrate low-paid labor as empowering forms of participation. Instead, we reveal how current policies in the Netherlands foster precarity, exhaustion, and disposability, undermining genuine inclusion and sustainable employment.</p
Decision-Making Process of Healthcare Providers Regarding Catheterization Method:A Nationwide Survey Study
No full textBackground: The decision on which catheterization method to prescribe should be made on an individual basis, considering each patient's individual needs and circumstances. However, the current decision-making process regarding assisted bladder drainage might not be transparent or standardized. Objectives: The aim of the present study was to explore and compare the decision-making processes of Dutch healthcare providers regarding the choice of catheterization method and relevant bladder management. This information is crucial in the empowerment of patient involvement and the development of a catheter decision aid. Design & Methods: We conducted a nationwide survey study including urologists, rehabilitation doctors, physician assistants, and specialized (continence)nurses. A 12-question survey was distributed regarding the decision-making process, including questions about treatment options discussed and factors upon which healthcare providers base their decisions. Results: A total of 108 healthcare providers responded (response rate 36%). The majority were (continence)nurses or urologists and worked in a hospital. (Continence)nurses were least often involved in the decision-making, and when involved, 53% did not discuss potential other treatment options for the underlying causes of impaired bladder emptying. Most healthcare providers base their decision on the patient characteristics. Conclusion: We observed differences in the decision-making process between the healthcare providers. Implementing shared decision-making can lead to more effective collaboration between the patient and healthcare provider when selecting the most appropriate type of bladder management. This could be achieved through comprehensive training supplemented by a validated decision aid.</p