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Access to Justice and the Right to Democratic Participation of Victims OF Domestic Violence. From Norms to Empirics
No full textThis study employs a sociolegal approach to examine the relationship between access to justice and democratic participation by exploring both legal frameworks and the lived experiences of domestic violence victims. Analyzing international and domestic laws—including the legal empowerment approach—and conducting 54 in-depth interviews with victims, the research reveals that although progressive legal norms exist to promote participation in policy processes, these remain largely unknown and underutilized by the affected individuals. Instead, victims often engage in peer-to-peer legal empowerment, sharing rights information within their networks. The findings underscore the need for enhanced rights awareness campaigns and more accessible legal information to foster meaningful democratic engagement among vulnerable populations
The impact of political alignment on resource rent distribution in Colombia
No full textSubnational governments that are politically aligned with the central government tend to receive more fiscal resources than their non-aligned counterparts. However, the motivations behind this pattern remain contested. While some studies argue that such transfers are intended to reward core supporters, others suggest they aim to buy political support from swing voters ahead of elections. This article revisits the debate through a case study of Colombia. In 2012, the country reformed its royalty revenue-sharing rules, granting the president greater discretion over municipal access to fiscal resources, thereby inducing an alignment effect. Using municipal-level panel data and fixed-effects models, we find evidence of political alignment in the allocation of resource rents. Moreover, the alignment effect is positive for swing municipalities. Our findings underscore the critical importance of balanced policy design in ensuring unbiased transfer distribution and mitigating the inequalities and inefficiencies associated with political alignment
Insights into the prevalence, reintegration and stigma of burnout:Special issue 'Reflection and practical perspectives on burnout' (part2)
Get PDFThis is the second part of the special issue 'Reflection and practical perspectives on burnout'. The issue consists of four articles covering the themes of 'Prevalence', 'Reintegration' and 'Burnout as narrative'. The first article shows that burnout complaints in the Netherlands increased over the period 2007-2023 and that there are certain risk groups where the increase was greater. The second article shows that the number of absenteeism days is related to the occupational physician's diagnosis and the severity ofburnout symptoms. However, the relationship with burnout symptoms was too small to be clinically relevant. The third article presents an e-tool that provides insight into the quality of reintegration after burnout and can predict future burnout symptoms. The fourth and final article shows that a burnout history can lead to stigmatization and have negative career consequences. All-in all, the contributions in this theme issue show that burnout symptoms can have major consequences for individuals and society. In addition, both theme issues show that while we increasingly understand burnout, there are still important unanswered questions. Hence, there is a high need for further research in the field of burnout
Cognitive appraisal modulates Theta Burst Stimulation effects on stress-reactive rumination and affect
No full textThe DLPFC plays a central role in cognitive appraisal and stress regulation, as this process-particularly secondary appraisal, where individuals assess their ability to cope with a situation-significantly influences stress responses on both psychological and physiological levels. We conducted a study where we applied different types of Theta Burst Stimulation (intermittent (i)TBS vs. continuous (c)TBS vs. sham (s)TBS) to the left DLPFC to increase or decrease the cortical excitability of the prefrontal neural network. We then examined how participants responded psychologically and physiologically to a potent psychosocial stressor, the Trier Social Stress Test (TSST), and aimed to investigate the influence of secondary cognitive appraisal on the effects of TBS on the stress response. Depending on the stimulation, we discovered that the cognitive appraisal significantly influenced rumination, positive and negative affect specifically in stress recovery. More precisely, as expected, individuals who perceived greater control experienced a faster recovery of stress-reactive ruminative thinking following sTBS and lower rumination following the stressor. We found lower increases and faster recovery of negative affect in all stimulation conditions and faster decreases in positive affect after the TSST following cTBS and iTBS, suggesting beneficial effects of both stimulation conditions. Concerning the assessed physiological variables, namely heart rate, heart rate variability, and salivary cortisol, we did not observe any impact of appraisal. These findings suggest that the effect of secondary appraisal on psychological variables depends on the type of stimulation, and while it may be linked to increased DLPFC activity, further research is needed to clarify the neurostimulation mechanisms involved
Impact of a moderate-intensity aerobic exercise intervention on systemic and uterine natural killer cells in women with unexplained recurrent pregnancy loss
No full textIntroduction Recurrent pregnancy loss (RPL) is associated with altered immune phenotypes and functions. It has been proposed that physical exercise might impact the immune system. Therefore, we evaluated the effect of a personalized 3-month moderate-intensity aerobic exercise intervention on the immune system of women with unexplained RPL (uRPL). Given the suggested supportive role of Natural Killer (NK) cells during early pregnancy, we focused on numerical, phenotypic, and functional changes in peripheral NK (pNK) and uterine NK (uNK) cells.Methods Mononuclear cells were isolated from peripheral blood (PB) (n=23) and menstrual blood (MB) (n=22) of women with uRPL. NK cell phenotypes were assessed with comprehensive flow cytometry panels. NK cell function was assessed with degranulation assays and intracellular staining of interferon-gamma (IFN-gamma), perforin and granzyme-B in a subgroup of women due to lower availability of samples (n=12).Results Attendance to the exercise intervention was overall 95%, which resulted in effects on the phenotype and function of pNK cells. We found a significant reduction in the median fluorescent intensity of CD161 (464 vs 410, p=0.011), NKp30 (432 vs 376, p=0.018), and NKG2A (886 vs 732, p=0.039) in pNK cells after exercise, while no differences were observed in uNK cells. We also observed decreased percentages of IFN-gamma+ pNK cells (49% vs 25.2%, p=0.027) after exercise.Discussion Our study shows promising results, suggesting that exercise can impact pNK cell phenotype and function in women with uRPL. Following the changes in pNK phenotype and function suggest a lower pro-inflammatory state post-exercise. Whether these exercise-induced phenotypic and functional changes of pNK cells impact subsequent pregnancies remains to be studied. The study details are available through HYPERLINK "https://clinicaltrials.gov/"Home | ClinicalTrials.gov, trial ID: HMOV
Consensus on Information Provision for Patients With Early-Stage Colorectal Cancer:A Delphi Study Among Healthcare Practitioners and Patients
No full textBackgroundPatients with radically endoscopically treated T1 colorectal cancer (CRC) with at least one high-risk histopathological characteristic are presented with the choice between additional surgical resection with lymphadenectomy or intensive surveillance. Healthcare practitioners (HCPs) from various disciplines provide information on the complex trade-offs involved.AimWe aimed to reach consensus on what information patients should be offered at the time of decision making.MethodsWe invited HCPs and patients with early-stage (pT1-3N0M0) CRC to participate in a three-round online Delphi study. In the first round, participants were asked to indicate the relevance of 163 items regarding CRC surgery and intensive surveillance, using five-point Likert-type scales. The following rounds only included the items on which no consensus had been reached yet, supplemented with new items that participants had suggested in the previous round(s). Criteria for consensus were defined in advance.ResultsThirty percent (109/341) of the invited participants completed >= 50% of items in the first round. After the third round, consensus was reached on 80/154 items regarding colon cancer and 129/179 items regarding rectal cancer; of these, respectively, 40 and 47 items were considered relevant. HCPs tended to consider more frequently occurring complications relevant compared to patients. Patients also considered rare complications relevant but expressed worries about information overload. There was clear consensus on items regarding different types of surgery and recovery expectations, the risk of anastomotic leakage and of receiving a stoma, and the risk of recurrence after both surgery and intensive surveillance.ConclusionA consensus-based, standardized set of information items was defined in order to facilitate that patients receive complete information in a uniform way. The results of this study aim to support patients and their HCPs to make a well-informed decision between additional surgical resection with lymphadenectomy and intensive surveillance
Small and Stable Pancreatic Cysts Are Reassuring During Surveillance:Results From the PACYFIC Trial
No full textBackground: Pancreatic cysts are increasingly discovered on imaging studies performed for unrelated conditions. Currently, surveillance of these lesions poses a substantial burden on patients, and health care recourses. We hypothesized that individuals with small and stable cysts have a diminutive risk of progressing to high-grade dysplasia (HGD) or pancreatic cancer (PC) that is similar to that in the general population. Methods: This nested PACYFIC-study is a collaboration among 44 centers in Europe and Northern-America, and investigates the risk of HGD and PC for different cyst sizes and growth rates in participants without baseline worrisome features (WF) or high-risk stigmata (HRS). Results: Of the 2369 PACYFIC participants, 975 met the inclusion criteria, with a mean age of 67 years (SD 13) and 65% being female. Of these, 438 individuals (45%) had a baseline small cyst size (< 15 mm), and 885 (91%) individuals had a slow growth rate (< 2.5 mm/year). During a median follow-up of 45 months (IQR 27), 20 individuals (2.1%) developed HGD, or PC. Individuals with small cysts had a 1.5-fold lower risk of developing WF or HRS (hazard ratio [HR] 0.7 [0.5–1.0], p = 0.03) than those with larger cysts but a similar risk of developing HGD or PC (p > 0.05). Slow growth was protective against the development of WF or HRS (HR 0.4 [0.2–0.6], p < 0.001) and HGD or PC (HR 0.04 [95% CI 0.02–0.12], p < 0.001). Individuals with small, stable sized cysts without baseline WF or HRS did not have a higher risk of HGD or PC than the general population (standardized incidence ratio [SIR] 1.13 [95% CI 0.01–6.30]). Conclusion: Cyst size < 15 mm and growth rate < 2.5 mm/year appear to be “reassuring” features associated with a negligible risk of developing WF or HRS and HGD or PC. For cysts with these characteristics—and without baseline WF or HRS—less intensive surveillance (than currently recommended) or even cessation may be appropriate.</p
Thromboinflammatory Biomarkers Are Early Predictors of Disease Progression in Non-Small Cell Lung Cancer Patients
No full text(1) Background: The hemostatic system and tumor biology display a tight and reciprocal interaction where clotting products enhance tumor growth and dissemination, and the tumor, in turn, triggers a hypercoagulable and inflammatory state. Evaluating circulating biomarkers related to thrombo-inflammatory may provide a promising tool for predicting tumor outcomes, especially in non-small cell lung cancer (NSCLC) characterized by unfavorable outcomes. (2) Aim: In a prospective cohort of NSCLC patients, we evaluated whether thromboinflammatory biomarkers could predict early disease progression (DP) during the first 6 months of first-line anticancer treatment. (3) Methods: 719 newly diagnosed advanced-stage NSCLC patients were included. Complete blood cell count, high-sensitivity C-reactive protein (hs-CRP), FVIII, fibrinogen, D-dimer, thrombin-antithrombin (TAT) complexes, and prothrombin fragment1+2(F1+2) were tested in blood samples collected before starting chemotherapy. DP was gathered during follow-up. (4) Results: The 6-month cumulative incidence rate for DP was 49%. Univariable Cox regression analysis identified metastatic status, BMI, hemoglobin, leukocytes, hs-CRP, FVIII, fibrinogen, TAT, and D-dimer as significant predictors of DP. In a multivariable analysis that included all previously significant variables, only hs-CRP and D-Dimer levels remained strongly associated with DP. The two variables were used to establish a risk stratification model that significantly identified patients at high risk of DP at 6 months (HR 2.9; 95% CI, 2.3-3.7), which can be applied to 3, 9, and 12 months. (5) Conclusions: Our model easily and precisely estimates early DP during chemotherapy. If externally validated, this model can significantly enhance the allocation of medical resources in managing advanced NSCLC, ensuring that patients receive the most effective care possible
Rethinking the literature on economic complexity indexes
No full textEconomic Complexity Indexes have gained prominence but exhibit conceptual and empirical shortcomings. This study delineates four primary deficiencies in the economic complexity literature and introduces a novel framework to fill these gaps. The deficiencies include (1) the absence of a formal, explicit definition, (2) the lack of a theoretical framework, (3) biases stemming from using gross exports in algorithms, and (4) inconsistencies between motivational concepts and estimation methods. The proposed framework defines product complexity as the latent sophistication inherent in goods production and country complexity as the weighted sum of a country's export specialization, with weights reflecting product complexities. Therefore, its scope is limited to countries' export competitiveness. Both product sophistication and country specialization depend on national technology levels. The empirical approach, termed the Technology-Based Economic Complexity Algorithm (TBECA), employs supervised principal component analysis of export specialization and country-level total factor productivity to estimate unobserved product and country complexities. TBECA ensures consistency in meaning and methodology, demonstrating robust predictability and stability for forecasting countries' total factor productivity based on export composition