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Voorbij kniepijn en slapeloze nachten: van real-world slaap analyse naar gepersonaliseerde zorg bij mensen met knieartrose en insomnia
No full textBackground and rationale
Knee osteoarthritis (KOA) is a prevalent, disabling musculoskeletal disorder with a rising global burden, characterized by complex interactions between biological, psychological, and social factors. Insomnia disorder is a highly prevalent comorbidity in KOA, with bidirectional links to pain, disability, and quality of life. Despite its clinical relevance, sleep disturbance in KOA remains under-assessed and undertreated. This doctoral thesis addresses critical gaps in the measurement, mechanistic understanding, and management of sleep in individuals with KOA and comorbid insomnia disorder, aiming to inform the development of personalized, integrated care.
Aims and structure
The thesis is structured in three interconnected parts:
Measurement: To evaluate the validity of consumer-grade wearable technology for sleep assessment in KOA with insomnia disorder.
Mechanisms: To elucidate psychological and behavioral factors underlying sleep disturbance, and the potential mediating role of physical activity.
Management: To identify barriers and strategies for implementing cognitive behavioral therapy for insomnia (CBT-I) in physiotherapy, and to develop a protocol for a physiotherapist-led, integrated intervention.
Main findings
Part 1: Measurement of sleep
A validation study compared a commercially available smartwatch (Fitbit Sense) with home-based polysomnography in individuals with KOA and insomnia disorder. The device demonstrated high sensitivity (96%) and overall accuracy (86%) for sleep/wake detection, but lower specificity for quiet wakefulness and limited precision in sleep stage classification. These findings support the feasibility of wearable-based, ecologically valid sleep monitoring in this population, while highlighting methodological limitations.
Part 2: Mechanisms linking psychological- and behavioral factors and sleep
A systematic review and meta-analysis (23 studies, N=3,381) revealed moderate associations between maladaptive pain- and sleep-related psychological factors (e.g., catastrophizing, low self-efficacy, dysfunctional beliefs) and poorer sleep health in chronic musculoskeletal pain, with stronger effects for subjective than objective outcomes. A cross-sectional study in KOA with insomnia disorder found that dysfunctional sleep beliefs were associated with greater insomnia severity. Adaptive sleep requirement beliefs were linked to longer subjective but shorter objective sleep, highlighting a subjective-objective mismatch. Physical activity partially mediated this relationship. These results support cognitive-behavioral models of insomnia and pain, but also indicate the need for further research into behavioral pathways and multidimensional sleep health.
Part 3: Implementation & translation of physiotherapy-led CBTI-based interventions
A qualitative study with 16 stakeholders identified 33 barriers to implementing CBT-I in physiotherapy, including training needs, scope-of-practice concerns, and systemic constraints. Thirteen implementation strategies were formulated, prioritizing education, structural changes, and interprofessional collaboration. A randomized controlled trial protocol was developed to evaluate the clinical and cost-effectiveness of physiotherapist-led, integrated CBT-I and best-practice KOA care, with broad biopsychosocial outcomes and comprehensive methodology.
Implications and conclusions
This thesis demonstrates that sleep in KOA with comorbid insomnia disorder can be measured using wearable technology, understood through multidimensional psychological and behavioral mechanisms, and addressed via structured, physiotherapist-delivered interventions. The work advances the field by integrating technological innovation, mechanistic insight, and implementation science, and provides a framework for personalized, transdisciplinary care. Limitations include geographical and sample representativeness, and the need for further research on causal pathways and intervention effectiveness. Overall, the findings underscore the centrality of sleep in pain management and rehabilitation, and support the integration of sleep assessment and intervention into routine care for KOA and comorbid insomnia disorder.status: Publishe
Comparing geometry and mechanical performance of as built and Hirtisation® treated Al-Cu-Mg-Ag-Ti-B-Si-Fe rhombic dodecahedron lattices manufactured by laser powder bed fusion
No full textThis study investigates the morphological, geometrical, and mechanical characteristics of Al-Cu-Mg-
Ag-Ti-B-Si-Fe aluminum alloy lattice structures fabricated via Laser Powder Bed Fusion (LPBF),
with emphasis on quasi-static and fatigue mechanical performance. Using the Gibson–Ashby model
as a framework, three relative lattice densities (RLDs) were examined in both as-built (AB) and
Hirtisation® surface treated (HIRT) conditions. Results confirm that geometric strut waviness is
inherent to the LPBF process, affecting both AB and HIRT samples. However, the Hirtisation®
treatment notably reduces surface roughness and dross, enhancing fatigue life and surface uniformity.
While strut length remains unchanged after post-treatment, a reduced strut diameter (thickness)
alters the final density, directly impacting RLD and strength. Quasi-static tests validate the
predicted strength–density relationship, with denser lattices exhibiting higher compressive strength.
Fatigue testing reveals bending-dominated failure behaviour, marked by crush bands and hybrid
brittle-ductile failure mode. These findings deepen understanding of LPBF lattice structures and
demonstrate the effectiveness of surface treatment in enhancing fatigue resistance and mechanical
performance.sponsorship: This work was supported by the European Union’s EU Framework Programme for Research and Innovation Europe Horizon under Grant Agreement No 101119917 METRAMAT Doctoral Network and by FWO/SBO project S006025N FORTAM (European Union’s EU Framework Programme for Research and Innovation Europe Horizon|No 101119917, FWO/SBO|S006025N FORTAM)status: Publishe
Chemical exposure in childhood: A study on organophosphate flame retardants and plasticizers in a Flemish birth cohort
No full textHumans are exposed daily to contaminants such as organophosphorus flame retardants (PFRs), legacy plasticizers (LPs), and alternative plasticizers (APs). To date, most biomonitoring studies in children have only focused on analysis of LP metabolites and a subset of PFRs and APs. This study investigated exposure to multiple PFRs, LPs and APs in the ENVIRONAGE birth cohort quantifying 13 PFR metabolites in 655 urine samples, while we measured 8 LP and 13 AP metabolites in urine of 328 children. For PFRs, more than 50 % of children were exposed to TNBP, TPHP, TDCIPP, TCIPP and EHDPHP. More than 93 % of children were exposed to the measured LPs (DEP, DiBP, DnBP, BBzP and DEHP), while for APs more than 50 % of children showed exposure to DEHA, DEHTP, DINCH and DIDP. Concentrations of PFR metabolites were higher in summer, while the presence of a pet in the house was associated with higher LP metabolite concentrations. Risk characterization ratios (RCRs) for single compounds and hazard indices (HIs) for compound classes suggested no risk for adverse health effects due to PFR exposure. For LPs, two children showed a HI above 1, while for APs, ten children had a HI above 1. The results indicate widespread exposure to PFRs and plasticizers, with most children being exposed to levels that are considered safe. However, the current study confirms a shift in exposure from LPs to APs, implying the need for further research on exposure to multiple APs in future studies.sponsorship: We thank all participants of the ENVIRONAGE cohort who voluntarily participated, filled in the questionnaires and donated urine. Without them, this research would not have been possible. Fatima den Ouden, Adam Cseresznye, Liesa Engelen and Elias Maris acknowledge the Flemish Exposome Project (GISMO 01IB1320, Flexigut project) for their PhD fellowship. Giulia Poma was supported by the Exposome Centre of Excellence of the University of Antwerp (BOF grant, Antigoon database number 41222) . Lieselot Y. Hemeryck was supported by the FWO (Research Foundation-Flanders) , as a senior postdoctoral fellow (1297623N) . Roger Pero-Gascon was supported by the FWO, as a junior postdoctoral fellow (12D4423N) . (Exposome Centre of Excellence of the University of Antwerp (BOF grant)|GISMO 01IB1320, Exposome Centre of Excellence of the University of Antwerp (BOF grant)|41222, FWO (Research Foundation-Flanders)|1297623N, FWO|12D4423N)status: Accepte
Bioenergetics and lipid metabolism in Alzheimer's disease: From cell biology to systemic health
No full textAlzheimer's disease (AD) is a complex neurodegenerative disorder characterized by progressive cognitive decline. Although amyloid-β and tau pathologies remain central to our understanding of AD, growing evidence suggests that disrupted lipid metabolism and impaired bioenergetics are closely linked to these hallmark features. Genetic, lipidomic and functional studies point to alterations in cholesterol, phospholipids and polyunsaturated fatty acids, which can influence mitochondrial function, organelle communication and glial responses. These processes are further modulated by apolipoprotein E (APOE) genotype, sex differences and systemic metabolic states such as obesity and diabetes, contributing to neuroinflammation and cognitive decline. Although findings are sometimes conflicting, an emerging theme is that lipid and energy metabolisms are central to how genetic and environmental risk factors shape AD pathogenesis. This integrated perspective highlights lipid and bioenergetic pathways as promising therapeutic targets, where metabolic modulators, lipid-directed interventions and lifestyle strategies may complement amyloid-based therapies and offer opportunities for precision approaches, particularly in women and APOE ε4 carriers.sponsorship: SM is supported by the Swedish Research Council (2024-03440), Alzheimerfonden (AF-1011030), King Gustaf V:s and Queen Victoria's Foundation, Gun och Bertil Stohnes Stiftelse, Stiftelsen Gamla Tjanarinnor and Margaretha af Ugglas Foundation. MS research is supported by the Swedish Research Council (2023-02054), the Swedish Brain Foundation (FO2024-0153-HK-50), Gun och Bertil Stohnes Stiftelse and Dementia Foundation. KLZ is supported by the National Institutes of Health (NIH) research grant R01 (NS110749). BW is supported by the Swedish Research Council (2024-03577), the Swedish Brain Foundation (2024-0287) and Margaretha af Ugglas Foundation. PP is supported by Italian Ministry of University and Scientific Research grants (PRIN2022943TH9 and PRIN P20225R4Y5, financed by the European Union, NextGeneration EU), the Cure Alzheimer's Fund (USA), the Alzheimer's Association grant (E2A-23-1148250), the Next Generation EU and Italian Ministry of Research, NRRP-National Recovery and Resilience Plan grant, National Centre of Research 'Development of gene therapy and drugs with RNA technology', spoke 3 'Neurodegenerative Diseases'. PAW is supported by the Ulla and Ingemar Dahlberg Foundation and the Swedish Research Council (2022-00799). LN is supported by starting grants from The Swedish Research Council (2023-02503) and the Strategic Research Program in Neuroscience-StratNeuro, and the Swedish Alzheimer Foundation (AF-1012350). The authors SM, PRR and LN also thank the private initiative 'Innovative ways to fight Alzheimer's disease' supported by Leif Lundblad Family and others. We thank Mattias Karlen for his support in the production of the figures for this review. (Strategic Research Program in Neuroscience-StratNeuro, King Gustaf V:s and Queen Victoria's Foundation, Gun och Bertil Stohnes Stiftelse, Stiftelsen Gamla Tjnarinnor, the Swedish Brain Foundation|FO2024-0153-HK-50, the Swedish Brain Foundation|2024-0287, Margaretha af Ugglas Foundation, Swedish Research Council|2024-03440, Swedish Research Council|2023-02054, Swedish Research Council|2024-03577, Swedish Research Council|2022-00799, Swedish Research Council|2323-02503, Swedish Alzheimer Foundation|AF-1012350, Swedish Alzheimer Foundation|AF-1011030, Italian Ministry of University and Scientific Research|PRIN2022943TH9, Italian Ministry of University and Scientific Research|PRIN P20225R4Y5, Cure Alzheimer's Fund (USA), Italian Ministry of Research, NRRP-National Recovery and Resilience Plan grant, National Centre of Research 'Development of gene therapy and drugs with RNA technology', spoke 3 'Neurodegenerative Diseases, Ulla and Ingemar Dahlberg Foundation, European Union, NextGeneration EU, Gun och Bertil Stohnes Stiftelse, Leif Lundblad Family and others, Dementia Foundation, National Institutes of Health (NIH) research|NS110749, Formas|2023-02054, Swedish Research Council|2022-00799, Swedish Research Council|2023-02054)status: Accepte
Machine Learning-Based Clustering of Right Ventricular Free-Wall Strain Features for Cardiovascular Risk Prediction.
No full textsponsorship: KU Leuven Research Council, Research Foundation Flandersstatus: Published onlin
Autocrine feedback maintains homeostatic neuropeptide expression in a peptidergic hub neuron
No full textOptimization of Stern Bearing Lubrication Performance Under Misaligned Journal Conditions Based on Length-to-Diameter Ratio
No full textsponsorship: The National Natural Science Foundation of China (U2341284).The China Scholarship Council (No. 202306950088).The Henan Province Science and Technology Research and Development Plan Joint Fund (242103810045).The Key Project Research and Application Plan of Henan Higher Education (25A460004). (National Natural Science Foundation of China|U2341284, China Scholarship Council|202306950088, Henan Province Science and Technology Research and Development Plan Joint Fund|242103810045, Key Project Research and Application Plan of Henan Higher Education|25A460004)status: Publishe
Werknemers onder de loep: Wet Private Opsporing toegepast in HR-praktijken
No full textstatus: Published onlin
