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Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep and increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1–12 years, admitted to a tertiary center, and compared this with home 6–8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58%) consented to participate. Key determinants of sleep included pain, number of previous admissions, (underlying) chronic illness, and environment-, staff-, and disease-related factors. Parents reported lower perceived sleep quality in the hospital compared to at home, 97-min (SE 9) lower TST, 100-min (5) longer WASO, more difficulties with falling asleep, lower sleep satisfaction, and more awakenings. Actigraphy outcomes revealed shorter TST (20 min (6)), but better sleep efficiency and fewer awakenings in the hospital. Conclusion: Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children. [ABSTRACT FROM AUTHOR]

Differences in organization of the primary motor cortex and altered trunk motor control (sensing, processing and motor output) have been reported in people with low back pain (LBP). Little is known to what extent these differences are related. We investigated differences in 1) organization of the primary motor cortex and 2) motor and sensory tests between people with and without LBP, and 3) investigated associations between the organization of the primary motor cortex and motor and sensory tests. We conducted a case-control study in people with (N=25) and without (N=25) LBP. The organization of the primary motor cortex (Center of Gravity (CoG) and Area of the cortical representation of trunk muscles) was assessed using neuronavigated transcranial magnetic stimulation, based on individual MRIs. Sensory tests (quantitative sensory testing, graphaesthesia, two-point discrimination threshold) and a motor test (spiral-tracking test) were assessed. Participants with LBP had a more lateral and lower location of the CoG and a higher temporal summation of pain. For all participants combined, better vibration test scores were associated with a more anterior, lateral, and lower CoG and a better two-point discrimination threshold was associated with a lower CoG. A small subset of variables showed significance. Although this aligns with the concept of altered organization of the primary motor cortex in LBP, there is no strong evidence of the association between altered organization of the primary motor cortex and motor and sensory test performance in LBP. Focusing on subgroup analyses regarding pain duration can be a topic for future research. [ABSTRACT FROM AUTHOR]

Background: Neuroinflammation and Alzheimer's disease (AD) co-pathology may contribute to disease progression and severity in dementia with Lewy bodies (DLB). This study aims to clarify whether a different pattern of neuroinflammation, such as alteration in microglial and astroglial morphology and distribution, is present in DLB cases with and without AD co-pathology. Methods: The morphology and load (% area of immunopositivity) of total (Iba1) and reactive microglia (CD68 and HLA-DR), reactive astrocytes (GFAP) and proteinopathies of alpha-synuclein (KM51/pser129), amyloid-beta (6 F/3D) and p-tau (AT8) were assessed in a cohort of mixed DLB + AD (n = 35), pure DLB (n = 15), pure AD (n = 16) and control (n = 11) donors in limbic and neocortical brain regions using immunostaining, quantitative image analysis and confocal microscopy. Regional and group differences were estimated using a linear mixed model analysis. Results: Morphologically, reactive and amoeboid microglia were common in mixed DLB + AD, while homeostatic microglia with a small soma and thin processes were observed in pure DLB cases. A higher density of swollen astrocytes was observed in pure AD cases, but not in mixed DLB + AD or pure DLB cases. Mixed DLB + AD had higher CD68-loads in the amygdala and parahippocampal gyrus than pure DLB cases, but did not differ in astrocytic loads. Pure AD showed higher Iba1-loads in the CA1 and CA2, higher CD68-loads in the CA2 and subiculum, and a higher astrocytic load in the CA1-4 and subiculum than mixed DLB + AD cases. In mixed DLB + AD cases, microglial load associated strongly with amyloid-beta (Iba1, CD68 and HLA-DR), and p-tau (CD68 and HLA-DR), and minimally with alpha-synuclein load (CD68). In addition, the highest microglial activity was found in the amygdala and CA2, and astroglial load in the CA4. Confocal microscopy demonstrated co-localization of large amoeboid microglia with neuritic and classic-cored plaques of amyloid-beta and p-tau in mixed DLB + AD cases. Conclusions: In conclusion, microglial activation in DLB was largely associated with AD co-pathology, while astrocytic response in DLB was not. In addition, microglial activity was high in limbic regions, with prevalent AD pathology. Our study provides novel insights into the molecular neuropathology of DLB, highlighting the importance of microglial activation in mixed DLB + AD. [ABSTRACT FROM AUTHOR]

Background: Cognitive decline is a major reason for dependence and resource use in long-term care. Objective: We explored whether social activities may prevent cognitive decline of older residents of long-term care facilities. Methods: In a routine care cohort, 3,603 residents of long-term care facilities were assessed on average 4.4 times using the interRAI-Long-Term-Care-Facilities instrument which includes frequency of participation in social activities of long standing interest over the last 30 days and the Cognitive Performance Scale. Linear mixed models repeated measures analyses were performed corrected for age, sex, physical activity, Activities of Daily Living, mood, and health indicators. Results: Social activity was associated with cognitive preservation over time. This association was stronger in those with no or mild cognitive impairment at baseline, relative to those with moderate to severe impairment. Participation in specific social activities such as conversing and helping others showed a similar positive association. The relation between social activity and cognitive impairment appeared to be bi-directional. Conclusions: The protective effects of social activity offer a window of opportunity to preserve cognitive functioning in long-term care residents. [ABSTRACT FROM AUTHOR]

Purpose: We sought to assess the impact of coronary revascularization on myocardial perfusion and fractional flow reserve (FFR) in patients without a cardiac history, with prior myocardial infarction (MI) or non-MI percutaneous coronary intervention (PCI). Furthermore, we studied the impact of scar tissue. Methods: Symptomatic patients underwent [15O]H2O positron emission tomography (PET) and FFR before and after revascularization. Patients with prior CAD, defined as prior MI or PCI, underwent scar quantification by magnetic resonance imaging late gadolinium enhancement. Results: Among 137 patients (87% male, age 62.2 ± 9.5 years) 84 (61%) had a prior MI or PCI. The increase in FFR and hyperemic myocardial blood flow (hMBF) was less in patients with prior MI or non-MI PCI compared to those without a cardiac history (FFR: 0.23 ± 0.14 vs. 0.20 ± 0.12 vs. 0.31 ± 0.18, p = 0.02; hMBF: 0.54 ± 0.75 vs. 0.62 ± 0.97 vs. 0.91 ± 0.96 ml/min/g, p = 0.04). Post-revascularization FFR and hMBF were similar across patients without a cardiac history or with prior MI or non-MI PCI. An increase in FFR was strongly associated to hMBF increase in patients without a cardiac history or with prior MI/non-MI PCI (r = 0.60 and r = 0.60, p < 0.01 for both). Similar results were found for coronary flow reserve. In patients with prior MI scar was negatively correlated to hMBF increase and independently predictive of an attenuated CFR increase. Conclusions: Post revascularization FFR and perfusion were similar among patients without a cardiac history, with prior MI or non-MI PCI. In patients with prior MI scar burden was associated to an attenuated perfusion increase. [ABSTRACT FROM AUTHOR]

Introduction:  One-stop surgery (OSS) allows for same-day outpatient clinic visit, preoperative assessment, and surgical repair. This study aims to determine the efficiency, (cost-)effectiveness, and family satisfaction of one-stop inguinal hernia surgery compared with usual care.Material and Methods:  Children (≥ 3 months) with inguinal hernia and American Society of Anesthesiologists (ASA) grades I-II, scheduled for OSS (intervention) or regular treatment (control) between March 1, 2017, and December 1, 2018, were eligible for inclusion. Exclusion criteria consisted of age less than 3 months and ASA grades III-IV. The primary outcome measure was treatment efficiency (i.e., total number of hospital visits and waiting time [days] between referral and surgery). Secondary outcome measures were the effectiveness in terms of complication and recurrence rate, and parent-reported satisfaction and cost-effectiveness using the Dutch Pediatric Quality of Life Healthcare Satisfaction and Institute for Medical Technology Assessment Productivity Cost Questionnaire.Results:  Ninety-one (intervention: 54; control: 37) patients (56% boys) were included. Median (interquartile range) number of hospital visits was lower in the intervention group (1 vs 3; p < 0.001). All but one of the OSS patients (98%) were discharged home on the day of surgery. Postoperative complication (1.9% vs 2.7%; p = 0.787) and recurrence rates (0% vs 2.7%; p = 0.407) did not differ between the intervention and control patients. "General satisfaction," "satisfaction with communication," and "inclusion of family" were higher after OSS, while satisfaction about "information," "technical skills," and "emotional needs" were similar. Median (range) follow-up was 28 (15-36) months.Conclusions:  Pediatric one-stop inguinal hernia repair seems to be an effective treatment strategy that limits the number of hospital visits and provides enhanced family satisfaction without compromising the quality of care. [ABSTRACT FROM AUTHOR]

Purpose: To develop an algorithm for the diagnosis of Behçet's disease (BD) uveitis based on ocular findings. Methods: Following an initial survey among uveitis experts, we collected multi-center retrospective data on 211 patients with BD uveitis and 207 patients with other uveitides, and identified ocular findings with a high diagnostic odds ratio (DOR). Subsequently, we collected multi-center prospective data on 127 patients with BD uveitis and 322 controls and developed a diagnostic algorithm using Classification and Regression Tree (CART) analysis and expert opinion. Results: We identified 10 items with DOR >5. The items that provided the highest accuracy in CART analysis included superficial retinal infiltrate, signs of occlusive retinal vasculitis, and diffuse retinal capillary leakage as well as the absence of granulomatous anterior uveitis or choroiditis in patients with vitritis. Conclusion: This study provides a diagnostic tree for BD uveitis that needs to be validated in future studies. [ABSTRACT FROM AUTHOR]

An important recent development in mediation analysis is the use of causal mediation analysis. Causal mediation analysis decomposes the total exposure effect into causal direct and indirect effects in the presence of exposure-mediator interaction. However, in practice, traditional mediation analysis is still most widely used. The aim of this paper is to demonstrate the similarities and differences between the causal and traditional estimators for mediation models with a continuous mediator, a binary outcome, and exposure-mediator interaction. A real-life data example, analytical comparisons, and a simulation study were used to demonstrate the similarities and differences between the traditional and causal estimators. The causal and traditional estimators provide similar indirect effect estimates, but different direct and total effect estimates. Traditional mediation analysis may only be used when conditional direct effect estimates are of interest. Causal mediation analysis is the generally preferred method as its casual effect estimates help unravel causal mechanisms. [ABSTRACT FROM AUTHOR]

Background: Psychotropic drugs are frequently prescribed to people with dementia in nursing homes although severe adverse events and side effects are common. Less is known about the prevalence and types of psychotropic drug prescription in primary care for people with dementia. Objective: This study examined the prevalence of psychotropic drug prescriptions in primary care among persons with dementia from the year of diagnosis onwards. Methods: A longitudinal observational study using electronic health record (EHR) data was conducted. People with dementia were selected from EHR data of 451 general practices in the Netherlands. Age and gender‐adjusted psychotropic drug prescription rates were calculated per 1000 person‐years from the year the dementia diagnosis was first recorded in general practice up to 8 years after diagnosis. Results: Data of 15,687 patients were analyzed. The prescription rate of psychotropic drugs (not including antidementia drugs) was 420 per 1000 person‐years (95% CI 409; 431) in the first year after the recorded dementia diagnosis, which increased to 801 per 1000 person‐years (95% CI 649; 989) in the eighth year. The most frequently prescribed drugs were antidepressants, antipsychotics, and antidementia drugs, followed by anxiolytics, hypnotics, and antiepileptics. Conclusions: After a dementia diagnosis is recorded in general practice, the prevalence of psychotropic drug prescriptions is substantial and increases steadily during the disease trajectory of persons with dementia. Although the (in)appropriateness of prescribing was not assessed, these insights may stimulate primary care clinicians to (re)consider their prescription policy of psychotropics for people with dementia more carefully. [ABSTRACT FROM AUTHOR]

Background: Whole blood donors may experience post‐donation symptoms such as fatigue, dizziness, or headache after blood donation, which could influence donor retention. We aimed to examine post‐donation symptoms during 1 week after whole blood donation, investigate donor characteristics associated with symptoms, and evaluate associations between symptoms and donor return. Methods: During 1 week, whole blood donors who donated successfully at one of the collection centers in The Netherlands were invited to participate. Three thousand seventy six donors filled in a diary, assessing post‐donation symptoms during days 1 to 6 after donation. We used linear mixed models analyses to determine the change in post‐donation symptoms after donation for male and female donors separately. Furthermore, we investigated associations between post‐donation symptoms and donors' physical characteristics using multivariable regression and determined associations between symptoms and donor return. Results: Donors reported fatigue as the most common symptom, with approximately 3% of donors experiencing severe problems at the first day after donation. Multiple symptoms improved significantly up to day 3 after whole blood donation. Age, BMI, blood pressure (male donors), and blood volume (female donors) were significantly associated with post‐donation symptoms. Donors with less fatigue after whole blood donation were more likely to return for their next donation within 31 days after receiving an invitation. Conclusion: Post‐symptoms improve up to 3 days after whole blood donation. Our results may help blood collection centers to identify donors more prone to post‐donation symptoms and provide personalized information about the presence and course of post‐donation symptoms, possibly increasing donor return rates. [ABSTRACT FROM AUTHOR]

In the Amsterdam Growth And Health Longitudinal Study (AGAHLS), a group of approximately 650 12- to 14-year-old boys and girls was followed in their growth, and development of their health their lifestyle including diet, physical activity and smoking. One of the main interests was the change in their aerobic fitness. From 12 to 36 years of age in total, eight repeated measurements were performed to measure peak oxygen uptake (peak VO2). In this study the data of peak VO2 are revisited and extended: We made use of all collected data as a mixed longitudinal design including cross-sectionally measured subjects as well as longitudinally measured subjects. This led to the availability of 1,194 boys and 1356 girls. With generalized estimating equations (GEE) the longitudinal changes with chronological age and differences between boys and girls were analyzed. Teenage boys and girls increased their peak VO2 (ml/min) significantly (p < .001) until age 14 in girls and until age 17 in boys. However peak VO2 relative to bodyweight (peak VO2/BW) had significantly (p < .001) decreased over the whole age range from 12 to 36 in both sexes. Vigorous physical activity (VPA) also showed a decrease and was significantly (p < .001) related with lower peak VO2/BW (Beta = 0.001). This relation was stronger in boys than in girls. Because at the start of AGAHLS no fast responding metabolic instruments were available, future longitudinal studies about aerobic fitness should include also measurement of VO2kinetics. [ABSTRACT FROM AUTHOR]

In the Amsterdam Growth And Health Longitudinal Study (AGAHLS), a group of approximately 650 12- to 14-year-old boys and girls was followed in their growth, and development of their health their lifestyle including diet, physical activity and smoking. One of the main interests was the change in their aerobic fitness. From 12 to 36 years of age in total, eight repeated measurements were performed to measure peak oxygen uptake (peak VO2). In this study the data of peak VO2 are revisited and extended: We made use of all collected data as a mixed longitudinal design including cross-sectionally measured subjects as well as longitudinally measured subjects. This led to the availability of 1,194 boys and 1356 girls. With generalized estimating equations (GEE) the longitudinal changes with chronological age and differences between boys and girls were analyzed. Teenage boys and girls increased their peak VO2 (ml/min) significantly (p < .001) until age 14 in girls and until age 17 in boys. However peak VO2 relative to bodyweight (peak VO2/BW) had significantly (p < .001) decreased over the whole age range from 12 to 36 in both sexes. Vigorous physical activity (VPA) also showed a decrease and was significantly (p < .001) related with lower peak VO2/BW (Beta = 0.001). This relation was stronger in boys than in girls. Because at the start of AGAHLS no fast responding metabolic instruments were available, future longitudinal studies about aerobic fitness should include also measurement of VO2kinetics. [ABSTRACT FROM AUTHOR]

Introduction: Besides programming of the hypothalamic-pituitary-adrenal (HPA) axis, changes in the activity of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) could contribute to the later metabolic and cardiovascular consequences of preterm birth. Objective: We compared serum cortisol, cortisone, and cortisol/cortisone ratio in early childhood in very-low-birthweight (VLBW) infants and term appropriate for gestational age (AGA) born infants. Methods: We included 41 VLBW infants, participating in the randomized controlled Neonatal Insulin Replacement Therapy in Europe trial, and 64 term AGA-born infants. Cortisol and cortisone were measured in blood samples taken at 6 months and 2 years corrected age (VLBW children) and at 3 months and 1 and 2 years (term children). At 2 years of (corrected) age (HDL) cholesterol, triglycerides, glucose, and insulin were also measured. Results: During the first 2 years of life, cortisol/cortisone ratio is higher in VLBW children compared to term children. In the total group of children, cortisol/cortisone ratio is positively related to triglycerides at 2 years of (corrected) age. In VLBW children, over the first 2 years of life both cortisol and cortisone are higher in the early-insulin group compared to the standard care group. Conclusions: In VLBW infants, lower 11β-HSD2 activity probably contributes to the long-term metabolic and cardiovascular risks. In VLBW infants, early insulin treatment could affect programming of the HPA axis, resulting in higher cortisol and cortisone levels during early childhood. [ABSTRACT FROM AUTHOR]

Objective: Attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. The authors sought to directly compare these disorders using structural brain imaging data from ENIGMA consortium data.Methods: Structural T1-weighted whole-brain MRI data from healthy control subjects (N=5,827) and from patients with ADHD (N=2,271), ASD (N=1,777), and OCD (N=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. The authors examined subcortical volume, cortical thickness, and cortical surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults, using linear mixed-effects models adjusting for age, sex, and site (and intracranial volume for subcortical and surface area measures).Results: No shared differences were found among all three disorders, and shared differences between any two disorders did not survive correction for multiple comparisons. Children with ADHD compared with those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller intracranial volume than control subjects and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared with adult control subjects and other clinical groups. No OCD-specific differences were observed across different age groups and surface area differences among all disorders in childhood and adulthood.Conclusions: The study findings suggest robust but subtle differences across different age groups among ADHD, ASD, and OCD. ADHD-specific intracranial volume and hippocampal differences in children and adolescents, and ASD-specific cortical thickness differences in the frontal cortex in adults, support previous work emphasizing structural brain differences in these disorders. [ABSTRACT FROM AUTHOR]

Summary Background: Primary prevention of overweight is to be preferred above secondary prevention, which has shown moderate effectiveness. Objective: To develop and internally validate a dynamic prediction model to identify young children in the general population, applicable at every age between birth and age 6, at high risk of future overweight (age 8). Methods: Data were used from the Prevention and Incidence of Asthma and Mite Allergy birth cohort, born in 1996 to 1997, in the Netherlands. Participants for whom data on the outcome overweight at age 8 and at least three body mass index SD scores (BMI SDS) at the age of ≥3 months and ≤6 years were available, were included (N = 2265). The outcome of the prediction model is overweight (yes/no) at age 8 (range 7.4‐10.5 years), defined according to the sex‐ and age‐specific BMI cut‐offs of the International Obesity Task Force. Results: After backward selection in a Generalized Estimating Equations analysis, the prediction model included the baseline predictors maternal BMI, paternal BMI, paternal education, birthweight, sex, ethnicity and indoor smoke exposure; and the longitudinal predictors BMI SDS, and the linear and quadratic terms of the growth curve describing a child's BMI SDS development over time, as well as the longitudinal predictors' interactions with age. The area under the curve of the model after internal validation was 0.845 and Nagelkerke R2 was 0.351. Conclusions: A dynamic prediction model for overweight was developed with a good predictive ability using easily obtainable predictor information. External validation is needed to confirm that the model has potential for use in practice. [ABSTRACT FROM AUTHOR]

Previous studies have discouraged the use of the Cox proportional hazards (PH) model for traditional mediation analysis as it might provide biased results. Accelerated failure time (AFT) models have been proposed as an alternative for Cox PH models. In addition, the use of the potential outcomes framework has been proposed for mediation models with time‐to‐event outcomes. The aim of this paper is to investigate the performance of traditional mediation analysis and potential outcomes mediation analysis based on both the Cox PH and the AFT model. This is done by means of a Monte Carlo simulation study and the illustration of the methods using an empirical data set. Both the product‐of‐coefficients method of the traditional mediation analysis and the potential outcomes framework yield unbiased estimates with respect to their own underlying indirect effect value for simple mediation models with a time‐to‐event outcome and estimated based on Cox PH or AFT. [ABSTRACT FROM AUTHOR]

Investigate the risk factors cluster of cardiovascular disease (CVD). Association of CVD risk factors with cardiopulmonary fitness; Impact of smoking on the development of CVD; Correlation between clustering of the lifestyle and lipoprotein levels.

Objectives: Impaired awareness of functional deficits is often observed in people with Korsakoff syndrome (KS) and may result in refusal of care, although this area has been understudied. This study aimed to investigate levels of impaired awareness and their relationships with neuropsychiatric symptoms (NPS) in people with KS residing in specialized nursing homes.Methods: A cross-sectional, observational study was conducted among 215 residents with KS or other alcohol-related cognitive disorders. Awareness was measured with the Patient Competency Rating Scale (PCRS). NPS and subsyndromes were measured with the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Adjusted multilevel regression analyses were performed to examine the relationships between the level of awareness and NPS.Results: The mean level of impaired awareness was 39.3 (SD = 19.9) indicating moderate impairment. Twenty-nine percent of the residents had no or mildly impaired awareness; 37% were moderately impaired, and 34% were severely impaired. Residents with moderately impaired awareness showed more severe apathy than residents with no or mildly impaired awareness (difference 1.23; 95% CI 1.02-1.48; p = 0.03). No associations were found between the level of awareness and other NPI outcomes. Cognitive functioning seems to have the strongest impact on the association between level of awareness and NPS in KS residents.Conclusions: Impaired awareness of functional deficits is highly common in KS residents; however, apart from apathy, is not significantly related with NPS. Additional research should further examine, which interventions are effective in dealing with impaired awareness in these people, particularly when apathy is present. [ABSTRACT FROM AUTHOR]

Grey matter (GM) atrophy is a prominent aspect of multiple sclerosis pathology and an important outcome in studies. GM atrophy measurement requires accurate GM segmentation. Several methods are used in vivo for measuring GM volumes in MS, but assessing their validity in vivo remains challenging. In this postmortem study, we evaluated the correlation between postmortem MRI cortical volume or thickness and the cortical thickness measured on histological sections. Sixteen MS brains were scanned in situ using 3DT1-weighted MRI and these images were used to measure regional cortical volume using FSL-SIENAX, FreeSurfer, and SPM, and regional cortical thickness using FreeSurfer. Subsequently, cortical thickness was measured histologically in 5 systematically sampled cortical areas. Linear regression analyses were used to evaluate the relation between MRI regional cortical volume or thickness and histological cortical thickness to determine which postprocessing technique was most valid. After correction for multiple comparisons, we observed a significant correlation with the histological cortical thickness for FSL-SIENAX cortical volume with manual editing (std. β = 0.345, adjusted R2 = 0.105, P = 0.005), and FreeSurfer cortical volume with manual editing (std. β = 0.379, adjusted R2 = 0.129, P = 0.003). In addition, there was a significant correlation between FreeSurfer cortical thickness with manual editing and histological cortical thickness (std. β = 0.381, adjusted R2 = 0.130, P = 0.003). The results support the use of FSL-SIENAX and FreeSurfer in cases of severe MS pathology. Interestingly none of the methods were significant in automated mode, which supports the use of manual editing to improve the automated segmentation. Hum Brain Mapp 37:2223-2233, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) has been found to predict sickness absence (SA). The present study investigated the effect of replacing single-item SRH by a multi-item health measure on SA predictions. Methods: Longitudinal study of 2059 Norwegian nurses with assessments in three waves each separated by 1 year. Health was measured by single-item SRH and multi-item SF-12 in waves 1 and 2. SA was self-reported in all three waves and high SA was defined as more than or equal to 31 SA days within the last 12 months. Predictions of high SA by a model including age, prior SA and single-item SRH were compared with predictions by a model including age, prior SA and multi-item SF-12. Both models were bootstrapped to correct for over-optimism and prospectively validated for their predictions in a new time frame. Results: 1253 nurses (61%) had complete data for analysis. The SF-12 model predicted the risk of high SA more accurately (X2= 4.294; df = 8) and was more stable over time than the SRH model (model X2= 14.495; df = 8). Both prediction models correctly discriminated between high-risk and low-risk individuals in 73% of the cases at wave 2 and in 71% of the cases at wave 3. Conclusions: The accuracy of predictions increased when single-item SRH was replaced by multi-item SF-12, but the discriminative ability did not improve. Single-item SRH suffices to identify employees at increased risk of high SA. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to evaluate the performance of first-trimester Down syndrome (DS) screening with serum sampling at different weeks of gestation. Material and Methods: We studied 35,431 singleton pregnancies (2005-2011), including 145 DS cases. Screening performance was determined in different maternal age groups with serum sampling between weeks 9 + 0 and 13 + 6. Results: No significant differences were found between the detection rates at different gestational weeks. The false-positive rate (FPR) in week 9 (6%) was comparable to the FPR in week 10 (6.5%; p = 0.214), whereas itwas significantly lower compared to weeks 11 (7.2%; p = 0.007), 12 (7.4%; p = 0.003) and 13 (8.5%; p < 0.001). The odds of receiving a false-positive result was significantly increased with serum sampling in week 11 (OR 1.32, 95% CI 1.08-1.63; p = 0.008) for women ≥36 years and from week 12 onwards (OR 1.28, 95% CI 1.01-1.61; p = 0.04) for women <36 years. There were no differences in mean log10 multiple of the median values of pregnancy-associated plasma protein-A, free β-human chorionic gonadotrophin or nuchal translucency between both age groups, nor in mean maternal age between the different gestational weeks in either age group. Discussion: Early serum sampling (<11 weeks) resulted in higher screening performance. The impact of the increase in the FPR was highest in women ≥36 years. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives To describe the patient safety culture of Dutch emergency departments (EDs), to examine associations between safety culture dimensions and patient safety grades as reported by ED staff and to compare these associations between nurses and physicians. Design Cross-sectional survey conducted in 2007. Setting Thirty-three non-academic EDs in the Netherlands. Participants Four hundred and eighty nurses, 159 physicians and 91 other professionals. Main Outcome Measure Self-reported level of patient safety. Results In unadjusted analyses, all dimensions of safety culture were positively associated with the reported level of patient safety and six of these associations with patient safety were statistically significant after adjustment (‘teamwork across units’, ‘frequency of event reporting’, communication openness', ‘feedback about and learning from errors’, ‘hospital management support for patient safety’). Differences between nurses and physicians were found on two dimensions (‘frequency of event reporting’ and ‘ hospital management support for patient safety’). Physicians tended to grade patient safety higher than nurses whilst having equal judgements on these two dimensions. Conclusions Staff identified several dimensions of safety culture that are associated with staff-reported safety in the ED. Physicians and nurses identified distinct dimensions of safety culture as associated with reported level of patient safety. [ABSTRACT FROM AUTHOR]

This study analyses distinct trajectories of vital exhaustion (VE; a measure of mental health incorporating signs of stress and depression) over a period of 15 years in healthy adults and investigates further the consequences for markers of low-grade inflammation as indicators of cardiovascular disease risk. Data of 341 participants of the Amsterdam Growth and Health Longitudinal Study were utilized. VE was measured by the Maastricht Questionnaire. Markers of low-grade inflammation included interleukin-6, interleukin-8 and tumour necrosis factor-α. Distinct trajectories of VE were obtained by latent class growth models, and consequences for markers of low-grade inflammation of the trajectories were analysed by linear regressions. We found comparable trajectories of VE for men and women; a 'never vitally exhausted' subgroup (16.9% and 25.1%, respectively), a 'stable preclinical VE' subgroup (51.7% and 68.1%) and a 'chronic VE state' subgroup (31.5% and 6.7%). The subgroups had similar levels of the markers investigated. This study is the first to analyse VE longitudinally in healthy adults and indicates that although distinct trajectories of VE were identified, differential consequences for cardiovascular disease risk were unapparent. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To validate previously computed correction factors for free β-human chorionic gonadotrophin (fβ-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies with hormone treatment and to determine the effect on false-positive rate (FPR). Methods: Retrospective study on 249 IVF and 250 ICSI cases and 20,190 controls. Correction factors 1.42 (PAPP-A), 1.17 (fβ-hCG) in IVF; 1.56 (PAPP-A) in ICSI were applied on the absolute serum concentrations. Analysis was done on log10-transformed multiples of medians (MoMs). Results: In the controls, mean PAPP-A and fβ-hCG MoM were 1.004 and 1.062. Before correction, mean PAPP-A MoM was significantly lower in IVF (0.757; p < 0.001) and in ICSI (0.671; p < 0.001) and after correction comparable (1.071; p = 0.053 in IVF; 1.048; p = 0.178 in ICSI). Before correction, mean fβ-hCG MoM was comparable (1.054; p = 0.59 in IVF and 1.051; p = 0.56 in ICSI) and after correction significantly higher in IVF (1.241; p < 0.001). After correction the likelihood for receiving a false-positive result was 1.03 in IVF pregnancies (95% CI 0.98-1.09; p = 0.248) and 1.02 in ICSI pregnancies (95% CI 0.97-1.07; p = 0.448). Conclusions: After correction the FPR in IVF and ICSI pregnancies with hormone treatment reduces to the observed FPR in the controls. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: The efficacy of psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of psychodynamic therapy with that of cognitive-behavioral therapy (CBT), hypothesizing nonsignificant differences and the noninferiority of psychodynamic therapy relative to CBT. Method: A total of 341 adults who met DSM-IV criteria for a major depressive episode and had Hamilton Depression Rating Scale (HAM-D) scores ⩾14 were randomly assigned to 16 sessions of individual manualized CBT or short-term psychodynamic supportive therapy. Severely depressed patients (HAM-D score >24) also received antidepressant medication according to protocol. The primary outcome measure was posttreatment remission rate (HAM-D score ⩽7). Secondary outcome measures included mean posttreatment HAM-D score and patient-rated depression score and 1-year follow-up outcomes. Data were analyzed with generalized estimating equations and mixedmodel analyses using intent-to-treat samples. Noninferiority margins were prespecified as an odds ratio of 0.49 for remission rates and a Cohen's d value of 0.30 for continuous outcome measures. Results: No statistically significant treatment differences were found for any of the outcome measures. The average posttreatment remission rate was 22.7%. Noninferiority was shown for posttreatment HAM-D and patient-rated depression scores but could not be demonstrated for posttreatment remission rates or any of the followup measures. Conclusions: The findings extend the evidence base of psychodynamic therapy for depression but also indicate that timelimited treatment is insufficient for a substantial number of patients encountered in psychiatric outpatient clinics. [ABSTRACT FROM AUTHOR]

Souvenaid aims to improve synapse formation and function. An earlier study in patients with Alzheimer's disease (AD) showed that Souvenaid increased memory performance after 12 weeks in drug-naïve patients with mild AD. The Souvenir II study was a 24-week, randomized, controlled, double-blind, parallel-group, multi-country trial to confirm and extend previous findings in drug-naïve patients with mild AD. Patients were randomized 1 : 1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks. The primary outcome was the memory function domain Z-score of the Neuropsychological Test Battery (NTB) over 24 weeks. Electroencephalography (EEG) measures served as secondary outcomes as marker for synaptic connectivity. Assessments were done at baseline, 12, and 24 weeks. The NTB memory domain Z-score was significantly increased in the active versus the control group over the 24-week intervention period (p = 0.023; Cohen's d = 0.21; 95% confidence interval [-0.06]-[0.49]). A trend for an effect was observed on the NTB total composite z-score (p = 0.053). EEG measures of functional connectivity in the delta band were significantly different between study groups during 24 weeks in favor of the active group. Compliance was very high (96.6% [control] and 97.1% [active]). No difference between study groups in the occurrence of (serious) adverse events. This study demonstrates that Souvenaid is well tolerated and improves memory performance in drug-naïve patients with mild AD. EEG outcomes suggest that Souvenaid has an effect on brain functional connectivity, supporting the underlying hypothesis of changed synaptic activity. [ABSTRACT FROM AUTHOR]

Background: To compare childhood arrestees with matched comparison groups on levels of autistic symptoms and to assess the unique predictive value of autistic symptoms for future delinquent behavior in childhood arrestees. Methods: Childhood first-time arrestees ( n = 308, baseline age 10.7 ± 1.5 years) were followed up for 2 years. Autistic symptoms, externalizing disorders and delinquent behavior were assessed yearly. Childhood arrestees were compared on autistic symptoms with matched (age, gender) general population and clinical autism spectrum disorder samples. The predictive value of autistic symptoms for delinquent behavior was analyzed using generalized estimating equations. Results: At each assessment, levels of autistic symptoms in childhood arrestees were in between levels found in the general population and autism spectrum disorder samples. Autistic symptoms were positively associated with delinquent behavior in childhood arrestees, even after adjustment for externalizing disorders: IRR (incidence rate ratio) 1.23; 95% CI 1.11-1.36 and IRR 1.29; 95% CI 1.15-1.45 for core autistic symptoms and total symptom score, respectively. Conclusions: Autistic symptoms are more prevalent in childhood arrestees compared to the general population and are uniquely associated with future delinquent behavior. Attention should, therefore, be given to the possible presence of autism related symptomatology in these children. Implications for diagnostic assessment and intervention need further investigation. [ABSTRACT FROM AUTHOR]

Aim: To assess longitudinally whether smoking tobacco is related to muscle strength in healthy adults and to assess the influence of lifestyle covariates on this relation. Methods: Data were obtained from the observational Amsterdam Growth and Health Longitudinal Study, with four repeated measurements at the ages of 21 (n = 181), 27 (n = 144), 32 (n = 426) and 36 (n = 373) years. Knee muscle strength (KMS) was measured at an angle of 300° per second. Smoking and the covariates physical activity and dietary intake were assessed with a questionnaire. Other covariates included physical fitness and body fat percentage. Cardiopulmonary fitness was assessed with a maximal running test and body fatness with skinfold measurements. Sex-specific longitudinal analyses were carried out using generalized estimating equations. Results: In men and women, an inverse relationship between smoking tobacco and KMS was found. Smoking 100 g of tobacco a week resulted in a reduction of 2.9% in KMS in men and a reduction of 5.0% in women. This relation existed largely independently of lifestyle covariates. Conclusion: This study indicates that smoking is inversely related to skeletal muscle strength in healthy adults. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Preterm infants are at risk of developing insulin resistance. It is not known whether insulin resistance in adult life is different between those with a low weight at term (preterm growth restraint, PGR) and those with a normal weight at term. Study Design: Insulin sensitivity, measured by the hyperinsulinemic euglycemic clamp, was investigated in 21-year-old adults born very preterm (i.e. <32 gestational weeks), of whom 17 were small for gestational age (SGA), 12 were appropriate for gestational age with PGR (AGA-PGR) and 28 were AGA-non-PGR. Results: Insulin sensitivity expressed as M value (glucose disposal mg/kg/min) was lower in AGA-non-PGR (8.9) than in SGA (11.0) or AGA-PGR subjects (10.4). These differences disappeared after adjustment for current body size. Linear growth between 3 months and 21 years of age was different between AGA-non-PGR and SGA subjects and between AGA-nonPGR subjects and the combined AGA-PGR and SGA subjects. Conclusion: In young adults born very preterm, differences in insulin sensitivity between those born SGA, with PGR and without PGR are related to the current body composition. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defences. [ABSTRACT FROM PUBLISHER]

Olfactory deficits and executive dysfunction are early and common symptoms in Parkinson's disease (PD). Previous studies have shown that hyposmia can be a first sign of PD. The aim of the present study was to determine which of three olfactory tests and two selected tests of executive function would be the best predictor of future PD over a 5 year period. In a cohort of 361 nonparkinsonian, nondemented first-degree relatives of PD patients, in whom alternative causes of olfactory dysfunction were excluded, we measured baseline performance on three olfactory and two executive function tasks. Five years from baseline, clinical neurological evaluation and/or a screening questionnaire, sensitive to the presence of Parkinsonism, were used to detect individuals developing clinical PD. Our results show that in first degree relatives of PD patients worse performance on each of three olfactory processing tasks was associated with an increased risk of developing PD within 5 years, whereas performance on selected tests of executive dysfunction was not associated with an increased risk of developing PD. Interestingly, impaired odor discrimination was the best predictor for future PD. © 2009 Movement Disorder Society [ABSTRACT FROM AUTHOR]

The article examines the generalizability of a prediction rule for sick leave developed from the Dutch shoulder study (DSS). After studying the calibration and discrimination in the validation cohorts, results showed that the prediction rule for sick leave related to shoulder pain in 6-month period following the first consultation in primary care showed adequate generalizability to another population of workers with shoulder pain participating in an observational cohort study.

Aims Alcohol septal ablation (ASA) has been successful in the treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study is to evaluate the effects of ethanol-induced myocardial infarcts on regional myocardial function using cardiac magnetic resonance (CMR) tissue tagging and 3-dimensional (3D) strain analysis. [ABSTRACT FROM PUBLISHER]

Data from the Longitudinal Aging Study Amsterdam were used to study the relationship between neuroticism and aging. At baseline, cross-sectional analyses of data from 2,117 respondents (aged 55-85 years, M = 70) showed no significant age differences. The magnitude of the 3- and 6-year stability coefficients was high, and 12% of the elderly participants showed a clinically relevant mean level change. Longitudinal multilevel analyses showed a small but statistical significant change with aging, but the mean change was not considered clinically relevant. A U-formed course was found, showing a slight decrease until respondents reached the age of 70. Adjusting the model for physical health-related variables slightly increased the stability. An additional interaction analysis showed that the individual trajectory of neuroticism was not affected by the physical health status. In conclusion, neuroticism remains rather stable in middle and older adulthood, with some apparent increase in late life. [ABSTRACT FROM AUTHOR]

To prepare the care system for a rising population of older people, it is important to understand what factors predict the use of care. This paper reports a study of transitions in the use of informal and professional care using Andersen-Newman models of the predictive predisposing, enabling and need factors. The study has drawn on Longitudinal Ageing Study Amsterdam (LASA) data on the use of care and the contextual factors. The data were collected at three-yearly intervals from a random, sex- and age-stratified, population-based sample of adults aged 55-85 years. In summary, the findings for those who initially did not receive care were that almost one-third received some kind of care three years later, most of which was provided by informal care-givers. Need factors were important predictors of most transitions in care, and predisposing and enabling factors, such as age, partner status and income, also played a role. On the relationship between informal and professional care, evidence was found for both 'compensatory processes', i.e. informal care substitutes for professional care, and 'bridging processes', i.e. informal care facilitates professional care. In view of the increasing discrepancy between the demand for professional care and its supply, the significant impact of predisposing and enabling factors offers opportunities for intervention. [ABSTRACT FROM AUTHOR]

: PurposeTo determine the ability of 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) positron emission tomography (PET) to monitor response in locally advanced gastroesophageal cancer (LAGEC). Additionally, optimal FDG-PET methods for response monitoring were selected.: ProceduresSequential dynamic FDG-PET scans were performed in 13 patients with LAGEC (T2-3N0-1M0-1a) treated with neoadjuvant cisplatin and gemcitabine plus granulocyte macrophage colony stimulating growth factor at a three weekly schedule. The standard FDG-PET method, nonlinear regression (NLR), was compared with computed tomography (CT), endoscopic-ultrasound (EUS), and histopathology as well as with 21 simplified analytical FDG-PET methods.: ResultsFive out of 12 operated tumors responded histopathologically with less than 10% residual tumorcells (42%). These had a higher decrease in FDG uptake compared with nonresponders (P = 0.008). Early (after two cycles) and late (after completed induction therapy) response evaluation showed a specificity of 86% and 100%, respectively, and a sensitivity of 100%. Both FDG-PET and EUS were superior to CT. From 21 methods analyzing FDG uptake, the quantitative Patlak analysis, the simplified kinetic method (SKM), and the semiquantitative standardized uptake value corrected for bodyweight (SUV-BW) seemed to correlate best with NLR.: ConclusionsFDG-PET reliably predicted response in LAGEC. FDG-PET measurements using Patlak analysis or the more clinical applicable SKM and SUV-BW were acceptable alternatives to NLR. [Copyright &y& Elsevier]

The purpose of this paper is to test the hypothesis that daily physical activity over a period of 15 years has been beneficial to aerobic fitness in young male and female participants (13-27 years) in the Amsterdam Growth and Health Longitudinal Study. Only subjects with the maximal data of six sets of measurements were included (83 male and 98 female participants). Daily physical activity was assessed using a standardized interview on activity and expressed as a weighted activity score. Aerobic fitness was assessed using a maximal running test on a treadmill and measuring the maximal oxygen uptake (VO2max) and the maximal slope of the track (Smax) To assess the longitudinal relationship between daily physical activity and aerobic fitness a real longitudinal analysis was carried out with generalized estimating equations, adjusting for differences in initial aerobic fitness at age 13, and for other lifestyle (dietary intake, smoking and alcohol consumption) and biological parameters (biological age, body fat, blood pressure and concentration of serum cholesterol). A significant relationship (P < 0.01) was observed between daily physical activity and both VO2max and Smax. It can be concluded that the development of aerobic fitness between the age of 13 and 27 years is independently and positively related to daily physical activity in this group of male and female participants in the study. The functional implications, however, are small: a relatively high increase in the weighted physical activity score of 30% over a period of 15 years results in a 2%-5% increase in aerobic fitness. [ABSTRACT FROM AUTHOR]