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Background: : Qualitative research shows barriers in access to healthcare for persons with a migration background, possibly leading to healthcare inequalities. We aimed to compare healthcare use between older community-dwelling persons with a migration background and native Dutch persons with dementia. Methods: : Observational cohort study using electronic health records of NIVEL Primary Care Database (2013–2014) linked to nationwide administrative registries managed by Statistics Netherlands. We included all community-dwelling persons with dementia in the Netherlands aged 65 years and older. Negative binomial and logistic regression analyses were conducted to assess differences in healthcare use outcomes. The largest migrant groups (persons born in Surinam, Turkey and Morocco) were studied separately. Results: : 138,864 persons with dementia were included in the study, whereof 3,991 persons with a migration background and 132,477 native Dutch persons. Moroccan-born persons showed 1.46 higher odds of having an unplanned hospital admission compared to native Dutch persons (95 % Confidence Interval [CI] 1.22–1.74). Persons with a migration background used less professional home care (Odds Ratio [OR] 0.55, 95 %CI 0.51–0.59), and received less home visits from their general practitioner (OR 0.50, 95 %CI 0.43–0.57) than native Dutch persons. Moroccan-born persons had more often an out-of-hours general practitioner consultation compared to native Dutch persons (Incidence Rate Ratio 1.36, 95 %CI 1.18–1.57). Conclusions: : We found significant quantitative differences in healthcare use between persons with a migration background and native Dutch persons with dementia. Further research is needed to gain insight into the reasons of these differences, with consideration of specific migration background.

Introduction Insomnia is a common symptom among patients with schizophrenia and schizoaffective disorder, negatively impacting symptom severity, functioning and well-being; however, it is rarely the direct focus of treatment. The main recommended treatment for insomnia is cognitive behavioural therapy (CBT-I). There is some evidence that CBT-I can also be used to treat insomnia in patients with schizophrenia, but only a few randomised controlled trials (RCTs) have been published. The aim of this ongoing RCT is to determine whether we can alleviate symptoms of insomnia and improve the quality of life in patients with schizophrenia and schizoaffective disorder through CBT-I delivered via the internet or in a group mode.Methods and analyses The aim of this study is to recruit 84–120 outpatients from the Psychosis Clinics of Helsinki University Hospital and the City of Helsinki Health Services. The main inclusion criteria are a diagnosis of schizophrenia or schizoaffective disorder and self-reported sleep problems. The study will be performed on a cyclic basis, with a target of 12–24 patients per cycle. Participants are randomly assigned into three groups: (1) a group receiving only treatment as usual (TAU), (2) internet-based individual therapy for insomnia (iCBT-I)+TAU or (3) group therapy for insomnia (GCBT-I) conducted via a virtual platform+TAU. The primary outcome measures are quantitative changes in the Insomnia Severity Index score and/or changes in health-related quality of life using the 15D quality of life measure. Secondary outcomes include self-reported variables for sleep, health, stress and the severity of psychotic and depressive symptoms; objective outcomes include actigraphy and bed sensor data to evaluate circadian rhythms and motor activity. Outcome measures are assessed at baseline and after the treatment period at weeks 12, 24 and 36.Ethics and dissemination The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa, Finland, approved the study protocol. The results will be published in peer-reviewed journals.Trial registration number NCT04144231.

This paper investigates how social workers in Sweden and the United States perceive the impact of social stigma, based on their experiences within a social service job. This is important because when social workers feel stigmatized (defined in this context as describing or regarding something, such as a characteristic or group of people in a way that shows strong disapproval (Merriam-Webster, n.d.)), they can affect clients negatively, i.e. poorer quality of interventions/results. Comparison of feelings of stigmatization among social workers in these distinct cultures enabled us to study how values, social policies and institutions influence stigmatization processes. Focus group data shows significant differences between Sweden and the U.S. regarding: 1) how social workers experience their society‘s view of social work, 2) what society’s view of social work means for social workers’ self-perception, 3) how social workers experience their society‘s views of clients, 4) what society’s view of clients means for social workers’ client work. Differences are mainly due to dissimilarities between the programs and institutions within each system. Findings indicate that promotion of the dignity and worth of people requires social workers to also experience dignity and worth in their professional role.

A promising pollution control technology is cold plasma driven chemical processing. The plasma is a pulsed electric gas discharge inside a near atmospheric-pressure-temperature reactor. The system is energized by a continuous stream of very short high-voltage pulses. The exhaust gas to be treated flows through the reactor. The methods applied involve the development of robust cold plasma systems, industrial applications and measuring technologies. Tests of the systems were performed at many industrial sites and involved control of airborne VOC (volatile organic compound) and odor. Electrical, chemical and odor measuring data were collected with state-of-the-art methods. To explain the test data an approximate solution of global reaction kinetics of pulsed plasma chemistry was developed. It involves the Lambert function and, for convenience, a simple approximation of it. The latter shows that the amount of removal, in good approximation, is a function of a single variable. This variable is electric plasma power divided by gas flow divided by input concentration. In the results sections we show that in some cases up to 99% of volatile pollution can be removed at an acceptable energy requirement. In the final sections we look into future efficiency enhancements by implementation of (sub)nanosecond pulsed plasma and solid state high-voltage technology and by integration with catalyst technology.

Background: Children and young adults needing surgery for a primary malignant bone tumour around the knee face a difficult, life changing decision. This study describes the level of shared decision making (SDM) experienced and preferred by these patients, parents and physicians in surgical consultations, and its relation to experienced decisional conflict and decisional regret. Methods: Multicentre, cross-sectional cohort study. All patients who underwent surgery for a primary bone tumour around the knee in the Dutch designated orthopaedic oncological centres between 2012 and 2015, and their parents, were invited to complete the SDM-patient-Questionnaire (SDM-Q-9), Decisional Conflict Scale (DCS), Decisional Regret Scale (DRS) and Control Preferences Scale (CPS). Physicians completed the SDM- physician-Questionnaire (SDM-Q-Doc) and CPS. Results: Twenty-four patients >16 years with twenty-two parents, and ten parents of patients between 5 and 16 years old, completed the questionnaires. Patients’ median SDM-Q-9 score was 60 (8.9–97.8), parents’ 77.8 (8.9–100) and physicians’ 82.2 (66.7–97.8). The SDM-Q-9 scores of patients (rs=−0.753, p

Abstract Background Culex pipiens sensu stricto (s.s.) is considered the primary vector of Usutu virus and West Nile virus, and consists of two morphologically identical but behaviourally distinct biotypes (Cx. pipiens biotype pipiens and Cx. pipiens biotype molestus) and their hybrids. Both biotypes are expected to differ in their feeding behaviour, and pipiens/molestus hybrids are presumed to display intermediate feeding behaviour. However, the evidence for distinct feeding patterns is scarce, and to date no studies have related differences in feeding patterns to differences in host abundance. Methods Mosquitoes were collected using CO2-baited traps. We collected blood-engorged Cx. pipiens/torrentium specimens from 12 contrasting urban sites, namely six city parks and six residential areas. Blood engorged Cx. pipiens/torrentium mosquitoes were identified to the species and biotype/hybrid level via real-time polymerase chain reaction (PCR). We performed blood meal analysis via PCR and Sanger sequencing. Additionally, avian host communities were surveyed via vocal sounds and/or visual observation. Results We selected 64 blood-engorged Cx. pipiens/torrentium mosquitoes of which we successfully determined the host origin of 55 specimens. Of these, 38 belonged to biotype pipiens, 14 were pipiens/molestus hybrids and the identity of three specimens could not be determined. No blood-engorged biotype molestus or Cx. torrentium specimens were collected. We observed no differences in feeding patterns between biotype pipiens and pipiens/molestus hybrids across different habitats. Avian community composition differed between city parks and residential areas, whereas overall avian abundance did not differ between the two habitat types. Conclusions Our results show the following: (1) Cx. pipiens s.s. feeding patterns did not differ between city parks and residential areas, regardless of whether individuals were identified as biotype pipiens or pipiens/molestus hybrids. (2) We detected differences in host availability between city parks and residential areas. (3) We show that in both urban habitat types, biotype pipiens and pipiens/molestus hybrids fed on both mammalian and avian hosts. This underscores the potential role in arbovirus transmission of biotype pipiens and pipiens/molestus hybrids. Graphical Abstract

Abstract Background During the COVID-19 pandemic, older patients in primary care were triaged based on their frailty or assumed vulnerability for poor outcomes, while evidence on the prognostic value of vulnerability measures in COVID-19 patients in primary care was lacking. Still, knowledge on the role of vulnerability is pivotal in understanding the resilience of older people during acute illness, and hence important for future pandemic preparedness. Therefore, we assessed the predictive value of different routine care-based vulnerability measures in addition to age and sex for 28-day mortality in an older primary care population of patients with COVID-19. Methods From primary care medical records using three routinely collected Dutch primary care databases, we included all patients aged 70 years or older with a COVID-19 diagnosis registration in 2020 and 2021. All-cause mortality was predicted using logistic regression based on age and sex only (basic model), and separately adding six vulnerability measures: renal function, cognitive impairment, number of chronic drugs, Charlson Comorbidity Index, Chronic Comorbidity Score, and a Frailty Index. Predictive performance of the basic model and the six vulnerability models was compared in terms of area under the receiver operator characteristic curve (AUC), index of prediction accuracy and the distribution of predicted risks. Results Of the 4,065 included patients, 9% died within 28 days after COVID-19 diagnosis. Predicted mortality risk ranged between 7–26% for the basic model including age and sex, changing to 4–41% by addition of comorbidity-based vulnerability measures (Charlson Comorbidity Index, Chronic Comorbidity Score), more reflecting impaired organ functioning. Similarly, the AUC of the basic model slightly increased from 0.69 (95%CI 0.66 – 0.72) to 0.74 (95%CI 0.71 – 0.76) by addition of either of these comorbidity scores. Addition of a Frailty Index, renal function, the number of chronic drugs or cognitive impairment yielded no substantial change in predictions. Conclusion In our dataset of older COVID-19 patients in primary care, the 28-day mortality fraction was substantial at 9%. Six different vulnerability measures had little incremental predictive value in addition to age and sex in predicting short-term mortality.

Combinatorial problems are formulated to find optimal designs within a fixed set of constraints and are commonly found across diverse engineering and scientific domains. Understanding how to best use quantum computers for combinatorial optimization remains an ongoing area of study. Here, we propose new methods for producing approximate solutions to quadratic unconstrained binary optimization problems, which are based on relaxations to local quantum Hamiltonians. We look specifically at approximating solutions for the maximum cut problem and its weighted version. These relaxations are defined through commutative maps, which in turn are constructed borrowing ideas from quantum random access codes. We establish relations between the spectra of the relaxed Hamiltonians and optimal cuts of the original problems, via two quantum rounding protocols. The first one is based on projections to random magic states. It produces average cuts that approximate the optimal one by a factor of least 0.555 or 0.625, depending on the relaxation chosen, if given access to a quantum state with energy between the optimal classical cut and the maximal relaxed energy. The second rounding protocol is deterministic and is based on the estimation of Pauli observables. The proposed quantum relaxations inherit memory compression from quantum random access codes, which allowed us to test the performances of the methods presented for 3-regular random graphs and a design problem motivated by industry for sizes up to 40 nodes, on superconducting quantum processors.

Abstract Background/aims Having type 2 diabetes (T2D) in combination with being overweight results in an additional increase in cardiovascular disease (CVD) risk. In addition, T2D and obesity are associated with increased levels of total homocysteine (tHcy), possibly contributing to the CVD risk. Weight loss dieting has positive effects on several CVD risk factors, but whether it affects tHcy remains unclear. Therefore, the aim of this study was to determine the effect of a calorie restricted diet on tHcy in overweight people with T2D. Methods In this post-hoc analysis of the POWER study, adults with T2D and a BMI greater than 27 kg/m² were included from the outpatient diabetes clinic of the Erasmus Medical Center, Rotterdam. The patients were subjected to a very low-calorie diet with fortified meal replacements for 20 weeks. Before and after this intervention, blood samples were collected to measure tHcy and other CVD risk factors like glycaemic and lipid parameters. Results 161 overweight participants with T2D were included, with a mean age of 54 years (range 26–74), mean weight of 104.6 ± 19.9 kg and mean HbA1c of 62.7 ± 14.3 mmol/mol. At baseline, men displayed higher tHcy than women, and tHcy level was positively correlated with body weight and triglyceride levels, while it was negatively correlated with renal function and HDL cholesterol. During the intervention, bodyweight was reduced by a mean of 9.7% (from 104.6 ± 19.9 to 94.5 ± 18.1 kg p 10 kg) showed an increase in tHcy. Future studies should explore the potential increase in tHcy induced by weight loss dieting and target the question if tHcy reduction strategies during weight loss could be clinically beneficial.

Abstract Background Men are more likely to have unmet need for mental healthcare than women. However, an under-investigated aspect of the gender difference is the role of mental health literacy. This study investigated how combinations of gender and mental health literacy were related to two indicators of unmet need: not perceiving a need for mental healthcare despite poor mental health, and refraining from seeking mental healthcare. Methods This cross-sectional study was based on a questionnaire sent to a general population sample, aged 16–84 years, in Stockholm County, Sweden, in 2019. Of the 1863 respondents (38%), 1563 were included (≥18 years). The sample was stratified into four groups, men and women with low or high mental health literacy, using the third quartile of the Mental Health Knowledge Schedule. The likelihood of not perceiving a need for mental healthcare and refraining from seeking mental healthcare, at any time in life, were investigated by calculating odds ratios with 95% confidence intervals. Results Men with low mental health literacy were most likely to not perceive a need for mental healthcare, also when adjusting for age, education, and poor mental health (OR 5.3, 95% CI 3.6–7.7), and to refrain from seeking mental healthcare, also when adjusting for age and education (OR 3.3, 95% CI 1.7–6.4), followed by men with high mental health literacy (OR 1.9, 95% CI 1.5–2.4, and OR 1.5, 95% CI 1.0-2.2) and women with low mental health literacy (OR 1.9, 95% CI 1.2–2.9, and OR 2.1, 95% CI 1.1–3.9). Women with high mental health literacy were least likely (reference group). Conclusion The results show differences in the likelihood of unmet need for mental healthcare based on combinations of gender and mental health literacy level, with men having low mental health literacy being most at risk, and women with high mental health literacy being least at risk. This challenges generalisations of a gender difference in unmet need by showing heterogeneity among men and women based on mental health literacy. Men with low mental health literacy may be particularly in need of targeted interventions to reduce potential individual and societal consequences of their unmet need.

Abstract Background We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period. Methods Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models. Results Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (β = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (β = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress. Conclusions The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components. Trial registration ISRCTN92968402 (27 February 2018).

Is family history research always life-changing and sensational? Or is there something significant in the banal that the participants in this study reported? This study aims to explore the spectrum of experiences of family history research, focusing specifically on the banal. I argue that it is in examining the banal everyday motivations, experiences, and findings that a greater understanding of how the average individual negotiates and builds meaning through their use of cultural heritage, family history, and the past. The everyday banal is what is reproduced and remains after the effervescence fades away and the normal redundancy in traditional society continues. The banal withstands the sands of time and effectively (re)produces narratives and binary tropes of identity and the past. This study examines the narratives collected from semi-structured interviews with seven participants from two Swedish non-formal courses in family history research. These narratives are important as they reveal participants’ engagement with historical consciousness and the relationship between the past, present and future. Moreover, the stories they tell are significant in revealing that participants learn family history research for numerous reasons, including “something to do” alongside those who wish to have a deeper historical understanding. Family history research is a collective and collaborative activity despite the individualised nature of focusing on one’s ancestors. Participants’ research led to discoveries that were not always revolutionary, reinforcing, for example, banal traits seen in themselves and banal activities they carry out today. This study found that while the reasons for participation, the act of attending class, and participants’ research may not necessarily result in the extraordinary–thieves or kings–for these individuals participating in family history research, the banal reasoning and banal results are significant.

Abstract The processes generating the earth’s montane biodiversity remain a matter of debate. Two contrasting hypotheses have been advanced to explain how montane populations form: via direct colonization from other mountains, or, alternatively, via upslope range shifts from adjacent lowland areas. We seek to reconcile these apparently conflicting hypotheses by asking whether a species’ ancestral geographic origin determines its mode of mountain colonization. Island-dwelling passerine birds at the faunal crossroads between Eurasia and Australo-Papua provide an ideal study system. We recover the phylogenetic relationships of the region’s montane species and reconstruct their ancestral geographic ranges, elevational ranges, and migratory behavior. We also perform genomic population studies of three super-dispersive montane species/clades with broad island distributions. Eurasian-origin species populated archipelagos via direct colonization between mountains. This mode of colonization appears related to ancestral adaptations to cold and seasonal climates, specifically short-distance migration. Australo-Papuan-origin mountain populations, by contrast, evolved from lowland ancestors, and highland distribution mostly precludes their further colonization of island mountains. Our study explains much of the distributional variation within a complex biological system, and provides a synthesis of two seemingly discordant hypotheses for montane community formation.

News source attribution in selective exposure has been examined in many contexts, but rarely in the context of selecting news from distrusted sources. As such, 800 US adults were asked to select one of two headlines attributed to CNN and/or Fox News. Results showed some people selected news from a distrusted source, but only under very specific circumstances. Others avoided the awkward moment of siding with a distrusted source, even when that meant selecting news from a trusted source that was counter-attitudinal to the source’s typical slant on global warming.

Introduction: In kidney transplantation (KT), the role of the intravascular innate immune system (IIIS) in response to ischemia-reperfusion injury (IRI) is not well-understood. Here, we studied parallel changes in the generation of key activation products of the proteolytic cascade systems of the IIIS following living donor (LD) and deceased donor (DD) transplantation and evaluated potential associations with clinical outcomes. Methods: In a cohort study, 63 patients undergoing LD (n = 26) and DD (n = 37) transplantation were prospectively included. Fifteen DD kidneys were preserved with hypothermic machine perfusion (HMP), and the remaining were cold stored. Activation products of the kallikrein-kinin, coagulation, and complement systems were measured in blood samples obtained systemically at baseline and locally from the transplant renal vein at 1, 10, and 30 minutes after reperfusion. Results: DD kidneys exhibited a prompt and interlinked activation of all 3 cascade systems of IIIS postreperfusion, indicating a robust and local thrombo-inflammatory response to IRI. In this initial response, the complement activation product sC5b-9 exhibited a robust correlation with other IIIS activation markers and displayed a strong association with short-term and mid-term (24-month) graft dysfunction. In contrast, LD kidneys did not exhibit this thrombo-inflammatory response. The use of HMP was associated with reduced thromboinflammation and preserved mid-term kidney function. Conclusion: Kidneys from DD are vulnerable to a prompt thrombo-inflammatory response to IRI, which adversely affects both short-term and long-term allograft function. Strategies aimed at minimizing graft immunogenicity prior to reperfusion are crucial to mitigate the intricate inflammatory response to IRI.