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Health professions education (HPE) research in the General Practice domain (GP-HPE) is vital for high-quality healthcare. Collaboration among GP-HPE researchers is crucial but challenging. Formulating a research agenda, involving stakeholders, and fostering inter-institutional collaboration can address these challenges and connect educational research and practice. We used Q-methodology to explore perspectives on GP-HPE research of participants from all Dutch postgraduate GP training institutes. Participants individually sorted statements based on the relevance of future GP-HPE research for educational practice. Data analysis comprised inverted factor analysis, rotation, and qualitative interpretation of configurations of all statements. The National Meeting on Educational Research took a participatory approach. We included 73 participants with diverse involvement in GP-HPE research. We identified five distinct perspectives, each representing a research focus area for developing and innovating GP education: the clinician scientist, the socially engaged GP, the specific GP identity, the GP as an entrepreneur, and the GP engaged in lifelong learning. The resulting five perspectives align with General Practice hallmarks. Q-methodology and a participatory approach facilitated collaboration among stakeholders. Successful inter-institutional collaboration requires a common goal, neutral leadership, participant commitment, regular meetings, audit trail support, process transparency, and reflexivity. Future research should address evidence gaps within these perspectives. Using Q-methodology turned out to be valuable for compiling a national research agenda for GP-HPE research. The research process helped to cross boundaries between researchers in different institutions, thus putting inter-institutional collaborative advantage center stage. Our approach could provide a conceivable procedure for HPE researchers worldwide.

Abstract Background Due to aging population and increasing part of immunocompromised patients, a raise in life-threatening organ damage related to VZV can be expected. Two retrospective studies were already conducted on VZV in ICU but focused on specific organ injury. Patients with high-risk of VZV disease still must be identified. The objective of this study was to report the clinical features and outcome of all life-threatening VZV manifestations requiring intensive care unit (ICU) admission. This retrospective cohort study was conducted in 26 French ICUs and included all adult patients with any life-threatening VZV-related event requiring ICU admission or occurring in ICU between 2010 and 2019. Results One-hundred nineteen patients were included with a median SOFA score of 6. One hundred eight patients (90.8%) were admitted in ICU for VZV disease, leaving 11 (9.2%) with VZV disease occurring in ICU. Sixty-one patients (51.3%) were immunocompromised. Encephalitis was the most prominent organ involvement (55.5%), followed by pneumonia (44.5%) and hepatitis (9.2%). Fifty-four patients (45.4%) received norepinephrine, 72 (60.5% of the total cohort) needed invasive mechanical ventilation, and 31 (26.3%) received renal-replacement therapy. In-hospital mortality was 36.1% and was significantly associated with three independent risk factors by multivariable logistic regression: immunosuppression, VZV disease occurring in ICU and alcohol abuse. Hierarchical clustering on principal components revealed five phenotypically distinct clusters of patients: VZV-related pneumonia, mild encephalitis, severe encephalitis in solid organ transplant recipients, encephalitis in other immunocompromised hosts and VZV disease occurring in ICU. In-hospital mortality was highly different across phenotypes, ranging from zero to 75% (p

Abstract Background The COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic. Methods We utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately. Results The study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰. Conclusions This study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.

AbstractObjectives This study aimed to assess the impact of on-demand versus continuous prescribing of proton pump inhibitors (PPIs) on symptom burden and health-related quality of life in patients with gastroesophageal reflux disease (GERD) presenting to primary care.Methods Thirty-six primary care centres across Europe enrolled adult GERD patients from electronic health records. Participants were randomised to on-demand or continuous PPI prescriptions and were followed for 8 weeks. PPI intake, symptom burden, and quality of life were compared between the two groups using mixed-effect regression analyses. Spearman’s correlation was used to assess the association between changes in PPI dose and patient-reported outcomes.Results A total of 488 patients (median age 51 years, 58% women) completed the initial visit, with 360 attending the follow-up visit. There was no significant difference in PPI use between the continuous and on-demand prescription groups (b=.57, 95%CI:0.40-1.53), although PPI use increased in both groups (b = 1.33, 95%CI:0.65 − 2.01). Advice on prescribing strategy did not significantly affect patient-reported outcomes. Both symptom burden (Reflux Disease Questionnaire, b=-0.61, 95%CI:-0.73 − -0.49) and quality of life (12-item Short Form Survey physical score b = 3.31, 95%CI:2.17 − 4.45) improved from baseline to follow-up in both groups. Increased PPI intake correlated with reduced reflux symptoms (n = 347, ρ=-0.12, p = 0.02) and improved quality of life (n = 217, ρ = 0.16, p = 0.02).Conclusion In real-world settings, both continuous and on-demand PPI prescriptions resulted in similar increases in PPI consumption with no difference in treatment effects. Achieving an adequate PPI dose to alleviate reflux symptom burden improves quality of life in GERD patients. EudraCT number 2014-001314-25.

Background: Many countries observed a sharp decline in the use of general practice services after the outbreak of the COVID-19 pandemic. However, research has not yet considered how changes in healthcare consumption varied among regions with the same restrictive measures but different COVID-19 prevalence. Aim: To investigate how the COVID-19 pandemic affected healthcare consumption in Dutch general practice during 2020 and 2021, among regions with known heterogeneity in COVID-19 prevalence, from a pre-pandemic baseline in 2019. Design & setting: Population-based cohort study using electronic health records. The study was undertaken in Dutch general practices involved in regional research networks. Method: An interrupted time-series analysis of changes in healthcare consumption from before to during the pandemic was performed. Descriptive statistics were used on the number of potential COVID-19-related contacts, reason for contact, and type of contact. Results: The study covered 3 595 802 contacts (425 639 patients), 3 506 637 contacts (433 340 patients), and 4 105 413 contacts (434 872 patients) in 2019, 2020, and 2021, respectively. Time-series analysis revealed a significant decrease in healthcare consumption after the outbreak of the pandemic. Despite interregional heterogeneity in COVID-19 prevalence, healthcare consumption decreased comparably over time in the three regions, before rebounding to a level significantly higher than baseline in 2021. Physical consultations transitioned to phone or digital over time. Conclusion: Healthcare consumption decreased irrespective of the regional prevalence of COVID-19 from the start of the pandemic, with the Delta variant triggering a further decrease. Overall, changes in care consumption appeared to reflect contextual factors and societal restrictions rather than infection rates.

Abstract Background A 3D printing grid-based method was developed to construct anthropomorphic phantoms with non-uniform activity distributions, to be used for evaluation of quantitative SPECT images. The aims were to characterize the grid-based method and to evaluate its capability to provide realistically shaped phantoms with non-uniform activity distributions. Methods Characterization of the grid structures was performed by printing grid-filled spheres. Evaluation was performed by micro-CT imaging to investigate the printing accuracy and by studying the modulation contrast ( $$C_{{\text{M}}}$$ C M ) in SPECT images for 177Lu and 99mTc as a function of the grid fillable-volume fraction (FVF) determined from weighing. The grid-based technique was applied for the construction of two kidney phantoms and two thyroid phantoms, designed using templates from the XCAT digital phantoms. The kidneys were constructed with a hollow outer container shaped as cortex, an inner grid-based structure representing medulla and a solid section representing pelvis. The thyroids consisted of two lobes printed as grid-based structures, with void hot spots within the lobes. The phantoms were filled with solutions of 177Lu (kidneys) or 99mTc (thyroids) and imaged with SPECT. For verification, Monte Carlo simulations of SPECT imaging were performed for activity distributions corresponding to those of the printed phantoms. Measured and simulated SPECT images were compared qualitatively and quantitatively. Results Micro-CT images showed that printing inaccuracies were mainly uniform across the grid. The relationships between the FVF from weighing and $$C_{{\text{M}}}$$ C M were found to be linear (r = 0.9995 and r = 0.9993 for 177Lu and 99mTc, respectively). The FVF-deviations from the design were up to 15% for thyroids and 4% for kidneys, mainly related to possibilities of cleaning after printing. Measured and simulated SPECT images of kidneys and thyroids exhibited similar activity distributions and quantitative comparisons agreed well, thus verifying the grid-based method. Conclusions We find the grid-based technique useful for the provision of 3D printed, realistically shaped, phantoms with non-uniform activity distributions, which can be used for evaluation of different quantitative methods in SPECT imaging.

Background: The development of novel medical imaging technologies and treatment procedures hinges on the availability of accurate and versatile phantoms. This paper presents a cost-effective approach for creating anthropomorphic abdominal phantoms. Methods: This study proposes a cost-effective method using 3D printing and readily available materials (beeswax, plaster, and epoxy resin) to create high-fidelity anthropomorphic abdominal phantoms. The three-dimensionally printed phantoms exhibited X-ray attenuation properties closely matching those of human tissues, with measured Hounsfield unit (HU) values of −115.41 ± 20.29 HU for fat, 65.61 ± 18.06 HU for muscle, and 510 ± 131.2 HU for bone. These values were compared against patient images and a commercially available phantom, and no statistically significant difference was observed in fat tissue simulation (p = 0.428). Differences were observed for muscle and bone tissues, in which the 3D-printed phantom demonstrated higher HU values compared with patient images (p < 0.001). The 3D-printed phantom’s bone simulation was statistically like that of the commercially available phantom (p = 0.063). Conclusion: This method offers a cost-effective, accessible, and customizable alternative for abdominal phantoms. This innovation has the potential to accelerate advancements in abdominal imaging research, leading to improved diagnostic tools and treatment options for patients. These phantoms could be used to develop and test new imaging techniques with high accuracy.

Background: Despite its high prevalence and impact on health, metabolic dysfunction-associated steatotic liver disease (MASLD) is inadequately addressed in European primary care (PC), with a large proportion of cases going undiagnosed or diagnosed too late. A multi-country European research consortium led a project to design and evaluate a patient-centered, integrated model for MASLD screening, diagnosis, and linkage to specialty care for European PC settings. Based on the lessons from this project, the latest research evidence, and existing guidelines for the management of MASLD, we sought to develop a set of practice recommendations for screening, referral, and management of MASLD in PC. Methods: The Rand/UCLA modified Delphi panel method, with two rounds, was used to reach consensus on practice recommendations. The international panel consisted of experts from six countries, representing family medicine, gastroenterology, hepatology, cardiology, and public health. Initially, fifteen statements were drafted based on a synthesis of evidence from the literature and earlier findings from our consortium. Prior to the consensus meeting, the statements were rated by the experts in the first round. Then, in a hybrid meeting, the experts discussed findings from round one, adjusted the statements, and reassessed the updated recommendations in a second round. Results: In round one, there was already a high level of consensus on 10 out of 15 statements. After round 2, there were fourteen statements with a high degree of agreement (>90%). One statement was not endorsed. The approved recommendations addressed the following practice areas: risk screening and diagnosis, management of MASLD–lifestyle interventions, pharmacological treatment of MASLD/MASH, pharmacological treatment for co-morbidity, integrated care, surgical management, and other referrals to specialists. Conclusions: The final set of 14 recommendations focuses on increasing comprehensive care for MASLD in PC. The recommendations provide practical evidence-based guidance tailored to PC practitioners. We expect that these recommendations will contribute to the ongoing discussion on systematic approaches to tackling MASLD and supporting European PC providers by integrating the latest evidence into practice.

Peter Muris,1,2 Henry Otgaar1,3 1Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; 2Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa; 3Institute of Criminology, Faculty of Law and Criminology, Catholic University of Leuven, Leuven, BelgiumCorrespondence: Peter Muris, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands, Email peter.muris@maastrichtuniversity.nlAbstract: The present review addressed the relationship between two self-related concepts that are assumed to play a role in human resilience and well-being: self-esteem and self-compassion. Besides a theoretical exploration of both concepts, a meta-analysis (k = 76, N = 35,537 participants) was conducted to examine the magnitude of the relation between self-esteem and self-compassion and their links to indices of well-being and psychological problems. The average correlation between self-esteem and self-compassion was strong (r = 0.65, effect size = 0.71), suggesting that – despite some distinct features – the overlap between both self-related constructs is considerable. Self-esteem and self-compassion displayed relations of a similar magnitude to measures of well-being and psychological problems, and both concepts accounted for unique variance in these measures once controlling for their shared variance. Self-esteem and self-compassion can best be seen as complementary concepts and we invite researchers to look more at their joint protective role within a context of well-being and mental health as well as to their additive value in the treatment of people with psychological problems.Keywords: self-esteem, self-compassion, resilience, well-being, psychological problems, interventions

Background: Legal cases and research have shown that due to suggestive therapeutic interventions, people can start to remember abuse that they never experienced. Some of these people eventually retract their claims of abuse. This study examined the memory reports of self-defined retractors of abuse and the prevalence of nonbelieved memories. Method: In this study, a retrospective survey method was used to investigate 56 individuals who had retracted their claims of abuse. We examined details, plausibility, beliefs, and recollections of the abuse before and after retraction, as well as the reasons for withdrawing their belief and the outcomes of both recovered and retracted memories. Results: Twenty-four participants took significantly longer to retract the memories than to initially recover them. The belief in the occurrence of the abusive event and personal plausibility scores were significantly lower after the retraction, whereas the recollection scores were similar before and after the retraction. The main reason for withdrawing the belief in the abuse-related memory was the emergence of external evidence putting doubt on the retractors’ claims. After the withdrawal of the memories, some retractors (n = 17, 70.83%, 95% CI [52.6%, 0.89%]) believed that they gained more benefits (e.g., giving them a new chance to re-build their lives and to establish new relationships with others). Conclusion: While the reliability of retractors’ reports is unclear, these findings support related work on retractor memory reports and highlight the presence of nonbelieved memories within retractors’ memory reports.

Background/aim: Child sexual abuse (CSA) is a pervasive issue that affects children and adolescents worldwide, and Spain is no exception. Despite its high impact, there is a lack of comprehensive data on the prevalence of CSA in Spain. This study aims to update the current state of the prevalence of CSA, providing a comprehensive picture of the prevalence of sexual abuse from data using varying defining criteria. Method: A cross-sectional design was conducted, including a total of 1,323 participants, aged between 18 and 70 years (M = 28.40, SD = 10.31) responded to a measure of exposure to child sexual abuse. Results: The results exhibited that the prevalence of CSA was 9.2% for male and 22.1% for female participants, significantly higher for them. In terms of prevalence rate, females reported more frequently than males having suffered a more severe form of sexual abuse when they were 13 to 18 years old, with a large magnitude of the effect. Another notable finding was that the occurrence of global CSA with and without intercourse was significant, not a trivial effect. Conclusions: Consequently, there is a need for increased awareness, education, and resources to prevent and address CSA. The results of this study highlight the need for continued research to better understand the extent of CSA and to develop evidence-based interventions to protect children and adolescents from CSA victimization.

Abstract Background Experiences with organizational changes in daytime general practices and out-of-hours (OOH) services during the COVID-19 pandemic may help to address the challenges in general practice care that were already a concern before the crisis. This study aimed to describe these experiences and the potential usefulness of the organizational changes for future general practice care and any future pandemics. Methods Semi-structured interviews were performed among 11 directors of OOH services, and 19 (locum) general practitioners (GPs) or practice managers, who were purposively sampled. Video or telephone interviews were performed in two rounds: between November 2020 and January 2021 and between May 2021 and August 2021. The data were analyzed using thematic analysis methods. Results Three themes emerged from the data: (1) Changes in the triage procedures; in GP practices and OOH services, stricter triage criteria were implemented, and GPs were more actively involved in the triage process. These measures helped to reduce the number of ‘low urgency’ face-to-face consultations. (2) Changes in GP care; there was a shift towards video and telephone consultations, allowing GPs to spend more time with patients during the remaining face-to-face consultations. For chronic patients, the shift towards telemonitoring appeared to encourage self-care, and postponing face-to-face consultations for regular checkups appeared to be unproblematic for stable patients. (3) Coordination of GP care and information communication flow during the COVID-19 pandemic; OOH directors perceived a lack of consistency in the information from various governmental and non-governmental parties on containment measures and guidelines related to COVID-19, making it difficult to act on them. The COVID-19 pandemic intensified collaboration between GPs, OOH services, and other healthcare professionals. Conclusions The results of this study indicate that some of the organizational changes, such as stricter triage, remote consultations, and changes in managed care of chronic patients, may help in tackling the pre-existing challenges in GP care from before the COVID-19 pandemic. However, more extensive research and continuous monitoring are necessary to establish the effects on patients and their health outcomes. To navigate future pandemics, the intensified collaboration between health professionals should be maintained, while there is considerable room for improvement in the provision of unambiguous information.

Purpose: Emerging lifestyle changes due to rapid urbanization have led to an epidemiological transition and the rising prevalence of obesity is responsible for major non-communicable diseases (NCDs) which have further aggravated due to the COVID-19 pandemic. This study aims to assess the effectiveness of a comprehensive school-based intervention on diet and physical activity-related behavior of adolescents. Methods: In 2019, a cluster-randomized controlled trial was conducted in randomly selected (n = 8) private schools. A 2-year intervention program was implemented over consecutive academic years (2019–2020 and 2020–2021) with students who were in the 6th and 7th grades when the study began. Four schools were randomly assigned to the intervention (n = 794) and four schools to the control group (n = 774). Results: The difference in changes in diet and physical-activity-related behaviors of the students between the intervention and control schools were not significant in the intention to treat analysis probably due to the large drop-out due to COVID-19 measures: 304 students were available for follow-up in the intervention group and 122 in the control group (391 cases were excluded to make data comparable with baseline survey). The intake of vegetables (once a day) [β = 0.35, OR = 1.42, 95% CI (1.03, 1.95)] in the per-protocol analysis has increased among adolescents in the intervention group as compared to the control group. Conclusion: The findings of this study indicated a positive effect of the intervention on diet and physical-activity-related changes in the expected direction and highlights the importance of addressing such behavior to prevent obesity among adolescents and thus NCDs in the later stage of life.

AimThe present study examined the relationship between addiction and hikikomori (extreme social withdrawal) symptoms.MethodA group of clinically referred addiction patients (n = 31) and a group of age- and gender-matched non-clinical controls (n = 34) completed a self-report scale for measuring hikikomori symptoms (the Hikikomori Questionnaire-25) along with some other questionnaires assessing substance use (frequency and severity) and quality of life.ResultsThe results showed that addiction patients displayed significantly higher levels of hikikomori symptoms than the non-clinical control (Cohen's d = 3.41); 87.1% even showed such a high score that they were identified as being at risk for the hikikomori syndrome (vs. only 2.9% in the non-clinical control group). Correlational analyses revealed that within the addiction group, the severity of the substance use problem (as quantified by an index of craving) correlated positively with the level of hikikomori symptoms and negatively with quality of life. In other words, the more severe the addiction, the more extreme the social withdrawal tendencies and the lower the quality of life.ConclusionAltogether, the findings provide further support for the marked social impairments of people with substance use problems and underline that this should be an important target of intervention.

Abstract While depression and chronic pain are frequently comorbid, underlying neuronal circuits and their psychopathological relevance remain poorly defined. Here we show in mice that hyperactivity of the neuronal pathway linking the basolateral amygdala to the anterior cingulate cortex is essential for chronic pain-induced depression. Moreover, activation of this pathway in naive male mice, in the absence of on-going pain, is sufficient to trigger depressive-like behaviors, as well as transcriptomic alterations that recapitulate core molecular features of depression in the human brain. These alterations notably impact gene modules related to myelination and the oligodendrocyte lineage. Among these, we show that Sema4a, which was significantly upregulated in both male mice and humans in the context of altered mood, is necessary for the emergence of emotional dysfunction. Overall, these results place the amygdalo-cingulate pathway at the core of pain and depression comorbidity, and unravel the role of Sema4a and impaired myelination in mood control.

Abstract The impact of the COVID-19 pandemic on general practitioners’ (GP) care for patients with asthma and/or COPD is largely unknown. To describe the impact of the pandemic on asthma or COPD-related GP care, we analysed routinely recorded electronic health records data from Dutch general practices and out-of-hours (OOH) services. During the COVID-19 pandemic (2020), the contact rates for asthma and/or COPD were significantly lower in GP practices and OOH services compared with the pre-pandemic period (2019) (respectively, 15% lower and 28% lower). The proportion of telephone contacts increased significantly with 13%-point in GP practices and 12%-point at OOH services, while the proportion of face-to-face contacts decreased. Furthermore, the proportion of high urgent contacts with OOH services decreased by 8.5%-point. To conclude, the overall contact rates in GP practices and OOH services decreased, while more contacts were remote. Lower contact rates have, after a short follow-up, not resulted in more patients with exacerbations in OOH care. However, this might still be expected after a longer follow-up.

Abstract Background To describe general practitioners (GPs) experiences with the impact COVID‐19 on the duration of cancer detection. Methods Cross‐sectional survey study among Dutch GPs. Results Fifty‐eight GPs participated. During the first wave, COVID‐19‐related delays were experienced by 88%, 52%, and 67% of GPs in the contact‐seeking, primary care, and referral phases, respectively. GPs reported delays due to telehealth consultations, longer waiting times and patient's concerns of COVID infections and overburdening GPs. Conclusions The majority of GPs experienced delays in cancer diagnostic processes during the beginning of the COVID pandemic, which was most prominent in the timeliness in which patients sought GP care.

The current experiment examined the effect of forewarning on children's (11 to 12 years of age) and adults' spontaneous false memory creation by presenting participants with semantically related word lists that are often used to elicit false memories (i.e., Deese-Roediger-McDermott (DRM) paradigm). The forewarning consisted of an explanation of the false memory effect and a demonstration of a DRM word list and an associated recognition task. It was hypothesized that children would have fewer false memories than adults using the DRM paradigm and that forewarning would reduce the number of critical lures remembered by children and adults. We found a developmental reversal effect in that children had lower false memory levels than adults and that forewarning reduced, but did not eliminate, false memory propensity in both children and adults. Our findings further indicated that forewarning was more effective in reducing false memory levels in 11- to 12-year-old children than in adults. Finally, analyses revealed that participants were more accurate when they received a forewarning as compared to when they did not.