Background: Anxiety is common among head and neck cancer (HNC) patients undergoing standard radiotherapy, with varying levels reported throughout treatment. While most studies suggest an overall...Show moreBackground: Anxiety is common among head and neck cancer (HNC) patients undergoing standard radiotherapy, with varying levels reported throughout treatment. While most studies suggest an overall decrease in anxiety during the treatment trajectory, some report no significant changes over time. Limited evidence exists regarding the role of social support and post-traumatic stress symptoms (PTSS) in predicting anxiety. Aim: This study investigated levels of anxiety throughout radiotherapy, and whether pre-treatment levels of social support as well as PTSS predicted post-radiotherapy anxiety. Hypotheses: It was hypothesized that overall anxiety would decrease during radiotherapy, while also indicating individual differences. Additionally, pre-radiotherapy anxiety was expected to be negatively associated with social support and positively associated with PTSS symptoms. Finally, both pre-radiotherapy social support and PTSS were hypothesized to predict post-radiotherapy anxiety. Method: 16 HNC patients undergoing radiotherapy at a university hospital completed self-report questionnaires at pre-treatment, including the Beck Anxiety Inventory (BAI), the Social Support Questionnaire-Interaction (SSL-I), and the Posttraumatic Stress Disorder Checklist (PCL-5). The BAI was also administered multiple times during treatment. Results: Friedman’s test showed no significant changes in anxiety levels before, during, or after radiotherapy. No clinically significant individual differences in anxiety were observed between pre- and post-radiotherapy, but some were detected between pre-radiotherapy and day 10 (control). Spearman’s rank-order correlation revealed no significant associations between pre-radiotherapy anxiety and social support (ρ = -0.352, p = 0.239) or PTSS (ρ = 0.324, p = 0.279). The Generalized Linear Model indicated that neither social support (ß = -0.010, p = 0.943) nor PTSS (ß = -0.028, p = 0.720) predicted post-radiotherapy anxiety. Conclusion: No support was found for an overall decrease in anxiety levels throughout radiotherapy. Although the direction of the associations between anxiety and social support as well as anxiety and PTSS symptoms were supported, there was no support that social support, as well as PTSS symptoms predicted post-radiotherapy anxiety. Future research recommends a larger study sample and a questionnaire measuring situational anxiety multiple times throughout treatment. This could provide a deeper insight into anxiety during radiotherapy.Show less
Psychological and physical conditions often occur together, having a cumulative negative influence on each other. These comorbidities influence the quality of life, reduce life expectancy, and...Show morePsychological and physical conditions often occur together, having a cumulative negative influence on each other. These comorbidities influence the quality of life, reduce life expectancy, and increase the healthcare burden. There is a need for interprofessional collaboration to manage the complexity and this burden. A difference exists between the medical departments at Zaans Medical Centre in the number of referrals done by the healthcare providers to the medical psychology department, and it is unclear why this difference exists. The study aims to gain a comprehensive understanding of the referral process to the medical psychology department and the discrepancies between departments. It also aims to explore factors that could possibly affect the referral rate. The predicting factors being examined in the study are the presence of a medical psychologist at the multidisciplinary consultation, the education of the healthcare provider about psychological symptoms, the ability of interprofessional communication of the healthcare provider, and the feeling of shared accountability of the healthcare provider. It is hypothesized that all predictor factors positively influence the referral rate. The data is collected through a Likert Scale, with the accountability variable being analysed through a qualitative method. 13 participants are interviewed through a semi-structured interview, with a separate dataset on the number of referrals also used in the analysis. The covariates used in this study include age, gender, and years of experience in the field of specialisation of the participants. A linear regression is performed to test the quantitative hypotheses. No significant results are found; therefore, no relationships are found between the predictor variables and the referral rate. The qualitative analysis consists of three main themes: full responsibility, partial, and no responsibility of the patient’s psychological condition. Possible explanations of the results include a small sample size and different predictor variables such as a stigma on psychological having a greater effect on the referral rate. The limitations to the study are the small sample size, subjective measures as the Likert scale filled in by the participant, and potential Dunning-Kruger effect and self-enhancement bias due to overestimating their skills or positively self-rating their work. For future studies a larger sample size, objective measures such as how often the departments meet added to the data, more in depth study on other predictor variables such as stigma of the healthcare provider, could help gain a more in-depth understanding of the referral rate.Show less
Pain, which substantially impacts one’s quality of life, is affected by various factors, including outcome expectancies. Although the effect of outcome expectancies has been studied extensively on...Show morePain, which substantially impacts one’s quality of life, is affected by various factors, including outcome expectancies. Although the effect of outcome expectancies has been studied extensively on pain perception, their impact on pain tolerance -defined as the ability to withstand a maximum pain intensity stimulus before seeking relief- remains mostly unknown. Furthermore, underlying mechanisms, that may be at play are not fully understood. This study aims to examine the role of induced outcome expectancies for pain tolerance, and the moderating role of optimism. It was hypothesized that the participants of the high outcome expectancy condition who received verbal suggestions about the expected outcome would exhibit higher pain tolerance than those in the neutral condition group, who did not receive any verbal suggestions. Additionally, optimism, comprised of positive outcome expectancies for the future, was hypothesized to moderate the relationship between outcome expectancies and pain tolerance meaning that outcome expectancies would decrease one’s sensitivity to pain more when optimism is high. The study’s factorial 2x2 between-subjects design involved randomizing healthy adults into a neutral control and high outcome expectancy condition group. Outcome expectancies were manipulated through verbal suggestions and assessed using a visual analog scale about the expected intensity of the upcoming stimulus. A Cold Pressor Test was used to assess pain tolerance, and dispositional optimism was measured by the Life Orientation Test-Revised. The analysis revealed no significant difference in expected intensity ratings between the two groups, suggesting a need for further improvement of the effectiveness of verbal suggestions. Similarly, no significant difference was observed in pain tolerance between the two groups and optimism did not demonstrate a moderating effect on the relationship between induced outcome expectancies and pain tolerance. Future research may further explore cognitive and psychological mechanisms while taking into account personal traits that may be responsible for the association between outcome expectancies and pain perception and tolerance.Show less
Objective: The goal of the current study is to investigate and quantify the association of the demographic factors of age and sex as risk factors in the psychosocial domain of post-intensive care...Show moreObjective: The goal of the current study is to investigate and quantify the association of the demographic factors of age and sex as risk factors in the psychosocial domain of post-intensive care syndrome (PICS) by conducting a meta-analysis and systematic review. It is expected that the current meta-analysis will shed more light on which patients are more likely to experience (increased) psychosocial problems post-intensive care based on these two demographic factors. This is needed to continue to improve and optimise the care for intensive care survivors. The hypotheses being postulated are that female sex and older age are respective risk factors for developing problems in the psychosocial domain of PICS. Review methods: The psychosocial domain of PICS was defined as anxiety, depression, or post-traumatic stress disorder (PTSD) after intensive care. PubMed, Web of Science, and Embase were searched for relevant articles and the selection of articles was based on the algorithm of ASReview. 22 relevant articles were selected. Of the included studies, 15 studies reported relevant information on the relation between sex and post-intensive care psychosocial problems, and 12 of the included studies reported relevant information on the relation of age and post-intensive care psychosocial problems. For the demographic factor of sex, a meta-analysis was conducted with odds ratios. The demographic factor of patient age was studied by conducting a systematic review because the available data did not lend itself to statistical pooling. Results: Log OR was calculated for female sex in comparison to male sex for the odds of experiencing psychosocial problems after intensive care with a result of 2.58 [2.03; 3.28]. Odds ratios calculated for anxiety, depression, and PTSD all show female patients to be more than two times as likely to suffer from these conditions compared to males. In the systematic review for patient age, eight of the studies reported younger patients being more at risk of developing psychosocial problems after intensive care, while four show older patients being more at risk for general psychosocial problems after intensive care. When it comes to the individual studied disorders, four studies found that younger patients were more at risk for anxiety, and two found older patients to be more at risk. For depression, three studies found younger patients to be more at risk, and four studies found older patients to be more at risk. For PTSD, seven studies found younger patients to be more at risk, and three studies found older patients to be more at risk. Conclusions: Statistical pooling and analysis show that women’s odds of developing these problems are more than twice as high compared to their male counterparts. For patient age, statistical analysis was not possible in the current study. Overall, eight studies stated that younger patients were more at risk, and four studies stated that older patients were more at risk of developing negative psychosocial outcomes after intensive care. Much variation of disorder prevalence and severity is seen between studies and types of disorders, preventing the possibility of drawing a uniform conclusion on the matter. It is unclear what factors cause these variances. These results found in the current study give more insight in which demographic groups of ICU patients are more likely to require additional care for psychosocial problems after hospital release. In future research, the underlying reasons that cause these trends in demographic groups should be investigated.Show less
This study aimed to create a better understanding of the neurobiological mechanisms underlying the induction of nocebo hyperalgesia. Nocebo hyperalgesia refers to an increased pain perception...Show moreThis study aimed to create a better understanding of the neurobiological mechanisms underlying the induction of nocebo hyperalgesia. Nocebo hyperalgesia refers to an increased pain perception resulting from negative outcome expectations, a phenomenon that can negatively influence a patient’s clinical outcome. Much concerning the mechanisms underlying the induction of nocebo hyperalgesia is still unknown, although it can be hypothesized that NMDA receptor-dependent learning may play a role. The current study tested this hypothesis by pharmacologically manipulating NMDA receptor- dependent learning in healthy participants, expecting that the pharmacological manipulation would facilitate the induction of nocebo hyperalgesia. Participants (n = 50) received either a placebo or an 80 mg dose of D-cycloserine (DCS), a partial NMDA receptor agonist. Nocebo hyperalgesia was induced in both groups with verbal suggestions and a classical conditioning paradigm consisting of an induction and evocation phase. In the induction phase, high intensity heat-pain stimuli were given during trials where a sham electrical stimulation device was supposedly turned on (nocebo trials), while moderate heat-pain stimuli were given during trials where a sham electrical stimulation device was supposedly turned off (control trials). During the evocation phase, only moderate pain stimuli were given. Nocebo hyperalgesia was indicated when participants rated their pain higher during nocebo trials compared to control trials. A significant paired-samples t-test (t (49) = -8.55, p < .001) suggested that nocebo hyperalgesia was successfully induced in both groups, further confirming that nocebo hyperalgesia can be induced by classical conditioning and verbal suggestions. Nevertheless, the pharmacological manipulation of NMDA receptor-dependent learning with 80 mg DCS did not facilitate the magnitude of the induced nocebo hyperalgesia more than a placebo, as indicated by a one-way ANOVA (F (1, 49) = 0.028, p = 0.867). The usability of DCS in nocebo research was discussed, and further research was recommended. It is important that the current study is replicated, possibly with the use of another glutamatergic agent. The results from future studies could play a significant role in diminishing the impact of nocebo hyperalgesia on clinical practice.Show less
Background: People with type 1 diabetes (T1D) often experience problems with their glucose regulation (glucose variability and glucose control), sleep quality, and cognitive functioning. However,...Show moreBackground: People with type 1 diabetes (T1D) often experience problems with their glucose regulation (glucose variability and glucose control), sleep quality, and cognitive functioning. However, their interrelation has not often been investigated. The aim of this study was to investigate how sleep quality and cognitive functioning are associated with glucose regulation in people with T1D. Method: Continuous glucose monitoring (CGM) data was collected over two weeks, in 18 participants, while each day subjective sleep quality (once in the morning) and cognitive functioning (e.g., ability to concentrate, finding words) (up to five times during the day) was measured using ecological momentary assessments (EMAs). Based on the CGM data, glycemic parameters (glucose variability and glucose control) during the night and day were calculated and a mean value of cognitive functioning per day was composed. Linear mixed model analyses were used to test for 1) whether sleep quality was influenced by glycemic parameters during the night and 2) whether cognitive functioning during the day was influenced by sleep quality and whether cognitive functioning was associated with glycemic parameters during the day. In addition, an interaction effect between sleep quality and glucose variability on cognitive functioning was explored. Lastly, visual plots were used to explore the associations on an individual level. Results: No statistically significant main effects were found for either association. However, an interaction trend (ß = -2.07, p = .070) between sleep quality and glucose variability on cognitive functioning scores was found. For days with normal fluctuations in glucose levels, better sleep quality was associated with better cognitive functioning, whereas for days with high glucose variability, this association could not be found. Regarding the individual plots, both, positive and negative relationships between all mentioned variables were apparent, exemplifying important inter-individual differences. Conclusion: For people with T1D, the relationships between glucose parameters, sleep quality, and cognitive functioning, vary from person to person. This finding advocates for looking at the individual level when implementing possible treatment methods for increasing sleep quality and cognitive functioning. More research in a larger sample is warranted to further examine the inter-individual factors in these associations.Show less
Abstract Yearly, many patients get admitted to the Intensive Care Unit (ICU) worldwide, with even more admissions since the Coronavirus Disease 2019 (COVID-19) pandemic. With the rising survival...Show moreAbstract Yearly, many patients get admitted to the Intensive Care Unit (ICU) worldwide, with even more admissions since the Coronavirus Disease 2019 (COVID-19) pandemic. With the rising survival number, investigating the long-term Health-Related Quality of Life (HRQoL) outcomes, which can be negatively influenced by depressive symptoms, became important. This study investigates whether there is a difference in depressive symptoms between COVID-19 and non-COVID patients that got admitted to the ICU; how depressive symptoms influence the HRQoL, and if there is a difference in HRQoL between COVID-19 patients and non-COVID patients; and if there is a relationship between the self-reported health, happiness, and satisfaction about the ICU stay and depressive symptoms. It was expected that COVID-19 patients would have a higher mean score on depressive symptoms than non-COVID patients, COVID-19 patients with depressive symptoms have lower HRQoL scores than non-COVID patients, and lastly, that there would be a negative relation between the self-reported health, happiness and satisfaction about the ICU stay and depressive symptoms. In this study, 278 patients participated. Approximately one year after ICU discharge, patients filled out a survey. For this study, the Patient Health Questionnaire (PHQ-9), the Euroqol Quality of Life (EQ6D), and general questions about the health, happiness, and satisfaction of the ICU stay were taken into account. An independent t-test demonstrated significant higher mean scores on depressive symptoms in COVID-19 patients than in non-COVID patients (p < .05). Regression analysis showed that depressive symptoms predicted HRQoL (p < .05), but HRQoL was not different between COVID versus non-COVID (p = .225). Regression analysis showed both health and happiness predicted depressive symptoms(p < .05), but not between satisfaction and depressive symptoms (p = .318). The results confirmed our hypothesis that there would be higher mean scores on depressive symptoms in COVID-19 patients than in non-COVID patients. Our findings are clinically relevant and can be used to provide better mental health care after ICU discharge. Follow-up studies should among other things focus on the length of ICU stay, the time during the pandemic that someone got admitted to the ICU, and the depressive symptoms two years after ICU discharge.Show less
Chronic pain occurs in 23% of the Dutch adult population. Psychological factors like expectancies of pain play a big role in pain and methods that can make these expectancies more positive could...Show moreChronic pain occurs in 23% of the Dutch adult population. Psychological factors like expectancies of pain play a big role in pain and methods that can make these expectancies more positive could greatly improve a patient his quality of life. The aim of this study was to examine the relationship between manipulated outcome expectancies and pain. It was hypothesised that a positive outcome expectancy would result in a higher tolerance of pain. 61 healthy students were randomly divided into two groups, where one group received the positive outcome expectancy manipulation and the other group the control manipulation. This was done by presenting information via a computer screen of which the participants believed was about their psychological factors based on a pain test and a questionnaire, but was only based on the group to which the participant was allocated. Pain tolerance was measured using the Cold Pressor Test, where the participant had to hold his/her hand in the water bath for as long as possible and the duration was the measurement for pain tolerance. Both groups showed equal outcome expectancies, p = .193, which means the manipulation was unsuccessful and both groups had the same belief on how well they could tolerate pain. Unsurprisingly, the total amount of time spent in the CPT between the conditions was also the same, p = .988. The research question remains unanswered as the outcome expectancy manipulation was ineffective. A successful manipulation is needed which could be achieved by telling participants face-to-face by a researcher that they are expected to handle pain well, as this might be more convincing and more effective to increase outcome expectancy. Future research could focus on this aspect. This study has gained insight into the possibility that a manipulation via a computer presentation might not be effective enough to induce a positive outcome expectancy.Show less
