Background. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience...Show moreBackground. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience cognitive complaints, as well as physical complaints about their health. Their general wellbeing can also be an issue. Fortunately, for most patients these complaints typically improve over time. This study investigates patients’ memory, concentration, energy, as well as general wellbeing, over time. Methods. Patients received questionnaires about their health and wellbeing every three months following hospital release, with the main goal to track their health and wellbeing after TBI. That data was used for this research. Energy, concentration, and memory were all measured by one question in the questionnaire. General wellbeing was measured by taking the average ratings of all questions on the questionnaire. Analyses were done with three and six questionnaires over time, using repeated measures ANOVAs. Descriptive statistics were used from the first questionnaire. Results. This study found that while patients rated all these measures on average positively, they still did not feel the same as before the injury, and most experienced hindrances in daily life. When looking at the ANOVAs with three questionnaires, there was a significant improvement on concentration, energy, as well as general wellbeing over time. For all of these, most improvement took place between the first and the second questionnaires. Memory did not change significantly over time. None of the ANOVAs with six questionnaires had any significant changes over time. Conclusion. This study shows that patients may suffer from long-lasting effects of TBI. It questions whether more should be done for these patients following hospital release, to alleviate symptoms. This study has limitations concerning selection bias and drop out.Show less
Advance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally...Show moreAdvance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally accepted in Western countries and has a positive effect on end-of-life care for people with dementia. However, culture affects expectations and preferences regarding end-of-life care and decision making. This study compared the acceptability of and preference for two types of ACP interventions for patients with dementia in health care providers from the Netherlands, the US and Japan. One intervention focused on concrete treatment orders in which the patient makes specific decisions. The other focused on what the patient finds important in life, resulting in global goals of care. A total of 125 participants were assessed by means of a structured interview and a questionnaire. Participants found both types of ACP acceptable, in general and per country. A multinomial logistic regression analysis indicated no significant difference in acceptability of the concrete or the global ACP approach between countries when adjusted for age and gender. However, age was a significant predictor of acceptability of the concrete ACP approach (2 (2, 123) = 6.32, p = .042), with older participants being less likely to find it acceptable compared to not finding it acceptable (W(8) = 5.50, p = 0.019). Participants preferred the global ACP approach for patients with dementia. A multinomial logistic regression analysis indicated no significant differences in preference between countries when adjusted for age and gender in general. However, Dutch participants were less likely to prefer the global ACP approach (W(8) = 5.18, p = .023). The relationship between country and preference was not influenced by whether participants most strongly considered what the patient with dementia wants for themselves, what the patient’s family wants or what they as the health care provider want for their patient when making medical decisions. ACP is generally regarded as an acceptable form of care for patients with dementia by health care providers across countries. Future research could more specifically determine which cultural or demographic aspects affect health care providers’ views on different ACP approaches.Show less
This thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and...Show moreThis thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and subjectively. Previous studies have established that a long delay occurs between the onset of mood symptoms in BD and the first form of treatment received, estimates ranging between 6 and 11 years. Cognitive impairments in the domains of executive functions, processing speed and memory were found to persist in BD patients even during euthymia. Such cognitive impairments burden BD patients, prevent them from regaining an appropriate level of general functioning and diminish their quality of life. Thus, in order to determine whether treatment delay impacts the cognitive impairments present in BD, 69 participants were followed over the course of one year, at three different time points. The participants took part in clinical interviews, and then were asked to complete multiple measures, such as the YMRS, the QIDS, four WAIS subscales (Block Design, Arithmetic, Information and Digit symbol), and the Cognition subscale of the WHODAS. The average treatment delay found in the current sample was 14.53 years. The results of the current study suggest that longer treatment delays did not significantly predict worse cognitive functioning in BD patients, either when measured subjectively, or when measured objectively.Show less
Suicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the...Show moreSuicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the relationship between suicidal ideation and borderline personality traits was explored. Shame and guilt were analysed as possible mediators. The Personality Assessment Inventory – Borderline Scale was used to assess borderline personality traits, and Ecological Momentary Assessment was used to gather data on suicidal ideation, guilt and shame four times a day, over the course of three weeks via an app. The sample consisted of (N = 82) adults with a history of a suicide attempt or moderate-to-severe suicidal ideation in the past year. The relationships were analysed using a parallel mediation model consisting of multiple multilevel regression analyses. All steps of the model showed significant relationships. The last step showed that instead of typical mediation, the model indicated suppression, because of an increase in the association between borderline personality traits and suicidal ideation when accounting for shame and guilt. More research is necessary to explore the possible cause of these findings.Show less
This research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing...Show moreThis research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing has concentrated on specific brain areas and connections between particular regions, rather than the brain's organization and architecture. By investigating this organisation, gaps in our understanding of the brain architecture can be addressed, which could in turn lead to a better understanding of pathologies that disrupt the brain’s architecture. It is hypothesized that the brain will be more integrated during reward processing, and that increased dopamine and norepinephrine activity will result in a more integrated brain organisation. To test this prediction, the Global Efficiency (GE) of a total of 132 Regions of Interest (ROIs) and BOLD- activity of the Substantia Nigra/Ventral Tegmental Area (SN/VTA) and the Locus Coeruleus (LC) were obtained during a reward processing task, which 38 participants completed. During a functional magnetic resonance imaging (fMRI) scan, participants completed a reward- emotion recognition test. As predicted, in the reward condition, the paired t-test showed a higher GE in comparison to the no-reward condition in several nodes, mostly in the default mode network. These findings imply that the brain is more integrated when processing reward than when it is not processing reward. However, the catecholamines showed no significant correlation with this integration. Future research is needed to investigate the topology and influence of different catecholamines in more detail. The implications of these findings will be discussed.Show less
Background Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are...Show moreBackground Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are also present in individuals with MCI and AD. This thesis study aims to evaluate motor sequence learning abilities in patients with amnestic MCI (aMCI) and AD compared to healthy controls. This thesis study also explores the relationship between amyloid-β burden, a known biomarker for MCI and AD, and motor sequence learning to study whether such motor learning could also be a behavioral biomarker. This is because measuring amyloid-β is very costly and invasive, and thus the search for other biomarkers is important. Methods A cross-sectional design was employed, and participants included 28 AD patients, 33 aMCI patients, and 53 healthy controls. Motor sequence learning was assessed using a computerized task measuring reaction time and accuracy per trial, and with this information the rate and final amount of learning was calculated, i.e. how fast and how much information the participants are able to learn, respectively. Amyloid-β burden was measured using PET imaging, with higher burden reflecting more severity of the symptoms of aMCI and AD. Results The final amount of learning was not different amongst the groups, and the rate of learning was only significantly different between the AD and aMCI groups, with the AD groups showing a faster rate of learning. The AD and healthy control group did not, however, differ significantly in terms of rate of learning. The amount of amyloid-β in the brain was not associated with motor sequence learning abilities. Conclusion The findings suggest that motor sequence learning abilities are preserved in individuals with aMCI and AD, both in terms of how fast and how much they learn. In fact, patients with AD showed a faster rate of learning than patients with aMCI, although this was not found when comparing the AD patients with the healthy individuals. It is possible that this finding is because patients had more to learn by the end of the task than the aMCI group given that their memory is worse, and displayed a faster rate of learning due to this. This thesis study also suggests that motor sequence learning is not a behavioral biomarker for aMCI and AD. The search for less invasive and more easily measurable biomarkers continues to be imperative.Show less
In a world of rising economic inequality, exploring factors that contribute to a more equal society is vital. The extent to which people are generous towards those around them can help reduce local...Show moreIn a world of rising economic inequality, exploring factors that contribute to a more equal society is vital. The extent to which people are generous towards those around them can help reduce local inequalities. While previous literature has established a link between economic mobility and preferences for redistribution, the impact on individual giving remains unclear. Therefore, this study examined the influence of economic mobility on giving behavior and whether meritocratic beliefs mediate this effect. The sample included 301 participants, predominantly from Global South countries. Participants were randomly assigned to ranks on a 5-rank ladder resembling socioeconomic classes and to conditions of low or high economic mobility. First, participants played a game in which they estimated the number of dots in a picture. Those with high economic mobility could earn 3 points, and those with low economic mobility could earn 1 point per round. In a dictator game, they could indicate how many points they want to give to reach rank. Results showed that the high economic mobility condition had significantly stronger meritocratic beliefs about the estimation game, aligning with the first hypothesis. However, contrary to the second hypothesis, participants in the high economic mobility condition gave significantly more to the ranks below them. Meritocratic beliefs about the estimation game did not mediate the effect. This suggests that inducing high economic mobility seems to increase generosity, particularly towards those with fewer resources. Policymakers and non-governmental organizations should promote high economic mobility to foster generosity in society.Show less
Social media has become a platform for sharing alcohol and other drug (AOD) recovery journeys, with #selflove as a prominent theme. This study explores the association of self- views, positive...Show moreSocial media has become a platform for sharing alcohol and other drug (AOD) recovery journeys, with #selflove as a prominent theme. This study explores the association of self- views, positive emotions, and social connections in the context of social media, particularly regarding #selflove and in AOD recovery. Specifically, social connections are examined as they are considered to be a relevant point of support during the recovery process. Positive emotions are examined, as employing a more positive outlook towards oneself is associated with a more positive self-view and a more sustained recovery process. The dataset comprises 902 posts from Instagram and Twitter in 2019 collected by Ziemer (2022). The present study addresses two research questions: (1) What is the association between positive and negative self-views in social media posts using chi-square analysis to identify a balanced self-view (discussing negative and positive self-views) during the recovery journey, (2) to what extent can positive self-view mentions be predicted through logistic regression, based on expressed connectedness with family/friends, the AOD recovery community, and positive emotions in the posts. Surprisingly, the results challenge the initial hypothesis of predominantly balanced self-views in these posts, as no association was found between mentioning positive and negative self-views within a single post. Contrary to expectations, mentioning positive self- views was not linked to references to connecting with others or positive emotions. Future research should employ more nuanced coding for emotions and social connections. Qualitative measures can help capture potential differences between sharing one's recovery journey online and the actual offline experience.Show less
Objective: Informal caregivers of palliative care patients face many challenges and are in need of support by healthcare providers. We aim to assess the care provided to informal caregivers, the...Show moreObjective: Informal caregivers of palliative care patients face many challenges and are in need of support by healthcare providers. We aim to assess the care provided to informal caregivers, the effects of healthcare providers’ background characteristics and actions undertaken to improve the care provided in healthcare organizations. Method: A cross-sectional mixed-method approach was applied. Questionnaires were used for statistical analysis. First, the care provided to informal caregivers (i.e. basic emotional care and specific care tasks) was examined using descriptive statistics. Second, the effects of healthcare providers’ background characteristics (i.e. healthcare setting, profession, age and work experience) on the care provided were examined using bivariable analyses and general linear model (GLM). Third, actions to improve the care provided in healthcare organizations were examined using qualitative conventional content analysis. Journey mapping workshops provided input for the 19 analyzed action plan reports. Results: 586 healthcare providers and volunteers of 19 Dutch healthcare organizations completed the questionnaire (response rate: 49%). First, participants had an average basic emotional care of 6.70 (SD = 3.33, 0-10 range) and an average of specific care tasks of 8.51 (SD = 2.89, 0-13 range). Second, volunteers and paramedics scored lower than other healthcare providers on basic emotional care (p = .003, p = .012) and volunteers scored lower on specific care tasks (p = .012). The age of healthcare providers and volunteers seemed to have a quadratic effect on the basic emotional care (p = .017) with an increase until 45-55 years. The same effect was found on specific care tasks (p = 0.042) after excluding the volunteers. Third, improvement categories were derived from the action plan reports. For individual healthcare providers: care and support for informal caregivers during the illness-trajectory, bereavement care for informal caregivers, cooperation with informal caregivers, interprofessional cooperation. For healthcare organizations: organizational support. Discussion: The care provided to informal caregivers is still in need of improvement. The age and profession of healthcare providers were found to affect the care provided. The actions found to improve the care provided to informal caregivers are promising and can be a source of inspiration for healthcare organizations.Show less
Changes in social cognition, encompassing all cognitive processes that underlie social interaction, have been noted in various types of dementia. Theory of Mind (ToM) is a key aspect of social...Show moreChanges in social cognition, encompassing all cognitive processes that underlie social interaction, have been noted in various types of dementia. Theory of Mind (ToM) is a key aspect of social cognition, defined as the ability to understand the mental state of another person, including their emotions, intentions and beliefs. Cartoon tests aim to adopt humour using cartoon jokes to assess ToM. In this study, a new Dutch cartoon test aimed to be applicable in clinical assessment of dementia was developed and validated. The test includes 12 cartoons (6 requiring ToM to understand the joke and 6 that do not), which were collected through an extensive search and were rated by experts (n = 17) on content and funniness. Normative data for the selected cartoons was obtained by control participants (n = 39), through annotation of these, scoring categories were formed. The test was then validated in a clinical sample, including patients referred to a memory clinic for cognitive complaints and suspected dementia (n = 9), in an observational cross-sectional study with a case-control type selection of participants. Patients were expected to score lower on the cartoon test than controls. An ANCOVA with demographic variables as covariates was performed: no significant differences between patients (n = 9) and control participants (n = 9) were found (p > .05). Further, the internal validity (Cronbach’s α of .864 for the total cartoon test) and convergent validity of test was good. Divergent validity was found to be questionable. Regarding demographics: females were expected to score higher than males; older participants were expected to score higher than younger participants; and higher educated participants were expected to score higher than lower educated participants on the cartoon test. A Mann-Whitney U analysis showed no gender differences (p > .05); assessment of Spearman-rank order correlation coefficients showed age was significant in its negative relation to cartoon test performance (p < .05); and education level significant in its positive relation to test performance (p < .05). Future investigation with a larger patient sample including differential dementia diagnoses is recommended to substantiate the results and make the test clinically applicable.Show less
Itch is a somatosensory stimulus and could potentially alter performance of daily activities. Since itch stimuli will signal potential danger, one might want to protect oneself from potential harm...Show moreItch is a somatosensory stimulus and could potentially alter performance of daily activities. Since itch stimuli will signal potential danger, one might want to protect oneself from potential harm by adapting ones behaviour. Pleading itch stimuli demands ones attention, which can be called the attentional bias (AB). Adapting ones behaviour might influence the effectiveness of treatment, due to not paying attention to the treatment. So far, an AB has been found in healthy individuals, but evidence is mixed. In addition, it is unclear if an AB is present in patients who experience chronic itch. Therefore, this study investigated attentional bias towards itch related visual stimuli in participants who suffer from chronic itch (N=34) compared to healthy controls (N=36). Attentional bias was measured in an online study with two attention tasks, the dot-probe paradigm and the spatial-cuing paradigm using itch-related pictures. During the dot-probe task, patients with chronic itch showed the presence of an AB. Yet, the results acquired from the spatial-cuing task showed the presence of an AB in every participant in disregard of the group they were in. This is not in line with previous research. However, previous research only investigated healthy individuals. Furthermore, all participants reacted faster on invalid trials once an itch cue was presented. One might interpret this as having an attentional avoidance of threat. Yet, also healthy participants seemed to react faster, which perhaps indicates that the itch cue is an overall negative cue regardless of having a past with itch. The discrepancy between the two attention tasks is remarkable, and could perhaps be ascribed to the different processing skills the two tasks ask from the participant. Therefore, future research should focus on the different components of attentional processing. This could eventually optimize current treatment/intervention options.Show less
Earlier research suggests that some exercise intensities are more beneficial to enhance creativity than others. However, if and why specific exercise intensities are related to better creativity is...Show moreEarlier research suggests that some exercise intensities are more beneficial to enhance creativity than others. However, if and why specific exercise intensities are related to better creativity is not exactly clear yet. This study aimed to gain insight into which exercise intensity is best for improving creativity and to explore the possible role of physical fitness in the relationship between exercise intensity and creativity. This is the first study in which participants were given a more objective individually-tailored instruction with regard to exercise intensity and in which four conditions (low intensity exercise, moderate-intensity exercise, high-intensity exercise and a control condition) were compared with respect to the enhancement of divergent creativity (including fluency and originality). First, it was expected that moderate-intensity is best to enhance creativity compared to low intensity exercise, highintensity exercise and no exercise. Second, it was expected that creativity is enhanced more after someone exercises at an intensity level that matches his/her level of physical fitness compared to someone exercising at an intensity level that does not match his/her physical fitness. A total of N = 73 students were studied. A between-subjects design was used in which participants were randomly assigned to one of the four conditions. The participants had to visit the lab of Leiden University twice. First they had to perform a physical fitness test and then they were randomly assigned to one of the four conditions and they had to do a task that measured divergent creativity. For the first hypothesis, the Two-Way ANOVA indicated that neither the fluency (η² = .009, p = .88) nor the originality scores (η² = .006, p = .94) differed between conditions. For the second hypothesis, the Two-Way ANOVA indicated that neither the fluency (η² = .024, p = .19) nor the originality scores (η² = .008, p = .45) differed between participants who had a match or non-match between their physical fitness level and the assigned exercise intensity. The results suggest that changing exercise intensity and matching exercise intensity to physical fitness level do not make a difference in the improvement of creativity.Show less
Job Burnout (JB) is a demanding syndrome that leaves employees exhausted and dealing with cognitive and emotional problems, with symptoms lasting up to 10 years. To understand why JB symptoms...Show moreJob Burnout (JB) is a demanding syndrome that leaves employees exhausted and dealing with cognitive and emotional problems, with symptoms lasting up to 10 years. To understand why JB symptoms pertain for so long, different resource theories were integrated to investigate the impact of JB on an individual gain process between job resources, personal resources, and recovery gained through physical exercise. It was predicted that skill discretion (SD), a common job resource, increases the personal resource self-efficacy (SE) which, in turn, enhances the recovery gained from physical exercise. This gain process was proposed to be dampened by JB, leaving employees with higher JB symptoms in a less advantageous position for resource gain as compared to those with lower symptoms. Using longitudinal data across three workweeks, self-report questionnaires were administered among full-time employees (N = 163). Although correlations revealed that the proposed relationships were found at specific weeks, hierarchical regression analyses revealed no across-time relationships, meaning no weekly gain process could be identified between SD, SE, and recovery gained through exercise. In addition, against expectations, no negative impact of JB on the gain process was found. Thus, the exact relationships between job resources, personal resources, recovery gained through exercise, and JB remain unclear. Future research is needed to further investigate these relationships preferably by using a different time lag than one week and by applying different roles of personal resources within the Job Demands-Resources framework.Show less
