Problematic behaviour remains a problem within healthcare of individuals with dementia, especially as its patient group is set to expand. Problematic behaviour is often caused by pain and places a...Show moreProblematic behaviour remains a problem within healthcare of individuals with dementia, especially as its patient group is set to expand. Problematic behaviour is often caused by pain and places a heavy burden on both professional and family caregivers. Especially since family caregivers are often overlooked as a factor in care. This study therefore investigates the effectiveness of the STA OP! method (SOM), a stepwise approach to address problematic behaviour and pain in individuals with dementia, as well as how the efficacy of SOM is moderated by family involvement. The study, conducted within the CARED-4 project, utilizes a quasi-experimental longitudinal design with measurements at baseline, 3 months, and 6 months after implementing SOM. It included 84 residents with dementia from 10 Dutch nursing homes units paired with their family caregivers. Problematic behaviour was examined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and family involvement was examined through a tailored questionnaire. Analysis was performed with RM Anova for problematic behaviour and family involvement and a general linear model for the moderation of SOM by family involvement. Results indicated that SOM effectively reduces problematic behaviour overall (F(2,55) = 3.81, p = 0.028), after 3 months (Mean Difference = 5.47 SE= 1.97, p = 0.007), but not after 6 months (Mean Difference = 5.70 SE = 3.36, p = 0.095). Family involvement did not change overall (F(1.62,30) = 2.12, p = 0.138). Accordingly, family involvement did not moderate the impact of SOM on problematic behaviour (F(2) = 1.43, p = 0.243). Despite methodological challenges mainly due to missing data, the study takes a first step towards understanding how the effectiveness of SOM interacts with family involvement. So, although family involvement did not moderate a significant reduction in problematic behaviour, the efficacy of SOM has further been established.Show less
Insomnia is highly prevalent in patients with long-term medical conditions. Although fatigue is the most common daytime symptom of insomnia, it is still largely unknown which underlying components...Show moreInsomnia is highly prevalent in patients with long-term medical conditions. Although fatigue is the most common daytime symptom of insomnia, it is still largely unknown which underlying components are associated with fatigue in a broader population of insomnia patients. Previous literature stated that dysfunctional sleep-related beliefs (DSRB) and pre-sleep arousal (PSA) could explain the relationship between insomnia and fatigue. Additionally, subjective sleep characteristics, such as insomnia severity, number of nocturnal awakenings (NoA) and sleep efficiency might also be components of this relationship. This study aimed to investigate how these factors affect fatigue in a broad medical population with insomnia. It was hypothesized that more disturbed sleep-related psychological factors and subjective sleep characteristics were associated with increased fatigue. This cross-sectional study, derived from the ongoing TIMELAPSE study, consisted of 154 participants. Participants completed questionnaires assessing fatigue (Checklist Individual Strength-20), DSRB (Dysfunctional Beliefs and Attitudes about Sleep-16), PSA (Pre-Sleep Arousal Scale), and insomnia severity (Insomnia Severity Index). The Consensus Sleep Diary tracked NoA and sleep efficiency daily for one week. Two multiple regression analyses were performed to assess the relationship between sleep-related psychological factors (DSRB, PSA), subjective sleep characteristics (insomnia severity, NoA, sleep efficiency) and fatigue. Age, gender, and depression were included as controlling variables. Results showed that DSRB (β = .174, p = .027), PSA (β = -.160, p = .036), and insomnia severity (β = .243, p = .002) were factors associated with fatigue in insomnia patients. More severe DSRB and higher insomnia severity predicted elevated levels of fatigue. Contrary to expectations, PSA was negatively associated with fatigue. Lastly, NoA and sleep efficiency were not related to fatigue. This study uncovered connections between more severe DSRB, lower PSA, and higher insomnia severity that led to higher levels of fatigue. The current study suggests that improvements in DSRB and reducing insomnia severity may reduce fatigue of insomnia patients with long-term medical conditions. Sleep interventions should emphasize on challenging these DSRB. Future research is needed to examine the complex relationship between PSA and fatigue, as well as whether changes in DSRB during CBT-I treatment reduce fatigue symptoms in this population.Show less
The global prevalence of Alzheimer’s disease is expected to rise from 50 to 152 million cases by 2050 due to the limited availability of therapeutic and preventive strategies and ageing populations...Show moreThe global prevalence of Alzheimer’s disease is expected to rise from 50 to 152 million cases by 2050 due to the limited availability of therapeutic and preventive strategies and ageing populations. Although digital tools can address the growing gap between healthcare supply and demand, their implementation is difficult, and personal factors can influence individuals’ intention to use such tools. Thus, this study explores the relationship between various personal factors, as self-reported by healthy individuals (N = 507) who are part of a brain research registry, and their intention to use and promote using digital tools in the context of brain health and dementia. According to the hypothesis formulated for the research, higher financial scarcity, lower educational attainment, and lower employment status predict lower intention to use and promote digital tools for brain health. The study examined four distinct digital tools: (1) MijnBreincoach (a prevention tool), (2) cCog (a diagnostic tool), (3) ADappt (a patient- orchestrated care tool), and Neurokeys (a prediction tool). It was found that Neurokeys exhibited the highest score for intention to use but the lowest score for intention to promote. In addition, medium and high educational attainment predicted higher behavioral intention to use MijnBreincoach, while the most beneficial (i.e., most secure, stable, and safe) employment status predicted higher intention to promote MijnBreincoach and cCog. In conclusion, it is important to recognize differences in intention to use and promote different types of digital tools across potential users and the influence of personal characteristics on the intention to use and promote digital tools for brain health. During the development of a digital tool, it is recommended to consider which target audience would derive the greatest benefit from it and tailor it accordingly.Show less
This study aims to investigate the effects of exercise-intensity on divergent creativity. It is hypothesized that exercise of moderate and high intensity enhance creativity more effectively than...Show moreThis study aims to investigate the effects of exercise-intensity on divergent creativity. It is hypothesized that exercise of moderate and high intensity enhance creativity more effectively than exercise of lower intensity. The study also investigates if arousal, positive high-arousal affect, and negative high-arousal affect serve as intermediary variables in this relationship. Scarce previous research has suggested a relationship between exercise-intensity and creativity, but studies comparing different exercise-intensities on creativity and potential underlying mechanisms were lacking. To address this knowledge gap, this study compares different intensities, namely low-intensity (cycling at 55% of maximum heart rate), moderate-intensity (cycling at 70% of maximum heart rate), high-intensity (cycling at 85% of maximum heart rate) and a control group, on divergent creativity (i.e., number and uniqueness of creative ideas); And looks at affect and arousal as underlying mechanisms. Happy (positive), elated (positive), upset (negative), tense (negative) and stressed (negative) are used as indicators for high-arousal affect and feelings of wakefulness and alertness as indicators for arousal. Participants in this study completed two appointments, of which the first appointment consisted of a fitness test to measure participants’ maximum heart rate. During the second appointment, participants were randomly assigned to one of the four conditions and their affect and arousal were measured before and after the exercise or control task. Creativity was measured after the exercise or control task was completed. A Kruskal-Wallis Test showed that participants in the moderate-intensity and high-intensity exercise did not show higher creativity. Further, macro PROCESS model 4 revealed a significant effect of moderate-intensity and high-intensity exercise on arousal in comparison to low-intensity exercise and a significant effect of moderate-intensity exercise on positive high-arousal affect, in comparison to the control group. Other than this, the model revealed that none of the mediators significantly explained a relationship between exercise-intensity and creativity. This study thus suggests that exercise-intensity does not play a significant role in creativity enhancement, nor does arousal or high-arousal affect. However, future research is needed to confirm this for other modes of exercise, regular exercise instead of acute bouts of exercise and for different individual characteristics, such as age and gender.Show less
Attentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from...Show moreAttentional bias (AB) is when certain stimuli catch attention quicker than others, which varies according to individual characteristics. The study investigated: (1) if there is an AB to or from itch; (2) whether this differs between people with chronic itch and healthy controls; (3) and if there is a possible AB/stress association. This is because understanding ABs to/from itch further elucidates the experience of patients with chronic itch and possible future clinical applications. Furthermore, an explorative analysis compared two tasks measuring AB, namely the Posner cueing and dot-probe task. The two tasks, alongside a stress-questionnaire, were administered online to the participants (N=70). A (frequentist and Bayesian) RM ANOVA was done for the main analysis, and a within- subjects t-test for the explorative task-comparison. Given that the task-comparison found the two tasks differing significantly (p = 0.01 d = -0.31), the results of the two tasks were interpreted separately. Overall, indications of AB being biased away from itch stimuli was found. When the AB was contrasted between participant group (people with and without chronic itch), the Posner cueing task found no significant difference (p = 0.68, ηp 2 = 0.003) whereas the dot-probe task found an AB away from itch-stimuli in patients with chronic itch (p = 0.02, ηp 2 = 0.077). Similar pattern unfolded with the stress-association: the Posner cueing task finding that AB did not significantly differ with stress (p = 0.23, ηp 2 = 0.021). The dot-probe task did find that they significantly differed (p = 0.01, ηp 2 = 0.091) where with higher stress, the AB switched to being an AB towards itch stimuli. The discrepancy between the two tasks aligns with expectations considering that the tasks were found inequivalent - highlighting one of the strengths of this study being that the two tasks were compared. Altogether this points towards differences in what the two tasks tap into, and that the attention of people with chronic itch is biased as a function of stress. Summarizing, AB to itch differed between the two groups and was associated with stress when using dot-probe task, which did not apply to the Posner cueing task.Show less
This current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and...Show moreThis current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and avoidance behaviour influence pain experience. However, there seems to be little research into the combined influence. Seeing that research also showed that pinpointing a cause for the chronic low back pain is difficult, this study aimed to give insight into interacting factors that influence chronic low back pain. To gather data participants (N=18) filled in a questionnaire five times a day for two weeks. This provided insight into their levels of pain in the morning and the evening, if they expected to experience pain and if they were more likely to avoid movements, they expected to be painful. These statements were answered with answering scales, ranging from 0 (not at all) to 6 (extremely), given how likely that statement was for the participant. A mediation analysis inspecting possible relations between the level of pain and expectancies, the level of pain and avoidance, and the level of pain, expectancies and avoidance yielded no significant relations. Therefore, it could not be concluded that avoidance and/or expectancy are influencing the level of pain in the evening when compared to the level of pain in the morning. There were two significant findings, the impact of level of pain in the morning on expectancies and the impact of expectancies on avoidance. These findings are in line with what was found in existing literature and give incitement for further research on this topic. Another incitement for further research is the small sample used in this current study. The implication for the scientific field therefore is to perform this study on a bigger sample. Another consideration for further research would be to try and use a more diverse sample in both age and gender, this to make a more representative sample to draw conclusions for the general population. This could also lead to more substantial implications for the clinical field since this study did not have significant results.Show less
Objective: The period after successfully coming off treatment (SCOT) following a childhood cancer diagnosis is known to be a vulnerable time for parents in which increased levels of distress can...Show moreObjective: The period after successfully coming off treatment (SCOT) following a childhood cancer diagnosis is known to be a vulnerable time for parents in which increased levels of distress can play a significant role. It is important to know more about the distress experienced by parents during this period to determine whether an intervention should be used to help parents return to ‘normal life’. The aim of this study was therefore to gain better understanding of parental distress and factors related to their distress during the first year after their child has successfully completed treatment. Methods: A sample of 283 parents of children who had successfully completed cancer treatment in the previous year were included in this cross-sectional study. These parents, who were part of the SCOT group, were invited to complete the Distress Thermometer for Parents (DT-P) within one year after treatment completion. The DT-P consists of a thermometer score to measure experienced distress and problem domains (practical, social, emotional, physical, cognitive, and parenting). Parents in the SCOT group were compared with parents in the general population (NORM group) to see if their distress levels were higher. In addition, the association between distress and the problem domains and child- or parent-related factors (time since the end of treatment, cancer type, child’s age, parental disease, and perceived support) was examined. Results: Parents (73.9% mothers) in the SCOT group experienced higher levels of distress in the first year after SCOT compared to the general population (fathers SCOT: M=3.5, SD=2.6 vs. fathers NORM: M=2.8, SD=2.5; p=.032; mothers SCOT: M=4.1, SD=2.7 vs. mothers NORM: M=3.5, SD=2.7; p=.001). Emotional (p<.001), practical (p=.016), and physical (p=.005) problems were predictors of higher distress levels. Parents’ perceived support from their environment contributed also to their level of distress (p<.001). Conclusions: Parents of children who have successfully completed cancer treatment experience increased levels of distress in the first year after treatment compared to parents in the general population. There may be value in developing an intervention to ease this transition that specifically addresses their emotional well-being and highlights the importance of their social network during this vulnerable period.Show less
Background: Childhood emotional maltreatment by a primary caregiver is a key predictor for PTSD symptoms, yet limited research explores connections with specific symptoms, especially in children....Show moreBackground: Childhood emotional maltreatment by a primary caregiver is a key predictor for PTSD symptoms, yet limited research explores connections with specific symptoms, especially in children. Literature reports gender differences on emotional maltreatment and the experience of PTSD, so it is worth investigating the existence of differences when looking at separate symptoms. Objective: This study aims to investigate the correlation between childhood emotional maltreatment and PTSD symptomatology and identify gender differences in children and adolescents. Method: A sample of 237 children (mean age 15.5) with PTSD symptoms from a Dutch mental health institution (2012-2015) underwent assessment using anonymous questionnaires. Network analysis examined partial correlations between emotional abuse, neglect, intrusions, avoidance, arousal, and negative mood. Results: The network analysis showed a high correlation between emotional abuse and most PTSD symptoms. However, emotional neglect only exhibited a strong association with emotional abuse. Gender differences in how emotional maltreatment and PTSD symptoms interacted were found. Girls reported higher PTSD symptoms and emotional maltreatment than boys. Conclusions: This study highlights the important role of childhood emotional maltreatment in the development of PTSD, among children and adolescents. These results emphasize the need for the customization of PTSD treatment based on the type of maltreatment and gender.Show less
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
