Breaking barriers, building bonds:Helping families to overcome intergenerational mental health challenges

This study introduces a novel approach by integrating multi-disciplinary treatments from both adult and child mental health services to target the entire family, with the possibility to incorporate professionals from other involved services to target environmental problems. We have provided a theoretical underpinning for this integrated family approach in mental health care treatment which was established in practice, with the aim to help parents and their young children to break the cycle of intergenerational transmission of mental health issues. Based on this study, by analyzing the literature, expertise and experiences of professionals using this approach, and experiences of patients who have undergone this approach in their treatment, this study offers professionals and mental health organizations a model of the key elements of success. Furthermore, an overview is given of the domains with risk and protective factors to intervene in when helping parents to prevent the intergenerational transmission of problems and mental disorders. It is not possible to recommend a standard treatment program that is appropriate for all families. This study demonstrated that almost all families who had undertaken this integrated treatment had a complexity of problems that necessitated an integrated approach to treatment. Significant and clinically relevant improvements of the quality of the parent-child interactions, parental perceptions of their parenthood, and the child’s upbringing were found by finishing treatment in the majority of cases, with mixed results on improvements in parental mentalization. In the literature, these aspects are shown to be important in the process of transmission of mental disorders between parents and their young children. Our findings indicated that an integrated family approach contributes to helping parents and their children in diminishing the risk of intergenerational transmission of mental disorders and adverse outcomes.<br/

Difference in the Perceptions of Asthma Control Between Children With Asthma and Their Parents

Introduction: Asthma is the most prevalent chronic condition in children in primary care. Asthma control can be quantified using the Childhood Asthma Control Test (C-ACT), which includes questions for both children and their parents. However, there can be discrepancies between children and parents in their perceptions of asthma control. Objective: This longitudinal study determines the difference in the perceptions of asthma control between children in primary care and their parents using the C-ACT, measured at five points in time. Method: Children aged 6–12 with asthma who are being treated in primary care were eligible. Data was obtained using electronic questionnaires from the Rotterdam Asthma Trial from baseline to 18 months follow-up. The primary outcome was a difference in C-ACT scores between parents and their children. The data was analyzed using Spearman's correlation and intraclass correlation coefficient (ICC).Results: We included 90 children and their parents. The mean age of the children was 9.6 years (SD 1.7). At baseline, the children gave a median C-ACT score of 9/12 (IQR 2.5) and the parents gave a median score of 14/15 (IQR 3.0). Children's median C-ACT scores were significantly lower throughout the study period (p &lt; 0.001). The Spearman test showed moderate to strong correlation (0.659–0.775, and the ICC showed good agreement (0.750–0.813). Conclusion: This study showed that parents gave significantly higher scores for the individual items of the C-ACT than their children. Considering the child's perspective on their symptoms is crucial when deciding on additional asthma treatment measures.</p

Visceral Pain in Preterm Infants with Necrotizing Enterocolitis:Underlying Mechanisms and Implications for Treatment

Necrotizing enterocolitis (NEC) is a relatively rare but very severe gastrointestinal disease primarily affecting very preterm infants. NEC is characterized by excessive inflammation and ischemia in the intestines, and is associated with prolonged, severe visceral pain. Despite its recognition as a highly painful disease, current pain management for NEC is often inadequate, and research on optimal analgesic therapy for these patients is lacking. Insight into the mechanisms underlying intestinal pain in infants with NEC—visceral pain—could help identify the most effective analgesics for these vulnerable patients. Therefore, this comprehensive review aims to provide an overview of visceral nociception, including transduction, transmission, modulation, and experience, and discuss the implications for analgesic therapy in preterm infants with NEC. The transmission of visceral pain differs from that of somatic pain, contributing to the diffuse nature of visceral pain. Studies evaluating the effectiveness of analgesics for treating visceral pain in infants are scarce. However, research in visceral pain models highlights agents that may be particularly effective for treating visceral pain based on their mechanisms of action. Further research is necessary to determine whether agents that have shown promise for treating visceral pain in preclinical studies and adults are effective in infants with NEC as well.</p

Increased Phosphorylation of Intracellular Signaling Molecules Indicates Continuous Activation of Human Autoreactive B-Cells

Many human autoimmune diseases (AIDs) are hallmarked by the presence and persistence of autoreactive B-cells. While autoreactive B-cells may frequently encounter antigens, the signals required to balance and maintain their activation and survival are mostly unknown. Understanding such signals may be important for strategies aimed at eliminating human B-cell autoreactivity. Here, we assessed intracellular signaling pathways in B cells targeting citrullinated protein antigens isolated from patients with rheumatoid arthritis (RA), a common and well-characterized AID. Peripheral blood mononuclear cells of 15 RA patients positive for anti-citrullinated protein antibodies (ACPA) were analyzed directly ex vivo using spectral flow cytometry and B-cell differentiation markers, citrullinated antigen-biotin-streptavidin tetramers, and intracellular (phosphoflow) markers. Tetanus toxoid (TT)-specific B cells served as antigen-specific comparators. In absence of any in vitro BCR stimulation, ACPA-expressing memory B cells (MBCs) displayed enhanced expression of Ki-67 and increased SYK-, BTK-, AKT-, and S6-phosphorylation compared with TT-specific MBCs. We demonstrate the simultaneous detection of B cell antigen-specificity and intracellular protein phosphorylation on the single-cell level. The data reveal that autoreactive B-cells in RA, in contrast to B cells against recall antigens, display enhanced phosphorylation of signaling molecules that point toward continuous, presumably antigen-mediated activation of the autoreactive B-cell compartment.</p

Clinical factors associated with hyponatremia correction during treatment with oral urea

Background. Oral urea is being used more commonly to treat hyponatremia, but factors contributing to the correction rate are unknown. We hypothesized that clinically relevant factors can be identified to help guide hyponatremia correction with oral urea. Methods. This was a retrospective study in two university hospitals including hospitalized patients with hyponatremia (plasma sodium &lt;135 mmol/L) treated with oral urea. Linear mixed-effects models were used to identify factors associated with hyponatremia correction. Rates of overcorrection, osmotic demyelination and treatment discontinuation were also assessed. Results. We included 161 urea treatment episodes in 140 patients (median age 69 years, 46% females, 93% syndrome of inappropriate antidiuresis). Oral urea succeeded fluid restriction in 117 treatment episodes (73%), was combined with fluid restriction in 104 treatment episodes (65%) and was given as the only treatment in 27 treatment episodes (17%). A median dose of 30 g/day of urea for 4 days (interquartile range 2–7 days) increased plasma sodium from 127 to 134 mmol/L and normalized hyponatremia in 47% of treatment episodes. Older age (β 0.09, 95% CI 0.02–0.16), lower baseline plasma sodium (β –0.65, 95% CI –0.78 to –0.62) and higher cumulative urea dose (β 0.03, 95% CI –0.02 to –0.03) were independently associated with a greater rise in plasma sodium. Concurrent fluid restriction was associated with a greater rise in plasma sodium only during the first 48 h of treatment (β 1.81, 95% CI 0.40–3.08). Overcorrection occurred in 5 cases (3%), no cases of osmotic demyelination were identified and oral urea was discontinued in 11 cases (11%) due to side effects. Conclusion. During treatment with oral urea, older age, higher cumulative dose, lower baseline plasma sodium and initial fluid restriction are associated with a greater correction rate of hyponatremia. These factors may guide clinicians to achieve a gradual correction of hyponatremia with oral urea.</p

Using PLS-SEM and XAI for causal-predictive services marketing research

Purpose: This study aims to redefine approaches to metrics in service marketing by examining the utility of partial least squares – structural equation modeling (PLS-SEM) and eXplainable Artificial Intelligence (XAI) for assessing service quality, with a focus on the airline industry. Design/methodology/approach: Using the Airline Passenger Satisfaction data set from Kaggle platform, this study applies PLS-SEM, facilitated by ADANCO software and XAI techniques, specifically using the SHapley Additive exPlanations TreeExplainer model. This study tests several hypotheses to validate the effectiveness of these methodological tools in identifying key determinants of service quality. Findings: PLS-SEM analysis categorizes key variables into Delay, Airport Service and In-flight Service, whereas XAI techniques rank these variables based on their impact on service quality. This dual-framework provides businesses a detailed analytical approach customized to specific research needs. Research limitations/implications: This study is constrained by the use of a single data set focused on the airline industry, which may limit generalizability. Future research should apply these methodologies across various sectors to enhance a broader applicability. Practical implications: The analytical framework offered here equips businesses with the robust tools for a more rigorous and nuanced evaluation of service quality metrics, supporting informed strategic decision-making. Social implications: By applying advanced analytics to refine service metrics, businesses can better meet and exceed customer expectations, ultimately elevating the societal standard of service delivery. Originality/value: This study contributes to the ongoing discourse on artificial intelligence interpretability in business analytics, presenting an innovative methodological guide for applying PLS-SEM and/or XAI in service marketing research. This approach delivers actionable insights, not only in the airline sector but also across diverse business domains seeking to optimize service quality.</p

Patients with immune mediated inflammatory diseases are insufficiently protected against vaccine-preventable infections

Background: Patients with Immune Mediated Inflammatory Diseases (IMIDs) using immunosuppressive therapy are at increased risk of infections, including vaccine-preventable infections. In this study, we aimed to evaluate whether patients with IMIDs on systemic immunosuppressive therapy are vaccinated according to current guidelines. Methods: A survey was sent out, between August 2022 and March 2023, to all patients with IMIDs that visited the departments of dermatology, rheumatology and gastroenterology at an academic and regional hospital in Rotterdam, the Netherlands. Patient-reported vaccination status was compared to the Dutch guidelines on vaccinations in patients with chronic inflammatory diseases. Results: A total of 1,905/5,987 patients responded to the survey (response rate 32%). After exclusion of patients without systemic immunosuppressive medication, the study population comprised 1,390 patients, median age 56 years (IQR 42–66) and 41% male. Most patients (92%) had been vaccinated according to the Dutch National Immunization Program. Before starting immunosuppressive therapy, 2% of the patients who were still considered at risk according to the Dutch guideline were vaccinated for measles, and 4% for diphtheria/tetanus/polio (DT-IPV). Additionally, 62% of patients received an annual influenza vaccine, 16% received a five-yearly pneumococcal vaccine, and 91% were fully vaccinated against COVID-19. Conclusion: Patients with IMIDs on immunosuppressive therapy are not vaccinated in accordance with the guidelines. Implementation strategies to improve the vaccination rates for patients with IMIDs should specifically focus on vaccinating against measles and diphtheria/tetanus/polio, and periodic vaccination against pneumococcal and influenza infections.</p

The Impact of Slight to Mild Hearing Loss on Academic Performance and Behavior of 9-15-Year-Olds

Objective: To examine the impact of slight to mild hearing loss in children by studying its association with academic performance and behavioral problems. Methods: This study was embedded within a prospective birth cohort in Rotterdam, the Netherlands. Participants underwent audiometric and behavioral evaluations between ages 9–11 (April 2012–October 2015) and 13–15 (May 2017–September 2019). At 13–15, a multiple linear regression was conducted to explore the relationship between hearing acuity and both academic and behavioral outcomes. A cross-lagged analysis using data from ages 9 to 11 investigated bidirectional associations between hearing loss and behavioral problems. Results: The cross-sectional part of the study involved 4688 participants at the age of 13–15 years. The relative risk for children with slight to mild hearing loss of being placed in a lower educational level compared with the highest level was 1.52 (95% confidence interval (CI) [1.14, 2.02]). Among boys, elevated high-frequency pure-tone average (HPTA) was associated with a higher total problem score (per 1 dB HPTA: β = 0.01; 95% CI [0.00, 0.02]). For girls, elevated low-frequency pure-tone average (LPTA) was associated with a higher attention problem score (per 1 dB LPTA: β = 0.02; 95% CI [0.01, 0.02]). Cross-lagged effects showed that participants with increased pure-tone averages in low frequencies at 9–11 years had more social problems at ages 13–15 years (Z-score difference: 0.01; 95% CI [0.01, 0.02]). Conclusion: Elevated hearing thresholds in slight to mild hearing loss were linked to poorer academic performance and increased behavioral problems. Level of Evidence: 2 (prospective cohort study) Laryngoscope, 135:1511–1519, 2025.</p

Value-based healthcare for inflammatory bowel disease:Improving (cost-)effectiveness

This thesis explores how value-based healthcare (VBHC) can enhance the cost-effectiveness of treatment of inflammatory bowel disease (IBD). The thesis is divided into five parts, beginning with a general introduction to VBHC, followed by an analysis of the methodological challenges in implementing VBHC in healthcare. The thesis also examines complexities in IBD treatment and evaluates interventions to improve cost-effectiveness by balancing effectiveness, costs, and safety.The section on methodology discusses the challenges of defining and implementing VBHC, particularly in IBD care. The IBD Value study, a collaborative effort involving eight hospitals, aims to evaluate outcomes and costs of IBD treatment through VBHC. The thesis also addresses issues related to data collection and analysis, such as the need for high-quality data and strategies for managing missing data. It presents a software package for electronic health records, and validates the self-administered comorbidity questionnaire to enhance the accuracy of comparisons between treatment outcomes across hospitals.In the third section, the thesis presents findings on the epidemiology and cost burden of IBD care, highlighting rising patient numbers and the increasing use of biologics. In the fourth section, the Lengthening Adalimumab Dosing Interval (LADI) trial is presented, which found a new dosing regimen to be non-inferior in terms of effectiveness while reducing side effects and costs. In the discussion future research directions are proposed, including the use of nationwide data, machine learning, and predictive models to optimize IBD care and improve clinical decision-making. These findings aim to guide the design of future VBHC studies and address gaps in the field to improve patient outcomes and healthcare efficiency.<br/