Clinical Leadership as an Agent for Change:A Health System Improvement Intervention in Curacao

Introduction: The healthcare system in Curaçao is complex, fragmented, and poorly organized and typifies a system in a resource-limited environment. Deficits in competencies and local cultural barriers are factors that hinder sustainable healthcare in such settings and a failure to meet WHO sustainable development goals. This study reports the potential cost-effectiveness and improved health outcomes of the first stage of a healthcare improvement project. The intervention, which is a multidisciplinary team-based leadership training program (MLP), reflects a promising strategy to tackle local healthcare needs. Methods: A Multidisciplinary group of healthcare professionals in St. Elisabeth hospital, Curaçao, was selected to 1) participate in the MLP and 2) co-design a healthcare pathway on the management of decubitus ulcers. Using a qualitative research methodology, we conducted interviews to assess the perceived leadership growth, teamwork, and the barriers to the introduction of the new care pathway in their setting. Six themes were identified that explained the perceived leadership development and interprofessional collaboration. These included 1) Professional background, 2) Healthcare pathway design, 3) Resources, 4) Personal development, 5) Collaboration 6) Execution. Conclusion/Implication: The participants valued the interdisciplinary approach of this health improvement project and acknowledged the added value of a training program that also addressed personal growth. This study shows how MLPs for health professionals can also serve as catalysts for health improvement efforts in resource-limited environments

What Does it Mean to Be a Cultural Omnivore? Conflicting Visions of Omnivorousness in Empirical Research

The ‘omnivore’ hypothesis currently dominates the academic literature on the social patterning of taste. It argues that cultural elites no longer resemble the traditional stereotype of an elitist snob. Instead, they are more likely to be ‘omnivores’ with broad tastes encompassing both elite and popular cultural forms. The omnivore hypothesis has inspired more than two decades of research and debate, without a clear resolution. In this article, we argue that progress in the omnivore debate has been impeded in part due to an elision of two distinct interpretations of the omnivore hypothesis: a strong interpretation, which holds that cultural elites are generally averse to class-based exclusivity; and a weak interpretation which holds that, while elites have broad tastes which encompass popular forms, they do not necessarily repudiate class-based exclusion. We demonstrate how drawing this distinction helps to clarify the existing empirical evidence concerning the omnivore hypothesis

The association between neuroticism and self-reported common somatic symptoms in a population cohort

OBJECTIVE: To test the hypotheses that (1) neuroticism is associated with self-reported somatic symptoms; (2) this association is especially found with regard to psychosomatic symptoms; and (3) it is not solemnly explained by somatic reflections of psychological distress. METHODS: We studied the cross-sectional association between neuroticism (as measured by EPQ-RSS-N), psychological distress (as measured by GHQ-12 sum score), and the occurrence of 22 common somatic symptoms by linear and logistic regression analyses in a population cohort of 6894 participants. RESULTS: Neuroticism is more strongly associated with the total number of somatic symptoms reported (beta=.32) than GHQ-12 sum score (beta=.15) and well-established risk markers such as gender (beta=.11) and age (beta=.04). Neuroticism was associated with all symptoms in individual logistic regressions controlled for age, gender, and psychological distress. Neuroticism is significantly more strongly related to psychosomatic symptoms (beta=.36) than to infectious/allergic symptoms (beta=.28). CONCLUSION: In a large, population-based cohort, we confirmed that neuroticism is associated with self-reported somatic symptoms. The associations were not attributable to somatic reflections of psychological distress associated with neuroticism and were relatively strong with respect to psychosomatic symptoms. Future studies should include both objective and subjective measures of health to study the mechanisms that connect neuroticism and ill health

Relationship between serum B12 concentrations and mortality:experience in NHANES

BACKGROUND: There is conflicting evidence in the literature on the association between (elevated) serum B12 concentrations and subsequent disease or mortality. We evaluated in the NHANES general population the association of serum B12 concentrations as well as vitamin B12 supplement intake with all-cause, cardiovascular, and cancer-related mortality, while taking into account demographic and lifestyle factors and significant other diseases which are known to be associated with poorer outcome. METHODS: The main outcomes of our study were all-cause mortality, cardiovascular mortality, and cancer-related mortality. Mortality status and cause of death were determined by NHANES-linked National Death Index public access files through December 31, 2015. The association of serum B12 concentrations and vitamin B12 supplement intake with mortality was assessed with Cox proportional hazard (PH) models, with adjustment for a number of relevant demographic and lifestyle factors and comorbidity. RESULTS: The final study population of 24,262 participants had a mean age of 48 (SD 19) years; 50.1% were males. The median follow-up duration was 109 months (range 1-201 months). On the census day of December 31, 2015, 3023 participants were determined as deceased (12.5%). The fully adjusted Cox PH model indicated that low serum B12 concentrations  700 pmol/l were associated with an increase in cardiovascular mortality only (HR 1.45, 95% CI 1.01-2.06, p = 0.042). Participants with a diagnosis of hypertension, dyslipidemia, CVD, and cancer more frequently used vitamin B12-containing supplements than those without these diagnoses. We could not demonstrate an association between vitamin B12 supplement intake and mortality, when adjusted for comorbidity. CONCLUSIONS: In the general population of NHANES, low serum B12 concentrations were associated with a moderate increase in all-cause mortality. There was a small but significant increase in cardiovascular mortality in the groups with low or high serum B12. High intake of vitamin B12 in the form of supplements was not associated with any adverse effect on mortality and therefore can be regarded as safe

The importance of contextual aspects in the care for patients with functional somatic symptoms

Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained. The pattern or clustering of such symptoms may lead to functional syndromes like chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, among many others. Since the underlying pathophysiology remains unknown, several explanatory models have been proposed, nearly all including social and psychological parameters. These models have stimulated effectiveness studies of several psychological and psychopharmacological therapies. While the evidence for their effectiveness is steadily growing, effect-sizes are at most moderate and many patients do not benefit. We hypothesize that the context in which interventions for functional somatic symptoms are delivered substantially influences their effectiveness. Although this hypothesis is in line with explanatory models of functional somatic symptoms, to our knowledge, studies primarily focusing on the influence of contextual aspects on treatment outcome are scarce. Contextual research in the field of somatic symptoms has (irrespective whether these symptoms can be medically explained or not), however, just begun and already yielded some valuable results. These findings can be organized according to Duranti's and Goodwin's theoretical approach to context in order to substantiate our hypothesis. Based on this approach, we categorized empirical findings in three contextual aspects, i.e. 1) the setting, 2) the behavioural environment, and 3) the language environment. Collectively, some support is found for the fact that early identification of patients with functional somatic symptoms, starting treatment as soon as possible, having a neat appearance and an organized office interior, a warm and friendly nonverbal approach and a language use without defensiveness are contextual parameters which enhance the assessment by the patient of the physician's competence to help. Nonetheless, in vivo studies addressing the most aspects, i.e. nonverbal behaviour and language, are needed for better understanding of these contextual aspect. Moreover, future research should address to what extent optimizing contextual aspects improve care for functional somatic symptoms