A Theory of Socioeconomic Disparities in Health over the Life Cycle

Understanding of the substantial disparity in health between low and high socioeconomic status (SES) groups is hampered by the lack of a suffciently comprehensive theoretical framework to interpret empirical facts and to predict yet untested relations. We present a life-cycle model that incorporates multiple mechanisms explaining (jointly) a large part of the observed disparities in health by SES. In our model, lifestyle factors, working conditions, retirement, living conditions and curative care are mechanisms through which SES, health and mortality are related. Our model predicts a widening and possibly a subsequent narrowing with age of the gradient in health by SES

Improved Imaging in Cardiac Patients: echocardiography and CT-coronary angiography

Diff erent non-invasive imaging modalities are used for to assess cardiac anatomy and function. Echocardiography and MRI allow assessment of cardiac structures and function of the cardiac chambers and valves as well as perfusion of the left ventricular wall while CT-angiography in addition provides unique information on the structure of the coronary arteries1. Nuclear cardiology off ers measurement of global, and to some extend regional left ventricular function and perfusion of the left ventricular wall. While these diff erent modalities continue to evolve, assessment of their accuracy, inter- and intraobserver reproducibility are crucial to assess their clinical value. In this thesis we present a series of studies of new applications of echocardiography. Echocardiography is a very versatile tool for diagnosis of valvular disease, congenital heart disease and cardiomyopathy. Yet, assessment of left ventricular function is hampered by uncertainty to determine the precise endocardial borders

Agro-landerij: een moderne, regionale samenwerking

Het project regionaal gemengd bedrijf Zuidoost Drenthe is gericht op het maken van een businessplan voor een vergaande samenwerking tussen akkerbouwers en veehouders in zuidoost Drenthe, gebaseerd op specialisatie in de bedrijfsvoering. Het uiteindelijk doel is het opzetten van het Nieuw Gemengd Bedrijf, waarin (lokale) ondernemers – die in verschillende takken van sport opereren – en bewoners van het gebied samenwerken. Kortom, samenwerkingsvormen op het gebied van voer, energie, mest en recreatie (beleving). Nieuwe vormen van landbouw vragen om innovatie, samenwerken en risicospreiding, om mee te kunnen gaan in de tijd en klaar te zijn voor de toekomst. De economische structuren vragen erom en de landbouw is in zuidoost Drenthe een belangrijke drager van de economie

Learning the ropes:strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

Background: Many residents experience their transitions, such as from medical student to resident, as demanding and stressful. The challenges they face are twofold: coping with changes in tasks or responsibilities and performing (new) social roles. This process of 'learning the ropes' is known as Organizational Socialization (OS). Although there is substantial literature on transitions from the perspective of residents, the voices of program directors (PDs) who facilitate and guide residents through the organizational socialization process have not yet been explored. PDs' perspectives are important, since PDs are formally responsible for Postgraduate Medical Education (PGME) and contribute, directly or indirectly, to residents' socialization process. Using the lens of OS, we explored what strategies PDs use to facilitate organizational socialization of newcomer residents. Methods: We conducted semi-structured interviews with 17 PDs of different specialties. We used a theory-informing inductive data analysis study design, comprising an inductive thematic analysis, a deductive interpretation of the results through the lens of OS and, subsequently, an inductive analysis to identify overarching insights. Results: We identified six strategies PDs used to facilitate organizational socialization of newcomer residents and uncovered two overarching insights. First, PDs varied in the extent to which they planned their guidance. Some PDs planned socialization as an explicit learning objective and assigned residents' tasks and responsibilities accordingly, making it an intended program outcome. However, socialization was also facilitated by social interactions in the workplace, making it an unintended program outcome. Second, PDs varied in the extent to which they adapted their strategies to the newcomer residents. Some PDs used individualized strategies tailored to individual residents' needs and skills, particularly in cases of poor performance, by broaching and discussing the issue or adjusting tasks and responsibilities. However, PDs also used workplace strategies requiring residents to adjust to the workplace without much intervention, which was often viewed as an implicit expectation. Conclusions: PDs' used both intentional and unintentional strategies to facilitate socialization in residents, which may imply that socialization can occur irrespective of the PD's strategy. PDs' strategies varied from an individual-centered to a workplace-centered approach to socialization. Further research is needed to gain a deeper understanding of residents' perceptions of PD's efforts to facilitate their socialization process during transitions

First clinical experiences with inclisiran in a real-world setting

Background and objective: Inclisiran is the first-in-class small interfering RNA (siRNA) PCSK9 inhibitor. In clinical trials inclisiran showed effective and sustained LDL-C reduction of ± 50 %. As data in clinical setting are scarce, we aim to investigate the efficacy and safety in clinical practice. Methods:We describe a registry of consecutive patients who started with inclisiran at a lipid clinic of a university hospital. Patients were eligible if they fulfilled the reimbursement criteria in the Netherlands. Patients were included if they started with inclisiran as first line (group 1) or switched from PCSK9 monoclonal antibody (mAbs) to inclisiran (group 2). LDL-C levels were measured at 3 and 9 months after initiation of inclisiran. Median change of LDL-C levels was calculated on an individual and group level. Results: We analysed 65 patients (36 women), median [25th percentile; 75th percentile] age of 63 [54; 68] years. Of these, 44 patients had both a 3 month and 9 month visit. At 3 months, patients who newly started inclisiran (group 1, n = 45) showed a LDL-C decrease of 38 [-49;-33] %. Patients who used statins as co-medication (n = 15) had a higher median LDL-C decrease compared to those without statin use (n=30; 45 % vs 38 %). However, patients who switched from mAbs to inclisiran (group 2, n = 20) had an increase in LDL-C of 38 [+4; +97] %. Adverse effects associated with inclisiran were mild and consisted of mild injection site reactions. Efficacy was slightly less whereas safety results were similar at 9 months. Conclusion: Our initial experience of inclisiran in a clinical setting showed less reduction in LDL-C levels compared to clinical trials but a similar safety profile. Moreover, patients who switched from PCSK9 mAbs to inclisiran generally showed an increase in LDL-C levels implying that inclisiran is less potent in LDL-C reduction compared to PCSK9 mAbs.</p