History helps us to better understand the particulars of the form and functions of institutions. In this paper we present the case study of the evolution of health care financing in the Netherlands ...over the past 150 years, through the lens of incremental institutional change.
Our historical and political analysis is based on a review of secondary literature as well as relevant policy documents, parliamentary debates and archival material. We use the conceptual framework of incremental institutional change (i.e. layering, conversion, drift and displacement) for our analysis.
The constitutional program of the mid-nineteenth century laid down the foundations of a ‘private initiative first, government last’-approach to health care financing in the Netherlands. Over the course of 150 years this led to the evolution of a complex layered system of financial arrangements consisting of direct public funding, national, social and private health insurance with complex interdependencies. This was not a conscious strategy, but a result of the fact that the central government in the Netherlands preferred to tackle specific problems in health care financing with very specific measures, so as not to intrude on the trade of civil society and commercial business in health care.
Regulatory authority and statist power in and over health care financing is not something that was created through dramatic reform in the Netherlands, but came about through many decades of small, incremental, yet accumulating changes. This provides a case study for further analysis of incremental versus rapid change in health care systems internationally.
•Health insurance in the Netherlands expanded gradually, not through big changes.•Dutch politics has always favoured ‘private initiative’ over state intervention.•The Dutch health care market is far more public than it seems.
Estimates for dead space ventilation have been shown to be independently associated with an increased risk of mortality in the acute respiratory distress syndrome and small case series of ...COVID-19-related ARDS.
Secondary analysis from the PRoVENT-COVID study. The PRoVENT-COVID is a national, multicenter, retrospective observational study done at 22 intensive care units in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The aim was to quantify the dynamics and determine the prognostic value of surrogate markers of wasted ventilation in patients with COVID-19-related ARDS.
A total of 927 consecutive patients admitted with COVID-19-related ARDS were included in this study. Estimations of wasted ventilation such as the estimated dead space fraction (by Harris-Benedict and direct method) and ventilatory ratio were significantly higher in non-survivors than survivors at baseline and during the following days of mechanical ventilation (p < 0.001). The end-tidal-to-arterial PCO
ratio was lower in non-survivors than in survivors (p < 0.001). As ARDS severity increased, mortality increased with successive tertiles of dead space fraction by Harris-Benedict and by direct estimation, and with an increase in the VR. The same trend was observed with decreased levels in the tertiles for the end-tidal-to-arterial PCO
ratio. After adjustment for a base risk model that included chronic comorbidities and ventilation- and oxygenation-parameters, none of the dead space estimates measured at the start of ventilation or the following days were significantly associated with 28-day mortality.
There is significant impairment of ventilation in the early course of COVID-19-related ARDS but quantification of this impairment does not add prognostic information when added to a baseline risk model.
ISRCTN04346342. Registered 15 April 2020. Retrospectively registered.
Most parents with young children pay routine visits to Well-Baby Clinics, or so-called Preventive Child Health Care (PCHC) services. This offers a unique opportunity to promote and deliver ...interconception care. This study aimed to integrate such care and perform an implementation evaluation.
In seven Dutch municipalities, PCHC professionals were instructed to discuss the possibility of an interconception care consultation during each routine six-months well-baby visit. The primary outcome of this study was coverage of the intervention, quantified as the proportion of visits during which women were informed about interconception care. Secondary outcomes included adoption, fidelity, feasibility, appropriateness, acceptability and effectiveness of the intervention, studied by surveying PCHC professionals and women considering becoming pregnant.
The possibility of interconception care was discussed during 29% (n = 1,849) of all visits, and 60% of the PCHC physicians adopted the promotion of interconception care by regularly informing women. About half of the PCHC professionals and most women judged integration of interconception care in PCHC appropriate and acceptable. Estimated feasibility was poor, since 13% of the professionals judged future integration in daily practice as probable. The uptake of interconception care consultations was low (n = 4 consultations).
Promotion of interconception care was achieved in approximately one-third of the routine PCHC consultations and appeared promising with regards to adoption, appropriateness and acceptability. However, concerns on feasibility and uptake of interconception care consultations in daily practice remain. Suggestions for improvement may include further integration of interconception care health promotion in routine PCHC consultations, while allocating sufficient resources.
Living in socially disadvantaged circumstances has a widespread impact on one's physical and mental health. That is why individuals living in this situation are often considered vulnerable. When ...pregnant, not only the woman's health is affected, but also that of her (unborn) child. It is well accepted that vulnerable populations experience worse (perinatal) health, however, little is known about the lived adversities and health of these vulnerable individuals.
With this article, insights into this group of highly vulnerable pregnant women are provided by describing the adversities these women face and their experienced well-being.
Highly vulnerable women were recruited when referred to tailored social care during pregnancy. Being highly vulnerable was defined as facing at least three different adversities divided over two or more life-domains. The heat map method was used to assess the interplay between adversities from the different life domains. Demographics and results from the baseline questionnaires on self-sufficiency and perceived health and well-being were presented.
Nine hundred nineteen pregnant women were referred to social care (2016-2020). Overall, women had a median of six adversities, distributed over four life-domains. The heat map revealed a large variety in lived adversities, which originated from two parental clusters, one dominated by financial adversities and the other by a the combination of a broad range of adversities. The perceived health was moderate, and 25-34% experienced moderate to severe levels of depression, anxiety or stress. This did not differ between the two parental clusters.
This study shows that highly vulnerable pregnant women deal with multiple adversities affecting not only their social and economic position but also their health and well-being.
Errorless learning (EL) is an approach in which errors are eliminated or reduced as much as possible while learning of new information or skills. In contrast, during trial-and-error − or errorful − ...learning (TEL) errors are not reduced and are often even promoted. There is a complex and conflicting pattern of evidence whether EL or TEL may result in better memory performance. One major confound in the extant literature is that most EL studies have not controlled for the number of errors made during TEL, resulting in a large variability in the amount of errors committed. This variability likely explains why studies on the cognitive underpinnings of EL and TEL have produced mixed findings. In this study, a novel object-location learning task was employed to examine EL and TEL in 30 healthy young adults. The number of errors was systematically manipulated, allowing us to investigate the impact of frequency of errors on learning outcome. The results showed that recall from memory was significantly better during EL. However, the number of errors made during TEL did not influence the performance in young adults. Altogether, our novel paradigm is promising for measuring EL and TEL, allowing for more accurate analyses to understand the impact of error frequency on a person's learning ability and style.
The energy landscape of reduced-dimensional perovskites (RDPs) can be tailored by adjusting their layer width (n). Recently, two/three-dimensional (2D/3D) heterostructures containing n = 1 and 2 RDPs ...have produced perovskite solar cells (PSCs) with >25% power conversion efficiency (PCE). Unfortunately, this method does not translate to inverted PSCs due to electron blocking at the 2D/3D interface. Here we report a method to increase the layer width of RDPs in 2D/3D heterostructures to address this problem. We discover that bulkier organics form 2D heterostructures more slowly, resulting in wider RDPs; and that small modifications to ligand design induce preferential growth of n ≥ 3 RDPs. Leveraging these insights, we developed efficient inverted PSCs (with a certified quasi-steady-state PCE of 23.91%). Unencapsulated devices operate at room temperature and around 50% relative humidity for over 1,000 h without loss of PCE; and, when subjected to ISOS-L3 accelerated ageing, encapsulated devices retain 92% of initial PCE after 500 h.A scheme to control the confinement within 2D/3D perovskite heterostructures results in stable, efficient inverted perovskite solar cells.
Alzheimer's disease is characterized by a decline in episodic memory and executive functioning, hampering learning ability. Insight into outcome‐based learning capacity may be relevant for optimizing ...the learning potential of these patients. To date, mixed results have been found in studies in which cognitively impaired participants have to learn based on positive and negative outcomes. In this study, we investigated the role of negative and positive feedback on memory performance and participants' ability to adjust their behaviour accordingly in a sample of 23 early‐stage AD patients and 23 matched healthy controls. We administered a novel computerized object‐location memory task, in which participants were instructed to learn and memorize the locations of different everyday objects following errorless learning (EL) and trial‐and‐error learning (TEL). A separate probabilistic TEL task was employed in which participants had to learn how to adjust their behaviour based on positive and negative feedback. EL had a beneficial general effect on memory performance for object locations. However, this effect was not larger in early‐stage AD patients compared to controls and error frequency during acquisition of object locations was unrelated to later recall performance. No group differences were found on the probabilistic learning task with respect to learning performance over time and based on positive and negative feedback. Although the error monitoring system seems intact in patients with early‐stage AD, errors during learning are likely acting as a source of interference causing difficulty in storage or retrieval of object locations.
Although past research has established a relationship between functional connectivity and cognitive function, less is known about which cognitive domains are associated with which specific functional ...networks. This study investigated associations between functional connectivity and global cognitive function and performance in the domains of memory, executive function and psychomotor speed in 166 older adults aged 75-91 years (mean = 80.3 ± 3.8) with minor cognitive deficits (Mini-Mental State Examination scores between 21 and 27). Functional connectivity was assessed within 10 standard large-scale resting-state networks and on a finer spatial resolution between 300 nodes in a functional connectivity matrix. No domain-specific associations with mean functional connectivity within large-scale resting-state networks were found. Node-level analysis revealed that associations between functional connectivity and cognitive performance differed across cognitive functions in strength, location and direction. Specific subnetworks of functional connections were found for each cognitive domain in which higher connectivity between some nodes but lower connectivity between other nodes were related to better cognitive performance. Our findings add to a growing body of literature showing differential sensitivity of functional connections to specific cognitive functions and may be a valuable resource for hypothesis generation of future studies aiming to investigate specific cognitive dysfunction with resting-state functional connectivity in people with beginning cognitive deficits.
Abstract
Ageing is associated with functional reorganization that is mainly characterized by declining functional connectivity due to general neurodegeneration and increasing incidence of disease. ...Functional connectivity has been studied across the lifespan; however, there is a paucity of research within the older groups (≥75 years) where neurodegeneration and disease prevalence are at its highest. In this cross-sectional study, we investigated associations between age and functional connectivity and the influence of cerebral small vessel disease (CSVD)—a common age-related morbidity—in 167 community-dwelling older adults aged 75–91 years (mean = 80.3 ± 3.8). Resting-state functional MRI was used to determine functional connectivity within ten standard networks and calculate the whole-brain graph theoretical measures global efficiency and clustering coefficient. CSVD features included white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and atrophy that were assessed in each individual and a composite score was calculated. Both main and interaction effects (age*CSVD features) on functional connectivity were studied. We found stable levels of functional connectivity across the age range. CSVD was not associated with functional connectivity measures. To conclude, our data show that the functional architecture of the brain is relatively unchanged after 75 years of age and not differentially affected by individual levels of vascular pathology.
Drenth et al. investigated age effects and the influence of common age-related vascular pathology on functional connectivity in adults aged 75 years and older. The authors show that the brain’s functional architecture is relatively unchanged after 75 years of age and not differentially affected by individual levels of vascular pathology.
See Schreiber and Arndt (https://doi.org/10.1093/braincomms/fcad135) for a scientific commentary on this article.
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