Children's perspectives on optimal health care are rarely considered in health care research. These routine health assessments are carried out by Youth Health Care services (YHC), which provide school health care as part of preventive care for children. The aim of this study is to explore the perspectives of children aged 9 to 12 years old, on current routine health assessments in Dutch school health services and how these could be improved to better align their preferences and needs. We conducted a qualitative focus group study with Dutch primary school children, 9 to 12 years old, who received their routine health assessment from YHC in the past twelve months. Discussion topics included experiences with preventive youth health care services, preferences regarding involvement of parents, and suggestions for improvement of the services. Reflexive thematic analysis was conducted using the 6-step approach by Braun and Clarke. Six focus groups were conducted with in total 41 children. We identified four main themes; 'We want more! Monitoring health matters to children'; 'Feeling safe and comfortable: be the nice and sweet professional in a two-way conversation'; 'Parents know a lot, but not everything: mixed feelings on their role and presence', and 'Preventive youth health care should be organized more attractive'. Our sample of Dutch children perceived preventive routine health assessments as important to monitor their health and suggested more frequent and comprehensive assessments. The children's perspectives, provided relevant insights in how to design child-friendly preventive youth health care.
IntroductionThe role of shared decision making (SDM) has become increasingly pivotal, particularly in nuanced choices such as those involving implantable cardioverter-defibrillator (ICD) therapy. This study evaluates the impact of the Dutch ICD Decision Aid on SDM in patients up for ICD implantation or replacement.MethodsA stepped-wedge randomized controlled trial was conducted across 6 Dutch hospitals between February 2018 and September 2019, involving patients eligible for ICD implantation or pulse-generator exchange. SDM experiences of the patients and involved medical professionals were assessed using SDM-Q-9 and SDM-Q-Doc questionnaires, respectively. The Decisional Conflict Scale (DCS) scores measured effective decision making. The intervention group received the decision aid on top of standard care.ResultsA total of 150 patients and 233 health care providers were included in the study. For health care providers, SDM scores did not differ: the SDM-Q-Doc median score was 36 (28-38) in the control phase and 35 (33-40) in the intervention phase (P = 0.81). Patients in both the intervention and control groups demonstrated high SDM scores as well. Decisional conflict scores were low: the median DCS score was 12.5 (4.3-23.4) in the intervention phase and 16.4 (6.25-25.0) in the control phase (P = 0.45). Patients with a higher education provided more correct answers to the theoretical knowledge questions. In addition, patients up for a pulse-generator exchange also had significantly more correct answers.ConclusionsAlthough the Dutch ICD Decision Aid did not result in significant differences in SDM scores or levels of decisional conflict between patient groups, both measures remained consistently favorable overall. The decision aid still holds promise as a valuable resource. Efforts should focus on refining decision-making tools and improving patient knowledge and the quality of patient-centered care.HighlightsA digital decision aid did not significantly increase shared decision-making (SDM) scores for patients and health care providers, as SDM levels were already high across all groups.Despite high SDM scores, patient knowledge about implantable cardioverter-defibrillator (ICD) therapy remained low, highlighting a gap in understanding.Patients with higher education or prior experience with ICDs demonstrated better knowledge retention, indicating the need for tailored educational interventions.The study emphasizes the ongoing challenge of ensuring unbiased, well-informed decision making in ICD therapy, especially during pulse-generator replacements.
APPE693Q ("Dutch") transgenic mice develop aging-related learning deficits and accumulate endogenously generated non-fibrillar aggregates (NFAs) of amyloid beta (Aβ) and amyloid precursor protein α-carboxy terminal fragments. NFA-Aβ correlates with synaptic loss and memory deficits more closely than does fibrillar Aβ. We assessed the physiological, transcriptomic, ultrastructural, histological, and metabolic changes associated with the accumulation of NFA of Dutch Aβ in brains of APPE693Q mice. Aging-related accumulation of NFA-Aβ in APPE693Q mice was revealed by A11 immunohistochemistry and cyclic D,L-α-peptide-fluorescein-5-isothiocyanate microscopy. Presynaptic termini of APPE693Q mice developed physiological abnormalities in post-tetanic potentiation, synaptic fatigue, synaptic vesicle replenishment, and an aging-related reduction in mitochondrial complex I activity. Single-cell RNA sequencing showed that excitatory neurons exhibited an altered transcriptomic profile involving "protein translation" and "oxidative phosphorylation." Accumulation of NFA-Aβ alters neuronal metabolism but does not activate inflammation. Depletion of all forms of Aβ may be required to eliminate Aβ toxicity with anti-amyloid antibodies.
Body mass index and physical activity are among the best established risk factors for breast cancer (BC). We examined changes in these factors and postmenopausal BC risk in a cohort of registered Dutch female nurses. Participants completed a questionnaire at enrollment and up to two follow-up questionnaires. Body mass index (BMI, in kg/m2) and physical activity were assessed at age 18, at enrollment and prospectively around menopause. Associations with postmenopausal BC risk were assessed using multivariable Cox models. With a median follow-up of 13.2 years, 1,776 incident breast cancers occurred among 43,127 postmenopausal women. A BMI ≥25 at menopause was associated with increased BC risk. A high level of sports activity was associated with decreased BC risk (ptrend 0.04) only among overweight (BMI = ≥25 to 30) women. The Hazard Ratio (HR) for postmenopausal BC increased 1.06-fold (95% Confidence Interval (CI)=1.04-1.09) with every 5kg weight gain between age 18 and menopause. Physical activity did not modify this association. Women with normal weight at enrollment, who developed overweight/obesity, had increased risk of postmenopausal BC (HR = 1.39, 95% CI = 1.06-1.83). We observed no clear associations between changes in physical activity since enrollment and BC risk, irrespective of BMI changes. Weight gain between age 18 and menopause is associated with increased postmenopausal BC risk, irrespective of physical activity. Being overweight/obese and developing overweight/obesity at menopause increases postmenopausal BC risk, however higher sports activity at the time of enrollment may be associated with a lower BC risk among overweight women.
The prevalence of diabetes in Belgium has steadily increased since 2001, reaching 6.9% in 2024, with type 2 diabetes (T2D) accounting for approximately 90% of cases. Diabetes-related healthcare expenditures were estimated at €2 billion in 2022. The European Care4Diabetes Joint Action aimed to transfer and adapt the evidence-based Dutch lifestyle program Reverse Diabetes2 Now to 12 European countries. This study evaluated the transferability and potential effectiveness of the Care4Diabetes lifestyle intervention on metabolic, behavioral, and subjective health outcomes among Belgian adults with T2D in primary care. This quasi-experimental implementation study was conducted in two primary care centers in Wallonia. Forty-three participants initiated the program and 37 completed the 12-month follow-up. The intervention included a 6-month intensive phase with five thematic group sessions and one individual check-up, followed by an additional check-up and a refresher session at Month 12. Primary outcomes were changes in HbA1c and T2D medication use. Secondary outcomes included anthropometric measures, lipid profile, behavioral outcomes, and subjective health indicators. Linear mixed models were used to assess changes over time, accounting for repeated measures. At Month 12, 46% of participants had no change in T2D medication, 43% underwent medication de-intensification, and 11% required intensification. After adjustment for T2D medication changes, HbA1c decreased significantly from baseline to Month 6 by 5.4 mmol/mol (0.49%; p = 0.002), but the reduction was attenuated at Month 12 to 2.8 mmol/mol (0.26%; p = 0.06). Sensitivity analyses restricted to participants without T2D medication changes showed significant decreases in HbA1c at Month 6 and Month 12. Body weight decreased significantly (- 3.6 kg at Month 12, p < 0.001). Improvements were also observed in dietary behaviors and perceived general health, and satisfaction among participants and healthcare providers was high. The Care4Diabetes program demonstrated good transferability and promising effectiveness in primary care in Wallonia. Larger studies across Belgium are needed to further assess clinical effectiveness and potential economic benefits.
The first 1000 days of life, from conception to age 2, are crucial for a child's development, with lasting health impacts. Evidence is growing that environmental and social factors, especially the neighbourhood of birth, play a significant role in shaping health during this period. This study investigates perinatal health disparities in 20 high-risk Dutch neighbourhoods identified by the governmental National Program on Livability and Safety and outlines an initiative to develop tools aimed at reducing geographical health inequalities and improving birth outcomes. Using data from the national perinatal registry (Perined) from 2015 to 2021, we analysed perinatal outcomes in 1 118 022 mother-child pairs, including perinatal mortality (24 weeks gestation to 7 days postbirth), small for gestational age (SGA; birthweight <10th percentile, corrected for gestational age and sex) and preterm birth (<37 weeks). Three-step logistic regression compared outcomes across all high-risk areas versus the rest of the country, each high-risk area versus national levels and each area versus its municipality, adjusting for confounders and multiple testing. We observed that SGA (OR 1.19 (95% CI 1.16 to 1.21)), preterm birth (OR 1.09 (95% CI 1.06 to 1.12)) and perinatal mortality (OR 1.13 (95% CI 1.02 to 1.24)) were significantly higher within high-risk areas compared with the rest of the Netherlands. These disparities persisted across the various comparisons. Living in high-risk neighbourhoods, as defined by livability and safety parameters, is linked to adverse birth outcomes, underscoring the need for targeted, location-based policies. Our collaborative initiative aims to co-develop a knowledge agenda with key stakeholders to create actionable tools that reduce health inequalities from birth.
Previous studies have demonstrated impaired expressive prosody in patients with frontotemporal dementia (FTD), but have been conducted in English-speaking cohorts. To examine whether findings generalize across languages, we replicated prior work in Dutch patients. We examined expressive prosodic features in semi-structured speech samples from patients with behavioral variant FTD (bvFTD; n = 17), primary progressive aphasia (PPA; n = 74) and controls (n = 45). We assessed group differences, classification abilities, and associations with neuropsychological tests and gray matter volume. Patients with non-fluent variant PPA (nfvPPA) showed the narrowest f0 range and shortest speech duration. f0 range separated patients with reduced prosody (nfvPPA/bvFTD) from those with relatively preserved prosody (semantic variant PPA/logopenic variant PPA). Lower f0 range correlated with reduced fluency and frontotemporal atrophy. Viewing expressive prosody as a multidimensional system helps explain why FTD syndromes become dysprosodic in different ways and highlights its diagnostic relevance. Future studies with larger patient samples in less canonical subtypes are needed to replicate and extend our findings.
This study evaluated the effects of moisture-wicking clothing and spacer garments on heat strain among Royal Netherlands Marechaussee personnel. In a within-subject design, 19 participants (4 females, 15 males) stationed in the Dutch Caribbean participated in the study; were scheduled to complete 4 shifts while wearing their usual gear, a spacer garment, a moisture-wicking garment, or both a spacer garment and a moisture-wicking garment. Thermal sensation and comfort were assessed hourly, and skin temperatures were continuously monitored. Linear mixed models showed that moisture-wicking clothing without a spacer garment improved thermal comfort (-3 to +3) by 0.49 points (95% CI: 0.16 to 0.82) without affecting mean skin temperature, while standard gear with a spacer garment reduced thermal comfort by 0.36 points (95% CI: -0.68 to -0.04) and increased chest skin temperature by 0.41 °C (95% CI: 0.04 to 0.78). Moisture-wicking clothing enhances perceived comfort, whereas spacer garments may increase thermal strain. This study examined how different gear configurations affect heat strain in Royal Netherlands Marechaussee personnel. Findings show that moisture-wicking clothing enhances perceived comfort, while spacer garments may increase thermal strain. Practical implications highlight the need for simple, implementable clothing strategies to mitigate heat strain without reducing operational effectiveness.
The Pediatric Quality of Life Inventory™ (PedsQL™ 4.0) is widely used to assess quality of life (QoL) in children, yet evidence on the reliability and validity of young children's self-reports is inconsistent. We evaluated whether self-reported QoL in young children varies by parental presence during administration and whether parent-child agreement differed between mothers and fathers. Secondary analyses were conducted using data from primary schools (n = 303, children aged 5-7 years) including at least one participating parent. Children completed the PedsQL self-report either at school with a trained research assistant (parent-absent) or at home with a parent who read items aloud and recorded answers (parent-present). Mothers and fathers completed parallel proxy-reports. Multilevel modeling was used to estimate mean differences and correlations between reporters and conditions, with age and sex as covariates. Internal consistency of child self-reports was limited across the four subdomains, with somewhat lower values in the parent-absent condition. Parent ratings showed no systematic differences between conditions, whereas children scored higher when a parent was present, yielding smaller parent-child gaps and higher correlations. These patterns were similar for mothers and fathers. In this school-based community sample, improved agreement with a parent present was driven by higher child scores, consistent with brief, non-leading parental assistance (clarification/recall). Self-reports of young children obtained without a parent present warrant caution. Clear, age-appropriate guidance on administration and structured parental support is needed.
To explore the cost-effectiveness of mavacamten + beta-blocker/calcium channel blocker therapy (BB/CCB) versus BB/CCB monotherapy for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM). A 5-state Markov model (New York Heart Association classes I-IV, death) that included treatment sequencing was developed. It used a Dutch societal perspective and lifetime horizon stratified into short-term (mavacamten + BB/CCB: 30 weeks; BB/CCB: 46 weeks) and long-term (i.e. post short-term) periods. The model population reflected the EXPLORER-HCM trial intention-to-treat population. Model parameters were aligned with 2016 Zorginstituut Nederland guidelines, including annual discount rates of 4.00% and 1.50% for costs and health outcomes. Costs (2022/2023 Euros), life-years (LYs) and quality-adjusted LYs (QALYs) per patient, incremental costs and LYs/QALYs, and incremental cost-utility ratios were estimated. Sensitivity and scenario analyses were conducted to evaluate the robustness of the results. Treatment with mavacamten + BB/CCB resulted in an incremental discounted gain of 3.09 QALYs and 3.17 LYs versus the BB/CCB monotherapy strategy. Incremental discounted costs were €49,388 over a lifetime; the additional costs of mavacamten were driven by increased treatment acquisition costs but partly offset by savings in healthcare resource utilization and indirect costs, particularly informal care costs. Mavacamten + BB/CCB was cost-effective at a €50,000 per QALY threshold versus BB/CCB monotherapy at €15,961 per QALY gain. The deterministic and probabilistic sensitivity and scenario analyses supported the robustness of the model results. In the Netherlands, mavacamten + BB/CCB is a cost-effective treatment strategy for symptomatic obstructive HCM compared to BB/CCB monotherapy. Obstructive hypertrophic cardiomyopathy (HCM) is a heart condition where the heart muscle becomes thick and blocks blood flow, impacting quality of life. Patients can have various symptoms including shortness of breath and fatigue.In recent years, a drug class called cardiac myosin inhibitors (CMI), has been tested in patients with symptomatic obstructive HCM, leading to approval for mavacamten (the first CMI) by the European Medicines Agency in 2024.This study aimed to compare mavacamten in combination with standard of care (SoC) vs SoC alone for patients with symptomatic obstructive HCM in the Netherlands. A model to assess cost-effectiveness was developed, to compare costs and health benefits, including length and quality of life, for these interventions over a patient’s lifetime. These cost-effectiveness estimates assist decision makers in selecting the treatment providing the best health outcomes for the lowest cost (i.e. good value for money). The model inputs are aligned with the Dutch guidelines.This study found patients live longer and have a better quality of life when treated with mavacamten compared to with SoC alone. Although treatment with mavacamten results in additional costs (€49,388 over a lifetime), patients should expect to live on average 3.17 years longer (3.09 when adjusting for quality of life). The cost per quality-adjusted life year gained is €15,961, which is considered good value for money in the Netherlands.The results of this study imply mavacamten offers meaningful health benefits for a reasonable cost, making it a valuable addition to the healthcare system in the Netherlands.
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How does follitropin delta administered with an individualized dose based on body weight and AMH perform in daily practice, and is this comparable to results from a randomized phase III clinical trial in terms of ovarian response, pregnancy, and safety? This is a descriptive analysis of real-world data obtained from the Erasmus University Medical Centre (EMC). Patients were treated with the dose of follitropin delta calculated according to the algorithm described in the ESTHER-1 trial. Outcome data were restricted to the first IVF cycle in patients with a regular ovulatory cycle treated with a GnRH antagonist protocol for whom the intended day of embryo transfer was day 5. The ongoing pregnancy rate was 30.8% per started cycle, which is equivalent to the ESTHER-1 trial. The number of oocytes retrieved (10.3 ± 5.4) was also comparable. All other ovarian response parameters were within the range that was expected on the basis of the results of the ESTHER-1 trial. The use of follitropin delta in a real-world clinical setting results in ovarian response outcomes comparable in range to those in the follitropin delta arm of the ESTHER-1 registration trial. No differences were observed in treatment outcomes.
Preventive strategies aim to reduce older adults' emergency department (ED) visits and related adverse health outcomes, but their impact on healthcare system utilisation remains unclear. This can be investigated using system dynamics modelling, which uses data to explore effects and test strategies across populations. In this study, we simulated and studied how preventive measures affect acute hospitalisations, intermediate care, home care, and nursing home admissions among community-dwelling older adults after an ED visit. We developed a system dynamics simulation model tracing older adults from ED visit to hospitalisation, intermediate care, discharge home (with or without care), nursing home admission, or death within 30 days. Simulated strategies included proactive care, geriatric emergency medicine, and hospital-at-home. Data from Amsterdam residents aged ≥65 who visited the ED in 2019 were used. Patients were categorised by home care status. 31,049 patient journeys were used in the modelling. Of the simulated strategies, hospital-at-home demonstrated the largest potential reductions in institutionalised care use after ED visits in the total cohort: acute hospitalisations (-10.2%), intermediate care (-16.7%), nursing home care (-10.7%). Furthermore, it showed a reduction in personal home care (-1.8%), and limited increases in household help (+2%) and nursing home care at home (+1.5%). Of the simulated strategies, hospital-at-home reduced healthcare use post-ED most effectively, causing the greatest decrease in institutional care without requiring a meaningful increase in home care services during one year of follow-up.These findings can guide policymakers, insurers, and institutions in choosing effective preventive strategies for regional populations.
BackgroundThe scope of research on pregnancy and menopause is growing, but the actual workplace changes that can support women during these transitional stages are falling behind.ObjectiveTo understand various interactional processes on the work floor that hamper changes in the context of an academic hospital we (i) explore how female nurses and doctors experience pregnancy and menopause in the workplace, and (ii) what management knows about these experiences.MethodsThis is an empirical qualitative exploratory study based on semi-structured interviews (n = 21), focus groups (n = 2) and discussion groups (n = 2) with female nurses and doctors, male and female managers, occupational specialists and external experts (in total N = 33). The focus groups and dialogue sessions were used to enrich and to validate the results. The data was analysed with the use of MAXQDA and followed the grounded theory approach.ResultsThree processes were identified: (1) internalisation of work ethos that transforms maternal bodies into work instruments; (2) self-silencing and physical invisibility of maternal bodies as survival strategies; and (3) normalisation of silence about pregnancy and/or menopause at all levels of the organisation.ConclusionMaternal bodies of the female employees become instruments of providing care and disappear in the workplace. These processes are facilitated by the current structure of an academic hospital and are a part of the organisational culture within the healthcare system in the Netherlands. Making these processes open to discussion will contribute to development of the tailor-made education and interventions involving all stakeholders.
Digital social interactions differ in many ways from face-to-face interactions. This study examines four preregistered hypotheses on the within-person interplay between interaction mode (i.e., digital vs. face-to-face interactions), interaction quality, and momentary well-being. Young adults from Spain (N 1 = 216) and the Netherlands (N 2 = 22)-provided 5,116 and 1,386 Ecological Momentary Assessments (EMA), respectively. In the Spanish sample, there were no differences in interaction quality between digital and face-to-face interactions, whereas in the Dutch sample, digital interactions were of higher quality. Interaction quality was positively associated with momentary well-being in both samples. Momentary well-being was higher after face-to-face interactions in the Spanish but not in the Dutch sample. Interaction quality did not mediate the relationship between interaction mode and well-being; instead, it moderated it in the Spanish sample. Although interaction quality was consistently associated with momentary well-being, it only partially explains why face-to-face interactions differ from digital ones.
Language provides a window onto how people conceptualize their subjective experiences, including emotions. Although rare, linguistic analyses that go beyond emotion words provide deep insights into emotional experience across cultures. In this study, we explored cultural models of emotion prevalent in the United States and Belgium using verbal descriptions of recent emotional events collected in 2020-2022 from speakers of North American (U.S.) English and Belgian Dutch in the form of semistructured interviews. We analyzed the interviews using three complementary approaches: (1) topic modeling to characterize content, (2) word counting to examine linguistic resources, and (3) inductive analysis to uncover broader themes. Our findings revealed notable cultural differences alongside some similarities. U.S. English speakers used more first-person pronouns and emotion words, emphasized high-arousal emotions, and prioritized asserting personal achievements and openly expressing their feelings. In contrast, Belgian Dutch speakers' descriptions reflected a more moderated approach to emotion, illustrating how social standards and broader worldviews gave meaning to the events, with the use of fewer first-person pronouns and more language focused on relativization and comparison. These differences are unlikely to be fully explained by differences in language structure or the analytical tools used. Our observations are consistent with previous psychological research on U.S. and Belgian culture. At the same time, our samples came only from California and Flanders, respectively, and had no recent history of immigration, potentially limiting the generalizability of our findings. We evaluate our approach against other means of exploring the conceptualization of emotion across cultures. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Hospitals can form condition-based units (CBUs) to support value-based healthcare (VBHC). Interprofessional collaboration is key to the success of CBUs, but insights into its quality are lacking. We aimed to examine professionals' perceived quality of interprofessional collaboration in CBUs, and factors influencing it. A single-center mixed-methods study was conducted within four CBUs in a Dutch top-clinical hospital: (1) geriatric trauma, (2) prostate cancer, (3) colon cancer and (4) breast cancer. A relational coordination (RC) survey was used to examine professionals' perceived collaboration quality, followed by semi-structured interviews to explore influencing factors. Varying RC scores were observed between professionals with different professions and disciplines within CBUs (geriatric trauma: 1.9-5.0; prostate cancer: 2.9-4.8; colon cancer: 2.1-4.8; breast cancer: 1.1-4.9), with higher scores among professionals involved in similar parts of related care pathways. Interview findings suggest that this variation is explained by four factors: (1) streamlined communication, (2) active engagement, (3) mutual recognition and (4) workflow efficacy. This exploratory study introduces a novel approach to studying professionals' perceived collaboration quality in CBUs through relational dynamics. The results suggest that traditional hospital structures can hinder interprofessional collaboration in CBUs by limiting physical interactions and shared administrative systems. Future studies with larger samples are needed to confirm these findings, and to provide recommendations for improving interprofessional collaboration in CBUs in order to unlock their potential in improving patient care.
The Coronavirus Diseases (COVID-19) pandemic led to excess mortality in many countries, i.e., to more deaths than expected. Older individuals generally had higher absolute risks of excess death. The complex dynamics of infection, vaccination and excess mortality have not yet been captured in one comprehensive model. With nationwide and unselected data from Statistics Netherlands, we analyzed the impact of documented infection and vaccination on excess mortality during 2020 and 2021 in the Dutch population aged over 63 on 1 January 2020 (n = 3,826,770) by incorporating relative survival into a multi-state model considering COVID-19 (re)infection, vaccination and death. Background mortality was based on the observed mortality in 2015-2019 per sex, age and month of the year. All analyses were performed for the total cohort as well as stratified per sex and age category. The absolute excess mortality in 2020-2021 was 0.34% (95% confidence interval 0.32-0.37), comprising 4.41% of the observed mortality. It was higher in men (except in the youngest age group) and older individuals. Excess mortality occurred mostly during the first four weeks after a positive COVID-19 test, but also thereafter. If infection occurred after vaccination, excess mortality was still observed, but considerably less than without prior vaccination. These patterns were observed in all groups. In conclusion, these analyses demonstrate the substantial impact of COVID-19 on excess mortality during and after acute SARS-CoV-2 infection in individuals aged over 63 years. Moreover, the results show a reduction of excess mortality after vaccination for all groups in this cohort.
In recent years, millions of adolescents have joined school strikes to demand climate action from governments and industries, standing in solidarity with young people from future generations and from vulnerable geographical regions (i.e., the Global South). The goal of the present study is to explore adolescents' climate activism from a developmental science perspective, analyzing how climate activism may be rooted in adolescents' developing identity and developmentally salient motives. Eleven 14-18-year-old Dutch adolescent climate activists (six female, two male, one non-binary, two not disclosed) participated in an online semi-structured interview between September 2022 and 2023. Data were analyzed in NVivo through theoretical reflexive thematic analysis, exploring patterns of meaning across the dataset while embracing researchers' active, subjective, and reflective role in data analysis. We constructed three themes: "Activism is motivated by the desire to make contributions to a just world;" "Activism is an autonomous choice that helps explore and express who I am;" and "Activism makes me feel connected to (some but not all) others." Taken together, the present analysis suggests that adolescents' climate activism-and pro-environmental engagement more generally-is driven by and satisfies their developmentally salient motives to contribute to a socially just world, to make autonomous choices, to explore and express their identity, and to feel connected to others. As such, our work sheds light on how we may promote and support adolescents' engagement in acts of solidarity to contribute to today's societal challenges, and suggests avenues for further research.
In this study, we translated and culturally adapted the Heart Failure-Specific HealthLliteracy Scale (HFsHLS) and psychometrically evaluated it among Slovenian patients with heart failure (HF). A cross-sectional study was conducted among 126 outpatients with chronic HF (mean age 69 ± 11 years; 71% male; 63% had LVEF ≤ 40%). Data were collected through face-to-face interviews using the HFsHLS, the Brief Health Literacy Screen (BHLS), the Dutch Heart Failure Knowledge Scale, and the European Heart Failure Self-Care Behavior Scale. Confirmatory factor analysis supported the original three-factor structure (Functional, Communicative, and Critical HL subscales) with acceptable model fit (CFI = 0.91, RMSEA = 0.07). The HFsHLS total scale demonstrated acceptable internal consistency (α = 0.71) and a moderate correlation with the BHLS (ρ = 0.49, p < 0.001), while correlations with HF knowledge and self-care were weak and non-significant (ρ = 0.12, p = 0.184; ρ = 0.16, p = 0.182). The Functional HL subscale performed best. Overall, the Slovenian version of the HFsHLS is a valid tool for assessing disease-specific HL in patients with HF.