Nederlands tijdschrift voor geneeskunde最新文献

Scapular fractures are predominantly managed non-operatively. However, a subset of patients develops persistent pain, weakness, and functional impairment due to malunion, non-union, rotator cuff dysfunction, or scapulothoracic dyskinesia. Early identification of patients at risk for ongoing symptoms is essential, as timely surgical intervention may improve outcomes. Owing to the lack of randomized controlled trials comparing operative and non-operative management, surgical indications remain controversial. This article reviews the biomechanics of the scapula, mechanisms of injury, fracture types, and current operative indications. Two clinical cases are presented to illustrate decision-making in operative versus non-operative treatment. While selected patients benefit from surgical fixation with good long-term functional outcomes, evidence indicates that both treatment strategies can achieve high union rates when appropriately individualized.

A 69-year-old man presented with decreased consciousness and a puzzling muscle paratonia. MRI showed extensive white matter abnormalities with diffusion restriction in the corpus callosum, consistent with Marchiafava-Bignami disease, a rare complication of chronic alcohol abuse. The phenomenon of paratonia should have raised a clinical suspicion towards endstage neurodegenerative disease.

Over 40% of cancer patients use supplements, such as herbs, vitamins, and minerals, while undergoing anticancer treatment. Patients often take these supplements because they assume they improve overall health, reduce side effects, or correct deficiencies. However, these products may carry risks, including pharmacokinetic or pharmacodynamic interactions with anticancer drugs. We present an overview of potential interactions between commonly used supplements and anticancer therapies, which can assist clinicians in evaluating their safety. Communication between clinicians and patients about herbs, vitamins, and minerals is often limited. Clinicians should proactively inquire about patients' expectations and needs regarding both conventional therapies and herbs, vitamins, or minerals. By initiating these discussions and making balanced, shared decisions, clinicians can help ensure the efficacy and safety of anticancer therapies while maintaining patients' trust.

Anthropological research on formal and informal migrant caregivers for the elderly in Italy shows how the government welcomes or tolerates these migrants because they are indispensable in Italy, where the imbalance between fertility and aging places great pressure on families with dependent (grand)parents. The presence of migrant caregivers in the country is very high, as it is in several other, primarily southern European countries. The question is whether such a (possibly adjusted) contribution from migrants is also possible and desirable in the Netherlands. Currently, the contribution of migrants to healthcare in general is lower in the Netherlands than in neighboring countries. This contribution does not focus on professional healthcare, but on in-home, 24/7 elderly care, which primarily consists of companionship, supervision, and household tasks for elderly people who can no longer live independently and for whom family members cannot provide the necessary care.

A 14-year-old boy developed acute chest pain after exertion without trauma. Imaging showed pneumomediastinum and pneumopericardium. He was admitted due to tamponade risk. Symptoms resolved spontaneously. This case shows spontaneous pneumopericardium can occur in healthy adolescents, and in the absence of tamponade signs, a conservative 'watchful waiting' approach is appropriate.

Many physical complaints cannot be explained by tissue damage or disease. The predictive-coding model describes the brain as an active predictive system that interprets signals based on expectations and actual input. Complaints arise from a dynamic interplay between predictions and signals, influenced by emotions, trauma, culture, and context. Strong expectations of symptoms can override actual signals, causing complaints to often persist after recovery. This explains also interindividual differences, discrepancies with objective findings, and the effect of psychological interventions. The model integrates biology, psychology, and context, and provides physicians with a framework to normalize complaints, and emphasizes diagnostics and integrated treatment.

Medical trauma refers to psychological symptoms that arise as a result of medical conditions or medical treatments. Although medical interventions are intended to promote healing, they may evoke feelings of powerlessness, fear, and loss of control in some patients, potentially leading to symptoms of PTSD or even PTSD. These reactions can occur in both children and adults and often go unrecognized or are misattributed to normal stressreactions or the recovery process. Several factors influence the development of medical trauma and its psychological consequences. Early recognition by physicians is essential. Greater awareness in clinical practice is crucial, as is appropriate referral for evidence-based psychological treatment. In this article, we use clinical cases to illustrate how to recognize medical trauma in adults, how preventive strategies can reduce risk, and which evidence-based treatments are available.

Objective: To gain insight into the nature of Public Mental Health Care (OGGZ) problems and identify opportunities for timely detection and referral to appropriate care.

Design: Retrospective observational study.

Method: OGGZ reports and forensic post-mortem examinations of residents from seventeen municipalities in the Utrecht region (2018-2024) were included. Descriptive analyses were conducted on all OGGZ reports and on a subgroup of individuals with both an OGGZ report and a registered forensic post-mortem examination.

Results: At the time of reporting, 73% of individuals were already known to one or more healthcare services, and 33% had repeated reports. Psychiatric problems were the most frequently reported issue (70%). Among 7,172 unique individuals with an OGGZ report, 155 subsequently underwent a forensic post-mortem examination. Within this subgroup, 70% died within one year of their last report, predominantly from non-natural causes.

Conclusion: Early identification, interdisciplinary collaboration, and accessible care are essential to reach individuals who avoid regular healthcare services.

Smoking remains the leading preventable cause of illness and death worldwide. The Dutch Government aims to reduce tobacco use to 5% of adults in 2040. Over 25% of the Dutch population has a migrant background. The prevalence of smoking is higher in certain migrant populations and cessation rates are lower than among native Dutch people. Social determinants, like culture, lifestyle and health skills together with limited knowledge of the healthcare system and distrust of healthcare institutions make that tobacco control measures do not reach them sufficiently, putting the 5% target at risk. In this article, we conclude that only by combining universal policies with culturally sensitive interventions, neighbourhood-focused cooperation, and coordinated efforts by healthcare providers, local authorities, employers, and social organisations these inequalities can be reduced.

A 5-year-old girl developed a unilateral exanthem after an upper respiratory infection. Clinical features were consistent with asymmetric periflexural exanthem of childhood (APEC), a rare, self-limiting dermatosis. Diagnosis is clinical, without further diagnostic investigations. Increased clinical awareness is essential, as the condition is often misdiagnosed.