Trends in incidence, health care consumption, and costs for proximal femoral fractures in the Netherlands between 2000 and 2019: a nationwide study.

This study evaluated the incidence rates and societal burden of hip fractures in The Netherlands. Although incidence in the elderly population is decreasing and hospital stay is at an all-time low, the burden of medical costs and crude numbers of proximal femoral fractures are still rising in our aging population. PURPOSE: The aim of this nationwide study was to provide an overview of the incidence rate and economic burden of acute femoral neck and trochanteric fractures in The Netherlands. METHODS: Data of patients who sustained acute proximal femoral fractures in the period January 1, 2000, to December 31, 2019, were extracted from the National Medical Registration of the Dutch Hospital Database. The incidence rate, hospital length of stay (HLOS), health care and lost productivity costs, and years lived with disability (YLD) were calculated for age- and sex-specific groups. RESULTS: A total of 357,073 patients were included. The overall incidence rate increased by 22% over the 20-year study period from 16.4 to 27.1/100,000 person-years (py). The age-specific incidence rate in elderly > 65 years decreased by 16% (from 649.1 to 547.6/100,000 py). The incidence rate in men aged > 90 has surpassed the incidence rate in women. HLOS decreased in all age groups, hip fracture subtypes, and sexes from a mean of 18.5 to 7.2 days. The mean health care costs, over the 2015-2019 period, were lower for men (€17,723) than for women (€23,351) and increased with age to €26,639 in women aged > 80. Annual cumulative costs reached €425M, of which 73% was spent on women. CONCLUSION: The total incidence of hip fractures in The Netherlands has increased by 22%. Although incidence in the elderly population is decreasing and HLOS is at an all-time low, the burden of medical costs and crude numbers of proximal femoral fractures are still rising in our aging population.

Foods with a high fat quality are essential for healthy diets.

Fat is generally a highly valued element of the diet to provide energy, palatability to dry foods or to serve as a cooking medium. However, some foods rich in fat have a low fat quality with respect to nutrition, i.e., a relative high content of saturated (SFA) as compared to unsaturated fatty acids, whereas others have a more desirable fat quality, i.e., a relative high content of unsaturated fatty acids as compared to SFA. High-fat dairy products and fatty meats are examples of foods with low fat quality, whereas vegetable oils (tropical oils such as palm and coconut oil excluded) are products with a generally high fat quality. The aim of this paper is to explore the nutritional impact of products made of vegetable oils, e.g. margarines and dressings, and how they can be designed to contribute to good health. Since their first industrial production, the food industry has endeavored to improve products like margarines, including their nutritional characteristics. With evolving nutrition science, margarines and cooking products, and to a lesser extent dressings, have been adapted to contain less trans fatty acids (TFA), less SFA and more essential (polyunsaturated, PUFA) fatty acids. This has been possible by using careful fat and oil selection and modification processes. By blending vegetable oils rich in the essential PUFAs alpha-linolenic acid (vegetable omega-3) or linoleic acid (omega-6), margarines and dressings with both essential fatty acids present in significant quantities can be realized. In addition, full hydrogenation and fat rearrangement have enabled the production of cost-effective margarines virtually devoid of TFA and low in SFA. Dietary surveys indicate that vegetable oils, soft margarines and dressings are indeed often important sources of essential fatty acids in people's diets, whilst providing negligible amounts of TFA and contributing modestly to SFA intakes. Based on empirical and epidemiological data, the public health benefit of switching from products with a low fat quality to products with a high fat quality can be predicted. For example, switching from butter or palm oil to a soft margarine shows a substantial improvement in the nutritional quality of the diet. These simple, practical dietary adaptations can be expected to contribute to the healthy growth and development of children and to reduce the burden of cardiovascular disease.

Modern fat technology: what is the potential for heart health?

Saturated and trans-fatty acids raise total cholesterol and LDL-cholesterol and are known to increase the risk of CHD, while dietary unsaturated fatty acids play important roles in maintaining cardiovascular health. Replacing saturated fats with unsaturated fats in the diet often involves many complex dietary changes. Modifying the composition of foods high in saturated fat, particularly those foods that are consumed daily, can help individuals to meet the nutritional targets for reducing the risk of CHD. In the 1960s the Dutch medical community approached Unilever about the technical feasibility of producing margarine with a high-PUFA and low-saturated fatty acid composition. Margarine is an emulsion of water in liquid oil that is stabilised by a network of fat crystals. In-depth expertise of fat crystallisation processes allowed Unilever scientists to use a minimum of solid fat (saturated fatty acids) to structure a maximum level of PUFA-rich liquid oil, thus developing the first blood-cholesterol-lowering product, Becel. Over the years the composition of this spread has been modified to reflect new scientific findings and recommendations. The present paper will briefly review the developments in fat technology that have made these improvements possible. Unilever produces spreads that are low in total fat and saturated fat, virtually free of trans-fatty acids and with levels of n-3 and n-6 PUFA that are in line with the latest dietary recommendations for the prevention of CHD. Individuals with the metabolic syndrome have a 2-4-fold increased risk of developing CHD; therefore, these spreads could make a contribution to CHD prevention in this group. In addition, for individuals with the metabolic syndrome the spreads could be further modified to address their unique dyslipidaemia, i.e. elevated blood triacylglycerols and low HDL-cholesterol. Research conducted in the LIPGENE study and other dietary intervention studies will deliver the scientific evidence to justify further modifications in the composition of spreads that are healthy for the heart disease risk factors associated with the metabolic syndrome.

Attributions of responsibility and affective reactions to decision outcomes.

Immediate affective reactions to outcomes are more intense following decisions to act than following decisions not to act. This finding holds for both positive and negative outcomes. We relate this "actor-effect" to attribution theory and argue that decision makers are seen as more responsible for outcomes when these are the result of a decision to act as compared to a decision not to act. Experiment 1 (N = 80) tests the main assumption underlying our reasoning and shows that affective reactions to decision outcomes are indeed more intense when the decision maker is seen as more responsible. Experiment 2 (N = 40) tests whether the actor effect can be predicted on the basis of differential attributions following action and inaction. Participants read vignettes in which active and passive actors obtained a positive or negative outcome. Action resulted in more intense affect than inaction, and positive outcomes resulted in more intense affect than negative outcomes. Experiment 2 further shows that responsibility attributions and affective reactions to outcomes are highly correlated; that is, more extreme affective reactions are associated with more internal attributions. We discuss the implications for research on post-decisional reactions.

Regret and Responsibility Resolved? Evaluating Ordóñez and Connolly's (2000) Conclusions.

T. Connolly, L. D. Ordo;aan;atez, and R. Coughlan (1997, Organizational Behavior and Human Decision Processes, 70, 73-85) argued, on the basis of 5 experiments, that regret need not be related to a sense of responsibility for the regretted outcome. We (M. Zeelenberg, W. W. van Dijk, & A. S. R. Manstead, 1998, Organizational Behavior and Human Decision Processes, 74, 254-272) showed in 2 experiments that this conclusion was premature, because it was based on an indirect measure of regret (i.e., overall happiness with the decision outcome). When regret was directly measured, the predicted effects of responsibility were found. L. D. Ordo;aan;atez and T. Connolly (2000, Organizational Behavior and Human Decision Processes, 81, 132-142) replicated our findings in 2 experiments. Based on their findings they arrived at 4 conclusions. In this rejoinder we first discuss Ordóñez and Connolly's new studies and we then discuss the validity of their 4 conclusions. Copyright 2000 Academic Press.

Reconsidering the Relation between Regret and Responsibility.

Recently Connolly, Ordóñez, and Coughlan challenged the view that regret is partly determined by perceived responsibility for the regretted outcome [Connolly, T. Ordóñez, L. D., & Coughlan, R. (1997). Regret and responsibility in the evaluation of decision outcomes. Organizational Behavior and Human Decision Processes, 70, 73-85]. In a series of experiments they manipulated whether actors arrived at an outcome through their own decision or through a "computer assignment" over which they had no influence. This decision agency manipulation did not affect their "regret measure." We show in two experiments that this null-effect is due to the fact that regret was measured by means of a general happiness assessment. In the present research we replicated the basic design of their experiments and also found no effects of decision agency on the happiness assessment. However, the results showed the predicted effects of decision agency when regret was directly measured. Moreover, a measure of disappointment seemed to indicate the opposite effect: People are more disappointed when a negative outcome is caused by a computer assignment than when caused by their own choice. The role of regret and disappointment in decision making is discussed. Copyright 1998 Academic Press.

Emotional Reactions to the Outcomes of Decisions: The Role of Counterfactual Thought in the Experience of Regret and Disappointment.

Regret and disappointment are emotions that can be experienced in response to an unfavorable outcome of a decision. Previous research suggests that both emotions are related to the process of counterfactual thinking. The present research extends this idea by combining it with ideas from regret and disappointment theory. The results show that regret is related to behavior-focused counterfactual thought in which the decision-maker's own actions are changed, whereas disappointment is related to situation-focused counterfactual thought in which aspects of the situation are changed. In Study 1 participants (N = 130) were asked to recall an autobiographical episode of either a regretful or a disappointing event. When asked to undo this event, regret participants predominantly changed their own actions, whereas disappointment participants predominantly changed aspects of the situation. In Study 2 all participants (N = 50) read a scenario in which a person experiences a negative event. Participants who were instructed to undo the event by changing the person's actions reported more regret than disappointment, while participants who were instructed to undo the event by changing aspects of the situation reported more disappointment than regret. Study 3 (N = 140) replicated the findings from Study 2 with a different scenario, and a design in which regret and disappointment were measured between rather than within subjects. In the discussion we address the relation among counterfactual thinking, attributions and affective reactions to decision outcomes, and the implications for decision research. Copyright 1998 Academic Press.

The impact of accuracy motivation on interpretation, comparison, and correction processes: accuracy x knowledge accessibility effects.

Four studies provide evidence for the notion that there may be boundaries to the extent to which accuracy motivation may help perceivers to escape the influence of fortuitously activated information. Specifically, although accuracy motivations may eliminate assimilative accessibility effects, they are less likely to eliminate contrastive accessibility effects. It was found that the occurrence of different types of contrast effects (comparison and correction) was not significantly affected by participants' accuracy motivations. Furthermore, it was found that the mechanisms instigated by accuracy motivations differ from those ignited by correction instructions: Accuracy motivations attenuate assimilation effects because perceivers add target interpretations to the one suggested by primed information. Conversely, it was found that correction instructions yield contrast and prompt respondents to remove the priming event's influence from their reaction to the target.