ORCID Profile
0000-0001-9819-383X
Current Organisations
Universiteit Utrecht
,
Vrije Universiteit Amsterdam
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Publisher: Oxford University Press (OUP)
Date: 04-12-2017
Abstract: Although most drinkers have experienced a hangover the day following heavy alcohol consumption, a minority claims to be hangover resistant despite consuming the same large quantities of alcohol as those reporting alcohol hangover. The aim of the current study was to examine if susceptibility to experiencing hangovers is related to a drinker's interpretation of wellbeing and psychological assets to bounce back. A survey was conducted among 2295 Dutch students assessing their past month alcohol consumption patterns, and measuring mental resilience and wellbeing. Estimated peak blood alcohol concentration (e-pBAC) for their heaviest drinking occasion in the past month was computed for each participant. Data from participants who reported a past month hangover, i.e. hangover sensitive drinkers, were compared with hangover resistant drinkers. The analyses were conducted for (a) all participants reaching an e-pBAC ≥ 0.11% (N = 986, of which 24.6% claimed to be hangover resistant) and (b) participants reaching an e-pBAC ≥ 0.18% (N = 480, of which 16.7% claimed to be hangover resistant). For both e-pBAC cut-off values, no significant differences between hangover sensitive and hangover resistant drinkers were found for mental resilience and wellbeing. The current findings suggest that having a hangover is not simply an expression of poor psychological coping with the next-day consequences of heavy alcohol consumption.
Publisher: MDPI AG
Date: 18-01-2023
Abstract: Reduced immune fitness can have a significant negative impact on work performance. The aim of the current study was to evaluate the impact of reduced immune fitness on job performance and associated costs for the Dutch economy. Data from n = 425 Dutch working adults (18–65 years old) who completed an online survey were analyzed to evaluate the number of days of absenteeism (not going to work) and presenteeism (working while sick) due to reduced immune fitness, and the performance level on days worked with reduced immune fitness. Data from for the year 2019 were analyzed. Participants reported 2.9 absenteeism days and 19 presenteeism days, with an average performance reduction of 22.8% when working on days with reduced immune fitness. Significantly more days of absenteeism and presenteeism were reported by women, in iduals with a poorer immune fitness, and those with underlying disease. Performance impairment on days worked while experiencing reduced immune fitness was significantly greater among in iduals with a younger age at the junior career level, those with underlying disease, and among highly educated in iduals. The associated costs of reduced immune fitness were estimated at €4.3 billion for absenteeism and €6.4 billion for presenteeism. Together, the costs of reduced immune fitness for the Dutch economy in 2019 were estimated at €10.7 billion. These findings demonstrate that reduced immune fitness has a significant negative impact on the Dutch economy.
Publisher: MDPI AG
Date: 27-08-2019
DOI: 10.3390/JCM8091316
Abstract: Several dietary components have been shown to influence alcohol metabolism and thereby potentially affect the development of a hangover. From the literature, it is evident that dietary nicotinic acid and zinc play a pivotal role in the oxidation of ethanol into acetaldehyde. The aim of the current study was to associate dietary intake of nicotinic acid and zinc with hangover severity. To this end, data from n = 23 healthy social drinkers who participated in a naturalistic hangover study were analyzed. n = 10 of them reported to be hangover-resistant (the control group), whereas n = 13 reported to have regular hangovers (the hangover-sensitive group). Two 24 h dietary recall records were completed, one for the day of alcohol consumption and another one for an alcohol-free control day. Dietary nutrient intake was averaged and did not significantly differ between hangover-sensitive and hangover-resistant drinkers. For the hangover-sensitive drinkers, partial correlations with overall hangover severity were computed, controlling for estimated blood alcohol concentration. A bootstrapping technique was applied to account for the relatively small s le size. The results showed that dietary intake of nicotinic acid (rPB = −0.521) and zinc (rPB = −0.341) were significantly and negatively associated (p 0.002) with overall hangover severity. Dietary zinc intake was also significantly and negatively associated with severity of vomiting (rPB = −0.577, p 0.002). No significant associations with hangover severity were found for other nutrients, such as fat and fibers. In conclusion, this study suggests that social drinkers who have a higher dietary intake of nicotinic acid and zinc report significantly less severe hangovers. As hangover-resistant and hangover-sensitive drinkers had a similar dietary nutrient intake, the claim of being hangover-resistant must be based on other unknown biopsychosocial factors. These findings should be replicated in a larger s le and include more elaborate food frequency questionnaires or nutrient-specific dietary intake records for zinc and nicotinic acid, and preferably accompanied by nutrient assessments in urine and/or blood.
Publisher: MDPI AG
Date: 05-06-2020
Abstract: Various factors may contribute to alcohol hangover severity. The purpose of the current investigation was to evaluate the possible impact of alcohol consumption patterns, perceived immune status, and baseline fatigue on hangover severity. A survey was completed by a convenience s le of N = 199 Dutch students who reported on their latest past month’s heavy drinking occasion, including subjective intoxication (perceived drunkenness) and next-day hangover severity, which were rated on single-item scales ranging from 0 (absent) to 10 (extreme). In addition, perceived (momentary) immune fitness was assessed, and the Checklist In idual Strength (CIS) was completed to assess baseline fatigue. The analysis revealed that instead of the amount of alcohol consumed or estimated blood alcohol concentration, it appeared that subjective intoxication (i.e., level of drunkenness) was the most important determinant of alcohol hangover severity. Especially in men, albeit modest, it was perceived that immune fitness also significantly contributed to the level of hangover severity experienced.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Informa UK Limited
Date: 03-2017
DOI: 10.2147/JMDH.S130432
Publisher: MDPI AG
Date: 25-10-2020
DOI: 10.3390/JCM9113421
Abstract: The limited number of available studies that examined the pathology of alcohol hangover focused on biomarkers of alcohol metabolism, oxidative stress and the inflammatory response to alcohol as potentially important determinants of hangover severity. The available literature on alcohol metabolism and oxidative stress is reviewed in this article. The current body of evidence suggests a direct relationship between blood ethanol concentration and hangover severity, whereas this association is not significant for acetaldehyde. The rate of alcohol metabolism seems to be an important determinant of hangover severity. That is, fast elimination of ethanol is associated with experiencing less severe hangovers. An explanation for this observation may be the fact that ethanol—in contrast to acetaldehyde—is capable of crossing the blood–brain barrier. With slower ethanol metabolism, more ethanol is able to reach the brain and elicit hangover symptoms. Hangover severity was also significantly associated with biomarkers of oxidative stress. More oxidative stress in the first hours after alcohol consumption was associated with less severe next-day hangovers (i.e., a significant negative correlation was found between hangover severity and malondialdehyde). On the contrary, more oxidative stress at a later stage after alcohol consumption was associated with having more severe next-day hangovers (i.e., a significant positive correlation was found between hangover severity and 8-isoprostane). In conclusion, assessment of biomarkers of alcohol metabolism suggests that fast elimination of ethanol is associated with experiencing less severe hangovers. More research is needed to further examine the complex interrelationship between alcohol metabolism, the role of acetaldehyde and oxidative stress and antioxidants, and the pathology of the alcohol hangover.
Publisher: MDPI AG
Date: 24-08-2018
DOI: 10.3390/JCM7090238
Abstract: Background: Irritable bowel syndrome (IBS) can have a significant negative impact on quality of life, mood and wellbeing. The aim of this study was to investigate the association between experiencing IBS symptoms and insomnia, and perceived health status. Method: An online survey was conducted among n = 1950 Dutch university students (83.6% women). IBS was assessed with the Birmingham IBS Symptom Questionnaire, quality of life with the WHO-5 wellbeing index, and sleep outcomes with the SLEEP-50 questionnaire. Perceived immune functioning and general health were assessed using 1-item scales. Results: IBS symptom severity was significantly associated with insomnia complaints (r = 0.32, p = 0.0001), sleep quality (r = −0.21, p = 0.0001), sleep onset latency (r = 0.11, p = 0.0001) and the number of nightly awakenings (r = 0.24, p = 0.0001). Total sleep time was not significantly associated with IBS symptom severity. Significant correlations were also found between IBS symptom severity and perceived general health (r = −0.30, p = 0.0001), perceived immune functioning (r= −0.25, p = 0.0001), and quality of life (r = −0.24, p = 0.0001). Conclusions: Experiencing IBS complaints is associated with reduced perceived immune functioning, a poorer perception of general health, and sleep disturbances. These effects are reflected in a significantly lower reported quality of life in subjects with more IBS and/or sleep complaints.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.DRUGALCDEP.2017.11.040
Abstract: Previous research demonstrated that urinary ethanol concentrations were significantly lower in hangover resistant in iduals compared to drinkers who reported having a hangover. This finding suggests that the rate of ethanol metabolism is faster in drinkers who do not experience an alcohol hangover. This study aimed to directly compare alcohol metabolism after administering a low dose of ethanol to hangover sensitive drinkers and hangover resistant drinkers. Social drinkers who previously participated in hangover trials at Utrecht University were invited to participate. It was aimed to include 12 hangover resistant drinkers and 12 hangover sensitive drinkers. Participants consumed alcohol to reach a breath alcohol concentration (BrAC) of 0.05%. Every 5 min BrAC was determined, until BrAC reached zero. Every 15 min, the Karolinska Sleeping Scale (KSS) was administered to assess subjective sleepiness, and subjective intoxication was measured. Data of N = 23 participants with a mean age of 22.4 (±1.9) years was included in the analyses. No significant difference in BrAC over time was found between the hangover resistant group and the hangover sensitive group. In line, subjective sleepiness scores and subjective intoxication ratings did not significantly differ between the groups at any point in time after alcohol consumption. Hangover resistant in iduals and hangover sensitive drinkers did not significantly differ on BrAC, subjective sleepiness, and subjective intoxication after consuming a moderate amount of alcohol. These findings suggest that drinkers who usually experience hangovers after a heavy drinking occasion do not experience alcohol intoxication differently than hangover resistant drinkers.
Publisher: MDPI AG
Date: 02-07-2020
DOI: 10.3390/JCM9072081
Abstract: An increasing number of studies are focusing on the inflammatory response to alcohol as a potentially important determinant of hangover severity. In this article, data from two studies were re-evaluated to investigate the relationship between hangover severity and relevant biomarkers of alcohol metabolism, oxidative stress and the inflammatory response to alcohol. Hangover severity was significantly and positively correlated with blood concentrations of biomarkers of the inflammatory response to alcohol, in particular, Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP). At 4 h after alcohol consumption, blood ethanol concentration (but not acetaldehyde) was significantly and positively associated with elevated levels of IL-6, suggesting a direct inflammatory effect of ethanol. In addition, biomarkers of oxidative stress, i.e., malondialdehyde and 8-isoprostrane, were significantly correlated with hangover severity, suggesting that oxidative stress also contributes to the inflammatory response. The timing of the assessments suggests initial slow elimination of ethanol in the first hours after alcohol consumption. As a consequence, more ethanol is present in the second half of the night and the next morning, which will elicit more oxidative stress and a more profound inflammatory response. Together, these processes result in more severe hangovers.
Publisher: MDPI AG
Date: 06-07-2022
DOI: 10.3390/JCM11143933
Abstract: In addition to developing effective medicines and vaccines, pandemic preparedness also comprises general health-related, behavioral, and psychological aspects related to being more resistant in the case of future pandemics. In the context of the 2019 coronavirus (COVID-19) pandemic, recent research revealed that reduced perceived immune fitness was the best predictor of reporting more frequent and more severe COVID-19 symptoms. Up until now (June 2022), during the COVID-19 pandemic, the majority of patients who have been hospitalized were characterized as being overweight. It is therefore essential to further evaluate the relationship between body mass index (BMI) and immune fitness. This was performed by analyzing pooled data from previously published studies, conducted among N = 8586 Dutch adults. It was hypothesized that attaining a normal, healthy body weight is associated with optimal perceived immune fitness. The analysis revealed that a deviation from normal weight (i.e., having a BMI outside the range of 18.5 to 24.9 kg/m2) was associated with significantly reduced perceived immune fitness, as assessed with the immune status questionnaire and a single item perceived immune fitness scale. The effects were significant for both underweight and overweight groups and most pronounced for the obese groups. The results suggest that attaining a normal, healthy body weight might significantly contribute to maintaining adequate perceived immune fitness. Therefore, attaining a normal body weight might be an essential component of pandemic preparedness and should be supported by creating awareness and promoting the importance of regular exercise and the consumption of healthy food.
Publisher: MDPI AG
Date: 04-2021
DOI: 10.3390/HEALTHCARE9040395
Abstract: This study investigated immunological changes during an alcohol hangover, and the possible difference between hangover-resistant and hangover-sensitive drinkers in terms of immune reactivity. Using a semi-naturalistic design, N = 36 healthy social drinkers (18 to 30 years old) provided saliva s les on a control day (after drinking no alcohol) and on a post-alcohol day. Hangover severity was rated directly after saliva collection. Cytokine concentrations, interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α, and hangover severity were compared between both test days and between hangover-sensitive and -resistant drinkers. Data from N = 35 drinkers (17 hangover-sensitive and 18 hangover-resistant) were included in the statistical analyses. Relative to the control day, there were significant increases in saliva IL-6 and IL-10 concentrations on the post-alcohol day. No significant differences in cytokine concentrations were found between hangover-sensitive and hangover-resistant drinkers, nor did any change in cytokine concentration correlate significantly with hangover severity. In line with previous controlled studies assessing cytokines in blood, the current naturalistic study using saliva s les also demonstrated that the immune system responds to high-level alcohol intake. However, further research is warranted, as, in contrast to previous findings in blood s les, changes in saliva cytokine concentrations did not differ significantly between hangover-sensitive and hangover-resistant drinkers, nor did they correlate significantly with hangover severity.
Publisher: Wiley
Date: 06-07-2017
DOI: 10.1002/HUP.2624
Publisher: MDPI AG
Date: 08-02-2021
Abstract: The Western 24 h society poses great psychological and physical demands on people, which may result in complaints such as stress or being overworked, and reduced immune fitness. Having a holiday may be a good way to reduce work-related stress and reduced mood and improve perceived immune fitness. Therefore, the aim of the current study was to assess the impact of having a holiday or work on perceived immune fitness and mood. A survey was held among N = 246 young adults who were on holiday in Fiji, and N = 87 subjects who were in Fiji for work. The s le comprised both students and in iduals with a job at home. Past year immune status was assessed with the Immune Status Questionnaire (ISQ). Current perceived immune functioning and mood were rated from 0 (very poor) to 10 (excellent). Assessments were made for two occasions: (1) the current situation (in Fiji), and (2) at home (before traveling). Compared to being at home, both students and working in iduals on holiday in Fiji reported significantly improved immune fitness and significantly improved mood. For ex le, both groups reported reduction of stress of about 60% while in Fiji. In students who came to Fiji for work or spending a holiday, improvements in perceived immune fitness were more pronounced than in working people coming on holiday in Fiji. In contrast, working people on holiday reported greater improvements in mood compared to students. The magnitude of improvements were significantly greater among women than men. In conclusion, the data suggest that both having a holiday or working in Fiji is associated with significant improvements of mood, which were themselves associated with improved immune fitness. The findings are of importance for the tourism industry as they demonstrate that, in addition to leisure (or being active) as a purpose for having a holiday, the observed mental health benefits and improved perceived immune fitness provide an additional motive to have a holiday.
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/1048302
Abstract: It has been suggested that the second (2D, index finger) to fourth (4D, ring finger) digit ratio, 2D : 4D, may be a biomarker for the risk of developing autism. The aim of the current study was to determine the usefulness of the 2D : 4D digit ratio as biomarker for autistic traits. N = 401 healthy young volunteers participated in the study. For both hands, digit lengths were measured using digital Vernier calipers. In addition to demographics, the Autism Spectrum Quotient (AQ) questionnaire was completed, comprised of five subscales, assessing “social insights and behavior,” “attention switching,” “communication,” “imagination,” and “attention to detail.” Overall, no significant correlations were observed between the AQ total score, its subscales, and the 2D : 4D digit ratio. For women, the left hand 2D : 4D digit ratio correlated significantly with the subscale score “communication” ( r = - 0.142 p = 0.036 ). For men, a significant positive correlation was found between the left 2D : 4D digit ratio and the total AQ score ( r = 0.157 p = 0.042 ) and AQ subscale “attention switching” ( r = 0.182 p = 0.017 ). In conclusion, gender specific associations between the 2D : 4D digit ratio and specific autism traits were observed, which were stronger in men than in women. Future studies should be conducted in patients that are formally diagnosed with autism.
Publisher: MDPI AG
Date: 20-12-2022
DOI: 10.3390/JCM12010022
Abstract: Immune fitness (i.e., adequate functioning of the immune system) is essential to maintain health, prevent and resolve disease, and improve quality of life. This article provides an overview of how to assess immune fitness. It discusses how a single-item rating scale can be used to assess immune fitness. The scale can be used in conjunction with a single “yes” or “no” question asking whether the in idual is experiencing reduced immune fitness. Retrospective assessments can be complemented with the Immune Status Questionnaire (ISQ) to provide more insight into the type and frequency of experiencing specific immune-related complaints. Momentary assessments of immune fitness can be complemented with biomarker measurements in body fluids. As in iduals may be unaware of systemic inflammation (e.g., biomarker concentrations outside the normal range), it remains critical to combine immune fitness assessments with biomarker measurements of immune functioning.
Publisher: MDPI AG
Date: 18-06-2018
Publisher: MDPI AG
Date: 20-02-2021
Abstract: This article provides an overview of the design and methodology of the “Corona lockdown: how fit are you?” (CLOFIT) study, including the questionnaires and scales that were included in the online survey. The aim of the CLOFIT study was to investigate the psychosocial and health consequences of the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands. The survey was conducted among the Dutch population to collect data on immune fitness and the psychological and health consequences of the 2019 coronavirus disease (COVID-19) pandemic lockdown in the Netherlands. The CLOFIT dataset contains measures from N = 1910 participants and is broadly representative of the Dutch general population. The dataset represents both sexes, a range of ages including the elderly, different education levels, and ethnic backgrounds. The cohort also includes people with a erse health status and range of medication use.
Publisher: MDPI AG
Date: 17-06-2020
Abstract: Assessments in blood and saliva suggests that the amount of ethanol present in the first hours after alcohol consumption and into the following morning is associated with hangover severity. The current analysis determines how ethanol elimination rate is related to hangover severity reported throughout the day. n = 8 subjects participated in two studies. The first was a naturalistic study comprising an evening of alcohol consumption. Hangover severity was assessed hourly from 10 a.m. to 4 p.m., using a 1-item hangover severity scale ranging from 0 (absent) to 10 (extreme). The second study comprised a highly controlled alcohol challenge to reach a breath alcohol concentration (BrAC) of 0.05%. Breathalyzer tests were conducted every 5 min until BrAC reached zero. The ethanol elimination rate, expressed in BrAC%/hour, was computed by iding the peak BrAC (%) by the time to BrAC of zero (h). At 11:00, 13:00, and 14:00, there were significant negative partial correlations, controlling for estimated BrAC, between ethanol elimination rate and hangover severity. The findings suggest that drinkers with a faster ethanol elimination rate experience less severe hangovers. The observations should be confirmed in a larger s le of subjects who participate in a single study that assesses both hangover severity and ethanol elimination rate.
Publisher: Elsevier BV
Date: 09-2022
Publisher: MDPI AG
Date: 12-04-2017
Publisher: MDPI AG
Date: 26-04-2022
DOI: 10.3390/JCM11092442
Abstract: Pandemic preparedness is an important issue in relation to future pandemics. The two studies described here aimed to identify factors predicting the presence and severity of coronavirus disease 2019 (COVID-19) symptoms. The CLOFIT study comprised an online survey among the Dutch population (n = 1415). Perceived immune fitness before the pandemic (2019) and during the first lockdown period (15 March–11 May 2020) and the number and severity of COVID-19 symptoms were assessed. The COTEST study, conducted between December 2020 and June 2021, replicated the CLOFIT study in n = 925 participants who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Dutch commercial test locations. The CLOFIT study revealed that immune fitness before the pandemic was the greatest predictor of the number and severity of COVID-19 symptoms (20.1% and 19.8%, respectively). Other significant predictors included immune fitness during the lockdown (5.5% and 7.1%, respectively), and having underlying diseases (0.4% and 0.5%, respectively). In the COTEST study, for those who tested positive for SARS-CoV-2, immune fitness before the pandemic was the single predictor of the number (27.2%) and severity (33.1%) of COVID-19 symptoms during the pandemic. In conclusion, for those who tested positive for SARS-CoV-2, immune fitness before the pandemic was the strongest predictor of the number and severity of COVID-19 symptoms during the pandemic. Therefore, the development of strategies to maintain an adequate immune fitness must be regarded as an essential component of pandemic preparedness.
Publisher: MDPI AG
Date: 23-02-2023
DOI: 10.3390/BIOMEDICINES11030676
Abstract: Asthma is the most prevalent pediatric chronic disease. Bronchodilator drug response (BDR) and fractional exhaled nitric oxide (FeNO) are clinical biomarkers of asthma. Although DNA methylation (DNAm) contributes to asthma pathogenesis, the influence of DNAm on BDR and FeNO is scarcely investigated. This study aims to identify DNAm markers in whole blood associated either with BDR or FeNO in pediatric asthma. We analyzed 121 s les from children with moderate-to-severe asthma. The association of genome-wide DNAm with BDR and FeNO has been assessed using regression models, adjusting for age, sex, ancestry, and tissue heterogeneity. Cross-tissue validation was assessed in 50 nasal s les. Differentially methylated regions (DMRs) and enrichment in traits and biological pathways were assessed. A false discovery rate (FDR) 0.1 and a genome-wide significance threshold of p 9 × 10−8 were used to control for false-positive results. The CpG cg12835256 (PLA2G12A) was genome-wide associated with FeNO in blood s les (coefficient= −0.015, p = 2.53 × 10−9) and nominally associated in nasal s les (coefficient = −0.015, p = 0.045). Additionally, three CpGs were suggestively associated with BDR (FDR 0.1). We identified 12 and four DMRs associated with FeNO and BDR (FDR 0.05), respectively. An enrichment in allergic and inflammatory processes, smoking, and aging was observed. We reported novel associations of DNAm markers associated with BDR and FeNO enriched in asthma-related processes.
Publisher: MDPI AG
Date: 27-11-2019
Abstract: The self-assessment of perceived immune status is important, as this subjective observation leads in iduals to decide whether or not to seek medical help or adapt their lifestyle. In addition, it can be used in clinical settings and research. The aim of this series of studies was to develop and validate a short questionnaire to assess perceived immune functioning. Five surveys were conducted among Dutch and International young healthy adults (18–30 years old), and two others among older age groups with various health complaints. For the first study, an existing immune functioning scale was modified and elaborated resulting in 23 immune-health-related items, of which the occurrence was rated on a 5-point Likert scale. A student s le was surveyed, and the results were used to shorten the 23-item listing into a 7-item scale with a predictive validity of 85%. Items include “sudden high fever”, “diarrhea”, “headache”, “skin problems (e.g., acne and eczema)”, “muscle and joint pain”, “common cold” and “coughing”. The scale is named Immune Status Questionnaire (ISQ), and it aims to assess perceived immune status over the preceding year. The second study revealed that the ISQ score correlated significantly with a 1-item perceived immune functioning (r = 0.383, p 0.0001). In the third study, the final Likert scale descriptors were determined (“never”, “sometimes”, “regularly”, “often” and “(almost) always)”. The fourth study showed that the test–retest reliability of the ISQ is acceptable (r = 0.80). The fifth study demonstrated the association of ISQ scores with various neuropsychological and health correlates in an international s le, including perceived health and immune fitness, as well as levels of stress, fatigue, depression and anxiety. Study 6 demonstrated significant associations between ISQ scores and experiencing irritable bowel syndrome (IBS) symptoms in a s le of insomnia patients. Study 7 compared the effect of a dietary intervention in participants reporting “poor health” versus “normal health”. It is shown that ISQ scores can differentiate between those with poor and normal health, and that an effective intervention is associated with a significant improvement in ISQ scores. Data from Study 7 were further used to determine an ISQ cut-off value for reduced immune functioning, and a direct comparison with 1-item perceived immune functioning scores enabled constructing the final scoring format of the ISQ. In conclusion, the ISQ has appropriate face, content, and construct validity and is a reliable, stable and valid method to assess the past 12 month’s perceived immune status.
No related grants have been discovered for Aletta Kraneveld.