1,721,015 research outputs found
Children with problematic severe asthma: A biopsychosocial perspective
No full textThis thesis focuses on problematic severe asthma in children and its treatment from a biopsychosocial perspective. Asthma is a chronic inflammatory disease of the airways. In children with problematic severe asthma, asthma is not under control despite optimal medical treatment. Asthma control is the main goal of asthma treatment in these children. This study is guided by a biopsychosocial model, assuming that both disease activity and psychosocial variables influence asthma control and quality of life. In the first part of the thesis, children’s behavioral problems and parenting stress are investigated in relation to asthma control and quality of life in children with problematic severe asthma. In the second part, the effects of multidisciplinary treatment on a broad set of biopsychosocial outcome variables are evaluated. This thesis stimulates multilevel investigations promoting understanding and treatment of the complex biopsychosocial phenomena of problematic severe asthma. This will ultimately reduce the burden, morbidity, and mortality of problematic severe asthma in children
Targeting distress in rheumatic diseases
No full textPsychological distress is highly prevalent in patients with rheumatic diseases. It is associated with a variety of negative outcomes, including pain, fatigue, disability, and maladaptive cognitive behavioural coping strategies. In this thesis, psychological distress was studied both as an outcome measure and as a therapeutic target in the context of multidisciplinary rehabilitation. The longitudinal role of coping in psychological distress was systematically reviewed, a questionnaire to assess coping flexibility was described and initially validated, and the effectiveness of multidisciplinary rehabilitation programmes for selected patients with rheumatic diseases and high levels of psychological distress were evaluated. Various coping strategies were categorised into a hierarchical taxonomy to systematically examine the longitudinal association between coping and psychological distress in rheumatoid arthritis (RA). The evidence for the prognostic value of coping strategies for subsequent changes in psychological distress in RA turned out to be weak. Contrary to previous cross-sectional findings, active-oriented engagement strategies (e.g., problem solving) were not associated with a decrease in psychological distress over time. Some support was found for the usefulness of identifying avoidant-oriented coping strategies (e.g., helplessness, resting, wishful thinking) among patients in routine clinical practice as these coping strategies may forecast poor adjustment to RA. The coping flexibility questionnaire (COFLEX) was developed to assess coping flexibility. Evaluation of conventional multidisciplinary treatment programmes indicated that poor psychological well-being is common among patients in multidisciplinary rehabilitation and that psychological distress was under-recognised and not adequately considered in treatment. Programmes to target psychological distress through a group-based cognitive-behavioural therapy (CBT) within a multidisciplinary rehabilitation setting are, however, scarce. Because of the potentially fluctuating disease course of rheumatic diseases and because of the weak evidence for the prognostic value of separate coping strategies for subsequent changes in psychological distress, a CBT was developed promoting coping flexibility. The development of the CBT was further guided by evidence-based cognitive therapy principles, by the dual-process coping model that stresses the fit between characteristics of the situation and the employed coping strategy, and by empirical evidence on the role of acceptance in the adjustment to a chronic illness. The integration and feasibility of this acceptance-oriented CBT within multidisciplinary rehabilitation is extensively described in this thesis. The potential effectiveness of the CBT to decrease psychological distress and to improve acceptance and coping flexibility was examined in a longitudinal observational proof-of-concept study. The acceptance-oriented CBT was effective in improving patient’s psychological well-being and quality of life, but coping flexibility did not significantly change. The majority of the highly distressed patients showed decreased levels of psychological distress, large improvements in illness acceptance, and improved quality of life. In conclusion, psychological distress is prevalent among patients with rheumatic diseases in multidisciplinary rehabilitation. The proof-of-concept intervention study suggested the reversibility of distress by yielding preliminary support for the beneficial effects of an acceptance-oriented CBT embedded in multidisciplinary rehabilitation for selected patient with rheumatic diseases and high levels of psychological distress
Depressive and anxiety disorders in different ethnic groups: A population based study among native Dutch, and Turkish, Moroccan and Surinamese migrants in Amsterdam
No full textIntroduction: To explore ethnic differences in psychopathology, this study examined the prevalence of depressive and anxiety disorders among different ethnic groups in Amsterdam and determined whether ethnic differences can be explained by socio-demographic differences. Methods: A population-based sample of 321 Dutch, 231 Turkish, 191 Moroccan, 87 Surinamese/Antilleans was interviewed by well-trained bilingual interviewers, using the CIDI 2.1. Educational level and income were used as indicators of socio-economic status. Results: The weighed 1-month prevalence of depressive and/or anxiety disorders was 6.6% (Dutch), 18.7% (Turkish), 9.8% (Moroccans) and 1.2 % (Surinamese/Antilleans). Among Moroccans, the prevalence of affective disorders seemed higher in men than in women, among the Turkish the opposite was observed. Ethnic differences in prevalence could not be explained by socioeconomic differences. Conclusion: Turkish women and men and Moroccan men in Amsterdam seem to have a higher risk of current affective disorders. Ethnicity is an independent predictor of common mental disorders in the Netherlands
The burden of Sjögren's syndrome, dryness and fatigue
No full textDryness and fatigue are prevalent and debilitating symptoms in Sjögren’s syndrome. In this thesis, consequences of dryness for patients’ well-being and daily life functioning, and possible targets for treatment were described. In the first part of this thesis, an encompassing overview of the consequences of dryness from the perspective of the patients was revealed. The hierarchical overview comprised generic psychosocial consequences and disease-specific consequences including primary symptoms of eyes and mouth and hindered participation in social activities, intimacy problems, and somatic (systemic) symptoms. Second, the consequences of dryness with respect to crying problems were studied. Compared with demographically matched control participants, patients with Sjögren’s syndrome reported lower crying sensibility and capability to cry with tears, a higher presence of bodily symptoms after crying, and a higher severity of suffering from a reduced capability to cry. The crying dimensions generally showed significant but weak associations with ocular dryness and mental well-being in patients. Third, consequences for emotional well-being of the hampered ability to cry are described. It was found that processing and regulating emotions generally did not deviate from normal with one exception: a relatively large number of patients, 22%, were alexithymic (i.e., had difficulty identifying and describing feelings and focusing on external events rather than inner experiences). Processing emotions more intensely or more deficiently and regulating emotions by more suppression was associated with worse mental well-being; virtually alike in patients and control participants. The second part of this thesis describes possible targets for treatment of fatigue in Sjögren’s syndrome. Physical activity and physical activity cognitions were found to be independently associated with fatigue. Moreover, the combination of low physical activity and high activity avoidance was associated with both fatigue. These results suggest that fatigue in patients with Sjögren’s syndrome might be reduced by targeting both physical activity and physical activity cognitions. In another study, we examined whether there were different psychological profiles (subgroups) in patients with Sjögren’s syndrome, and how these profiles were related to fatigue. Four psychological profiles were identified using cluster analyses, a functional profile (in which 39% of the patients were grouped), an alexithymic profile (27%), a self-reliant profile (23%), and a dysfunctional profile (11%). Irrespective of the psychological profile of patients, the level of fatigue was substantially higher than in the general population. Patients with a dysfunctional or an alexithymic profile reported more fatigue than those with a self-reliant profile. Since cognitive behavioural therapy and graded exercise therapy are promising treatments in reducing fatigue, this thesis describes the development and feasibility of such an intervention for patients with Sjögren’s syndrome. This intervention seemed convenient for people to follow and the participants in the first intervention group noted that it had changed their way of coping with fatigue. The next, ongoing, step is to conduct a randomised controlled trial examining whether a combination of cognitive behavioural group therapy and exercise therapy are effective in reducing fatigue in Sjögren’s syndrome. Using information about psychological profiles of patients, treatment might be customized to make it effective and suitable for a large group of patients. This could improve the quality of life of patients with Sjögren’s syndrome
Local Geographical Distribution of Acute Involuntary Psychiatric Admissions in Subdistricts In and Around Utrecht, the Netherlands
No full textAbstractBackgroundAcute involuntary psychiatric admissions (AIPA) tend to be applied more often in urban areas.ObjectiveThe current study aims to describe AIPA prevalence differences between the subdistricts in an urban area, and to identify which district characteristics are associated with a higher AIPA district density.MethodsInformation was collected on consecutive AIPAs over a 64-month period (2005–2010) in 49 subdistricts in and around the city of Utrecht, the Netherlands, including 1098 AIPAs. District characteristics included several demographic and economical factors and health care characteristics such as number of sheltered living facilities.ResultsThe AIPA density (mean 4.4/10,000 inhabitants/y) was four to five times higher in the most urbanized subdistrict (around 12) compared to the suburban subdistricts (2.5–3). On the district level, the main correlates with AIPA density per district were unemployment rate and small household size. Other correlates were percentage of non-Western immigrants and number of facilities of sheltered living.ConclusionsThe considerable AIPA density variation between subdistricts in this urban environment reflects that people who are prone to psychiatric admissions live in economically less prosperous environments. Impaired social networks and economic concerns may also contribute to an environment representing social defeat, increased demoralization, or social fragmentation
The effects of lameness on reproductive performance, milk production and culling in Dutch dairy farms
No full textA retrospective cohort study design was used to investigate the effect of lameness on reproductive performance on 13 commercial Dutch dairy farms. The data were collected during a routine herd health and production control program. The cumulative 100-DIM (days in milkl) production in the previous lactation of lame cows was higher and the culling rate lower than that of the controls. The 100- and 270-DIM production of the cows with a sole ulcer was higher than that of the control cows. There was no difference in 100- and 270-DIM production between cows with a lameness diagnosis other than sole ulcer and the controls. Lameness prolonged the interval from calving to first service and the interval from first service to conception. The pregnancy rate at first service was not affected by lameness
Huilen zonder tranen? Een onderzoek naar huilen bij mensen met het syndroom van Sjögren en het non-Sjögren sicca syndroom
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