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OBJECTIVE: Multicomponent interventions are recommendable to achieve the greatest mental health benefits, but are difficult to evaluate due to their complexity. Defining long-term outcomes, arising from a Theory of Change (ToC) and testing them in a pilot phase, is a useful approach to plan a comprehensive and meaningful evaluation later on. This article reports on the pilot results of an outcome evaluation of a complex mental health intervention and examines whether appropriate evaluation measures and indicators have been selected ahead of a clustered randomised control trial (cRCT). METHODS: The MENTUPP pilot is an evidence-based intervention for Small and Medium Enterprises (SMEs) active in three work sectors and nine countries. Based on our ToC, we selected the MENTUPP long-term outcomes, which are reported in this article, are measured with seven validated scales assessing mental wellbeing, burnout, depression, anxiety, stigma towards depression and anxiety, absenteeism and presenteeism. The pilot MENTUPP intervention assessment took place at baseline and at 6 months follow-up. RESULTS: In total, 25 SMEs were recruited in the MENTUPP pilot and 346 participants completed the validated scales at baseline and 96 at follow-up. Three long-term outcomes significantly improved at follow-up (p

BACKGROUND: There is a gap between the necessity of effective mental health interventions in the workplace and the availability of evidence-based information on how to evaluate them. The available evidence outlines that mental health interventions should follow integrated approaches combining multiple components related to different levels of change. However, there is a lack of robust studies on how to evaluate multicomponent workplace interventions which target a variety of outcomes at different levels taking into account the influence of different implementation contexts. METHOD: We use the MENTUPP project as a research context to develop a theory-driven approach to facilitate the evaluation of complex mental health interventions in occupational settings and to provide a comprehensive rationale of how these types of interventions are expected to achieve change. We used a participatory approach to develop a ToC involving a large number of the project team representing multiple academic backgrounds exploiting in tandem the knowledge from six systematic reviews and results from a survey among practitioners and academic experts in the field of mental health in SMEs. RESULTS: The ToC revealed four long-term outcomes that we assume MENTUPP can achieve in the workplace: 1) improved mental wellbeing and reduced burnout, 2) reduced mental illness, 3) reduced mental illness-related stigma, and 4) reduced productivity losses. They are assumed to be reached through six proximate and four intermediate outcomes according to a specific chronological order. The intervention consists of 23 components that were chosen based on specific rationales to achieve change on four levels (employee, team, leader, and organization). CONCLUSIONS: The ToC map provides a theory of how MENTUPP is expected to achieve its anticipated long-term outcomes through intermediate and proximate outcomes assessing alongside contextual factors which will facilitate the testing of hypotheses. Moreover, it allows for a structured approach to informing the future selection of outcomes and related evaluation measures in either subsequent iterations of complex interventions or other similarly structured programs. Hence, the resulting ToC can be employed by future research as an example for the development of a theoretical framework to evaluate complex mental health interventions in the workplace. ispartof: BMC PUBLIC HEALTH vol:23 issue:1 ispartof: location:England status: published

ispartof: Vesalius (ALFAGEN) pages:38-40 status: published

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Supplemental material, sj-pdf-1-pmj-10.1177_02692163211070228 for How are family caregivers of people with a serious illness supported by healthcare professionals in their caregiving tasks? A cross-sectional survey of bereaved family caregivers by Orph�� Matthys, Sigrid Dierickx, Luc Deliens, Lore Lapeire, Peter Hudson, Chantal Van Audenhove, Aline De Vleminck and Joachim Cohen in Palliative Medicine

Supplemental material, sj-docx-1-pmj-10.1177_02692163211070228 for How are family caregivers of people with a serious illness supported by healthcare professionals in their caregiving tasks? A cross-sectional survey of bereaved family caregivers by Orph�� Matthys, Sigrid Dierickx, Luc Deliens, Lore Lapeire, Peter Hudson, Chantal Van Audenhove, Aline De Vleminck and Joachim Cohen in Palliative Medicine

Supplemental material, sj-docx-1-pmj-10.1177_02692163211070228 for How are family caregivers of people with a serious illness supported by healthcare professionals in their caregiving tasks? A cross-sectional survey of bereaved family caregivers by Orph�� Matthys, Sigrid Dierickx, Luc Deliens, Lore Lapeire, Peter Hudson, Chantal Van Audenhove, Aline De Vleminck and Joachim Cohen in Palliative Medicine

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Supplemental material, sj-docx-1-pcr-10.1177_26323524211058895 for How can social workers be meaningfully involved in palliative care? A scoping review on the prerequisites and how they can be realised in practice by Brent Taels, Kirsten Hermans, Chantal Van Audenhove, Nadine Boesten, Joachim Cohen, Koen Hermans and Anja Declercq in Palliative Care and Social Practice

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Supplemental material, sj-docx-2-pcr-10.1177_26323524211058895 for How can social workers be meaningfully involved in palliative care? A scoping review on the prerequisites and how they can be realised in practice by Brent Taels, Kirsten Hermans, Chantal Van Audenhove, Nadine Boesten, Joachim Cohen, Koen Hermans and Anja Declercq in Palliative Care and Social Practice

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Supplemental material, sj-docx-2-pcr-10.1177_26323524211058895 for How can social workers be meaningfully involved in palliative care? A scoping review on the prerequisites and how they can be realised in practice by Brent Taels, Kirsten Hermans, Chantal Van Audenhove, Nadine Boesten, Joachim Cohen, Koen Hermans and Anja Declercq in Palliative Care and Social Practice

Supplemental material, sj-docx-1-pcr-10.1177_26323524211058895 for How can social workers be meaningfully involved in palliative care? A scoping review on the prerequisites and how they can be realised in practice by Brent Taels, Kirsten Hermans, Chantal Van Audenhove, Nadine Boesten, Joachim Cohen, Koen Hermans and Anja Declercq in Palliative Care and Social Practice

Achtergrond Er bestaat internationale consensus dat afzondering en fixatie enkel zo kort en zo weinig mogelijk worden toege-past. Audits van Zorginspectie tonen aan dat dit in de Vlaamse geestelijke gezondheidszorg (ggz) niet steeds het geval is. Doel We ontwikkelden een multidisciplinaire richtlijn voor de preventie en toepassing van afzondering en fixatie in de residentiële ggz, onderbouwd met zowel klinisch-wetenschappelijke als juridische evidentie. Methode De GRADE-methode vormde de basis voor de ontwikkeling van de richtlijn. Om de twee vormen van evidentie te integreren, voegden we twee onderzoeksfasen toe. In dit artikel bieden we een overzicht van de uitdagingen die gepaard gingen met de uitvoering van deze interdisciplinaire methode. Resultaten Zowel de klinisch-wetenschappelijke als de juridische evidentie vertoonde lacunes. Toch resulteerde de studie in een uitgebreide richtlijn doordat we in de eerste plaats de aanbevelingen mede onderbouwden met praktijk-en erva-ringsgerichte expertise van de Vlaamse belanghebbenden, en in de tweede plaats de klinisch-wetenschappelijke en juridische evidentie integreerden. Conclusie De inzet op implementatieonderzoek en een duidelijk wettelijk kader voor Vlaanderen zijn noodzakelijk om de (men-sen)rechten van zorggebruikers in de ggz-ook in het geval van agressie en escalatie-beter te vrijwaren. Afzondering en fixatie zijn in de geestelijke gezond-heidszorg omstreden maatregelen, zowel vanuit klinisch als juridisch oogpunt. Vanuit klinisch perspectief loopt de zorggebruiker bij de toepassing van deze maatregelen het risico op lichamelijke verwondingen, (her)traumatisering en gevoelens van onmacht, woede, angst, vernedering en onbegrip (bijv. min-derheid van de gevallen rapporteren zorggebruikers ook positieve gevoelens, waaronder een gevoel van vei-ligheid en zelfcontrole (Aguilera-Serrano e.a. 2018). Bij hulpverleners kunnen naast lichamelijke verwondingen ook secundaire traumatisering en gevoelens van angst, kwaadheid, onzekerheid en schuld optreden (Stewart e.a. 2010). Bovendien kan de onderlinge werkrelatie ernstig onder druk komen te staan (Stewart e.a. 2010; Bowers 2014). Enkel van bepaalde vormen van medica-menteuze fixatie is aangetoond dat het agitatie bij vol-wassenen op een veilige manier kan verminderen (Sailas & Fenton 2012; Bak e.a. 2019; Chieze e.a. 2019). Vanuit juridisch perspectief zijn afzondering en fixa-tie verregaande inmengingen in de fysieke integriteit. Daardoor vormen ze een restrictief te interpreteren uitzondering op het autonomiebeginsel. Het uitgangs-punt is immers dat de zorggebruiker-of zijn of haar vertegenwoordiger-zelf beslist welke behandeling hij of zij krijgt (artikel 8, 12 en 14 Wet Patiëntenrechten; Lemmens 2014). Vanuit mensenrechtelijk oogpunt zijn afzondering en fixatie slechts toegelaten indien ze als laatste hulpmid-del kortdurend plaatsvinden binnen een juridisch kader met strikte waarborgen (Opgenhaffen 2020). Dat kader moet ervoor zorgen dat zorggebruikers niet onrechtma-tig worden afgezonderd of gefixeerd, dat hulpverleners hun rechten tijdens de maatregel maximaal respecteren, en dat de maatregel onder toezicht plaatsvindt. Vanuit zowel klinisch als juridisch oogpunt bestaat er dus al langer internationale consensus om afzondering en fixatie zo weinig en zo kort mogelijk toe te passen. Background International consensus states that seclusion and restraint should only be applied as briefly and as little as possible. However, audits by the Care Inspectorate show that this is not always the case in Flemish mental health care (MHC). Aim To describe the development of a multidisciplinary guideline for the prevention and application of seclusion and restraint in inpatient MHC, underpinned by both clinical-scientific and legal evidence. Method The GRADE method formed the basis for the development of the guideline. To integrate both types of evidence, two research phases were added. This article provides an overview of the challenges involved in implementing this interdisciplinary method. Results There are gaps in both clinical-scientific and legal evidence. Nevertheless, the study resulted in a comprehensive guideline because we underpinned the recommendations with practice- and experience-based expertise of the Flemish stakeholders, and integrated the clinical-scientific and legal evidence. Conclusion Focus on implementation research and a clear legal framework for Flanders are necessary to safeguard the (human) rights of MHC users, also in the event of aggression and escalation.

ispartof: Tijdschrift voor Geneeskunde vol:76 issue:17 pages:806-814 status: published

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The 'European Alliance Against Depression' community-based intervention approach simultaneously targets depression and suicidal behaviour by a multifaceted community based intervention and has been implemented in more than 115 regions worldwide. The two main aims of the European Union funded project "Optimizing Suicide Prevention Programmes and Their Implementation in Europe" were to optimise this approach and to evaluate its implementation and impact. This paper reports on the primary outcome of the intervention (the number of completed and attempted suicides combined as 'suicidal acts') and on results concerning process evaluation analysis. Interventions were implemented in four European cities in Germany, Hungary, Portugal and Ireland, with matched control sites. The intervention comprised activities with predefined minimal intensity at four levels: training of primary care providers, a public awareness campaign, training of community facilitators, support for patients and their relatives. Changes in frequency of suicidal acts with respect to a one-year baseline in the four intervention regions were compared to those in the four control regions (chi-square tests). The decrease in suicidal acts compared to baseline in the intervention regions (-58 cases, -3.26%) did not differ significantly (χ2 = 0.13; p = 0.72) from the decrease in the control regions (-18 cases, -1.40%). However, intervention effects differed between countries (χ2 = 8.59; p = 0.04), with significant effects on suicidal acts in Portugal (χ2 = 4.82; p = 0.03). The interviews and observations explored local circumstances in each site throughout the study. Hypothesised mechanisms of action for successful implementation were observed and drivers for 'added-value' were identified: local partnership working and 'in-kind' contributions; an approach which valued existing partnership strengths; and synergies operating across intervention levels. It can be assumed that significant events during the implementation phase had a certain impact on the observed outcomes. However, this impact was, of course, not proven. ispartof: PLOS ONE vol:14 issue:11 ispartof: location:United States status: published

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The ‘European Alliance Against Depression’ community-based intervention approach simultaneously targets depression and suicidal behaviour by a multifaceted community based intervention and has been implemented in more than 115 regions worldwide. The two main aims of the European Union funded project “Optimizing Suicide Prevention Programmes and Their Implementation in Europe” were to optimise this approach and to evaluate its implementation and impact. This paper reports on the primary outcome of the intervention (the number of completed and attempted suicides combined as ‘suicidal acts’) and on results concerning process evaluation analysis. Interventions were implemented in four European cities in Germany, Hungary, Portugal and Ireland, with matched control sites. The intervention comprised activities with predefined minimal intensity at four levels: training of primary care providers, a public awareness campaign, training of community facilitators, support for patients and their relatives. Changes in frequency of suicidal acts with respect to a one-year baseline in the four intervention regions were compared to those in the four control regions (chi-square tests). The decrease in suicidal acts compared to baseline in the intervention regions (-58 cases, -3.26%) did not differ significantly (χ2 = 0.13; p = 0.72) from the decrease in the control regions (-18 cases, -1.40%). However, intervention effects differed between countries (χ2 = 8.59; p = 0.04), with significant effects on suicidal acts in Portugal (χ2 = 4.82; p = 0.03). The interviews and observations explored local circumstances in each site throughout the study. Hypothesised mechanisms of action for successful implementation were observed and drivers for ‘added-value’ were identified: local partnership working and ‘in-kind’ contributions; an approach which valued existing partnership strengths; and synergies operating across intervention levels. It can be assumed that significant events during the implementation phase had a certain impact on the observed outcomes. However, this impact was, of course, not proven. publishersversion published

Aujourd’hui, les nouvelles formes d’habitat se présentent comme une innovation sociale et offrent une alternative intéressante aux modes d’hébergement traditionnels. L’innovation majeure réside dans l’accent mis sur l’implication des habitants dans la vie sociale et sur la co-construction des modes de fonctionnement de leur habitation. Parmi ces nouvelles formes d’habitat, l’habitat groupé autogéré de type Abbeyfield offre une combinaison entre espace privé et espace partagé, autonomie et vie sociale. En effet, la préservation de l’autonomie et le développement personnel des habitants des maisons sont des éléments-clés du projet Abbeyfield. L’entrée dans une maison Abbeyfield met en tension la préservation du projet personnel et le projet des autres cohabitants, voire le projet de la maison partagée. Cette tension, observée dans la plupart des initiatives comparables au niveau international, est à l’origine du souhait d’identifier des « outils pour mieux vivre ensemble ». Ce souhait a conduit à faire appel à une équipe de recherche pour appuyer et documenter ce processus de réflexion portant sur de tels outils. Ce processus a duré un an, de juin 2018 à juin 2019. L’étude s’est déroulée dans le respect des valeurs-clé du projet Abbeyfield. Elle a pris la forme d’une recherche-action incluant les habitants à toutes les étapes, en ce compris l’élaboration du protocole de recherche ; le recrutement des habitants pour la partie empirique ; la discussion des résultats et la rédaction des recommandations. Le déroulement de l’étude incluait des réunions avec le comité de suivi, des entretiens collectifs auxquels tous les habitants des maisons étaient invités, et un processus itératif permettant la discussion des résultats émanant de l’analyse réalisées par l’équipe de recherche et la rédaction collégiale des résultats. Comme premier outil, les habitants ont formulé la nécessité de redéfinir et d’exprimer à intervalles réguliers leur projet personnel dans la maison, mais également le projet communautaire pour la maison. En effet, des éléments comme la configuration des profils des habitants dans la maison, la nature et l’intensité des engagements extérieurs à la maison ou des éléments de la vie personnelle des habitants vont influencer leur projet dans la maison. Dès lors, les auteurs recommandent que le projet de la maison intègre cette diversité et évolue au cours du temps. Ceci nous mène au deuxième outil : la communication dans la maison, qui suppose l’apprentissage d’une qualité d’écoute qui est rarement acquise spontanément. La recommandation porte donc sur une aide extérieure, sous la forme d’accompagnement par des structures d’appui à l’habitat groupé. Vient ensuite le troisième outil : celui des processus décisionnels. Ces processus permettent de mettre en œuvre le projet de la maison. Les décisions prises de manière collective et participative, feront vivre les valeurs d’autonomie, de respect et de solidarité. La recommandation est donc que ces valeurs sous-tendent à la fois les processus décisionnels et, de manière globale, le projet de la maison. Le quatrième outil concerne les réunions. En fonction de leurs objectifs, elles seront structurées formellement, comme les conseils des habitants pour les processus décisionnels, soit organisées plus librement, tels des groupes de parole, où les habitants vont créer un espace de liberté pour échanger sereinement et en toute sécurité. Dans les deux cas, des règles de base seront définies et partagées, afin de permettre une écoute et un échange vrais, dans une logique d’intelligence collective. Concrètement, cela signifie que chaque membre s’approprie le fonctionnement de ces réunions et prenne à son tour la fonction de facilitateur, de secrétaire ou d’observateur, dans le respect de ses compétences. Les règles de base de vie en groupe sont respectées, telles l’absence de communication toxique, le fait de parler en « je » et de ne pas projeter ses idées sur les autres, en particulier si la personne est absente. Comme cinquième outil, les habitants ont relevé les formations – entendues au sens large – comme moteurs de développement personnel et de la maison, pour identifier et faire vivre les outils du mieux vivre ensemble. À la suite de ce processus d’identification des outils pour vivre ensemble, les habitants ont exprimé le souhait de poursuivre le cheminement d’appropriation de développement de ces outils du vivre ensemble, dans le contexte d’intelligence collective, évoqué dès les premiers contacts. L’étude a été réalisé dans des maisons bruxelloises mais les résultats sont largement transférables à d’autres maisons, pour peu le contexte extérieur réglementaire et culturel soit pris en compte. Si vous avez des questions au sujet de cette étude et la manière dont vous envisagez d’utiliser les outils, veuillez vous adresser à Mme Séverine Laneau contact@abbeyfield.be

Contains fulltext : 170085.pdf (Publisher’s version ) (Open Access) BACKGROUND: Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals recently proposed reformulating the static WHO definition of health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. METHOD: Based on the expertise of the Social Health Taskforce members (N = 54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: (1) capacity to fulfil potential and obligations; (2) ability to manage life with some degree of independence; (3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). RESULTS: The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. CONCLUSION: A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.

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How adverse outcomes and complaints are managed may significantly impact on physician well-being and practice. We aimed to investigate how depression, anxiety and defensive medical practice are associated with doctors actual and perceived support, behaviour of colleagues and process issues regarding how complaints investigations are carried out. ispartof: BMJ Open vol:7 issue:11 ispartof: location:England status: published

AIM: The aims of the present study were: (i) to describe palliative care needs and symptoms of older adults anticipated to be in the last year of their life in Flemish nursing homes (Belgium); and (ii) to evaluate whether these needs differ between residents with and without dementia. METHODS: A cross-sectional study was carried out in 2014. Nurses and nursing assistants in 15 Flemish nursing homes (Belgium) completed the Palliative care Outcome Scale for 109 residents with palliative care needs. RESULTS: Pain, as well as other physical symptoms, was present in more than half of the nursing home residents according to caregivers. The most prominent needs occurred on psychosocial and spiritual domains, such as patient anxiety, support, finding life worth living and self-worth. Caregivers reported that residents with dementia experienced fewer physical symptoms apart from pain than did residents without dementia (coeffficient -0.73, 95% CI -1.18-0.84; P = 0.001. Furthermore, residents with dementia received higher scores on the items "support" (coefficient 0.75; 95% CI 0.15-1.34, P = 0.015), "life worthwhile" (coeffficient 0.58; 95% CI 0.090-1.07, P = 0.020) and "self-worth" (coefficient 0.58, 95% CI 0.13-1.03, P = 0.012). CONCLUSIONS: According to caregivers, residents with dementia experienced fewer other physical symptoms (e.g. nausea) than residents without dementia. This, however, might be a result of an underdetection of other symptoms in nursing home residents with dementia. Furthermore, most challenges in nursing homes lie within the spiritual and psychosocial domains of palliative care, particularly in people with dementia. These aspects should be integrated in the professional education of caregivers. Assessment tools might be of help to improve the identification of needs and symptoms. Geriatr Gerontol Int 2017; 17: 1501-1507. ispartof: Geriatrics & Gerontology International vol:17 issue:10 pages:1501-1507 ispartof: location:Japan status: published

Due to memory loss, most people with dementia are increasingly disorientated in space, time, and identity, which causes profound feelings of insecurity, anxiety and homelessness. The built environment is expected to hold great potential for offering support in coping with the challenges resulting from disorientation. However, scientific research offers little adequate architectural design knowledge. This paper indicates three reasons for this lack of adequate architectural design knowledge: prevailing research takes an objectivist approach to value-bound matters, lacks insights into living with dementia, and hardly addresses architects’ core business of form and spatial organization. Next, this article presents and discusses a novel research approach that aims to overcome these limitations, illustrated with a study on how architecture could support people with dementia in orientating in space, time, and identity. This study explored three cases from a critical realist and constructionist perspective and by means of ethnographic techniques combined with an architectural analysis. Five implications for architectural design are highlighted: create strategic places, articulate proper boundaries and connections, include everyday places and objects, create contemporary architectural qualities, and take into account social dynamics. The approach taken allowed to give voice to people with dementia and provide insights into their experiences in a format that helps architects to develop affinity with their perspective. Care givers are introduced to the repertoire (or at least a part of it) that architects possess to design architecture for people with dementia. Linking insights into living with dementia with architects’ core business, i.e. organization of form and space, enhances dialogues between architects and their clients, and broadens their view on possible roles of architecture in the daily lives of people with dementia. no ISSN ispartof: pages:55-70 ispartof: ARCH17 - 3RD INTERNATIONAL CONFERENCE ON ARCHITECTURE, RESEARCH, CARE AND HEALTH pages:55-70 ispartof: International Conference on Architecture, Research, Care, Health (ARCH17) location:Copenhagen date:26 Apr - 27 Apr 2017 status: published

Background: Public attitudes toward depression and help-seeking behaviour are important factors influencing depressed people to obtain professional help and adequate treatment. OSPI-Europe is a multi-level suicide prevention programme including a public awareness campaign. It was implemented in four regions of four European countries (Germany, Hungary, Ireland and Portugal). This paper reports the results of the evaluation of the campaign, including its visibility and effects of the campaign on stigma associated with depression and help-seeking behaviour. Methods: A representative general population survey (N = 4004) including measures on personal stigma, perceived stigma, openness to help, perceived value of help, and socio-demographic variables was conducted in the four intervention and four control regions in a cross-sectional pre-post design. Results: The public awareness campaign was considerably more visible in Germany and Portugal compared to Ireland and Hungary. Visibility was further affected by age and years of schooling. Personal stigma, perceived stigma and openness toward professional help varied significantly across the four countries. Respondents in the intervention regions showed significantly less personal depression stigma than respondents in the control regions after the campaign. Respondents of the intervention region who were aware of the campaign reported more openness toward seeking professional help than respondents who were unaware of it. Conclusion: The OSPI-Europe awareness campaign was visible and produced some positive results. At the same time, it proved to be difficult to show strong, measurable and unambiguous effects, which is in line with previous studies. Public awareness campaigns as conducted within OSPI-Europe can contribute to improved attitudes and knowledge about depression in the general public and produce synergistic effects, in particular when the dissemination of awareness campaign materials is simultaneously reinforced by other intervention levels of a multi-level intervention programme. Limitations: The survey was cross-sectional and based on self-report, so no causal inferences could be drawn.

Hospital buildings are experienced from a, for most architects, a-typical perspective. Once you are admitted to the hospital, you are assigned a bed and from that moment on, this is your sole truly personal space, which travels with you through the building. Insight into patients’ spatial experience in motion is thus of crucial importance for architects and hospital boards who aim to put patients’ experience centre stage in a hospital design. To gain a nuanced and in-depth understanding of how this insight can be introduced in design processes, we organised a one and a half day workshop in which participants were asked to design a lift based on research data about hospital patients’ spatial experience in motion. The aim of the workshop was to test and evaluate design input based on different information formats to provide designers with an extended background on real people’s experience of moving through a hospital environment. We analysed the workshop in terms of the design outcome and the design process, paying specific attention to the affordances of the information formats. We conclude that spatial experience in motion is a complex phenomenon, layering sensory perceptions, social ties, and time related issues. Moving space can hold different meanings. The diverse design solutions illustrate that the hospital environment is not a priori static, and suggest that the information format plays a significant role in the design outcome. ispartof: Mobilising Design pages:169-185 ispartof: Routledge Studies in Human Geography pages:169-185 ispartof: Designing Mobilities 2015 location:London date:14 Apr - 15 Apr 2015 status: published

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Agitatie tijdens de nacht of nachtelijke onrust is een onderschat probleem. Hoewel er weinig prevalentiecijfers bekend zijn en niet alle personen met dementie ermee te maken hebben, is het zeer belastend voor de betrokkene en voor de zorgverleners. Dit veldonderzoek verkent de problematiek van nachtelijke onrust in woonzorgcentra aan de hand van twee onderzoeksvragen: (1) Wat verstaan zorgverleners onder nachtelijke onrust? en (2) Hoe gaat men om met nachtelijke onrust? Data werden verzameld aan de hand van dagboeken, interviews met zorgmedewerkers en telkens één nacht observatie in acht woonzorgcentra. Dwalen en roepen blijken veel voorkomende vormen van nachtelijke onrust te zijn. Tal van factoren kunnen volgens de zorgverleners bijdragen tot het ontstaan van nachtelijke onrust. Omgevingsfactoren zoals geluid en licht worden zelden spontaan vermeld. Uit de observaties blijken lawaai en licht echter opvallende stoorzenders voor een goede nachtrust te zijn. Zorgverleners proberen meerdere oplossingen uit: bijvoorbeeld de persoon met dementie verbaal tot rust brengen, gebruik maken van een nachtlampje of medicatie en/of fysieke fixatie toepassen. De aanpak van nachtelijke onrust vereist een totaalaanpak. Verandering van de materiële omgeving voor vermindering van nachtelijke onrust wordt door zorgverleners beperkt toegepast. Nighttime restlessness in dementia is an underestimated problem. Although little is known about the prevalence and not every person with dementia struggles with it, nighttime restlessness puts a heavy burden on the persons themselves and their caregivers. This field study explores nighttime restlessness in nursing homes based on two research questions: 1. What is nighttime restlessness according to professional caregivers? and 2. How is nighttime restlessness managed? Data were collected through diaries, interviews with caregivers and one night of observation in eight nursing homes. Wandering and screaming seem to be the most prevalent nighttime agitated behaviours. Caregivers identify many possible causes, but spatial and sensory factors, such as light or noise, were rarely mentioned spontaneously. The observations highlighted that a lot of light and noise is prominent and this might be causing nighttime restlessness. Caregivers try several strategies: for example talking with the resident, put on a light and apply medication or physical restraints. The management of nighttime restlessness requires a holistic approach. Caregivers’ attention for and efforts to ameliorate the spatial and sensory environment in the management of nighttime restlessness are limited. ispartof: Tijdschrift voor Gerontologie en Geriatrie vol:47 issue:2 pages:78-85 ispartof: location:Netherlands status: published

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Objective: Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not).Method: Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data.Results: Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment.Conclusions: Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature. Aims: To identify effective interventions for the prevention of suicidal behavior. Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches. Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies. Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.