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Frail, older care recipients are often thought of as individuals with a decreased mastery of everyday life skills. Various authors have proposed to acknowledge a relational dimension of mastery, defined as the ability to maintain control over one's life with the help of others. This study explores how frail, older adults experience relational aspects of mastery and the role of their informal caregivers in maintaining these aspects of mastery over the care process. Qualitative interviews (N = 121) were conducted in 2016 with potentially frail, community‐dwelling older adults participating in the Detection, Support and Care for Older people: Prevention and Empowerment (D‐SCOPE) project. A secondary analysis of 65 interviews reveals that, according to frail, older adults, informal caregivers contribute in various ways to the preservation of their mastery. This differs across the four elements of care: caring about (attentiveness), taking care of (responsibility), care‐giving (competence), and care‐receiving (responsiveness). However, in some cases, older adults experienced a loss of mastery; for example, when informal caregivers did not understand their care needs and did not involve them in the decision, organisation, and provision of care. A relational dimension of mastery needs to be acknowledged in frail, older care recipients since stimulating mastery is a crucial element for realising community care objectives and person‐centred and integrated care.

IMPORTANCE: Dexamethasone initiated after the first week of life reduces the rate of death or bronchopulmonary dysplasia (BPD) but may cause long-term adverse effects in very preterm infants. Hydrocortisone is increasingly used as an alternative, but evidence supporting its efficacy and safety is lacking. OBJECTIVE: To assess the effect of hydrocortisone initiated between 7 and 14 days after birth on death or BPD in very preterm infants. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, placebo-controlled randomized trial conducted in 19 neonatal intensive care units in the Netherlands and Belgium from November 15, 2011, to December 23, 2016, among preterm infants with a gestational age of less than 30 weeks and/or birth weight of less than 1250 g who were ventilator dependent between 7 and 14 days of life, with follow-up to hospital discharge ending December 12, 2017. INTERVENTIONS: Infants were randomly assigned to receive a 22-day course of systemic hydrocortisone (cumulative dose, 72.5 mg/kg) (n = 182) or placebo (n = 190). MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death or BPD assessed at 36 weeks' postmenstrual age. Twenty-nine secondary outcomes were analyzed up to hospital discharge, including death and BPD at 36 weeks' postmenstrual age. RESULTS: Among 372 patients randomized (mean gestational age, 26 weeks; 55% male), 371 completed the trial; parents withdrew consent for 1 child treated with hydrocortisone. Death or BPD occurred in 128 of 181 infants (70.7%) randomized to hydrocortisone and in 140 of 190 infants (73.7%) randomized to placebo (adjusted risk difference, -3.6% [95% CI, -12.7% to 5.4%]; adjusted odds ratio, 0.87 [95% CI, 0.54-1.38]; P = .54). Of 29 secondary outcomes, 8 showed significant differences, including death at 36 weeks' postmenstrual age (15.5% with hydrocortisone vs 23.7% with placebo; risk difference, -8.2% [95% CI, -16.2% to -0.1%]; odds ratio, 0.59 [95% CI, 0.35-0.995]; P = .048). Twenty-one outcomes showed nonsignificant differences, including BPD (55.2% with hydrocortisone vs 50.0% with placebo; risk difference, 5.2% [95% CI, -4.9% to 15.2%]; odds ratio, 1.24 [95% CI, 0.82-1.86]; P = .31). Hyperglycemia requiring insulin therapy was the only adverse effect reported more often in the hydrocortisone group (18.2%) than in the placebo group (7.9%). CONCLUSIONS AND RELEVANCE: Among mechanically ventilated very preterm infants, administration of hydrocortisone between 7 and 14 days after birth, compared with placebo, did not improve the composite outcome of death or BPD at 36 weeks' postmenstrual age. These findings do not support the use of hydrocortisone for this indication. TRIAL REGISTRATION: Netherlands National Trial Register Identifier: NTR2768. ispartof: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION vol:321 issue:4 pages:354-363 ispartof: location:United States status: published

BACKGROUND: Although it is generally agreed that personality disorders are an important topic in old-age psychiatry, DSM-5 has paid relatively little attention to older persons affected with this severe mental disorder. AIM: To look closely and carefully at several aspects of the way in which DSM-5 defines personality disorders relating to older persons. METHOD: We make a critical evaluation of the description of personality disorders given in DSM-5. RESULTS: First of all, we question whether the phrase 'personality change due to another medical condition' should really be included in the dsm-5 chapter of personality disorders because a personality change actually has the features of a persistent conduct disorder. Secondly, we argue that in a future revised version of dsm-5 personality disorders affecting older persons should be referred to specifically as 'late-onset' personality disorders. Thirdly, we stress that the research programme relating to the dimensional dsm-5 model of personality disorders should involve a larger number of older persons. In addition, more research is needed with regard to the use, wording and validity of the phrase 'personality change due to a medical condition'. Those responsible for the revision of the DSM-5 should ensure that the concept 'late-onset personality disorders' is incorporated in the text. CONCLUSION: The description of personality disorders in DSM-5 is confusing. This is probably due to the transitional period between the old categorical (dsm-iv) system and the newly proposed dimensional approach to personality disorders in DSM-5, an approach that needs further investigation. However, this intervening period could be a good opportunity for doing further research into personality disorders in older adults.

Contains fulltext : 138751.pdf (Publisher’s version ) (Open Access) BACKGROUND: Although it is generally agreed that personality disorders are an important topic in old-age psychiatry, DSM-5 has paid relatively little attention to older persons affected with this severe mental disorder. AIM: To look closely and carefully at several aspects of the way in which DSM-5 defines personality disorders relating to older persons. METHOD: We make a critical evaluation of the description of personality disorders given in DSM-5. RESULTS: First of all, we question whether the phrase 'personality change due to another medical condition' should really be included in the dsm-5 chapter of personality disorders because a personality change actually has the features of a persistent conduct disorder. Secondly, we argue that in a future revised version of dsm-5 personality disorders affecting older persons should be referred to specifically as 'late-onset' personality disorders. Thirdly, we stress that the research programme relating to the dimensional dsm-5 model of personality disorders should involve a larger number of older persons. In addition, more research is needed with regard to the use, wording and validity of the phrase 'personality change due to a medical condition'. Those responsible for the revision of the DSM-5 should ensure that the concept 'late-onset personality disorders' is incorporated in the text. CONCLUSION: The description of personality disorders in DSM-5 is confusing. This is probably due to the transitional period between the old categorical (dsm-iv) system and the newly proposed dimensional approach to personality disorders in DSM-5, an approach that needs further investigation. However, this intervening period could be a good opportunity for doing further research into personality disorders in older adults.

Objectives: To analyse whether or not there is a relationship between participating in the breast cancer screening programme in the city of Antwerp (Flanders, Belgium) and the socio-economic status of the neighbourhood the women reside in. Methods: Social and demographic characteristics that might explain the variance in the participation rate at the district level were listed and a multiple linear regression analysis was performed. Results: In general, 13,415 women (37.8%) took part in the screening programme in Antwerp. The difference in participation rate of women living in privileged and underprivileged areas is 9.3%. Statistical sectors with a high percentage of people above 65 years and couples with children tend to have a higher attendance, whereas the percentage of foreigners has a negative influence. The linear regression model including these three independent variables, explains 30% of the variance in attendance. Conclusions: There is a need to discover the specific causes of the lower participation rate in the underprivileged areas and how one can cope with this problem. Further research is also needed on the assessment of the socio-economic status.

BACKGROUND: Although it is generally agreed that personality disorders are an important topic in old-age psychiatry, DSM-5 has paid relatively little attention to older persons affected with this severe mental disorder. AIM: To look closely and carefully at several aspects of the way in which DSM-5 defines personality disorders relating to older persons. METHOD: We make a critical evaluation of the description of personality disorders given in DSM-5. RESULTS: First of all, we question whether the phrase 'personality change due to another medical condition' should really be included in the dsm-5 chapter of personality disorders because a personality change actually has the features of a persistent conduct disorder. Secondly, we argue that in a future revised version of dsm-5 personality disorders affecting older persons should be referred to specifically as 'late-onset' personality disorders. Thirdly, we stress that the research programme relating to the dimensional dsm-5 model of personality disorders should involve a larger number of older persons. In addition, more research is needed with regard to the use, wording and validity of the phrase 'personality change due to a medical condition'. Those responsible for the revision of the DSM-5 should ensure that the concept 'late-onset personality disorders' is incorporated in the text. CONCLUSION: The description of personality disorders in DSM-5 is confusing. This is probably due to the transitional period between the old categorical (dsm-iv) system and the newly proposed dimensional approach to personality disorders in DSM-5, an approach that needs further investigation. However, this intervening period could be a good opportunity for doing further research into personality disorders in older adults.

In 1990, Jeffrey Young developed the concept of early maladaptive schemas (EMS) to account for the dysfunctional beliefs in individuals with chronic characterological problems. He developed the Schema-Focused Cognitive Therapy to treat these conditions (Young, 1990). Schema Therapy, as it is now called, has been increasingly applied in patient samples with several psychiatric disorders, such as mood disorders, eating disorders (ED) and substance use disorders (SUD) as well as in patients with personality disorders (e.g. borderline personality disorder) (e.g., Ball & Young, 2000; Ohanian, 2002). Central in the Schema Theory are the EMS which develop through an interaction of negative childhood experiences and temperament. Within the schema theory, EMS are believed to contribute to the development and maintenance of psychological symptoms. A specific questionnaire, the Young Schema Questionnaire (YSQ) was developed to assess these EMS (1990). Throughout the years, several versions of the YSQ were developed to measure the EMS. This PhD project focuses on two research lines within the framework of the Schema Theory of Young: (1) the psychometric properties of the YSQ 2nd version - Long Form (YSQL2), and (2) the relationship between EMS and eating and substance use disorder symptoms. The first research line consists of 4 studies. Study 1 investigates the psychometric properties of the YSQL2 in a clinical sample of patients with a SUD or an ED. Study 2 investigates the psychometric properties of a shorter version of the YSQL2 (i.e., the YSQ-SF16) in a Flemish community sample. Study 3 addresses the age neutrality of the YSQL2 in patients with SUD and study 4 investigates the age neutrality of the YSQ-SF16 in a Flemish community sample. The second research line focuses on differences in EMS between different patient groups and consists of two studies. Study 5 compares differences in EMS between patients with ED (Restrictive versus Purging subtype) and the presence/absence of Non-Suicidal Self-Injury. Study 6 compares similarities and differences in EMS between patients with ED (Restrictive versus Purging type) and patients with SUD. This PhD dissertation is concluded with a summary of the main findings and a discussion of the strengths and limitations of the studies. Finally, recommendations for future research and a discussion of the clinical implications of our findings are formulated. status: published

The Minnesota Multiphasic Personality Inventory-2-Restructured Form scales (MMPI-2-RF; Ben-Porath & Tellegen, 2008) were linked to Millon's basic personality styles as measured by the Personality Adjective Check List (PACL; Strack, 1987, 1991b). Bivariate correlations and a joint factor analysis of both instruments were examined in independent samples of Driving Under Influence (DUI) offenders (N = 61) and normal adults (N = 84). Using the RF scales, free of conceptual item-overlap and a common psychopathology factor, we expect more distinguishable areas of convergence and divergence between the MMPI-2-RF and PACL. Consistent with previous research, Millon's neurotic, introverted styles were positively associated with MMPI-2-RC scales measuring introversion and affective states (RCd, RC2, RC7), whereas extroverted, socially dominant Millon styles were negatively associated with these same scales. In contrast to the correlations found in the normal sample, the PACL neurotic and introverted styles were negatively associated with the MMPI-2-RF specific internalizing problem scales among the DUI offenders (e.g. HLP, SFD, MSF). A joint factor analysis yielded three factors for the entire sample. We found high loadings for MMPI-2-RF scales, representing a General Distress dimension, in line with previous research on the MMPI-2. Furthermore, PACL and MMPI-2-RF scales were associated along two bipolar dimensions measuring Neuroticism/Introversion versus Extroversion and Emotional Distress versus Emotional Stability. To compare the three factor solutions of the DUI and normal sample subgroups, congruency coefficients were calculated by correlating the factor loadings of corresponding factors across sets. Differences between the groups on the FA will be discussed during the presentation.

Among all instruments that currently exist to assess the Five-Factor Model of personality (FFM), the Structured Interview for the Five-Factor Model of Personality (SIFFM; Trull & Widiger, 1997) stands out because of its specific advantages for clinical applications. First, it is thus far the only interview-based measure and therefore allows for follow-up questions and probes - an opportunity that is highly valued by clinicians. Second, the SIFFM explicitly assesses maladaptive variants of the FFM personality traits, which makes it even more applicable to personality disordered patients. This study is a first attempt to evaluate the psychometric properties of the Dutch version of the SIFFM (Rossi & De Fruyt, 2006) in a Flemish psychiatric sample (N=80). Internal consistency was examined by calculating Cronbach's alpha's for each of the five SIFFM domains. All domains displayed satisfying alpha's, ranging between .75 (Openness to Experience) and .85 (Neuroticism). Next, convergent and divergent validity with the NEO-PI-R was investigated within a subsample of 26 patients. Strongly significant correlations (p