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Dementia is related to disturbances in the sleep-wake pattern, behavioural and psychological symptoms of dementia (BPSD). These phenomena are the main reason for institutionalization. Assistive light technology is relevant to study, as mitigation of BPSD may allow for the improvement of quality of life for both people with dementia and their caregivers. Studies of dynamic light exposure in home-dwelling populations are scarce. In this single-case experimental design study, we evaluated the effects of exposure to dynamic light on the sleep-wake pattern and symptoms of depression, agitation, and anxiety in 11 home-dwelling people with dementia. A four-phase light-exposure therapy oscillating between the control and intervention waves was offered. Objective and questionnaire data were analysed and discussed. The results show that the used dynamic light system did not significantly affect the sleep variables. The severity of BPSD fluctuated in the expected pattern, reducing in intensity with increased light exposure. This pattern was significant for depression and agitation. This longitudinal study included an exploration of a low-cost assistive light intervention within a hard-to-study home-dwelling dementia population. The lessons learned are discussed and recommendations are made for future studies, as this design seems suitable for studying lifestyle interventions to support home-dwelling people with dementia.

Background Since dementia is an irreversible progressive disease characterized by a decline in mental functions and overall health, a palliative care approach is recommended. Nevertheless, many persons with dementia experience burdensome hospitalizations in end-of-life care. Their quality of life during hospitalization can be improved by palliative nursing care that suits their fragile health. Aim To explore hospital nurses' perceived support needs while providing high-quality palliative care for persons with dementia and to identify differences between nurses in different ward types and at different educational levels. Design Cross-sectional, multicenter survey study. Method Between January 2021 and April 2021, a convenience sample of Dutch hospital nurses received a web-based questionnaire on the topics of palliative caregiving, communication, collaboration, and hospital admissions. The data were analyzed using descriptive statistics. Results The survey was completed by 235 nurses. The most frequently endorsed support needs were "communicating with persons with severe dementia" (58.3%), "appointing a permanent contact person in the care for persons with dementia" (53.6%), and "dealing with family disagreement in end-of-life care" (53.2%). If nurses had more time to provide care, 66.4% of them would prioritize providing personal attention. Most support needs identified by nurses were similar. Conclusion A heterogeneous group of nurses demonstrates overall similar support needs in providing palliative care for persons with dementia and their families in the hospital setting. Clinical Relevance Nursing practices should implement dementia-friendly interventions to improve the quality of dementia care in the hospital.

ImportancePredictors consistently associated with psychosis liability and course of illness in schizophrenia (SCZ) spectrum disorders (SSD), including the need for clozapine treatment, are lacking. Longitudinally ascertained medication use may empower studies examining associations between polygenic risk scores (PRSs) and pharmacotherapy choices.ObjectiveTo examine associations between PRS-SCZ loading and groups with different liabilities to SSD (individuals with SSD taking clozapine, individuals with SSD taking other antipsychotics, their parents and siblings, and unrelated healthy controls) and between PRS-SCZ and the likelihood of receiving a prescription of clozapine relative to other antipsychotics.Design, Setting, and ParticipantsThis genetic association study was a multicenter, observational cohort study with 6 years of follow-up. Included were individuals diagnosed with SSD who were taking clozapine or other antipsychotics, their parents and siblings, and unrelated healthy controls. Data were collected from 2004 until 2021 and analyzed between October 2021 and September 2022.ExposuresPolygenic risk scores for SCZ.Main Outcomes and MeasuresMultinomial logistic regression was used to examine possible differences between groups by computing risk ratios (RRs), ie, ratios of the probability of pertaining to a particular group divided by the probability of healthy control status. We also computed PRS-informed odd ratios (ORs) for clozapine use relative to other antipsychotics.ResultsPolygenic risk scores for SCZ were generated for 2344 participants (mean [SD] age, 36.95 years [14.38]; 994 female individuals [42.4%]) who remained after quality control screening (557 individuals with SSD taking clozapine, 350 individuals with SSD taking other antipsychotics during the 6-year follow-up, 542 parents and 574 siblings of individuals with SSD, and 321 unrelated healthy controls). All RRs were significantly different from 1; RRs were highest for individuals with SSD taking clozapine (RR, 3.24; 95% CI, 2.76-3.81; P = 2.47 × 10−46), followed by individuals with SSD taking other antipsychotics (RR, 2.30; 95% CI, 1.95-2.72; P = 3.77 × 10−22), parents (RR, 1.44; 95% CI, 1.25-1.68; P = 1.76 × 10−6), and siblings (RR, 1.40; 95% CI, 1.21-1.63; P = 8.22 × 10−6). Polygenic risk scores for SCZ were positively associated with clozapine vs other antipsychotic use (OR, 1.41; 95% CI, 1.22-1.63; P = 2.98 × 10−6), suggesting a higher likelihood of clozapine prescriptions among individuals with higher PRS-SCZ.Conclusions and RelevanceIn this study, PRS-SCZ loading differed between groups of individuals with SSD, their relatives, and unrelated healthy controls, with patients taking clozapine at the far end of PRS-SCZ loading. Additionally, PRS-SCZ was associated with a higher likelihood of clozapine prescribing. Our findings may inform early intervention and prognostic studies of the value of using PRS-SCZ to personalize antipsychotic treatment.

Objectives: Studies suggest that advance care planning (ACP) results in improved quality of life and reduced healthcare consumption. We assessed how the use of a structured advance care planning tool (ACPT) in oncology patients relates to their healthcare consumption before death, and to the match between preferred and actual place of death. Methods: We performed a pilot study at a teaching hospital in the Netherlands. Endpoints were 1) healthcare consumption at three and one month(s) before death, and 2) the match between preferred and actual place of death. Results: The study included 75 patients without an ACPT (group 1) and 59 patients with an ACPT (group 2) of whom the preferred place of care or death were documented at least three months before death in 15 patients (subgroup 2b). Compared to group 1, patients in group 2 had significantly more healthcare consumption. However, compared to group 1, patients in subgroup 2b underwent significantly less diagnostic (33.3% (n = 5) versus 69.3% (n = 52), p < 0.05) and laboratory tests (33.3% (n = 5) versus 62.7% (n = 47), p < 0.05) one month before death. Patients in subgroup 2b died at their preferred place more often (76.9%, n = 10) compared to patients in group 1 (58.3%, n = 7) (NS), which meant more deaths at home and less in-hospital-deaths. Conclusions: The results suggest that timely documentation of the preferred place of care or death in a structured ACPT may result in less healthcare consumption and a better match between the preferred and actual place of death.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment program for patients with borderline personality disorder (BPD). The program was intended to be highly accessible, both for patients and therapists. During STEPPS, patients are taught emotion regulation and behavior management skills. This systematic review synthesizes the current empirical status of STEPPS, focusing on research designs, quality of studies, target groups, protocols, and outcome. We selected 20 studies, with three randomized controlled trials. Patients with BPD, subthreshold BPD, and patients with BPD and comorbid antisocial personality disorder were investigated. One study was conducted in adolescents. There were no studies in older adults. Results demonstrated STEPPS to be associated with reduced BPD symptoms, improved quality of life, decreased depressive symptoms, and decreased negative affectivity. Mixed results were found for impulsivity and suicidal behaviors. STEPPS has both been studied as an add-on therapy to patients' ongoing treatment, and, with the addition of individual STEPPS sessions, as a stand-alone treatment. High attrition rates were found in patients attending STEPPS, complicating the generalizability of the results. Although the evidence for STEPPS is promising, further research is needed before firm conclusions can be drawn. Recommendations for future research are discussed.

The importance of shared decision-making (SDM) in youth care is increasingly emphasised. Professional reflection on the decision-making process is an important means to improve the use of SDM in practice. In this study, we report on the development of a reflection tool for youth professionals primarily to use when they hold a different opinion then parents about referral to specialised youth care services. In co-creation with local youth professionals and parent representatives from the South of the Netherlands, the tool was developed and tested in practice. This process was guided by a three-stage cyclical research project. First, reflective group discussions provided an initial understanding of professionals’ needs, interests and experiences. This input then was analysed and documented into a draft tool with reflective questions. Next, this tool was tested on fictive and real life cases and adjusted with input from youth professionals and parents. This process resulted in an online reflection tool covering 16 overarching reflective questions to support youth professionals’ reflection on their shared decision-making in practice. The tool can be used and adapted by others in the field of youth care to improve the process of making shared decisions with parents in complex cases.

To ensure that families with social and behavioral health problems get the support they need, organizations collaborate in child service networks. These networks are generally lead-organization governed. It is assumed that network members have relatively accurate information about the governance mode. However, discrepancies between the formally administered and perceived governance mode could raise legitimacy questions and lead to conflicts, and ultimately affect network effectiveness. Therefore, we investigated to what extent such discrepancies exist and how they might be explained. Hereby, the focus was on the concepts level of trust, interaction, and strength of relationship with the lead organization in the network. A comparative case study was conducted of three inter-organizational networks of child services in different-sized municipalities in the Netherlands in 2018 and 2019. A multiple generalized linear mixed model analysis was used. We found that only a minority of the network members had an accurate perception of the governance mode. This awareness did improve over time. The level of interaction and relationship strength with the lead organization were independently associated with an accurate perception of the governance mode. Trust of a network member in the network, however, had no significant association. These insights underline the necessity to consider network information accuracy as an important variable for understanding network behavior and as crucial for the effective delivery of child services.

BackgroundMothers of young adults with profound intellectual and multiple disabilities that live at home are less likely to be on the radar of formal services. We explored the experience of these mothers over the course of the COVID-19 pandemic.MethodsA qualitative study using three case studies. Transcripts were analysed using Interpretative Phenomenological Analysis.ResultsTwo overarching themes with various subthemes emerged. The first theme focuses on the impact of being a mother of a young adult with profound intellectual and multiple disabilities who lives at home during the COVID-19 pandemic. The second theme describes both the vulnerability and resilience of the broader system, as well as its need to experience togetherness.ConclusionsFamilies of a young adult with profound intellectual and multiple disabilities exhibit both resilience and vulnerability during the COVID-19 pandemic, underscoring the importance to support and promote the visibility of these families.

Aggressive behaviour is often displayed by people with intellectual disabilities (ID) in forensic healthcare settings. Research on the causal beliefs (i.e. attributions) of aggressive behaviour are commonly studied from the perspective of support staff. As aggressive behaviour is mostly a product of interaction between the person showing it and their environment, it is valuable to include the perspective of people with ID as well. Four group interviews, consisting of a total of 20 people with mild ID or borderline intellectual functioning and forensic and/or psychiatric problems, were held to explore incidents of aggressive behaviour. The attributions were analysed using the Leeds Attributional Coding System. Clients almost equally distributed the causes of aggressive behaviour to themselves (intrapersonal domain; 48.0%) and to other persons (interpersonal domain; 45.7%). There is a distinction related to the attributions given between the client as agent (intrapersonal domain), being uncontrollable (72.1%) and global (68.9%), versus other persons as agent (interpersonal domain), being controllable (86.2%) and specific (56.9%). This analysis of attributions regarding aggressive behaviour given by clients resulted in information on causal beliefs of aggressive behaviour from the perspective of clients. Incorporating their views will possibly increase involvement and commitment in support and treatment.

Spousal loss due to nursing home admission or death is challenging for the well-being of the remaining partner and for aging in place. We explored: “How does social network change due to spousal loss impact older adults who are aging in place?.” In-depth interviews were held with six older women who were aging in place and who lost their spouses in the past two years. Narrative analysis was conducted. Results indicate that the impact varies in three dimensions and that variations within dimensions follow three themes. The results emphasize the complexity of impact and the urgent need for a person-centred approach toward older adults after spousal loss.

Background:Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults.Aim:The aim was to explore the outcome of STEPPS in older adults with personality disorders.Method:In this naturalistic pre- vs post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning.Results:Twenty-four patients, with a mean age of 63.9 years (SD=4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- vs post-treatment decrease of BPD symptoms, with a large effect size (Cohen’s d=1.577). Self-control improved significantly and demonstrated a large effect size (r=.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen’s d=.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning.Conclusions:The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed.

This qualitative study investigated which types of interventions are made by group therapists during group cognitive-behavioral therapy (GCBT) with individuals who have perpetrated intimate partner violence (IPV) in the "Not 'Losing It' Anymore"(NLIA) outpatient programs across the Netherlands. Audio recordings of group sessions (N = 60) facilitated by 13 co-therapist teams across 25 different groups were analyzed using the general inductive approach. Fifteen distinct therapist interventions were identified, categorized, and described using examples from the data. Two categories of interventions could be distinguished: CBT interventions and process-oriented interventions. In future research the coding manual can be tested for interrater reliability and might be used in research on the effectiveness of GCBT therapist interventions.

Objective: The narrative enhancement and cognitive therapy (NECT) intervention aims to reduce self-stigma among people with severe mental illness. Based on previous studies that showed the intervention’s beneficial outcomes, we conducted an uncontrolled pilot study of NECT in the Netherlands to assess both feasibility in delivering NECT and outcomes of the intervention for self-stigma, hope, recovery, and self-concept clarity. Methods: Feasibility was assessed through uptake and implementation data that included an assessment of enhancing and impeding factors according to surveys with NECT facilitators, and interviews with participants. Outcomes of NECT were studied through scales that assess self-stigma, self-concept clarity, hope, personal recovery, and quality of life.Results: Forty-one participants from five treatment sites participated in the pilot study, among whom 78% were considered “exposed” (i.e., attended at least six sessions). The analysis of enhancing and impeding factors indicated that support from the organization, sense of ownership, expectations of outcomes, and content of the intervention were reported as important in the implementation process. Participants reported decreases in self-stigma and increases in hope during the intervention.Conclusions and Implications for Practice: Assessments of feasibility provided valuable insights regarding ways to improve implementation of the intervention (such as increasing facilitators’ sense of ownership of the intervention). Outcomes of NECT showed a decrease in self-stigma and improvement of hope among participants in this pilot study, supporting the previously found positive effects of the intervention.

BackgroundTransitioning from paediatric medical care to adult care is a challenging process for children, parents and healthcare professionals. The aim of this study was to explore the experiences, concerns and needs of parents of children with Down syndrome and of professionals regarding this transition.MethodA qualitative study was performed using semi-structured interviews with 20 parents of children with Down syndrome and six healthcare professionals.ResultsWe showed that parents and professionals have concerns during each of the three distinct phases of transition (preparation, transfer and integration). Data disclose specific concerns regarding communication, continuity of care and rebuilding trust. We propose a framework for the transition to adult care.ConclusionsThe transition in medical care for children with Down syndrome should be flexible, patient-centred and coordinated together with patients and parents. Only in ensuring continuity of care will individuals with Down syndrome not get lost in transition.

PurposeFlexibility is essential for healthcare organizations to anticipate the increasing internal and external dynamics. Mental healthcare organizations in the Netherlands face major policy reforms made by the government, increasing involvement from municipalities and gradual replacement of clinical care with outpatient care. Top management plays an important strategic role in creating this flexibility because they make important choices, give direction and structure the organization. To create flexibility, managers have to deal with complexity and paradoxes. In this study, the authors aim to contribute to the knowledge on how healthcare managers can create flexibility in their organizations.Design/methodology/approachThis is a qualitative empirical field study. In total, 21 managers of mental healthcare organizations participated in open in-depth interviews. The authors explored flexibility on three perspectives: organizational direction, structure and operations. The COVID-19 pandemic has provided an opportunity to explore flexibility. The authors asked participants to reflect on their organization's response to the pandemic.FindingsMost mental healthcare organizations create flexibility in an implicit way. Flexibility and resilience are closely linked mechanisms. Flexibility ensures a quick response while resilience provides the counterforce and rebound needed to adapt. Adaption ensures that healthcare professionals learn from their experiences and do not return completely to the way things were done before. The primary urge to survive ensured rapid and adequate responses to the COVID-19 pandemic. Whether this is a manifestation of flexibility remains difficult to conclude.Practical implicationsThe complexity theory offers some guidance in creating a flexible organization without losing consistency. Flexibility and resilience are closely linked mechanisms that antagonize and protect each other. With this insight, managers in mental healthcare can utilize the qualities and balance them without falling into the various pitfalls.Originality/valueIn this research, the authors are concerned with flexibility as a proactive attitude and capacity of organizations. By looking at the response of organizations to the COVID-19 crisis, the authors find out that responding to a disaster out of survival instinct is something else than flexibility. There is an interesting relationship between flexibility, resilience and adaptability, and they can balance each other.

Abstract. The COVID-19 pandemic has affected all societies worldwide. The heightened levels of stress that accompanied the crisis were also expected to affect parenting in many families. Since it is known that high levels of stress in the parenting domain can lead to a condition that has severe consequences for health and well-being, we examined whether the prevalence of parental burnout in 26 countries (9,923 parents; 75% mothers; mean age 40) increased during COVID-19 compared to few years before the pandemic. In most (but not all) countries, analyses showed a significant increase in the prevalence of parental burnout during the pandemic. The results further revealed that next to governmental measures (e.g., number of days locked down, homeschooling) and factors at the individual and family level (e.g., gender, number of children), parents in less (vs. more) indulgent countries suffered more from parental burnout. The findings suggest that stricter norms regarding their parenting roles and duties in general and during the pandemic in particular might have increased their levels of parental burnout.

Background and research objectives: Technological innovation is often described as a solution for or considered to have the potential of meeting the challenges of the ageing society, improving older persons' quality of life, well-being, and healthcare, and supporting ageing in place in a safe and independent environment. At the same time, older persons often experience ageism, defined as stereotypes, prejudice, and discrimination, in the context of digital technology. Such stereotypes are omnipresent in various contexts (e.g., workforce, healthcare, and media) and can hinder active and successful ageing in a highly digitalizing reality. The main goal of this dissertation is to understand what are the manifestations of ageism in the context of digital technology and the potential role of ageism as an underlying factor that may affect the design, acceptance, and use of digital technology. Methods: A mixed-methods approach was utilized to initiate and present a coherent and holistic outcome intending to discover paradoxes, contradictions, and new perspectives on the design, acceptance, and use of digital technology. Six studies were conducted, triangulating data from 1) different methodologies, 2) various stakeholders' perspectives (older persons, designers, researchers, and healthcare professionals) 3) and different contexts of use and design of digital technology. Main results: The triangulation of this dissertation's qualitative and quantitative findings are synthesized in a theoretical model of Ageism in the Use and Design of Digital Technology (see figure). Manifestations of ageism in the use and design of digital technology are identified throughout the different dimensions of ageism: (1) Social-psychological level of stereotypes, prejudice, and discrimination, (2) Negative-positive valance, (3) Explicit-implicit representations, (4) and three levels of individual-micro level (self-ageism), a social-organizational meso level of inter-generational interaction, and policy and design macro level. Importantly, ageism may influence the acceptance and use of digital technology in a dynamic and iterative process of interaction between different levels and interchanging between individuals, design processes, and technological devices and services. Recommendations for future research and policy: Ageism in the use and design of digital technology is a developing field for future research, entrepreneurship, and policy. The main recommendations are to: 1.Develop interventions to mitigate self-ageism, empower older persons, and reduce ageism in the design process of digital technology and intergenerational tension. 2.Raise awareness and training to change the discourse on ageing and technology. 3.Promote inclusion and aim for partnership and meaningful involvement of older persons throughout the development of digital technology-related products, services, and policy. 4.Design digital technologies for versatile social, leisure, and communication needs. 5.Develop methodological innovations to measure the influence of ageism on the use and design of digital technology. In particular concerning discrimination; intersectionality of digital technology, ageism, and other characteristics; and the use of data and artificial intelligence (AI). 6.Ensure access to digital technology to eliminate the access divide influenced by age, education, and other characteristics.

Background and hypothesis Several studies suggest that raloxifene, a selective estrogen receptor modulator, improves symptoms and cognition in post-menopausal women with Schizophrenia-Spectrum Disorders (SSD). We aimed to assess the effects of adjunctive raloxifene in women and men with SSD. Study design This parallel, randomized, double-blind, placebo-controlled trial included adult SSD patients across the Netherlands and Belgium. Participants were stratified by age, sex, and global functioning and randomly assigned 1:1 to 12-week add-on raloxifene or placebo. Primary outcomes were symptom severity at 6, 12, and 38 weeks and cognition at 12 and 38 weeks, as measured with the Positive and Negative Syndrome Scale and the Brief Assessment of Cognition in Schizophrenia, respectively. Intention-to-treat analyses were performed using linear mixed-effect models. Study results We assessed 261 patients for eligibility, of which 102 (28% female) were assigned to raloxifene (n = 52) or placebo (n = 48). Although we found no main effect of raloxifene, secondary sex-specific analysis showed that in women, raloxifene had beneficial effects on negative symptoms at week 6 (LSM −2.92; adjusted P = 0.020) and week 12 (LSM −3.12; adjusted P = 0.030), and on working memory at week 38 (LSM 0.73; adjusted P = 0.040), while having negative effects on working memory at week 38 in men (LSM −0.53; adjusted P = 0.026). The number of adverse events was similar between groups. Conclusions Our results do not support the use of raloxifene in patients with SSD in general, but suggest female-specific beneficial effects of raloxifene on negative symptoms and working memory. Our findings encourage further research on sex-specific pharmacotherapeutic treatment.

Contains fulltext : 251282.pdf (Publisher’s version ) (Open Access) The current study examined to what extent a valid instrument that predicts repeat victimization can be based on a victim's prior police contacts. Police records between 2010 and 2017 were retrieved for a sample of 68,229 victims. The data was split into a training set (n = 34,224) and a test set (n = 34,005). Using logistic regression analyses in the training set, three models were developed linking prior police contacts to repeat victimization. The predictive validity was assessed in the test set. Results indicated that (a) prior police contacts as victims, suspects and witnesses were associated with an elevated risk of repeat victimization and (b) the model correctly classified a majority of both repeat victims and non-repeat victims across various cut-off points. Findings demonstrated moderate to acceptable predictive validity, thereby suggesting that there is considerable room for improvement. 15 juni 2022 19 p.

Samenvatting Introductie Alcoholproblematiek komt vaker voor bij ziekenhuispatiënten dan bij de algemene bevolking. Veel ziekenhuizen slagen er echter niet in om mensen met alcoholproblematiek op te sporen en hierbij te interveniëren. Het doel van dit onderzoek was een verkenning van belemmerende en bevorderende factoren die zorgprofessionals ervaren bij het in praktijk brengen van alcoholinterventies in ziekenhuizen. Daarnaast verkenden wij welke alcoholinterventies worden gebruikt in de geselecteerde ziekenhuizen en welke stakeholders daarbij betrokken zijn. Methode We hebben semigestructureerde telefonische interviews afgenomen met twintig zorgprofessionals die in, of met, zes algemene ziekenhuizen (samen)werkten. Resultaten Zorgprofessionals noemden belemmerende en bevorderende factoren op het gebied van protocol, motivatie, kennis en vaardigheden, patiëntkenmerken, interne en externe samenwerking/ondersteuning, middelen, rolgeschiktheid en maatschappelijke ondersteuning. Vijf categorieën van benaderingen om alcoholproblematiek op te sporen en hierbij in te grijpen, en achttien betrokken stakeholders van binnen en buiten het ziekenhuis werden geïdentificeerd. Conclusie Het realiseren van alcoholinterventies voor patiënten in Nederlandse ziekenhuizen lijkt nog in de kinderschoenen te staan. De respondenten benadrukken het belang van één duidelijk protocol voor de aanpak van alcoholproblematiek binnen ziekenhuizen, herhaalde trainingen rond alcoholgerelateerde kennis en vaardigheden, (klinische) champions die zorgprofessionals ondersteunen, en het ontwikkelen en onderhouden van de samenwerking met stakeholders binnen en buiten het ziekenhuis.

SamenvattingWereldwijd is alcoholgebruik een van de oorzaken van een groot deel van de (vermijdbare) ziektelast. Het heeft negatieve gevolgen voor de drinker zelf en voor (anderen in) de maatschappij. Zo hangt alcoholgebruik samen met ongeveer 200 verschillende aandoeningen en ziekten, waaronder verslaving, kanker en hart- en vaatziekten. Ook is alcoholgebruik gerelateerd aan risico’s, zoals verkeersongevallen, geweld en de fetal alcohol spectrum disorder. Hierbij is de schade veelal voor de ander. Dit artikel geeft op basis van een quickscan van de literatuur een beeld van de omvang van de schade die door alcoholgebruik wordt veroorzaakt, voor de drinker zelf en (anderen in) de maatschappij. Hoewel het beeld niet allesomvattend is, geeft deze quickscan wel een helder beeld van de huidige stand van de wetenschappelijke kennis.

Objectives:Categorical criteria are not well suited to inform personality disorder (PD) diagnoses in older adults. More promising are the ICD-11 and DSM-5 alternative models. Both conceptualize PD by level of severity and maladaptive traits. Severity is conditional for making a PD diagnosis. Trait levels portray stylistic differences in PD expression. Yet, in older adults the hierarchical trait structure is unknown. Neither is the differentiation of the severity criterion from maladaptive traits confirmed.Methods:A series of exploratory factor analyses with progressively greater numbers of factors were conducted to examine the hierarchical trait structure in 293 community dwelling older adults. The on average differentiation of a single higher order personality functioning factor from trait factors at succeeding levels of the hierarchy was estimated with Cohen q effect size.Results:Six meaningful trait levels were identified. From the fourth trait level on the general personality functioning factor shared less than 15% variance on average with the trait factors. Trait factors at the sixth level corresponded to both DSM-5 and ICD-11 pathological traits.Conclusion:A future nosology integrating DSM-5 and ICD-11 trait proposals would be applicable in older adults. Personality functioning can be differentiated from traits, so separate assessment of traits and severity is worthwhile.

Lareb is in Nederland het meld- en kenniscentrum voor bijwerkingen van medicijnen en vaccins. Na vaccinatie van een kind wordt ‘wegraking’ geregeld bij Lareb als bijwerking gemeld. Bij een wegraking is er sprake van kortdurend bewustzijnsverlies dat niet is ontstaan door een uitwendige oorzaak, zoals trauma of intoxicatie. Er zijn verschillende typen wegrakingen die kunnen optreden na vaccinatie, zoals vasovagale syncope (‘flauwvallen’), hypotone-hyporesponsieve episode (‘wegraking met bleekheid en slapte’) en breath holding spell (‘wegraking door adem inhouden’). Deze wegrakingen ontstaan doorgaans binnen enkele uren na de vaccinatie en houden seconden tot minuten aan. Vanuit de praktijk van Lareb geven we een overzicht.

Public Summary: The Unheard Voices and Capacities of Children Involved in Family Law Proceedings: The Development of an Innovative Rights-Based Standard of Practice to Ensure the Meaningful Participation of Children The United Nations Convention on the Rights of the Child (UNCRC, 1989) is a human rights treaty that aims to ratify the rights of children. Extensive research emphasizes that there are many ambiguities between language and practicality in the application of the UNCRC. Specific articles pertaining to this language and were included in this research are Articles: 3,5,9 & 12. These provisions, and others, reference or infer the importance of a child’s capacities and participation or discuss children’s best interests. However, there are still ambiguities in terms of what capacity or best interests of the child entails. How to assess or consider a child’s capacity or best interests is also noticeably limited within literature and practice. The UNCRC emphasizes participation, but that practical application piece is still limited, this is especially true for children under the age of 12. One reason for this participation issue is the assumed lack of capacity of children under the age of 12, this research highlights the requirement of systemic, ideological change in the way society views children. This research aimed to shift towards recognizing children as rights-holders and providing them with the space, audience, considerable influence to have their voices heard and creating a standard that would actualize their participation. The aim of the present study has thus intended to, look for gaps and limitations within literature and relevant research and to gather the perspectives of professionals and children through qualitative interviews. Develop a rights—based standard to uphold the rights of children throughout any evaluation in family law proceedings and determine the criteria that should be embedded in a new standard of practice. To introduce a transdisciplinary approach to meet the best interests of children. And shift ideologies surrounding children’s presumed incapacity. These research aims led to the following main research question: How can relevant literature regarding rights and capacity, transdisciplinary expert interviews, and the opinions of children inform the creation of a rights-based standard to support the unique capacities of children and ensure their meaningful participation in family law proceedings? The methodological approach of this study combined literature analysis, and qualitative interviews with children between the ages of 6 and 12, and experts in the field(s) of family law and child development. The findings of this research maintained that there are limitations and gaps in current family law proceedings and custody evaluations relating to the participation of children under the age of 12. The findings also highlighted children are extremely capable of understanding language and concepts pertaining to their own rights, participation and capacities. The literature and qualitative research efforts contributed to the creation of a new standard of practice, referred to in this research as Qualitative Understandings Informing Notions of Capacity and Children’s Rights (QUINCCR- Standard). This standard of practice upholds the rights of children in custody evaluations, and adds a practical layer to the UNCRC. This research and its findings will contribute to the body of knowledge surrounding children’s unique capacity levels, challenge the ideologies of children as ‘incapable’ and instead uphold children as citizens with agency and actualize their rights, voices, participation, and capacities.

Since the Dutch tolerance policy, allowing the purchase of cannabis in ‘coffeeshops’, is associated with problems of public order and safety as well as health risks, there has been a long debate about legalisation of cannabis production and supply. It was therefore decided to conduct an experiment with a controlled legal (‘closed’) cannabis supply chain for recreational use. This is of international relevance in view of the current illegal cannabis exports from the Netherlands, the importance of sharing knowledge about the effectiveness of cannabis policies, and the accumulation of evidence needed to evaluate and update international treaties. Here we describe and discuss the background, general approach and design of the experiment.An independent expert committee elaborated how the closed chain will operate and be evaluated, based on the experience with the medicinal cannabis chain, and round table discussions with stakeholders (mayors, coffeeshop owners, cannabis consumers, growers, regulators, scientists, and addiction experts).Ten trusted cannabis growers are contracted to produce and supply cannabis to the coffeeshops in intervention municipalities, with product quality control, law enforcement against criminal interference, and preventive efforts to reduce health risks being implemented. No changes will be made in the cannabis supply to the coffeeshops in participating control municipalities. A process evaluation will assess whether the chain from production to sale in the intervention municipalities was really closed. In a quasi-experimental study comparing intervention and control municipalities, the chain's effects on public health, cannabis-related crime, safety and public nuisance will be estimated.The fieldwork period is expected to start early 2024 and will take four years, including reporting to the government and parliament. These will then decide whether and what further steps towards legalisation of the production and supply of cannabis will be taken.

Purpose: Cognitive Adaptation Training (CAT) is a psychosocial intervention with demonstrated effectiveness. However, no validated fidelity instrument is available. In this study, a CAT Fidelity Scale was developed and its psychometric properties, including interrater reliability and internal consistency, were evaluated. Methods: The fidelity scale was developed in a multidisciplinary collaboration between international research groups using the Delphi method. Four Delphi rounds were organized to reach consensus for the items included in the scale. To examine the psychometric properties of the scale, data from a large cluster randomized controlled trial evaluating the implementation of CAT in clinical practice was used. Fidelity assessors conducted 73 fidelity reviews at four mental health institutions in the Netherlands. Results: After three Delphi rounds, consensus was reached on a 44-item CAT Fidelity Scale. After administration of the scale, 24 items were removed in round four resulting in a 20-item fidelity scale. Psychometric properties of the 20-item CAT Fidelity Scale shows a fair interrater reliability and an excellent internal consistency. Conclusions: The CAT fidelity scale in its current form is useful for both research purposes as well as for individual health professionals to monitor their own adherence to the protocol. Future research needs to focus on improvement of items and formulating qualitative anchor point to the items to increase generalizability and psychometric properties of the scale. The described suggestions for improvement provide a good starting point for further development.

As a consequence of the outbreak of the COVID-19 global pandemic in the spring of 2020, large-scale social distancing measures were implemented, resulting in the forced adoption of online or digital forms of psychological treatment. This sudden transition to digital care offered a unique opportunity to investigate if and how this experience impacted mental healthcare professionals’ perceptions and use of Digital Mental Health tools. The current paper presents findings of a repeated cross-sectional study consisting of three iterations of a national online survey in the Netherlands. This survey contained open and closed questions on professionals’ adoption readiness, frequency of use, perceived competency, and perceived value of Digital Mental Health collected in 2019 (before the pandemic), in 2020 (after the first wave), and in 2021 (after the second wave). The inclusion of data gathered prior to the COVID-19 pandemic offers a unique window to assess how professionals’ adoption has developed through this transition from voluntary to mandatory use of Digital Mental Health tools. Our study also re-assesses the drivers, barriers, and needs of mental healthcare professionals after having gained experience with Digital Mental Health. In total, 1,039 practitioners completed the surveys (Survey 1: n = 432, Survey 2: n = 363, and Survey 3: n = 244). Results indicate that compared to the period before the pandemic, there was a particularly large increase in use, competency, and perceived value regarding videoconferencing. Small differences were also found for some other basic tools that were crucial to ensure the continuation of care, such as e-mail, text messaging, and online screening, but not for more innovative technologies, such as virtual reality and biofeedback. Many practitioners reported to have gained skills regarding Digital Mental Health and experienced several benefits of it. They expressed the intention to continue with a blended approach, using Digital Mental Health tools in combination with face-to-face care, focused on situations in which they found it to have specific added value, such as when clients are unable to travel. Others were less satisfied with the technology-mediated interactions and remained more reluctant to future use of DMH. Implications for broader implementation of Digital Mental Health and future research are discussed.

Background Childhood obesity is a complex disease resulting from the interaction of multiple factors. The effective management of childhood obesity requires assessing the psychosocial and lifestyle factors that may play a role in the development and maintenance of obesity. This study centers on available scientific literature on psychosocial and lifestyle assessments for childhood obesity, and experiences and views of healthcare professionals with regard to assessing psychosocial and lifestyle factors within Dutch integrated care. Methods Two methods were used. First, a scoping review (in PubMed, Embase, PsycInfo, IBSS, Scopus and Web of Science) was performed by systematically searching for scientific literature on psychosocial and lifestyle assessments for childhood obesity. Data were analysed by extracting data in Microsoft Excel. Second, focus group discussions were held with healthcare professionals from a variety of disciplines and domains to explore their experiences and views about assessing psychosocial and lifestyle factors within Dutch integrated care. Data were analysed using template analysis, complemented with open coding in MAXQDA. Results The results provide an overview of relevant psychosocial and lifestyle factors that should be assessed and were classified as child, family, parental and lifestyle (e.g. nutrition, physical activity and sleep factors) and structured into psychological and social aspects. Insights into how to assess psychosocial and lifestyle factors were identified as well, including talking about psychosocial factors, lifestyle and weight; the professional-patient relationship; and attitudes of healthcare professionals. Conclusions This study provides an overview of psychosocial and lifestyle factors that should be identified within the context of childhood obesity care, as they may contribute to the development and maintenance of obesity. The results highlight the importance of both what is assessed and how it is assessed. The results of this study can be used to develop practical tools for facilitating healthcare professionals in conducting a psychosocial and lifestyle assessment.

Health information systems play a crucial role in responding to population health and health systems’ challenges both at national and European level. The COVID-19 pandemic has been instrumental to show the utility and the conditio sine qua none of health information systems for health research, health care and policy development. National and the current EU health information system are connected with each other. The EU health information system feeds on data and information that is generated by the national health information systems. Within the current political set-up of the EU, strong national health information systems are essential for a functional EU health information system. The competency of the EU in health information is limited, but investments have been made to support health information activities through EU projects and initiatives to set up an EU health information system. Despite these investments, the current EU health information system remains fragmented with substantial inequalities across Europe with issues of timeliness and usefulness. This thesis aims to investigate national health information systems and the current EU health information system, and how these systems can be strengthened through a common approach. The thesis is divided in three parts, responding to the following three main questions: What is the current status of national health information systems and which elements of the current EU health information system exist? What can European collaboration offer to health information and health information systems? How can collaboration in health information in the EU be structurally improved? Chapters two and three focus on the first question: what is the current status of national health information systems and which elements of the current EU health information system exist? Chapter two describes the factors that enable and hamper the functioning of national population-based health information systems in Europe. The study reveales that each national health information system has its strengths and weaknesses. Five main barriers are identified across all areas of national health information systems. Common barriers and enablers in national health information systems across Europe provide evidence that a common European strategy and approach to strengthen national health information systems is needed. Within the current political set-up of the EU, strong national health information systems are essential for a functional EU health information system. Chapter three describes the needs to strengthen the current EU health information system. The competency of the EU in health information is limited, but investments have been made to support health information activities through EU projects and initiatives to set up an EU health information system. This chapter shows that despite these investments, the current EU health information system remains highly fragmented and lacks sustainability, coherence, and comprehensiveness. The second part of this thesis focuses on what European collaboration can offer to health information and health information systems through several concrete examples of collaborations in EU-projects. It provides two examples of what European collaboration can offer to health information and health information systems. In chapter four, Healthy Life Years (HLY), a disability-free life expectancy metric, and its underlying measure the Global Activity Limitation Indicator (GALI) are examined. Chapter five and six describe the added value of a peer administered health information system assessment methodology based on a WHO assessment tool and adapted by the Joint Action on Health Information (InfAct). A health information system assessment is an evaluation of the functioning of the main elements that compose a national health information system. The study showed the relative easy to implement and use the developed peer administered health information system assessment methodology across Europe. Chapters four, five and six demonstrate that European collaboration leads to structured build-up of knowledge and strengthening of expertise. European collaboration supports the creation of a health information community within and across countries. Moreover, the collaboration thoroughly contributes to capacity building and therefore also likely addresses health information inequalities. This provides evidence that there is a clear added value of having a European common approach to strengthen health information systems. The third part of this thesis describes how collaboration in health information in the EU can be structurally improved, considering the gaps identified in Part 1. Chapter seven describes the potential of a European Research Infrastructure Consortium on Health Information for Research and Evidence based Policy or later defined as the Distributed Infrastructure on Population Health to address current challenges of the EU health information system. Results show that a research infrastructure is a suitable tool to support the goal of working towards more and better coordination in activities related to health information in the EU. It discusses its functions and way of operating. A research infrastructure provides a bottom-up approach where Member States and associated countries have a pragmatic solution for an EU infrastructure for health information. This provides evidence that a European common approach to strengthen health information systems can be given by a research infrastructure. Based on the main findings of the thesis, professional experience by working in the field as coordinator in several EU projects and by bringing in the current evolutions in the field, in chapter eight a selection is made of what is identified to be the most pressing actions that need to be taken, where the biggest gains can be made and what implications these have for practice, policy and research. Four main area of action are fragmentation, governance aspects, human resources and European financing mechanism. Fragmentation concerns the fragmentation of data sources in the national health information systems and EU health information system. It is recommended to set-up a central coordination body in each country to streamline health data management, access and (re)-use. Three major roles need to be executed by these bodies: (i) centralised development of metadata catalogues, (ii) provision of streamlined and transparent data access procedures, and (iii) support during data request procedures. Also the set-up of a European metadata catalogue is recommended which can built on the European Health Information Portal developed by InfAct and the Population Health Information Research Infrastructure. The second area of action is regarding overarching, political governance of health information systems in European countries. It is recommended to set-up health information system coordination mechanisms at national and European level through National Nodes, Domain specific (Research) Nodes and by bringing these together. This addresses better organisation of health information activities and support for stronger health information strategies. The third area of action is human resources. Given the current state-of-the-art health information systems, specific skill sets are needed to support health information systems. These are believed to be common across Europe and are recommended to be addressed through a peer-to-peer common European approach. This approach entailed joint trainings across domains, mandatory capacity building in EU projects, and increasing the visibility of existing trainings. The fourth area of action is European financing mechanism. This last area covers sustainability and considers how investments in health information systems need to change to have a long-term approach. This thesis recommends to redesign the European Health Programme funding mechanism. In addition, a better alignment between the European Commissions’ funding schemes and closer collaboration with international organisations is recommended. Finally, this thesis recommends the deployment of the Distributed Infrastructure on Population Health to support, through a European common approach, the strengthening of national health information systems and the current EU health information system. It also supports the developments of the European Health Data Space which provides an important framework for the future developments of national health information systems and the EU health information system.

The need to transform mental health care toward person-centered, recovery-based, and network-oriented care is recognized worldwide. Open Dialogue (OD) is seen as a hopeful approach in the context of this transformation and is introduced in countries around the globe. Five Dutch mental health care organizations spread over the Netherlands introduced the Peer-supported Open Dialogue (POD) approach, which adds an explicit role of peer-support workers to the OD approach. It appeared that (P)OD-trained professionals face issues in introducing the (P)OD approach in existing MHC settings. One of the reasons, which is the focus of this study, may be that they encounter difficulties in explaining to non-(P)OD-trained professionals what (P)OD entails. The main objective of this study is to provide guidance to and contribute to making (P)OD better understandable for non-(P)OD-trained professionals. In this study, we used a qualitative design and conducted 23 semi-structured interviews with POD-trained professionals with various backgrounds, to cultivate a rich understanding of which aspects could contribute to a better understanding of POD for non-POD-trained professionals. We used a hybrid approach to analyze the data, meaning that the technique of both inductive and deductive thematic analyses has been applied. From these analyses, six aspects emerged that could give guidance to and contribute to making (P)OD more understandable for non-(P)OD-trained professionals: (1) Experiencing (P)OD by attending treatment network sessions, (2) a coherent and profound narrative about (P)OD, (3) adjusting terminology to better fit the context, such as the two terms “principles” and “responsibility” in this study, (4) the order in which (P)OD elements are introduced in the narrative, (5) bringing the elements “presence,” “reflecting,” and “expertise by experience” more to the foreground, and (6) conceptualizing the main elements in a “talking paper.” A better understanding of (P)OD might be one of the building blocks for improving (P)OD adoption in existing MHC practices, which are on their way toward person-centered, recovery-based, and network-oriented care.

Background When improving the health of local and regional populations, cross-sector collaboration between different policy domains, non-governmental organisations and citizens themselves is needed. Previously, enabling factors and strategies have been identified to improve cross-sector collaboration for health. However, few longitudinal studies have been conducted to understand how the implementation of strategies for cross-sector collaboration changes throughout the collaboration process. The aim of this study is therefore to learn more about the different strategies that were implemented throughout three cross-sector collaboration projects for a healthy living environment. Methods The realist evaluation approach was used to understand how the implemented strategies worked, in which context, why and with what outcomes. Project partners were asked to reflect on their implemented strategies at two different moments in the project timelines, and quarterly updates with project leaders were held. In addition two reference panels were organised for data triangulation. Results Three key insights for successful cross-sector collaboration throughout projects for a healthy living environment were identified, namely 1. Investing in trust among the partners and faith in the project has a positive influence on continuing the collaboration throughout the project; 2. Making stakeholders actively participate throughout the project requires additional strategies after the onset of the project, and 3. Defining roles, tasks, and other prerequisites at the start of the project helps in pursuing the project over time, but needs re-examination throughout the project. These key insights were based on multiple examples of implemented strategies, linked to context, mechanisms and outcomes. Conclusions This study shows the different strategies that can be employed as the collaboration in projects for a healthy living environment progresses. We found that ‘trust’ does not merely include the relationships built between the partners, but at the onset of projects can also be based on faith in the project itself. In addition, as it can be difficult to foresee the right investments and strategies at the onset of the project, frequent reflection moments to choose fitting strategies might benefit regional partners in their cross-sector collaboration for health.

This study examines the motivating effects of goal congruence on outcomes in teams. Building on psychological contract theory and theories of person–environment fit, we proposed at the team level of analysis a mediating role of psychological contract fulfilment (PCF) and moderating effects of task interdependence and team identification. The results indicate partial mediation of shared PCF in the goal congruence – team performance relationships and a significant moderation effect of team identification with team alignment in learning goal orientations.

Autonomy is important for people, even when they have physical impairments and are living in nursing homes. The way staff respond to residents is important for the realisation of autonomy. In order to gain knowledge about what nursing home staff, registered and assistant nurses, occupational therapists and nutritional assistants do and experience in relation to the autonomy of residents, a qualitative study design was chosen. Shadowing, a non-participatory observation method, was used. A total of 15 staff members of a care unit from two different nursing homes participated. Short interviews followed these observations to reflect on intentions of observed activities. The COREQ guidelines were used to report on the study. Four activities to enhance autonomy were identified: getting to know each older adult as a person and responding to his/her needs; encouraging an older adult to perform self-care; stimulating an older adult to make choices; and being aware of interactions. The exploration showed that staff considered it important to strengthen autonomy of older adults living in nursing homes and that they used different activities related to autonomy. However, activities could both enhance as well as hinder autonomy.

Background: Due to the restrictive measures introduced to tackle the COVID-19 pandemic, therapists working with people with mild intellectual disabilities have had to use video conferencing to continue to conduct their psychological assessments and therapy sessions. This qualitative study explored therapists’ experiences of using video conferencing during the initial lockdown period in the Netherlands.Method:In total, seven therapists working at a service organisation supporting people with intellectual disabilities participated in this qualitative study (M = 34.4 years; SD = 6.0, range: 26-42). The therapists documented their experiences via audio recordings, which were subsequently analysed using thematic analysis.Results:Five themes emerged: 1) An immediate transition to virtual working; 2) Developing virtual ways to support service users in both coping with COVID-19 related stress and with continuing therapy; 3) Lacking the appropriate equipment; 4) Limitations in virtually attuning to people with mild intellectual disabilities; and 5) Unforeseen opportunities for distance-based psychological assessments and therapy.Conclusions:This study provides valuable insights into the experiences of therapists using video conferencing to support people with mild intellectual disabilities during the COVID-19 pandemic. These insights can help inform clinical practice with respect to the use of video conferencing for psychological assessment and therapy with people with mild intellectual disabilities.

Previous research suggests that music training relates positively to executive functions that are considered domain-general cognitive skills – far transfer effects – and to creative achievements in domains other than music. However, it remains unclear whether music training can offer self-regulation skills (the mother component of executive functions) beyond playing songs. In addition, findings from music psychology suggest that the family plays a significant role in the development of musical motivation of young music learners. The present research will examine whether psychological support by the family moderates the relationship between music training, self-regulation skills, and creative achievement in domains other than music. To explore these relationships, a survey study will be conducted, aiming at recruiting 400 adult music learners who reside in the Netherlands and have at least one year of instrumental experience. The far transfer effect will be measured by the Creative Activities and Achievements Questionnaire (Diedrich et al., 2018). Self-regulation will be measured by the Creative Self-Regulation Questionnaire (Zielińska et al., 2022). Family’s psychological support will be measured by three scales that refer to the general relationships between music learners and their parents (or other guardians) and the communication and emotional support they receive from their parents. It is expected that self-regulation will fully and positively mediate the relationship between music training and creative achievement. The level of parental support will indicate how strong and positive will be the mediating effect on music learners’ self-regulation skills and their ability to transfer them to other domains.

The COVID-19 pandemic profoundly impacted the work of professionals who support people with intellectual disabilities. This study aimed to explore the experiences of outreach support staff supporting people with mild intellectual disabilities in the Netherlands during different phases of the pandemic between March 2020 and May 2021. Overall, seven outreach support staff from three intellectual disability services participated in this qualitative study. Using semi-structured interviews, participants were interviewed on three occasions between December 2020 and May 2021. A thematic analytical framework was used to analyze the interviews. Four overarching themes could be distinguished based on the data: (1) balancing between one’s professional and personal life; (2) vaccination as both a stress reducer and a source of agitation; (3) service users: vulnerable versus resilient; and (4) contact with colleagues and service users. These themes provided valuable insights into the experiences of outreach support staff during different phases of the pandemic, both in the enduring impact of the pandemic and its measures on support staff, as well as in terms of how the pandemic and its preventive measures impacted their profession.

It is often the case that distinct social services work independently of each other, and by providing integrative services this can be prevented. This study focuses on integrated care between the social service fields of social work and financial- and employment services in the Netherlands. This article examines client’s perspective, in terms of needs, benefits, and results they experience, of the integrated care. A qualitative case study was conducted in three different Dutch municipalities. Between November 2018 and March 2021, integrated care trajectories of eight clients were followed. Data was collected by interviewing twice the participating clients and observing 20 joint client consultations. Analyses revealed insights to strengthen the integrated care approach. Three main benefits were found: Co-ownership, self-regulation and inner peace. The results suggested that a primary focus on providing integrated care for the financial-related problems contributed to an increased sense of inner peace within the clients. The implementation of a joint client consultation strengthened the integrated care between the different social services studied. Future research into the perspectives of the professional, organization, and policy/governance is recommended, as well as quantitative research to obtain quantitative effects on employment and finances in conjunction with the reduction of social issues.

Previous studies have found evidence for a relationship between debt and crime, and for problems in childhood, education, work, and mental and physical health as underlying risk factors. However, insight into the interplay between these possible risk factors is limited. Therefore, a mixed methods approach was applied by both creating a quantitative Gaussian Graphical Model (GGM) and conducting qualitative analyses on 250 client files including risk assessment data from the Dutch probation service, to gain more specific insight into the interaction between potential risk factors. The results show that debt is strongly related to criminal behavior and problems in many life domains for most probation clients. Debt seems to be a direct risk factor for crime, but debt and crime also appear to be highly interrelated as part of a complex interplay of risk factors. The most frequently rated factors – limited or incomplete education, no job and related lack of income, and mental and physical health problems – are highly interwoven and increase the risk of both debt and crime. The findings stress the importance of paying attention to and using interventions focusing on strongly related crime risk factors, including debt, and their complex interplay, to supervise probation clients effectively.

Background: Information regarding the common-daily support needs of older people with intellectual disabilities remains scarce, despite the necessity of such knowledge to the provision of adequate support. This exploratory study aims to identify the most important support needs. Method: A mixed-method design was conducted, in which 11 semi-structured interviews were held with psychologists to gain insight into the support needs of older people with intellectual disabilities. Results: The data provide an overview of the support needs of older people with intellectual disabilities in all quality-of-life (QoL) domains. Physical well-being, emotional well-being, interpersonal relationships and self-determination were identified as the most important domains for older people with intellectual disabilities. Conclusions: The findings of this study may guide the development of a specific training for support staff and constitute a valuable contribution to raising awareness among support staff concerning the broad range of support needs existing among older people with intellectual disabilities.

Background and objective: Stories from older adults give insight into their personal lives and in the care they receive. The story as a quality instrument is a narrative quality improvement method with which care professionals can interview older adults about how care is experienced. Each performed interview will be translated into a portrait containing the core themes of the shared story. The objective of this study was to assess the feasibility of and experiences with the story as a quality instrument amongst care professionals and older adults receiving long-term care.Methods: Five care locations providing nursing home care and one providing home care participated in the current study. In total 19 trained care professionals performed interviews with 52 older adults. Both the performed interviews and written portraits were scored according to preset criteria to establish the compliance to the predetermined protocol. Next to that, experiences from care professionals as insider researchers and respondents were gathered.Results: Overall the fidelity for performing the interview was good. In 90% of cases interviewers posed one inviting open question. Following, interviewers used proposed interviewing techniques such as asking in depth questions, asking for an example or summarizing what has been said. In 20 of the interviews, the respondents input accounted for over 80% of the total number of words, and in 27 interviews the respondents’ input accounted for 60%-80%. Fidelity with the protocol for drawing up portraits was sufficient in most cases. In 66% the portrait contained all important themes and in 32% the majority of important themes. One portrait missed a significant proportion of themes mentioned during the interview. The experiences from care professionals consist of successes, challenges, added value and prerequisites.Conclusions: Care professionals were mostly capable of following the method according to protocol after being trained. The method is believed to be a promising innovation because care professionals play a key role in gathering and using stories to improve quality of care. The outcomes can be used by care professionals to learn and improve within their care location according to the quality framework for nursing home care.

Background Frailty is a syndrome that is defined as an accumulation of deficits in physical, psychological, and social domains. On a global scale, there is an urgent need to create frailty-ready healthcare systems due to the healthcare burden that frailty confers on systems and the increased risk of falls, healthcare utilization, disability, and premature mortality. Several studies have been conducted to develop prediction models for predicting frailty. Most studies used logistic regression as a technique to develop a prediction model. One area that has experienced significant growth is the application of Bayesian techniques, partly due to an increasing number of practitioners valuing the Bayesian paradigm as matching that of scientific discovery.Objective We compared ten different Bayesian networks as proposed by ten experts in the field of frail elderly people to predict frailty with a choice from ten dichotomized determinants for frailty.Methods We used the opinion of ten experts who could indicate, using an empty Bayesian network graph, the important predictors for frailty and the interactions between the different predictors. The candidate predictors were age, sex, marital status, ethnicity, education, income, lifestyle, multimorbidity, life events, and home living environment. The ten Bayesian network models were evaluated in terms of their ability to predict frailty. For the evaluation, we used the data of 479 participants that filled in the Tilburg Frailty indicator (TFI) questionnaire for assessing frailty among community-dwelling older people. The data set contained the aforementioned variables and the outcome “frail”. The model fit of each model was measured using the Akaike information criterion (AIC) and the predictive performance of the models was measured using the area under the curve (AUC) of the receiver operator characteristic (ROC). The AUCs of the models were validated using bootstrapping with 100 repetitions. The relative importance of the predictors in the models was calculated using the permutation feature importance algorithm (PFI).Results The ten Bayesian networks of the ten experts differed considerably regarding the predictors and the connections between the predictors and the outcome. However, all ten networks had corrected AUCs 0.700. Evaluating the importance of the predictors in each model, “diseases or chronic disorders” was the most important predictor in all models (10 times). The predictors “lifestyle” and “monthly income” were also often present in the models (both 6 times). One or more diseases or chronic disorders, an unhealthy lifestyle, and a monthly income below 1800 euro increased the likelihood of frailty.Conclusions Although the ten experts all made different graphs, the predictive performance was always satisfying (AUCs >0.700). While it is true that the predictor importance varied all the time, the top three of the predictor importance consisted of “diseases or chronic disorders”, “lifestyle” and “monthly income”. All in all, asking for the opinion of experts in the field of frail elderly to predict frailty with Bayesian networks may be more rewarding than a data-driven forecast with Bayesian networks because they have expert knowledge regarding interactions between the different predictors.

Our aim was to examine the co-design process of two educational programs based on scientific research, to investigate which factors influenced the co-design processes and which lessons we learned. Participatory qualitative research on multiple cases was conducted with representatives of the university, healthcare education (university of applied science), secondary vocational education and training and nursing home care practice. Data were analyzed using a critical creative hermeneutic analysis. Three themes influenced the co-design processes: (1) facilitation of the processes, (2) team members’ attributes and (3) diverse interests and structures. Participants’ diversity slowed down and deepened the collaboration. The positive climate and personal attributes enabled the processes. The complexity of the co-design processes, conflicting interests and making use of the full potential of the diversity were challenging aspects. These challenges can be overcome by organizing and facilitating co-design processes skillfully.

ObjectivesSmoking may still occur at sports clubs with an outdoor smoke-free policy (SFP). This study aims to map the occurrence of smoking at various sports clubs in the Netherlands and to understand why smoking occurs at some clubs but not at others.Study designThis was a qualitative design in the form of semistructured interviews.MethodsSemistructured interviews (n = 34) were held online with smoking and non-smoking members of 17 Dutch outdoor sports clubs (in field hockey, korfball, football, and tennis) with an outdoor SFP. Data were analyzed using content analysis.ResultsWe identified four situations where smoking still occurred: (1) directly at the entrance, (2) at some distance from the entrance, (3) in particular places on the premises, and (4) in various places or on occasions when alcohol is consumed. Smoking directly at the entrance was most often perceived as a bothersome situation that was difficult to avoid. The occurrence of these situations differed per sports club depending on the scope of the SFP (the comprehensiveness of the SFP and the presence or absence of a smoking area) and factors influencing policy compliance (physical characteristics of the sports club's premises, the presence or absence of children, and several enforcement difficulties).ConclusionIn some sports clubs, smoking remained common on the premises despite an outdoor SFP. Exposure to second-hand smoke might be reduced by formulating a comprehensive SFP, improving policy compliance also in situations where children are absent, and organizing the enforcement of the policy.

Background: Most cognitive remediation (CR) programs are based on multiple scientific learning principles. The role of those learning principles in the beneficial effects of CR is poorly understood. A better understanding of such underlying mechanisms is important to further tailor the intervention and to learn about optimal contexts. Method: An explorative secondary analysis was conducted of data from a randomized controlled trial (RCT) comparing the effects of Individual Placement and Support (IPS) with and without CR. The present study evaluated how CR learning principles of “massed practice,” “errorless learning,” “strategy use” and “therapist contribution” (therapist fidelity) were associated with cognitive and vocational outcomes within 26 participants in this RCT who were treatment exposed. Results: Cognitive gains after CR were positively associated with “massed practice” and “errorless learning.” Negative associations were found with “strategy use” and “therapist fidelity.” No direct relationship was found between CR principles and vocational outcomes. Conclusions: Results tentatively suggest that CR is most effective and efficient with a good balance between sufficient intensity, of more than 200 tasks, and a limited duration of the training up to 20 h, using tasks that remain both challenging and rewarding, being applied in a context that facilitates real-life practice.