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Empowerment is a central paradigm in the care for older people. Social work requires measuring instruments to be able to meaningfully justify its efforts and interventions. This study aims at the validation of the Psychological Empowerment Scale for Older People, a measuring instrument build on this operationalization. The PESOP was administered to a large sample and completed by 398 older people in the Netherlands. The results provided evidence for a single-factor scale consisting of 17 items, with strong reliability and validity scores. The PESOP provides social work with a tool by which to measure the empowerment of older service users.

Empowerment is central in gerontological social work. Operationalizing empowerment from the perspective of the target population is important to align with context specific interpretations of what empowerment means. This study aims at operationalizing psychological empowerment from the perspective of older people. A design was chosen that is based on the concept mapping method, though tailored to accommodate the specific principles we assume in empowerment research and to align with target specific conditions that come to play with older persons. The results show an empowerment with 58 statements divided over four components of empowerment; emotional, cognitive, relational and behavioural component.

Introduction: Families with multiple and complex problems often deal with multiple professionals and organizations for support. Integrated social care supposedly prevents the fragmentation of care that often occurs.We identified facilitators and barriers experienced by families receiving integrated social care and by the professionals who provide it., Method: We performed a scoping review following Arksey and O'Malley's framework, using the following databases: PsycINFO, Web of Science Core Collection, Psychology and Behavioral Sciences Collection, CINAHL, PubMed, and Medline. Furthermore, conducted a thematic analysis. The results were divided into facilitators and barriers of integrated social care., Results: We identified 278 studies and finally included sixteen in our scoping review. We identified facilitators, including: linking formal care with informal networks, promoting collaboration among professionals e.g., working in pairs, and professionals autonomy. We identified barriers, including: time constraints, tasks outside professionals' expertise, along with resistance to integrated collaboration among organizations. These findings can enhance the advancement of social integrated care as a promising approach to support families facing multiple and complex problems., Conclusion: To empower families, integrated social care requires a systematic approach based on trust. It involves coordinated care, shared decision-making, informal networks and the participation of all family members, including children., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Disclosures of sibling sexual behavior (SSB) usually affect all family members but there remains, however, a paucity in studies on therapeutical family interventions and how they can initiate changes in families. This study was designed to explore relational impacts of SSB disclosures, goals for therapy and interventions that helped a family initiate the recovery process after a SSB disclosure. A single case study design was used to analyze a family's long-term therapy process. Data on this N = 1 study comprised 18 interviews with involved therapists, five interviews with involved family members, therapy files, and notes on family sessions. Data was analyzed using a thematic approach. Relational traumas were experienced in broken relationships, relationships under pressure and damaged trust between family members. Therapy goals were to (1) recreate family's safety, (2) help the family process the SSB consequences and (3) restore trust and search for relationship healing. Appropriate interventions to target the goals included individual-centered psycho trauma treatment as well as interventions for the parents, the involved siblings, and the uninvolved siblings, followed by sessions between the involved siblings and with the whole family. Therapy outcomes were found in reduced individual trauma symptoms, a recreated sense of family safety, the start of relational trauma processing, and newfound forms of sibling/family relationships. This study provides a unique and comprehensive insight into a family's healing process after SSB disclosures from the perspectives of both professionals and family members. The effective interventions identified in this study may provide tools for therapists working with these families. This study may also offer greater insights into both the abusive and mutual types of SSB., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The restrictive measures taken by nursing homes during the COVID-19 outbreak in 2020 (e.g., quarantine) may have been important stressors for which residents needed resilience to safeguard their well-being. Based on 30 semi-structured interviews with nursing home residents and close relatives, this study explored the lived experiences with respect to the restrictive measures. The data were collected in psychogeriatric, somatic, and mixed wards in The Netherlands and Flanders, Belgium. The restrictive measures were important stressors for residents, indicated by feelings of loneliness, sadness, and powerlessness. To deal with these measures, residents used various resources, which were determined by factors in the individual (e.g., health), interactional (e.g., possibilities for social interactions) and contextual (e.g. nursing home policy) domains. Because the lived experiences with respect to the restrictive measures seemed to relate to the resilience of nursing home residents, it is crucial to reinforce resources in the individual, interactional, and contextual domains.

Objectives: Research on what matters most to people with dementia is crucial for developing tailored interventions and support. This study explored how people with dementia experience their everyday lives, providing insight into what is important to them to live the best they can at home., Methods: Inspired by a phenomenological approach, open interviews were conducted with 15 people with dementia, supplemented by home tours and walking interviews. Data collection included one to three sessions per participant. Data were analysed using descriptive content analysis and followed the phases of open, axial, and selective coding. A co-researcher group of seven people with dementia was consulted during the analysis to help interpret the emergent findings., Findings: Six dimensions of what matters most in everyday life were identified: 1) Engaging in meaningful activities, which included routines, household chores, leisure, day activities, and volunteering or work; 2) Keeping a sense of connection, in relationships within the home, with family, friends, groups, and the neighbourhood; 3) Having a sense of belonging, which included attachments inside and outside the home, and to cherished objects; 4) Connecting to self, which included the ability to reflect on past experiences, live in the present moment and anticipate the future; 5) Adjusting to ongoing changes, which included alterations in sensory perceptions, perceptions of the physical environment, and navigating shifts in interpersonal dynamics; 6) Being open to help and support, from professionals, community and society., Conclusions: For people with dementia, everyday life is a continuous balancing act between what matters most and what can be achieved daily. This is not only related to dementia but is also embedded in the wider perspective of life history, relational networks, and the physical environment. This study highlights the importance of identifying what matters most to people with dementia to provide person-centred support., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Background: Deinstitutionalization in mental health care has been an ongoing process for decades. More and more people with severe mental illness (SMI), who previously lived in residential supported housing settings and were formerly homeless, are now living independently in the community but need intensive support to enable independent living. The support provided by regular outpatient teams is inadequate for this target group. This study explored the ingredients for an alternative form of outpatient support: intensive home support (IHS)., Methods: Concept mapping was used, following five steps: (1) brainstorming, (2) sorting, (3) rating, (4) statistical analysis & visual representation, and (5) interpretation. Purposive sampling was used to represent several perspectives, including researchers, professionals, peer workers, and policy makers., Results: Experts (n = 17) participated in the brainstorming step and the sorting and rating steps (n = 14). The 84 generated statements were grouped into 10 clusters:. (1) housing rights; (2) informal collaboration; (3) reciprocity in the community; (4) normalization and citizenship; (5) recovery; (6) sustainable funding; (7) equivalence; (8) flexible, proactive 24/7 support; (9) public health and positive health; and (10) integrated cooperation in support at home., Conclusions: Given the diversity of the ingredients contained in the clusters, it seems that IHS should be designed according to a holistic approach in collaboration with several sectors. Additionally, IHS is not only the responsibility of care organizations but also the responsibility of national and local governments. Further research about collaboration and integrated care is needed to determine how to implement all of the ingredients in practice., (© 2023. The Author(s).)

Background: For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare., Methods: We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals., Results: The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships., Conclusion: We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 van Genk, Roeg, van Vugt, van Weeghel and Van Regenmortel.)

Increasing attention has been paid to the 'voice' of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider's perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living at home. A scoping review of qualitative studies, guided by the Joanna Briggs Institute Reviewers Manual, was conducted. Eight databases were searched, resulting in 6345 records, of which 58 papers published between 2011 and 2021 were included. Analysis was carried out by descriptive content analysis. Findings were categorized into seven spheres of everyday life: experiences related to the condition, self, relationships, activities, environment, health and social care and public opinions. The results show many disruptions and losses in everyday life and how people try to accommodate these changes. In all areas of everyday life, people show a deep desire to have reciprocal relationships, stay engaged through participation in activities and have a sense of belonging in the community. However, more research is needed on the factors that promote and impede the sense of reciprocity and belonging.

Background: The target group of this study concerns young people with a mild intellectual disability. The central research question is: What evidence can be found in the literature for common and specific factors for a play therapy intervention for young people with a mild intellectual disability struggling with aggression regulation. Method: The criteria used for selecting articles are presented according to the PRISMA, and the PRISMA guidelines for writing a review have been applied. Results: Common factors have been found in the literature that relate to the relationship between therapist and client and the therapeutic skills of the play therapist. Clues have also been found for specific factors of play therapy, such as the use of play as a language and a connection with the child's inner world. In addition, certain factors have been found that are specific to the target group of this article. The non-verbal element of play therapy is an active part of this., Competing Interests: No potential conflict of interest was reported by the authors., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

This study aims to contribute to the evaluation of online therapy during Covid-19 pandemic lockdowns, by exploring family therapists' experiences of therapy for twelve Sibling Sexual Abuse (SSA) families in the Netherlands. Seven transcripts of interviews with highly specialised Dutch family therapists were analysed using thematic analysis (TA). Two main findings emerged from this study. First, the Dutch therapists reported no acute worries about their clients' sexual safety during the pandemic lockdowns. Nonetheless, the switch to online therapy for the SSA families created concern regarding victim safety in speaking out freely at home. Second, while the sudden switch to online therapy enabled SSA therapists to stay connected with their SSA families, therapists experienced a decline in therapy quality and in their own well-being. In the therapists' experience, it was almost impossible to conduct their most fundamental interventions online, such as intervening in family relationships., Competing Interests: No potential competing interest was reported by the authors., (© 2022 The Authors. Journal of Family Therapy published by John Wiley & Sons Ltd on behalf of Association for Family Therapy and Systemic Practice in the UK.)

Aims and Objectives: To evaluate measurement invariance of the Individualized Care Scale (ICS) across patients and nurses, and assess the degree of congruence in nurses' and patients' perceptions on patient-centredness and the impact of an intervention there on., Methods: A pre-post intervention study design with an expert by experience intervention was conducted in 2016 to 2017. Nurses (n = 138) and patients (n = 199) of two hospital departments in Belgium were surveyed. Patient-centredness was measured using the ICS (ICS-Nurse and ICS-Patient). Measurement invariance was evaluated by conducting multiple-group confirmatory factor analysis. Unpaired t tests and difference in difference analysis were used to evaluate the degree of congruence in nurses' and patients' perceptions on patient-centredness and assess pre-post changes in nurses' and patients' scores, respectively. SQUIRE guidelines were followed to report the study., Results: There was no evidence of measurement non-invariance. Nurses perceived the individuality of care more positively than patients both before and after the implementation of the intervention. Pre-post changes in nurses' and patients' scores were not statistically significant., Conclusion: There is a significant gap between the perceptions of nurses and patients regarding the support and provision of individual care: nurses consider provided care as more individualized than patients do. To orient nurses' perspectives more towards their patients' perspective, multicomponent interventions are needed. Researchers and hospital managers may use the ICS to evaluate interventions that have the ability to close the gap in nurses' and patients' perceptions of patient-centredness. Embedding experts by experience in the professionals' team has the potential to foster patient-centredness but needs to focus on patients and nurses equally., (© 2020 John Wiley & Sons, Ltd.)

In the present study, we aimed to test the protectiveness of the bioavailability-normalization procedure, with its associated hazardous concentrations for x% of the species (HCx), that is currently implemented to derive environmental threshold concentrations for nickel (Ni) in European environmental legislative frameworks. We exposed a natural plankton-dominated community to 3 constant Ni concentrations, that is, a control with no Ni added (background Ni of 1.2-4 µg/L) and the bioavailability-normalized HC5 and HC50 of 24 and 97 µg dissolved Ni/L, respectively, during a 56-d microcosm experiment under high dissolved organic carbon (DOC) conditions (DOC of 14 mg/L at test initiation). The effects of the bioavailability-normalized HC5 and HC50 values were evaluated at the levels of community structure (community composition and plankton group abundances), community functioning (measured as indirect physicochemical proxies for overnight respiration and carbon fluxes), and individual species abundances. The bioavailability-normalized HC50 treatment had clear effects (defined as effects occurring on at least 2 consecutive sampling days) on both the structure and functioning of the investigated aquatic community. Through its effect on community functioning (i.e., reduced pH and DOC), Ni also influenced its own bioavailability. Clear direct effects of Ni were observed for only 3 species (the Cyanobacteria Oscillatoria sp. 1 and the rotifers Asplanchna/Testidunela sp. and Trichocerca group similis). Most other effects occurring in the plankton community in the HC50 treatment were indirect and likely driven by the direct effect of Ni on the Cyanobacteria Oscillatoria sp. 1, which was the dominant phytoplankton species in the control microcosms. In contrast, the bioavailability-normalized HC5 did not induce clear effects on community structure and functioning endpoints: these were only affected on individual sampling days. Clear (direct) effects were observed for only 2 plankton species (the rotifer Trichocerca group similis and the Cyanobacteria Oscillatoria sp. 1), but their abundances recovered to control levels at the end of the study. In addition, a few species (1 phytoplankton and 3 zooplankton species) were affected in the HC5 treatment only on the last sampling day. It is uncertain whether these species would have shown clear effects over a longer exposure duration. Thus, our study shows that the bioavailability-normalized HC5 of Ni at high DOC induced clear effects on a few individual species. However, the overall conclusion is that the bioavailability-normalized HC5 of Ni as derived through the procedure that is currently implemented in European legislative frameworks protects against clear effects on community structure and function. Environ Toxicol Chem 2019;38:1923-1939. © 2019 SETAC., (© 2019 SETAC.)

It is generally assumed that as long as the majority of species experiences no direct adverse effects attributable to a single substance (i.e., potentially affected fraction [PAF] <5%), no significant structural or functional effects at the community level are expected to occur. Whether this assumption holds for mixed metal contamination is not known. In the present study, we tested this by performing a microcosm experiment in which a naturally occurring freshwater planktonic community was exposed to a copper-nickel-zinc (Cu-Ni-Zn) mixture for 8 wk and various structural and functional community-level traits were assessed. In the low mixture concentration treatments (i.e., Ni-Zn mixtures, because there was no difference in Cu concentrations in these treatments with the control), community-level effects were relatively simple, only involving phytoplankton species groups. In the high mixture concentration treatments (Cu-Ni-Zn mixtures), community-level effects were more complex, involving several phytoplankton and zooplankton species groups. Multisubstance PAF (msPAF) values for all mixture treatments were calculated by applying the concentration addition model to bioavailability-normalized single-metal species sensitivity distributions (SSDs). Consistent effects on the structural traits community composition, abundance of zooplankton species groups, species diversity, and species richness and on the functional trait dissolved organic carbon (DOC) concentration (as a proxy for the microbial loop and pelagic food web interactions) were only observed at msPAF values >0.05 (i.e., in the Cu-Ni-Zn mixture). However, consistent effects on the abundance of various phytoplankton species groups (structural traits) and on 2 measures of community respiration, overnight Δ dissolved oxygen (ΔDO) and ΔpH (functional traits), were already observed at msPAF values of ≤0.05 (i.e., in the Ni-Zn mixture). This indicates that the threshold msPAF value of 0.05 was not protective against metal mixture exposure for all community-level structural and functional endpoints in the present study. A possible explanation for this result is the mismatch between the species in the SSD and those in our microcosm community. Indeed, our data suggest that the presence of one single dominant and very Zn- and/or Ni-sensitive species in the investigated community (i.e., a cyanobacteria of the genus Oscillatoria), which is not represented in the SSD of these metals, was probably the driver of all observed effects at or below an msPAF of 0.05. Overall, the present results show that SSDs are not necessarily a good predictor of community-level effects for all types of communities and that the presence of dominant sensitive species may result in significant, consistent effects on certain structural and functional community-level endpoints at msPAF values ≤0.05, which is generally considered protective in many regulatory frameworks. Environ Toxicol Chem 2018;37:2380-2400. © 2018 SETAC., (© 2018 SETAC.)

Although metal mixture toxicity has been studied relatively intensely, there is no general consensus yet on how to incorporate metal mixture toxicity into aquatic risk assessment. We combined existing data on chronic metal mixture toxicity at the species level with species sensitivity distribution (SSD)-based in silico metal mixture risk predictions at the community level for mixtures of Ni, Zn, Cu, Cd, and Pb, to develop a tiered risk assessment scheme for metal mixtures in freshwater. Generally, independent action (IA) predicts chronic metal mixture toxicity at the species level most accurately, whereas concentration addition (CA) is the most conservative model. Mixture effects are noninteractive in 69% (IA) and 44% (CA) and antagonistic in 15% (IA) and 51% (CA) of the experiments, whereas synergisms are only observed in 15% (IA) and 5% (CA) of the experiments. At low effect sizes (∼ 10% mixture effect), CA overestimates metal mixture toxicity at the species level by 1.2-fold (i.e., the mixture interaction factor [MIF]; median). Species, metal presence, or number of metals does not significantly affect the MIF. To predict metal mixture risk at the community level, bioavailability-normalization procedures were combined with CA or IA using SSD techniques in 4 different methods, which were compared using environmental monitoring data of a European river basin (the Dommel, The Netherlands). We found that the simplest method, in which CA is directly applied to the SSD (CA SSD ), is also the most conservative method. The CA SSD has median margins of safety (MoS) of 1.1 and 1.2 respectively for binary mixtures compared with the theoretically more consistent methods of applying CA or IA to the dose-response curve of each species individually prior to estimating the fraction of affected species (CA DRC or IA DRC ). The MoS increases linearly with an increasing number of metals, up to 1.4 and 1.7 for quinary mixtures (median) compared with CA DRC and IA DRC , respectively. When our methods were applied to a geochemical baseline database (Forum of European Geological Surveys [FOREGS]), we found that CA SSD yielded a considerable number of mixture risk predictions, even when metals were at background levels (8% of the water samples). In contrast, metal mixture risks predicted with the theoretically more consistent methods (e.g., IA DRC ) were very limited under natural background metal concentrations (<1% of the water samples). Based on the combined evidence of chronic mixture toxicity predictions at the species level and evidence of in silico risk predictions at the community level, a tiered risk assessment scheme for evaluating metal mixture risks is presented, with CA SSD functioning as a first, simple conservative tier. The more complex, but theoretically more consistent and most accurate method, IA DRC , can be used in higher tier assessments. Alternatively, the conservatism of CA SSD can be accounted for deterministically by incorporating the MoS and MIF in the scheme. Finally, specific guidance is also given related to specific issues, such as how to deal with nondetect data and complex mixtures that include so-called data-poor metals. Environ Toxicol Chem 2018;37:623-642. © 2017 SETAC., (© 2017 SETAC.)

Recently, scholars have emphasized the importance of examining how employees cope with psychological contract violation and how the coping process contributes to psychological contract violation resolution and post-violation psychological contracts. Recent work points to the important role of problem-focused coping. Yet, to date, problem-focused coping strategies have not been conceptualized on a continuum from constructive to destructive strategies. Consequently, potential differences in the use of specific types of problem-focused coping strategies and the role these different strategies play in the violation resolution process has not been explored. In this study, we stress the importance of focusing on different types of problem-focused coping strategies. We explore how employee upward dissent strategies, conceptualized as different forms of problem-focused coping, contribute to violation resolution and post-violation psychological contracts. Two sources of data were used. In-depth interviews with supervisors of a Dutch car lease company provided 23 case descriptions of employee-supervisor interactions after a psychological contract violation. Moreover, a database with descriptions of Dutch court sentences provided eight case descriptions of employee-organization interactions following a perceived violation. Based on these data sources, we explored the pattern of upward dissent strategies employees used over time following a perceived violation. We distinguished between functional (thriving and reactivation), dysfunctional (impairment and dissolution) and deserted psychological contract end states and explored whether different dissent patterns over time differentially contributed to the dissent outcome (i.e., psychological contract end state). The results of our study showed that the use of problem-focused coping is not as straightforward as suggested by the post-violation model. While the post-violation model suggests that problem-focused coping will most likely contribute positively to violation resolution, we found that this also depends on the type of problem-focused coping strategy used. That is, more threatening forms of problem-focused coping (i.e., threatening resignation as a way to trigger one's manager/organization to resolve the violation) mainly contributed to dysfunctional and deserted PC end states. Yet, in some instances the use of these types of active coping strategies also contributed to functional violation resolution. These findings have important implications for the literature on upward dissent strategies and psychological contract violation repair.

Freshwater biota are usually exposed to mixtures of different metals in the environment, which raises concern because risk-assessment procedures for metals are still mainly based on single-metal toxicity. Because microalgae are primary producers and therefore at the base of the food web, it is of utmost importance to understand the effects of metal mixtures on these organisms. Most studies that have investigated the combined interactive effects of mixtures on microalgae performed tests in only one specific water. The objective of the present study was to test if combined effects of mixtures to Pseudokirchneriella subcapitata were the same or different across natural waters showing diverse water-chemistry characteristics. This was done by performing experiments with ternary Cu-Ni-Zn mixtures in 3 natural waters and with binary Cu-Ni mixtures in 5 natural waters. We showed that the ternary mixture acted noninteractively on algal growth, except in one water in which the mixture acted antagonistically. We suggest that a low-cationic competition situation in the latter water could be the reason for the antagonistic interaction between the metals. On the other hand, the binary mixture acted noninteractively on algal growth in all tested waters. We showed that both the concentration addition and independent action models can serve as accurate models for toxicity of ternary Cu-Ni-Zn and binary Cu-Ni mixtures to P. subcapitata in most cases and as protective models in all cases. In addition, we developed a metal mixture bioavailability model, by combining the independent action model and the single-metal bioavailability models, that can be used to predict Cu-Ni-Zn and Cu-Ni toxicity to P. subcapitata as a function of metal concentration and water characteristics. Environ Toxicol Chem 2018;37:587-598. © 2017 SETAC., (© 2017 SETAC.)

Risk assessment in the European Union implements Zn bioavailability models to derive predicted-no-effect concentrations for Zn. These models are validated within certain boundaries (i.e., pH ≤ 8 and Ca concentrations ≥ 5mg/L), but a substantial fraction of the European surface waters falls outside these boundaries. Therefore, we evaluated whether the chronic Zn biotic ligand model (BLM) for Daphnia magna and the chronic bioavailability model for Pseudokirchneriella subcapitata could be extrapolated to pH > 8 and Ca concentrations < 5 mg/L. Results from D. magna experiments suggested that the BLM is not able to reflect the pH effect over a broad pH range (5.5-8.5). In addition, because of Ca deficiency of D. magna in the soft water tests, we cannot conclude whether the BLM is applicable below its Ca boundary. Results for P. subcapitata experiments showed that the bioavailability model can accurately predict Zn toxicity for Ca concentrations down to 0.8 mg/L and pH values up to 8.5. Because the chronic Zn BLM for D. magna could not be extrapolated beyond its validity boundaries for pH, a generalized bioavailability model (gBAM) was developed. Of 4 gBAMs developed, we recommend the use of gBAM-D, which combines a log-linear relation between the 21-d median effective concentrations (expressed as free Zn 2+ ion activity) and pH, with more conventional BLM-type competition constants for Na, Ca, and Mg. This model is a first step in further improving the accuracy of chronic toxicity predictions of Zn as a function of water chemistry, which can decrease the uncertainty in implementing the bioavailability-based predicted-no-effect concentration in the risk assessment of high-pH and low-Ca concentration regions in Europe. Environ Toxicol Chem 2017;36:2781-2798. © 2017 SETAC., (© 2017 SETAC.)

Although chemical risk assessment is still mainly conducted on a substance-by-substance basis, organisms in the environment are typically exposed to mixtures of substances. Risk assessment procedures should therefore be adapted to fit these situations. Four mixture risk assessment methodologies were compared for risk estimations of mixtures of copper (Cu), zinc (Zn), and nickel (Ni). The results showed that use of the log-normal species sensitivity distribution (SSD) instead of the best-fit distribution and sampling species sensitivities independently for each metal instead of using interspecies correlations in metal sensitivity had little impact on risk estimates. Across 4 different monitoring datasets, between 0% and 52% of the target water samples were estimated to be at risk, but only between 0% and 15% of the target water samples were at risk because of the mixture of metals and not any single metal individually. When a natural baseline database was examined, it was estimated that 10% of the target water samples were at risk because of single metals or their mixtures; when the most conservative method was used (concentration addition [CA] applied directly to the SSD, i.e., CA SSD ). However, the issue of metal mixture risk at geochemical baseline concentrations became relatively small (2% of target water samples) when a theoretically more correct method was used (CA applied to individual dose response curves, i.e., CA DRC ). Finally, across the 4 monitoring datasets, the following order of conservatism for the 4 methods was shown (from most to least conservative, with ranges of median margin of safety [MoS] relative to CA SSD ): CA SSD  > CA DRC (MoS = 1.17-1.25) > IA DRC (independent action (IA) applied to individual dose-response curves; MoS = 1.38-1.60) > IA SSD (MoS = 1.48-1.72). Therefore, it is suggested that these 4 methods can be used in a general tiered scheme for the risk assessment of metal mixtures in a regulatory context. In this scheme, the CA SSD method could serve as a first (conservative) tier to identify situations with likely no potential risk at all, regardless of the method used (the sum toxic unit expressed relative to the 5% hazardous concentration [SumTU HC5 ] < 1) and the IA SSD method to identify situations of potential risk, also regardless of the method used (the multisubstance potentially affected fraction of species using the IA SSD method [msPAF IA,SSD ] > 0.05). The CA DRC and IA DRC methods could be used for site-specific assessment for situations that fall in between (SumTU HC5  > 1 and msPAF IA,SSD  < 0.05). Environ Toxicol Chem 2017;36:2123-2138. © 2017 SETAC., (© 2017 SETAC.)

Although aquatic organisms in the environment are exposed to mixtures of metals, risk assessment for metals is most commonly performed on a metal-by-metal basis. To increase the knowledge about chronic mixture effects, the authors investigated whether metal mixture effects are dependent on the biological species, mixture composition, and metal concentration ratio. The authors evaluated the effects of quaternary Ni-Zn-Cu-Cd and ternary Ni-Zn-Cu mixtures on 48-h algal growth rate (Pseudokirchneriella subcapitata) and 7-d daphnid reproduction (Ceriodaphnia dubia) using a ray design. Single metals were 3-fold to 42-fold more toxic for C. dubia than for P. subcapitata, based on the 50% effective concentration expressed as free metal activity, the range representing different metals. Statistical analysis of mixture effects showed that the ternary and quaternary mixture effects were antagonistic on algal growth relative to the concentration addition (CA) model, when the analysis was based on dissolved concentrations and on free metal ion activities. Using the independent action (IA) model, mixture effects in both rays were statistically noninteractive for algal growth when the analysis was based on dissolved concentrations; however, the interactions shifted toward antagonism when based on free ion activities. The ternary Ni-Zn-Cu mixture acted antagonistically on daphnid reproduction relative to both reference models, either expressed as free ion activities or dissolved concentrations. When Cd was added to the mixture, however, the mixture effects shifted toward noninteractivity for daphnids. The metal concentration ratio did not significantly influence the magnitude of observed antagonistic effects. Regardless of statistical interactions observed, based on the present study, CA and in most instances also IA can serve as a protective model for ternary Ni-Zn-Cu and quaternary Ni-Zn-Cu-Cd toxicity to both species. Environ Toxicol Chem 2017;36:1056-1066. © 2016 SETAC., (© 2016 SETAC.)

Objectives: The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. This absence of theoretical and conceptual clarity has led to (1) poor understanding and communication among researchers, health practitioners and policy makers and (2) problems in measurement and comparison between studies across different hospitals., Methods: This paper examines all three concepts through a concept analysis based on the method of Avant and Walker (2005) [1] and the simultaneous concept analysis of Haase et al. (1992) [2]., Results: Through these methods, the antecedents, attributes, consequences and empirical referents of each concept are determined. In addition, similarities and differences between the three concepts are identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts is mapped, and definitions are proposed., Conclusions: It can be concluded that patient empowerment is a much broader concept than just patient participation and patient-centeredness., Practice Implications: The present study may provide a useful framework that researchers, policy makers and health care providers can use to facilitate patient empowerment., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

A major problem with risk assessment of chemicals is the extrapolation of laboratory single-species toxicity tests, which oversimplify the actual field situation by ignoring species interactions, to natural communities. The authors tested if the bioavailability-normalized 5% hazardous concentration (HC5) estimated from chronic planktonic single-species toxicity data (HC5 plankton ) for zinc (Zn) is protective for a plankton community and investigated the direct and indirect effects of Zn (at HC5 and HC50) on a freshwater community's structure and function. Microcosms were exposed to 3 different Zn concentrations (background, HC5 plankton  = 75 μg Zn/L and HC50 plankton  = 300 μg Zn/L) for 5 wk. The planktonic groups revealed a consistent no-observed-effect concentration for the community of 75 μg Zn/L, similar to or higher than the HC5 plankton , thus suggesting its protectiveness in the present study. At 300 μg Zn/L a significant reduction in cladocerans resulted in increases of rotifer, ciliate, and phytoplankton abundance. In addition, the phytoplankton community shifted in dominance from grazing-resistant to edible species. Contrary to the species sensitivity distribution (SSD) prediction, which identified phytoplankton as the most sensitive group, only the total chlorophyll and the abundance of 2 phytoplankton species were adversely affected at 300 μg Zn/L. Thus, although the HC5 estimated from the bioavailability-normalized SSD was overall protective for the plankton community, the SSD was not able to correctly predict the species sensitivity ranking within their community context at the HC50. Environ Toxicol Chem 2016;35:2698-2712. © 2016 SETAC., (© 2016 SETAC.)

Although it is increasingly recognized that biotic ligand models (BLMs) are valuable in the risk assessment of metals in aquatic systems, the use of 2 differently structured and parameterized BLMs (1 in the United States and another in the European Union) to obtain bioavailability-based chronic water quality criteria for copper is worthy of further investigation. In the present study, the authors evaluated the predictive capacity of these 2 BLMs for a large dataset of chronic copper toxicity data with 2 Daphnia magna clones, termed K6 and ARO. One BLM performed best with clone K6 data, whereas the other performed best with clone ARO data. In addition, there was an important difference between the 2 BLMs in how they predicted the bioavailability of copper as a function of pH. These modeling results suggested that the effect of pH on chronic copper toxicity is different between the 2 clones considered, which was confirmed with additional chronic toxicity experiments. Finally, because fundamental differences in model structure between the 2 BLMs made it impossible to create an average BLM, a generalized bioavailability model (gBAM) was developed. Of the 3 gBAMs developed, the authors recommend the use of model gBAM-C(uni), which combines a log-linear relation between the 21-d median effective concentration (expressed as free Cu(2+) ion activity) and pH, with more conventional BLM-type competition constants for sodium, calcium, and magnesium. This model can be considered a first step in further improving the accuracy of chronic toxicity predictions of copper as a function of water chemistry (for a variety of Daphnia magna clones), even beyond the robustness of the current BLMs used in regulatory applications., (© 2015 SETAC.)

Although multi-disciplinary cooperation between professionals is a prerequisite to provide integrated care in the community, this seems hard to realise in practice. Yet, little is known about the experiences of professionals who implement it nor about the organisational features professionals identify as empowering during this cooperation process. Therefore, a case study of a multi-disciplinary geriatric team was performed. The data-collection included observations of meetings, in-depth interviews and focus groups with professionals (N = 12). Data were analysed inductively and related to the three organisational levels within the model of organisational empowerment of Peterson and Zimmerman. Signs of empowering organisational features on the intraorganisational level were mutual trust and clear working routines. On the interorganisational level important features included improved linkages between participating organisations and increased insight into each other's tasks. Tensions occurred relating to the inter- and the extraorganisational level. Professionals felt that the commitment of the management of involved organisations should be improved just as the capacity of the team to influence (local) policy. It is recommended that policymakers should not determine the nature of professional cooperation in advance, but to leave that to the local context as well as to the judgement of involved professionals., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky's salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others' perspective, and have a dialogue with each other, taking the life narrative of clients into account.