Introduction: Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context. Methods and analysis: The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results. Ethics and dissemination: No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences.
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For delayed and long-term students, the education process is often a lonely journey. The main conclusion of this research is that learning should not be an individual process of the student connected to one lecturer, but rather a community where learning is a collective journey. The social interaction between lecturers, groups of delayed students and other actors is an important engine for arriving at the new knowledge, insights and expertise that are important to reach their final level. This calls for the design of social structures and the collaboration mechanism that enable the bonding of all members in the community. By making use of this added value, new opportunities for the individual are created that can lead to study success. Another important conclusion is that in the design and development of learning communities, sufficient attention must be paid to cultural characteristics. Students who delay are faced with a loss of self-efficacy and feelings of shame and guilt. A learning community for delayed students requires a culture in which students can turn this experience into an experience of self-confidence, hope and optimism. This requires that the education system pays attention to language use, symbols and rituals to realise this turn. The model ‘Building blocks of a learning environment for long-term students’ contains elements that contribute to the study success of delayed and long-term students. It is the challenge for every education programme to use it in an appropriate way within its own educational context. Each department will have to explore for themselves how these elements can be translated into the actions, language, symbols and rituals that are suitable for their own target group.
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Cannabis is commonly characterized as the most normalized illicit drug. However, it remains a prohibited substance in most parts of the world, including Europe, and users can still be subject to stigmatization. The objective of this study is to assess to what extent and how cannabis users in different countries with different cannabis policies perceive, experience and respond to stigmatization. We conducted a survey in the Dutch coffeeshops among 1225 last year cannabis users from seven European countries, with national cannabis policies ranging from relatively liberal to punitive. Three dimensions of cannabis-related stigma were investigated (discrimination, perceived devaluation and alienation) and a sum score was used to reflect the general level of stigmatization. Perceived devaluation was the highest-scoring dimension of stigma and discrimination the lowest-scoring. The general level of stigmatization was lowest in the Netherlands and highest in Greece. This indicates that punitive cannabis policy is associated with stigma and liberal cannabis policy is associated with de-stigmatization. Besides country, daily cannabis use was also found to be a significant predictor of stigma, but gender, age, household type and employment status were not.
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