Zoekresultaten

The impact of scars on health-related quality of life after breast surgery: a qualitative exploration

Purpose The purpose of this research was to explore women’s experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). Material andmethods A qualitative study using semi-structured face-to-face interviewswas conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were “physical and sensory symptoms,” “impact of scar symptoms,” “personal factors,” “impact of scar interventions,” and “change over time.” Results The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. Conclusion Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. Implications for Cancer Survivors Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.

Noncollapsibility and its role in quantifying confounding bias in logistic regression

BackgroundConfounding bias is a common concern in epidemiological research. Its presence is often determined by comparing exposure effects between univariable- and multivariable regression models, using an arbitrary threshold of a 10% difference to indicate confounding bias. However, many clinical researchers are not aware that the use of this change-in-estimate criterion may lead to wrong conclusions when applied to logistic regression coefficients. This is due to a statistical phenomenon called noncollapsibility, which manifests itself in logistic regression models. This paper aims to clarify the role of noncollapsibility in logistic regression and to provide guidance in determining the presence of confounding bias.MethodsA Monte Carlo simulation study was designed to uncover patterns of confounding bias and noncollapsibility effects in logistic regression. An empirical data example was used to illustrate the inability of the change-in-estimate criterion to distinguish confounding bias from noncollapsibility effects.ResultsThe simulation study showed that, depending on the sign and magnitude of the confounding bias and the noncollapsibility effect, the difference between the effect estimates from univariable- and multivariable regression models may underestimate or overestimate the magnitude of the confounding bias. Because of the noncollapsibility effect, multivariable regression analysis and inverse probability weighting provided different but valid estimates of the confounder-adjusted exposure effect. In our data example, confounding bias was underestimated by the change in estimate due to the presence of a noncollapsibility effect.ConclusionIn logistic regression, the difference between the univariable- and multivariable effect estimate might not only reflect confounding bias but also a noncollapsibility effect. Ideally, the set of confounders is determined at the study design phase and based on subject matter knowledge. To quantify confounding bias, one could compare the unadjusted exposure effect estimate and the estimate from an inverse probability weighted model.

Dynamische verlichting in de zorg: de feiten

De interesse in licht is de afgelopen jaren enorm toegenomen. In het bijzonder betreft dit de invloed van licht op onze gezondheid, prestatie en andere, niet direct visueel gerelateerde aspecten. Het laatste heeft bijvoorbeeld tot gevolg gehad dat basisscholen momenteel op grote schaal uitgerust worden met dynamisch verlichting die de concentratie van scholieren zou verhogen, verlichting in kantoren die de prestatie van medewerkers moet verbeteren en verlichting voor ouderen met dementie die hun verstoorde slaapwaakritme kan stabiliseren. Maar de vraag is nu: hebben we wetenschappelijk bewijs dat deze systemen ook de beoogde claims halen? Dit artikel vraagt aandacht voor de feiten op het gebied van dynamische verlichting voor mensen met dementie en probeert deze van de fictie te onderscheiden.

Youth Work in the Netherlands. History and Future Direction.

Hoofdstuk in The history of youth work in Europe and its relevance for youth policy today. Youth work in the Netherlands goes back a long way and since the 1970s has taken on a rather strong professional image. During the last decades, it went through some hard times, but recently it has undergone a revival and revaluation. (Griensven & Smeets, 2003). The first section of this paper is about how the characteristics of the Dutch affect social work and youth work concepts. The second part discusses the Dutch framework for youth work: definition, fields of activities, core tasks and the ambiguous relationship between youth work and social work. The third section deals with the history of youth work. The paper concludes with a reflection on the future directions that youth work could take. The article is based on Dutch historical research, some by the author, and the author’s involvement in youth work, both as a youth worker and editor- in- chief of the semi-scientific journal Jeugd en samenleving.

De ondersteuningsroute bewegen en motoriek

Wie heeft de prijs gewonnen?

In 1524 publiceert Jan van Doesborch een bundel met refereynen. Een ervan gaat over een schetenwedstrijd tussen begijnen. Dit refereyn heb ik op 16e-eeuwse wijze voorgedragen op 21e-eeuwse muziek: http://itunes.apple.com/nl/album/wie-heeft-de-prijs-gewonnen-1/id512331302?i=512331322&ign-mpt=uo%3D4