Zoekresultaten

Somatic symptoms, pain, catastrophizing and the association with disability among children with heritable connective tissue disorders

The aim of the present study was to investigate the nature and prevalence of nonspecific somatic symptoms, pain and catastrophizing in children with Heritable Connective Tissue Disorders (HCTD), and to determine their association with disability. This observational, multicenter study included 127 children, aged 4–18 years, with Marfan syndrome (MFS) (59%), Loeys-Dietz syndrome (LDS) (8%), Ehlers-Danlos syndromes (EDS) (12%) and hypermobile Ehlers-Danlos syndrome (hEDS) (23%). The assessments included the Children's Somatization Inventory or parent proxy (CSI, PCSI), pain visual-analogue scale (VAS), SUPERKIDZ body diagram, Pain Catastrophizing Scale Child or parent proxy (PCS-C, PCS-P) and Childhood Health Assessment Questionnaire (CHAQ-30). Data from children aged ≥8 years were compared to normative data. In children ≥ 8 years (n = 90), pain was present in 59%, with a median of 4 (IQR = 3–9) pain areas. Compared to normative data, the HCTD group reported significantly higher on the CSI (p ≤ 0.001, d = 0.85), VAS pain intensity (p ≤ 0.001, d = 1.22) and CHAQ-30 (p ≤ 0.001, d = 1.16) and lower on the PCS-C (p = 0.017, d = −0.82) and PCS-P (p ≤ 0.001, d = −0.49). The intensity of nonspecific somatic symptoms and pain explained 45% of the variance in disability (r2 = 0.45 F(2,48) = 19.70, p ≤ 0.001). In children ≤ 7 years (n = 37), pain was present in 35% with a median of 5(IQR = 1–13) pain areas. The mean(SD) VAS scores for pain intensity was 1.5(2.9). Functional disability was moderately correlated to the number of pain areas (r = 0.56, p ≤ 0.001), intensity of nonspecific somatic symptoms (r = 0.63, p ≤ 0.001) and pain (r = 0.83, p ≤ 0.001). In conclusion, this study supports the need for comprehensive assessment of nonspecific somatic symptoms, pain, and disability in children with HCTD to allow tailored treatment.

Particulate matter in the workplace: effects of a mental models-based folder combined with a practical assignment

Background: With increasing knowledge on the adverse health efects of certain constituents of PM (particulate matter), such as silica, metals, insoluble ions, and black carbon, PM has been under the attention of work safety experts. Previously, we investigated the perceptions of blue-collar workers in highly exposed areas of work. Subsequently, we developed an instruction folder highlighting the most important aspects of PM risk and mitigation, and tested this folder in a digital experiment. The digital experiment yielded positive results with regards to acquired knowledge about PM, but did not on risk perception or safety behavior. Methods: In this study, we investigate the efects of the folder when combined with a practical assignment involving a PM exposimeter, showing the amount of particulate matter in microgram per cubic meter in real time on its display for various activities. We tested this at six workplaces of four companies in the roadwork and construction branch. Results: The results indicate that the folder itself yields an increased knowledge base in employees about PM, but the efects of the practical assignment are more contentious. Nevertheless, there is an indication that using the assignment may lead to a higher threat appraisal among employees for high exposure activities. Conclusion: We recommend implementing our folder in companies with high PM exposure and focusing further research on appropriate methods of implementation.

Development and usability of educational material about workplace particulate matter exposure

Background: Particulate matter (PM) exposure is an important health risk, both in daily life and in the workplace. It causes respiratory and cardiovascular diseases and results in 800,000 premature deaths per year worldwide. In earlier research, we assessed workers’ information needs regarding workplace PM exposure, the properties and effects of PM, and the rationale behind various means of protection. We also concluded that workers do not always receive appropriate risk communication tools with regards to PM, and that their PM knowledge appears to be fragmented and incomplete. Methods: We considered several concepts for use as an educational material based on evaluation criteria: ease of use, costs, appropriateness for target audiences and goals, interactivity, implementation issues, novelty, and speed. We decided to develop an educational folder, which can be used to inform employees about the properties, effects and prevention methods concerning PM. Furthermore, we decided on a test setup of a more interactive way of visualisation of exposure to PM by means of exposimeters. For the development of the folder, we based the information needs on our earlier mental models-based research. We adjusted the folder based on the results of ten semi-structured interviews evaluating its usability. Results: The semi-structured interviews yielded commentaries and suggestions for further improvement, which resulted in a number of alterations to the folder. However, in most cases the folder was deemed satisfactory. Conclusion: Based on this study, the folder we developed is suitable for a larger-scale experiment and a practical test. Further research is needed to investigate the efficacy of the folder and the application of the exposimeter in a PM risk communication system.

Negotiating (dis)ability in the context of chronic pain rehabilitation

Chronic pain rehabilitation programs are aimed at helping patients to increase their functioning despite being in pain, thereby improving their quality of life. However, conversations between patients and practitioners about how the patient could deal with his/her pain and pain-related disabilities in a different way can be interactionally challenging. This study adopts a discursive psychological perspective to explore how pain-related disability is negotiated by patients and practitioners during consultations. The analysis shows that pain-related disability is treated by both patients and practitioners as negotiable rather than a fixed reality. Moreover, it shows that patients’ and practitioners’ negotiations of disability are subject to issues of agency, accountability, and blame, and it provides insight into the interactional dilemmas that are at stake, both for patients and practitioners. Revalidatieprogramma’s voor patiënten met chronische pijn zijn gericht op het verbeteren van het functioneren ondanks de pijn, waardoor kwaliteit van leven wordt bevorderd. Conversaties tussen patiënten en behandelaars over de manier waarop de patiënt kan omgaan met de pijn en gerelateerde beperkingen kunnen interactionele uitdagingen met zich meebrengen. Dit hoofdstuk verkent vanuit discursief-psychologisch perspectief hoe beperkingen worden onderhandeld door patiënten en behandelaars in consulten. De analyse toont aan dat de beperkingen worden behandeld als onderhandelbaar in plaats van als een onveranderbare werkelijkheid. Bovendien toont de analyse dat in deze onderhandelingen bepaalde issues relevant worden gemaakt, zoals ‘agency’, verantwoordelijkheid en schuld. Inzicht wordt geboden in de interactionele dilemma’s die op het spel staan voor zowel patiënten als behandelaars.

Simulating Small-Scale Agricultural Adaptation Decisions in Response to Drought Risk: An Empirical Agent-Based Model for Semi-Arid Kenya

In Eastern Africa, increasing climate variability and changing socioeconomic conditions are exacerbating the frequency and intensity of drought disasters. Droughts pose a severe threat to food security in this region, which is characterized by a large dependency on smallholder rain-fed agriculture and a low level of technological development in the food production systems. Future drought risk will be determined by the adaptation choices made by farmers, yet few drought risk models … incorporate adaptive behavior in the estimation of drought risk. Here, we present an innovative dynamic drought risk adaptation model, ADOPT, to evaluate the factors that influence adaptation decisions and the subsequent adoption of measures, and how this affects drought risk for agricultural production. ADOPT combines socio-hydrological and agent-based modeling approaches by coupling the FAO crop model AquacropOS with a behavioral model capable of simulating different adaptive behavioral theories. In this paper, we compare the protection motivation theory, which describes bounded rationality, with a business-as-usual and an economic rational adaptive behavior. The inclusion of these scenarios serves to evaluate and compare the effect of different assumptions about adaptive behavior on the evolution of drought risk over time. Applied to a semi-arid case in Kenya, ADOPT is parameterized using field data collected from 250 households in the Kitui region and discussions with local decision-makers. The results show that estimations of drought risk and the need for emergency food aid can be improved using an agent-based approach: we show that ignoring individual household characteristics leads to an underestimation of food-aid needs. Moreover, we show that the bounded rational scenario is better able to reflect historic food security, poverty levels, and crop yields. Thus, we demonstrate that the reality of complex human adaptation decisions can best be described assuming bounded rational adaptive behavior; furthermore, an agent-based approach and the choice of adaptation theory matter when quantifying risk and estimating emergency aid needs.

Traumabehandeling bij kinderen met een licht verstandelijke beperking : Naar een methodiek voor de behandeling van getraumatiseerde kinderen en jongeren met een licht verstandelijke beperking.