Across all health care settings, certain patients are perceived as ‘difficult’ by clinicians. This paper’s aim is to understand how certain patients come to be perceived and labelled as ‘difficult’ patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among ‘difficult’ patients, and three case studies of ‘difficult’ patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The ‘difficult’ patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient’s behaviours is made. The status of ‘difficult’ patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into ‘difficult’ or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients’ contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here.
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This article presents the life stories of four older women in Vienna in order to better understand the role of occupation in the course of ageing. A qualitative life-story method in the narrative tradition was used as a design of this multiple case study. The stories presented extend beyond an illness or deficit narrative and contribute to a more multifaceted narrative of the subjective experience of ageing in occupational terms in connection with identity. The women did not perceive themselves as old or sick despite problems in mobility, the presence of chronic disease and advanced age. This was associated with their engagement in occupation that was meaningful and linked to their identity. Engaging occupation is the means to continue, test, and adapt to the ageing self. Because occupation is like a litmus-test of one's identity and capacities, the women used it as a measure of change while ageing. Using Atchley's continuity theory, the attempt of the four older women to maintain a balance between adapting and struggling to continue their occupations is discussed in relation to their identity. The results expand Atchley's continuity theory by adding an occupational perspective.
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In the literature about web survey methodology, significant e orts have been made to understand the role of time-invariant factors (e.g. gender, education and marital status) in (non-)response mechanisms. Time-invariant factors alone, however, cannot account for most variations in (non-)responses, especially fluctuations of response rates over time. This observation inspires us to investigate the counterpart of time-invariant factors, namely time-varying factors and the potential role they play in web survey (non-)response. Specifically, we study the effects of time, weather and societal trends (derived from Google Trends data) on the daily (non-)response patterns of the 2016 and 2017 Dutch Health Surveys. Using discrete-time survival analysis, we find, among others, that weekends, holidays, pleasant weather, disease outbreaks and terrorism salience are associated with fewer responses. Furthermore, we show that using these variables alone achieves satisfactory prediction accuracy of both daily and cumulative response rates when the trained model is applied to future unseen data. This approach has the further benefit of requiring only non-personal contextual information and thus involving no privacy issues. We discuss the implications of the study for survey research and data collection.
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This paper explores whether constitutional litigation contributes to sustaining the equity element of the right to health. Equity entails a fair distribution of the burden of healthcare financing across the different socio-economic groups of the population. A shift towards uncontrolled private healthcare provision and financing raises equity challenges by disproportionately benefitting those who are able to afford such services. The extent to which equity is enforced is an indicator of the strength of the right to health. However, do domestic constitutional courts second-guess, based on equity, policy decisions that impact on healthcare financing? Is it the task of constitutional courts to scrutinize such policy decisions? Under what conditions are courts more likely to do so? The paper addresses these questions by focusing on the case of Hungary, where the right to health has been present in the Fundamental Law adopted in 2010 and the Constitutions preceding it. While the Hungarian Constitutional Court has been traditionally cautious to review policy decisions pertaining to healthcare financing, the system has been struggling with equity issues and successive government coalitions have had limited success in tackling these. The paper discusses the role of constitutional litigation in addressing such equity concerns. In doing so, it contributes to the discussion on the role of domestic constitutional courts in the protection of social and economic rights.
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Het verzuim en de instroom in de WIA als gevolg van een psychische aandoening zijn hoog. Dat komt niet alleen door de aandoening, maar ook doordat werknemers met een psychische aandoening daar vaak niet open over durven te zijn. Ze zijn bijvoorbeeld bang dat collega’s en leidinggevenden hen buitensluiten of dat ze hun baan verliezen, als bekend wordt wat er aan de hand is. Deze angst is terecht want er bestaan veel vooroordelen over werken met een psychische aandoening en er is sprake van stigmatisering. Het gevolg van niet-open erover zijn is echter dat de werkgever er ook geen rekening mee kan houden. Veel medewerkers met een psychische aandoening staan er daardoor alleen voor, lopen op hun tenen of gaan onderpresteren. Eventuele klachten worden daardoor erger. Werkgevers en HR-professionals kunnen daar wat aan doen. In dit artikel bespreken Aukje Smit, Dorien Verhoeven en Tinka van Vuuren de vooroordelen, de benodigde maatregelen en de strategieën om werkgevers (en dus ook HR-professionals) in beweging te krijgen aan de hand van een literatuuronderzoek naar stigmatisering van werkenden met een psychische aandoening
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Background Running-related injuries (RRIs) can be considered the primary enemy of runners. Most literature on injury prediction and prevention overlooks the mental aspects of overtraining and under-recovery, despite their potential role in injury prediction and prevention. Consequently, knowledge on the role of mental aspects in RRIs is lacking. Objective To investigate mental aspects of overtraining and under-recovery by means of an online injury prevention programme. Methods and analysis The ‘Take a Mental Break!’ study is a randomised controlled trial with a 12 month follow-up. After completing a web-based baseline survey, half and full marathon runners were randomly assigned to the intervention group or the control group. Participants of the intervention group obtained access to an online injury prevention programme, consisting of a running-related smartphone application. This app provided the participants of the intervention group with information on how to prevent overtraining and RRIs with special attention to mental aspects. The primary outcome measure is any self-reported RRI over the past 12 months. Secondary outcome measures include vigour, fatigue, sleep and perceived running performance. Regression analysis will be conducted to investigate whether the injury prevention programme has led to a lower prevalence of RRIs, better health and improved perceived running performance. Ethics and dissemination The Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands, has exempted the current study from ethical approval (reference number: NL64342.041.17). Results of the study will be communicated through scientific articles in peer-reviewed journals, scientific reports and presentations on scientific conferences.
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Young professional dancers find themselves in a demanding environment. GJH within dancers is often seen as aesthetically beneficial and a sign of talent but was found to be potentially disabling. Moreover, high-performing adolescents and young adults (HPAA), in this specific lifespan, might be even more vulnerable to anxiety-related disability. Therefore, we examined the development of the association between the presence of Generalized Joint Hypermobility (GJH) and anxiety within HPAA with a one-year follow-up. In 52.3% of the HPAA, anxiety did not change significantly over time, whereas GJH was present in 28.7%. Fatigue increased significantly in all HPAA at one year follow-up (respectively, females MD (SD) 18(19), p < 0.001 and males MD (SD) 9(19), p < 0.05). A significantly lower odds ratio (ß (95% CI) 0.4 (0.2–0.9); p-value 0.039) for participating in the second assessment was present in HPAA with GJH and anxiety with a 55% dropout rate after one year. This confirms the segregation between GJH combined with anxiety and GJH alone. The fatigue levels of all HPAA increased significantly over time to a serious risk for sick leave and work disability. This study confirms the association between GJH and anxiety but especially emphasizes the disabling role of anxiety. Screening for anxiety is relevant in HPAA with GJH and might influence tailored interventions.
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Background: Medically unexplained physical symptoms (MUPS) are a leading cause of reduced work functioning. It is not known which factors are associated with reduced work functioning in people with moderate MUPS. Insight in these factors can contribute to prevention of reduced work functioning, associated work-related costs and in MUPS becoming chronic. Therefore, the aim of this study was to identify which demographic and health-related factors are associated with reduced work functioning, operationalized as impaired work performance and absenteeism, in people with moderate MUPS. Methods: Data of 104 participants from an ongoing study on people with moderate MUPS were used in this cross-sectional study. Ten independent variables were measured at baseline to determine their association with reduced work functioning: severity of psychosocial symptoms (four domains, measured with the Four-Dimensional Symptom Questionnaire), physical health (RAND 36-Item Health Survey), moderate or vigorous physical activity (Activ8 activity monitor), age, sex, education level and duration of complaints. Two separate multivariable linear regression analyses were performed with backward stepwise selection, for both impaired work performance and absenteeism. Results: Absenteeism rate rose with 2.5 and 0.6% for every increased point on the Four-Dimensional Symptom Questionnaire for domain 'depression' (B = 0.025, SE = 0.009, p = .006) and domain 'somatization' (B = 0.006, SE = 0.003, p = .086), respectively. An R2 value of 0.118 was found. Impaired work performance rate rose with 0.2 and 0.5% for every increased point on the Four-Dimensional Symptom Questionnaire for domain 'distress' (B = 0.002, SE = 0.001, p = .084) and domain 'somatization' (B = 0.005, SE = 0.001, p < .001), respectively. An R2 value of 0.252 was found. Conclusions: Severity of distress, probability of a depressive disorder and probability of somatization are positively associated with higher rates of reduced work functioning in people with moderate MUPS. To prevent long-term absenteeism and highly impaired work performance severity of psychosocial symptoms seem to play a significant role. However, because of the low percentage of explained variance, additional research is necessary to gain insight in other factors that might explain the variance in reduced work functioning even better.
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Hospitalisation is stressful for children. Play material is often offered for distraction and comfort. Weexplored how contact with social robot PLEO could positively affect a child’s well-being. To this end, we performed a multiple case study on the paediatric ward of two hospitals. Child life specialists offered PLEO as a therapeutic activity to children in a personalised way for a well-being related purpose in three to five play like activity sessions during hospital visits/stay. Robot–child interaction was observed; care professionals, children and parents were interviewed. Applying direct content analysis revealed six categories of interest: interaction with PLEO, role of the adults, preferences for PLEO, PLEO as buddy, attainment of predetermined goal(s) and deployment of PLEO. Four girls and five boys, aged 4–13, had PLEO offered as a relief from stress or boredom or for physical stimulation. All but one started interacting with PLEO and showed behaviours like hugging, caring or technical exploration, promoting relaxation, activation and/or making contact. Interaction with PLEO contributed to achieving the well-being related purpose for six of them. PLEO was perceived as attractive to elicit play. Although data are limited, promising results emerge that the well-being of hospitalised children might be fostered by a personalised PLEO offer.
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Onderzoeksplatform ‘Connected Learning: ’Al ruim vijftien jaar houdt De Haagse Hogeschool zich bezig met onderzoek als deel van haar missie. Terwijl onderwijs vaak geworteld is in monodisciplinaire vakgebieden, kan met onderzoek wat makkelijker gekeken worden naar domeinen in de samenleving (zorg, veiligheid, ondernemen, etc.) waarin complexe problematiek steeds vaker wél dan niet een multidisciplinaire aanpak vereist. Bijna niemand werkt nog alleen of met alleen vakgenoten aan problemen of uitdagingen. En die veranderende beroepspraktijk is bij uitstek het domein van het hoger beroepsonderwijs. Daar leiden we voor op. Het onderzoeken van en experimenteren met nieuwe uitdagingen in de praktijk verbindt ons sterker met de samenleving, het stelt ons in staat om ons beroepsonderwijs te vernieuwen en geeft docenten, onderzoekers en studenten de kans om zich te ontwikkelen door samen te werken aan vragen en uitdagingen die de toekomst van de beroepspraktijk vorm geven. Veel onderzoek wordt uitgevoerd onder begeleiding van lectoren die samenwerken met docent-onderzoekers, studenten, en professionals in het werkveld aan veelal meerjarige onderzoeksagenda’s die lijn aanbrengen in verschillende deelactiviteiten. Een van de manieren waarop De Haagse Hogeschool onderzoek organiseert is in de vorm van onderzoeksplatforms die zich richten op verschillende domeinen van de samenleving. Wij zijn ‘Connected Learning’, een onderzoeksplatform dat zich richt op leren in de netwerksamenleving - in de samenleving zelf, maar ook in de beroepspraktijk en in ons onderwijs. Aangenaam. Wat wij doen? Daar gaat dit boek over, dus daar verklappen we hier nog niets over. Wat verwacht u als u nadenkt over onze naam? Enig idee? Geen idee? Benieuwd? Lees verder om te ontdekken wat ons inspireert, uitdaagt en nieuwsgierig maakt. Sommige van onze ideeën zijn doordacht en doorleefd omdat we er al jaren onderzoek naar doen, andere zijn nieuw en dagen ons uit om er grip op te krijgen. Wij geven met dit boek een beeld van waar we staan in 2018. Zie het als een eerste kennismaking, met de nadruk op ‘eerste’: we werken graag met veel en verschillende partners. Zie het als visitekaartje van onze onderzoeksagenda. We hopen van harte dat u zich als lezer uitgenodigd voelt om met ons samen op zoek te gaan—misschien wel naar een gezamenlijke toekomst. ‘Connected Learning’ Research Platform: For over fifteen years, The Hague University of Applied Sciences has been carrying out research as part of its mission. While education is often rooted in monodisciplinary subject areas, research allows for a broader look at areas of society (care, security, entrepreneurship etc.), where complex problems more often than not require a multidisciplinary approach. Today, barely anyone works on problems or challenges alone or solely with colleagues from within the same subject area. Universities of applied sciences are uniquely placed to deal with these changes in professional practices; after all, we train the professionals who will one day enter that field. Researching and experimenting with new challenges in professional practice allows us to connect more strongly with society, enables us to be innovative in our professional training and gives lecturers, researchers and students the opportunity to develop themselves by cooperating on the challenges and issues that will shape the future of that professional practice. Most research is carried out under the guidance of professors who cooperate with lecturers/researchers, students and the professional field, mainly on long-term research agendas that provide an outline for various sub-activities. One of the ways in which research is organised at The Hague University of Applied Sciences is in the form of research platforms that focus on various areas of society. We are ‘Connected Learning’, a research platform focusing on learning in the network society — in that society as such, but also in professional practice and our education. Nice to meet you! So, what do we do? That’s what this book is about, so we’re not going to give anything away just yet. Just thinking about our name, what do you expect we do? Any ideas? Or not a clue at all? If you’d like to find out, keep reading to find out what inspires us, what challenges we face and what drives our curiosity. Some of our ideas are well-established because we’ve been researching them for years, while other, newer ideas are more challenging to grasp. This book provides an overview of where we stand in 2018. You could see it as an initial introduction, with the emphasis on “initial”; we work with many different partners, and we enjoy doing so. Alternatively, you could see it as a calling card for our research agenda. We sincerely hope that, as a reader, you feel encouraged to join us in our quest — possibly towards a joint future.
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