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The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown.
To investigate the frequency and risk factors for repeated emergency compulsory psychiatric admission (ECPA); and to identify targets for interventions to reduce repeated ECPA.
Data were collected from a database of electronic patient files (EPFs) held by three psychiatric emergency services (PES) in the Netherlands. Analyses were based on the data for adult patients (aged 18–75 years) with a first PES contact in 2010–2015. Using descriptive statistics and regression analysis, we studied the associations between baseline patient factors and repeated ECPA and time to readmission, within a 2-year follow-up period.
We included 6059 patients: 15.6% had two or more ECPAs. In total, 66% of second ECPAs had occurred within 6 months of the first. About 30% of all ECPAs were repeated ECPAs. Two baseline factors were associated with a higher frequency of a second ECPA: history of receiving any mental healthcare treatment, whether in-patient or out-patient or both, and a lower level of self-care. Three were associated with a lower frequency: ethnicity (other than Dutch), older age and suicidality. Lower Global Assessment of Functioning (GAF) scores and housing problems were associated with a shorter time to compulsory readmission and persistent psychiatric problems with a longer time to compulsory readmission.
We found that 15.6% of patients had two or more ECPAs. Two-thirds of the second ECPAs had occurred within 6 months of the first. Like earlier studies, the risk factors we identified suggest that interventions to reduce the risk of repeated compulsory psychiatric admission should seek to improve self-care, general daily functioning and homelessness.
In the past, food-based dietary guidelines (FBDGs) were derived nearly exclusively by using systematic reviews on diet–health relationships and translating dietary reference values for nutrient intake into foods. This approach neglects many other implications that dietary recommendations have on society, the economy and environment. In view of pressing challenges, such as climate change and the rising burden of diet-related diseases, the simultaneous integration of evidence-based findings from different dimensions into FBDGs is required. Consequently, mathematical methods and data processing are evolving as powerful tools in nutritional sciences. The possibilities and reasons for the derivation of FBDGs via mathematical approaches were the subject of a joint workshop hosted by the German Nutrition Society (DGE) and the Federation of European Nutrition Societies (FENS) in September 2019 in Bonn, Germany. European scientists were invited to discuss and exchange on the topics of mathematical optimisation for the development of FBDGs and different approaches to integrate various dimensions into FBDGs. We concluded that mathematical optimisation is a suitable tool to formulate FBDGs finding trade-offs between conflicting goals and taking several dimensions into account. We identified a lack of evidence for the extent to which constraints and weights for different dimensions are set and the challenge to compile diverse data that suit the demands of optimisation models. We also found that individualisation via mathematical optimisation is one perspective of FBDGs to increase consumer acceptance, but the application of mathematical optimisation for population-based and individual FBDGs requires more experience and evaluation for further improvements.
The area of individual leaves in oil palm has been conventionally estimated from a regression equation that is based on the size and number of leaflets. The aim of the present study is to verify the accuracy of this equation, which became standard in oil palm research. Therefore, true leaf area, measured with a video camera, was estimated from the product of number of leaflets per leaf (n) with mean length (l) times mid-width (w) of six of the longest leaflets (nlw). The database was assembled, annually for the first 4 years after planting, from 2961 leaves of dura × pisifera testcrosses descending from six distinct pisifera origins. The regression coefficients of the regression lines of nlw plotted against true area did not show a trend with age of the palms or a difference among pisifera origins. The common regression equation fitted through all data of this study accurately estimated true leaf area of the testcrosses and also the areas of 2- to 3.5-year-old dura palms of three distinct origins as well as 18-year-old tenera palms. These outcomes are at odds with the conventional regression equation that overestimates the true leaf areas by about 24%. A more recently-developed variant underestimates true area of the young tenera and dura palms by 28%, while overestimating true area of old tenera palms by 19%. Possible causes for these deviations from true area are discussed. The paper argues that parameters depending on leaf area of previous physiological studies need to be reassessed.
The Younger Dryas cold period caused major changes in vegetation and depositional environments. This study focuses on the aeolian river-connected dunes along the former, Weichselian Late Glacial, course of the Scheldt River in the southern Netherlands. Aeolian dunes along the Scheldt have received little attention, as they are partly covered by Holocene peat and marine deposits. The spatial distribution of the dunes is reconstructed by digital elevation model analysis and coring transects. Dunes are present on the high eastern bank of the Scheldt and in the subsurface of the polder area west of the Brabantse Wal escarpment. A reach-specific higher channel gradient probably caused a channel pattern change from meandering to braiding during the Younger Dryas. This enabled deflation from the braid plain and accumulation in source-bordering river dunes east of the incised and terraced, subsurface Late Pleistocene Scheldt valley. The age of the dune formation is established by pollen analysis and radiocarbon dating of underlying and overlying peat beds. The peat layer below the dune at Zomerbaan is attributed to the Allerød and early Younger Dryas periods. Dune formation occurred predominantly during the second part of the Younger Dryas stadial, both on and in front (west) of the Brabantse Wal escarpment. Wind direction was reconstructed by geomorphic analysis and sedimentary structures on lacquer peels. A southwesterly wind direction is demonstrated by the parabolic dune morphology. For the first time, Younger Dryas wind direction is reconstructed based on adhesion ripple cross-laminated sets on lacquer peels. Sand-transporting south-southwesterly winds were dominant during the Younger Dryas, most likely during summer.
We investigated the impact of recent caffeine drinking on glucose and other biomarkers of cardiometabolic function under free-living conditions while also accounting for lifestyle and genetic factors that alter caffeine metabolism and drinking behaviour. Up to 447 794 UK Biobank participants aged 37–73 years in 2006–2010 provided a non-fasting blood sample, for genetic and biomarker measures, and completed questionnaires regarding sociodemographics, medical history and lifestyle. Caffeine drinking (yes/no) about 1 h before blood collection was also recorded. Multivariable regressions were used to examine the association between recent caffeine drinking and serum levels of glycated Hb, glucose, lipids, apo, lipoprotein(a) and C-reactive protein. Men and women reporting recent caffeine drinking had clinically and significantly higher glucose levels than those not recently drinking caffeine (P < 0·0001). Larger effect sizes were observed among those 55+ years of age and with higher adiposity and longer fasting times (P ≤ 0·02 for interactions). Significant CYP1A2 rs2472297×caffeine and MLXIPL rs7800944 × caffeine interactions on glucose levels were observed among women (P = 0·004), with similar but non-significant interactions in men. Larger effect sizes were observed among women with rs2472297 CC or rs7800944 CC genotypes than among rs2472297 T or rs7800944 T carriers, respectively. In summary, men and women drinking caffeine within about 1 h of blood draw had higher glucose levels than those not drinking caffeine. Findings were modified by age, adiposity, fasting time and genetic factors related to caffeine metabolism and drinking behaviour. Implications for clinical and population studies of caffeine-containing beverages and cardiometabolic health are discussed.
Early identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors.
To develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups.
The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered.
The six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value.
The Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.
Over the past decade in the Netherlands, most operators have only developed a single doublet. The learning effect from these single events is suboptimal, and operators have only been capable of developing doublets in areas with relatively low exploration risk. This ‘stand-alone’ approach can be significantly improved by a collective approach to derisk regions with similar subsurface characteristics. Such a play-based portfolio approach, which is common in the oil and gas industry, can help to accelerate the development of the geothermal industry through unlocking resource potential in areas marked by high upfront geological risk, effectively helping reduce costs for the development. The basis of the methodology is to deploy new information to the play portfolio by trading off with the risk of the first wells, resulting in a strong geological risk reduction.
The added value of the portfolio approach is demonstrated for the Netherlands in this paper through a comparison with a ‘stand-alone’ development. In the stand-alone approach, each new project will be equally risky, and therefore relatively unprofitable. In the case of a portfolio approach, all experience about the play is used optimally for derisking. In case of success, subsequent projects will have a higher chance of being successful, due to the experience gained in previous projects. Even if a project fails, this may help in increasing the probability of success for subsequent projects. For plays that are initially considered too risky for the market to start developing, the value of information (VoI) of a play-based portfolio approach will help by derisking the play to such an extent that it becomes attractive for the market to develop, even at high initial risk. It can be demonstrated for several geothermal plays in the Netherlands that by adopting the portfolio approach, the probability of a play being developed becomes higher, the number of successfully developed projects increases and the average profitability of the project will also be higher. Five more advantages are: (1) continuous improvement by integrated project development, (2) cost reduction through synergy, efficiency and standardisation, (3) optimisation of the surface heat demand and infrastructure, (4) the possibility of structural research and development (R&D) and innovation, and (5) financing advantages. The advantages reinforce each other.
A preliminary estimate of the geothermal potential of the Netherlands adopting the portfolio approach is between 90 and 275 Petajoules (PJ). For about 350 doublets being developed, producing about 70 PJ, the value of the advantage of the play-based portfolio approach is €2 billion for the three main plays: Rotliegend, Triassic and Jurassic/Cretaceous. The learning effects of synergy, efficiency and standardisation are expected to be significant.
In this lecture, an overview will be given of the literature concerning treatment for comorbid diabetes and depression. A systematic review and analysis will be presented. It turns out that, although many clinicians and researchers find this an important subject of research, and although the clinical implications of such research seem obvious, randomized clinical trials evaluating effectiveness of treatment are scarce and often the numbers of patients included are small. However, all RCTs point in the direction of efficacy of treatment of this combined condition in terms of combined impact. Severity of depressive symptoms and glycemic control are most often used as outcome measures. Psychotherapeutic interventions show a moderate to large effect on both ; antidepressant treatment as well as collaborative care show moderate effects on depressive symptom severity. The clinical, public health and research implications of these findings will be discussed.
In the Netherlands, the Depression Initiative has been launched in 2006 as a nationwide attempt to implement the Multidisciplinary Guideline for Depression and to evaluate its cost effectiveness. Evaluation of a collaborative stepped care model in several health care settings is one of the objectives of the Depression Initiative. Currently a stepped collaborative care project is being evaluated in the primary care setting, evaluating stepped collaborative care for depressive disorder provided by the primary care practitioner, a nurse-care-manager, and a consultant psychiatrist, in a Randomised Controlled Trial. 150 Patients with depressive disorder are offered a treatment plan. They can choose from two options: Problem Solving Treatment with or without antidepressant treatment. The medication is prescribed by the PCP, PST and monitoring is provided by the care manager, and the psychiatrist can be consulted every 6 weeks in order to see if the intervention is sufficient to improve the symptoms of the patient. The PHQ is used for monitoring. A two step approach is aimed at; if the patient does not achieve remission after 18 weeks, the patient is referred to mental health care. This stepwise approach is supported by a training and supervision program and by a web-based tracking system in which the care-manager and the patient can monitor progress and consult the psychiatrist. This approach is compared with Care As Usual in the primary care setting. In the presentation, preliminary results will be presented.
In the Netherlands, the Depression Initiative has been launched in 2006 as a nationwide attempt to implement the Multidisciplinary Guideline for Depression and to evaluate its cost effectiveness. An evaluation of the selected strategy to implement the guidelines, a Breakthrough Collaborative, was conducted as a quasi experimental trial. The intervention group consisted of around 530 patients coming from 10 multidisciplinary teams in primary care. The intervention teams received a set of implementation strategies, as part of the Breakthrough Method, developed by the Institute for Healthcare Improvement (www.ihi.org). The aim of the participants in this implementation project was to implement guideline recommendations directed at a reduction of unnecessary antidepressant treatment for patients with mild depression, better use of effective, but minimally invasive treatment options and improved antidepressant and psychotherapeutic treatment for patients with severe symptoms. Monitoring depression severeness was also one of the goals. This guideline derived, stepped care approach was compared to Care As Usual in the primary care setting, as provided in a different study group (NESDA). Outcomes were measured in terms of quality of care provided by the general practitioner (antidepressant prescription rates) and clinical outcomes (BDI, IDS-SR, WHODAS). A process evaluation and simple economic evaluation was part of the study design. In the presentation, preliminary results will be presented.
There is a high frequency of attendance at emergency medical service for suicide attempts.
Determine the type of urgency for suicide attempt in our country.
Material and methods
The present study treats of suicide attempts (n = 248) attended by the Psychiatric Emergency Service of Hospital in our city between 2004–2008. The diagnoses were made by clinical interview following ICD-10 criteria.
248 suicide attempts (60% women), with age between 15 and 88 years.There are equal proportions of singles and married (a 38%). 53% live with couple with/without children, 30%live with parents and a 10%live alone. >55% of patients have a middle education and socioeconomic level. The average time from suicide attempt until the assessment in the emergency department is 2.71 ± 3.64 hours. The day of the week with more assistance for this reason is Monday. Also it's observed an increase in the months between May and October. The cases are uniformly distributed throughout the month, although there is a decrease in the number of cases in the initial and final days of the month. 60% of patients haven’t history of previous attempts and use an only method that is drug overdose. Personality disorders are the most frequent diagnose and 44% patients need an internment in a psychiatric ward.
Profile of the patient who makes a suicide attempt and that is evaluated in the Psychiatric Emergency Service of our Hospital: woman 36 years old, married/with couple and lives with him/her. She comes to emergency department in the first 4 hours after the drug overdose. She hasn’t history of previous attempts.She is diagnosed of emotionally unstable personality disorder.
Ensuring appropriate review, approval, and oversight of research involving animals becomes increasingly complex when researchers collaborate across multiple sites. In these situations, it is important that the division of responsibilities is clear and that all involved parties share a common understanding. The National Institutes of Health Office of Laboratory Animal Welfare and the United States Department of Agriculture Animal Plant Health Inspection Service require an Institutional Animal Care and Use Committee (IACUC) to review the care and use of animals in research, and both agree that it is acceptable for one IACUC to review the work taking place at multiple institutions. With this in mind, several Harvard-affiliated hospitals and academic centers developed the Master Reciprocal Institutional Agreement for Animal Care and Use (Master IACUC Agreement) to support collaboration, decrease administrative burden, increase efficiencies, reduce duplicative efforts, and ensure appropriate protections for animals used in research. Locally, the Master IACUC Agreement has fostered greater collaboration and exchange while ensuring appropriate review and oversight of research involving animals. As multisite animal protocols become more prevalent, this Agreement could provide a model for a distributed, national network of IACUC reliance.
Educating cooking skills through applying healthy recipes is an effective intervention to stimulate healthy diets. The Netherlands Nutrition Centre applies this strategy by distributing recipes via websites, recipe books, and newsletters. The recipe database exists of 1891 recipes of which 1188 are main courses. In 2018, the recipes website was consulted through 338.598 unique pageviews. Healthier diets tend to be also more sustainable. This study analyses the climate impact of the recipes and its relationship with recipe characteristics.
materials and methods
1188 main courses were analysed on their popularity (top 100 > 500 pageviews/y), climate impact, vegetarian or not, preparation time (< 15 minutes, 15–30 min, > 30 min), price (‘budget’ < €2.25 pp), kilocalorie content (low < 525kcal) and nutrient density. The environmental impact was calculated by summing the greenhouse gas emissions (GHGE) of the ingredients (CO2eq-ingr) and of the energy used for preparation (CO2eq-prep), together CO2eq-tot. Recipes with GHGE lower than 1300 g CO2eq-tot were labelled as ‘Klimaatkanjer’ (climate topper). Nutrient density was estimated with the Sustainable Nutrient-Rich Foods index (SNRF). Differences between recipe groups (t-test and Chi-square) and regressions (ANOVA) between characteristics were statistically analysed.
The average GHGE of the recipes is per person 1365 g CO2eq-ingr plus 200 g CO2eq-prep (1566 g CO2eq-tot). Popular recipes do not differ significantly from average (1680g). ‘Klimaatkanjer’ (754 versus 2277g), vegetarian (812 vs 2132g), nutrient-dense (SNRF > 1; 1087 vs 1880g), fish (1483 vs 2604 g meat), budget (1312 vs 1695g), and low-calorie recipes (1486 vs 1653g) have significant lower GHGE. The longer the preparation time, the higher GHGE. Popular recipes are more often budget (p = 0.01) and less often low-calorie (p = 0.03), but they do not significantly differ in vegetarian (p = 0.14), ‘Klimaatkanjer’ (p = 0.15), nutrient density (p = 0.09), or preparation time (p = 0.06). Recipes show a positive correlation between GHGE and kcal (R = 0.313, p < 0.01), GHGE and protein content (R = 0.508,p < 0.01), GHGE and saturated fat content (R = 0.399, p < 0.01), and a negative between GHGE and SNRF (R = 0.188,p < 0.01). 90% of the healthy recipes has a positive SNRF, of which 36% SNRF > 1.
Healthy recipes are supposed to have a lower climate impact than unhealthy ones. But the climate impact of diets can be further reduced by choosing and promoting recipes that are highly nutrient-dense (SNRF > 1), (pesco-)vegetarian, affordable (< €2.25), low-calorie (< 525kcal) and/or quick to prepare (< 15min). Promoting affordable recipes as intervention is most promising because they are already more popular among Dutch consumers.
This article examines the cases of children born out of wedlock and adopted children with the aim of depicting the mechanisms through which the concepts of biological fatherhood, derived from the human-rights framework, and adoption, derived from the customary law framework, have been adopted into Indonesian Islamic family law. We argue that the introduction of external concepts into family law pertaining to Muslims requires an adaptation process in which the relation between these external concepts and core Islamic family law concepts is determined. In the case of children born out of wedlock, this adaptation to core Islamic norms means that biological fatherhood does not lead to a full legal father-child relationship, despite a 2012 Constitutional Court ruling establishing that children born out of wedlock have a civil relationship with their biological father. In the case of adoption, it means that there is no full adoption, despite recognition of customary adoptions under Indonesian law. We argue that in a context of strong support for a religion-based family law, reforms tend to take the form of conditions or exceptions to core religious concepts, as replacing these concepts altogether would be perceived as jeopardizing the religious character of the law. While attempts to replace core Islamic family law concepts will inevitably meet strong resistance, there is much more tolerance for introducing family law reforms that aim at changing the way that Islamic concepts are applied in practice.
Faults in the Roer Valley Rift System (RVRS) act as barriers to horizontal groundwater flow. This causes steep cross-fault groundwater level steps (hydraulic head differences). An overview of the size and distribution of fault-related groundwater level steps and associated fault zone permeabilities is thus far lacking. Such an overview would provide useful insights for nature restoration projects in areas with shallow groundwater levels (wijstgronden) on the foot wall of fault zones. In this review study, data on fault zone permeabilities and cross-fault hydraulic head differences were compiled from 39 sources of information, consisting of literature (starting from 1948), internal reports (e.g. from research institutes and drinking water companies), groundwater models, a geological database and new fieldwork. The data are unevenly distributed across the RVRS. Three-quarters of the data sources are related to the Peel Boundary Fault zone (PBFZ). This bias is probably caused by the visibility of fault scarps and fault-adjacent wet areas for the PBFZ, with the characteristic iron-rich groundwater seepage. Most data demonstrate a cross-fault phreatic groundwater level step of 1.0 to 2.5 m. Data for the Feldbiss Fault zone (FFZ) show phreatic cross-fault hydraulic head differences of 1.0 to 2.0 m. In situ measured hydraulic conductivity data (K) are scarce. Values vary over three orders of magnitude, from 0.013 to 22.1 m d−1, are non-directional and do not take into account heterogeneity caused by fault zones. The hydraulic conductivity (and hydraulic resistance) values used in three different groundwater models are obtained by calibration using field measurements. They also cover a large range, from 0.001 to 32 m d−1 and from 5 to 100,000 days. Heterogeneity is also not taken into account in these models. The overview only revealed locations with a clear cross-fault groundwater level step, and at many locations the faults are visible on aerial photographs as cropmarks or as soil moisture contrasts at the surface. Therefore, it seems likely that all faults have a reduced permeability, which determines the size of the groundwater level steps. In addition, our results show that cross-fault hydraulic head gradients also correlate with topographic, fault-induced offsets, for both the Peel Boundary and the Feldbiss fault zone.
Nosocomial outbreaks due to multidrug-resistant microorganisms in rehabilitation centers have rarely been reported. We report an outbreak of extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae (ESBL-K. pneumoniae) on a single ward in a rehabilitation center in Rotterdam, The Netherlands.
A 40-bed ward of a rehabilitation center in the Netherlands.
In October 2016, 2 patients were found to be colonized by genetically indistinguishable ESBL-K. pneumoniae isolates. Therefore, an outbreak management team was installed, by whom a contact tracing plan was made. In addition to general outbreak measures, specific measures were formulated to allow continuation of the rehabilitation process. Also, environmental cultures were taken. Multiple-locus variable-number tandem-repeat analysis and amplification fragment-length polymorphism were used to determine strain relatedness. Selected isolates were subjected to whole-genome multilocus sequence typing.
The outbreak lasted 8 weeks. In total, 14 patients were colonized with an ESBL-K. pneumoniae, of whom 11 patients had an isolate belonging to sequence type 307. Overall, 163 environmental cultures were taken. Several sites of a household washing machine were repeatedly found to be contaminated with the outbreak strain. This machine was used to wash lifting slings and patient clothing contaminated with feces. The outbreak was contained after taking the machine temporarily out of service and implementing a reinforced and adapted protocol on the use of this machine.
We conclude that in this outbreak, the route of transmission of the outbreak strain via the household washing machine played a major role.
The mediational sequence from body dissatisfaction through dieting to bulimia—often referred to as the “restraint pathway”—has been validated in numerous samples of adolescent girls, but the prevalence rate of bulimic pathology pales in comparison to rates of body dissatisfaction and dieting in this risk group. This discrepancy indicates that the restraint pathway may only apply to adolescent girls possessing certain characteristics or experiencing certain circumstances. Accordingly, the current study examined the moderating roles of thin-ideal internalization, interoceptive deficits, and age by using self-report data from a community sample of 353 middle school (n = 115), high school (n = 112), and college girls (n = 126). We found that (a) body-dissatisfied girls who reported high, versus low, thin-ideal internalization engaged in greater dietary restraint; (b) only dieters who reported high interoceptive deficits and were of college age expressed bulimic symptoms; and (c) the mediating effect pertained only to college girls with high interoceptive deficits, but was strongest for those who reported high, versus low, thin-ideal internalization. These results suggest that the restraint pathway's precision may be fine-tuned through greater sensitivity to potentiating factors and developmental context. Theoretical, empirical, and practical implications are discussed.