[Contact between neighbourhood residents and residents of a residential care facility]. / Contacten van buurtbewoners met bewoners van beschermende woonvormen.

BACKGROUND: Residential care facilities are available to patients unable to live independently, in order to improve their self-reliance and participation. To succeed, integration in the neighbourhood is essential.
AIM: To assess the contact between neighbours and residents of a residential care facility.
METHOD: 364 surveys were distributed in two neighbourhoods with a Yulius residential facility, including questions on frequency and type of contacts, acceptance of psychiatric facilities and of psychiatric patients.
RESULTS: The response rate was 24% (n = 86). Contact with the facility residents was minimal. The experience of nuisance by neighbours was negatively correlated to the acceptance of psychiatric facilities.
CONCLUSION: This limited contact does not point to a successful integration. A more active role of mental health institutions is desired.

[Intensive home treatment: a first observational evaluation]. / Intensive home treatment: een eerste observationele evaluatie.

BACKGROUND: Yulius intensive home treatment (iht) offers six weeks of home-care to psychiatric patients in crisis who would normally be hospitalised.
AIM: To study patient characteristics and the content and outcomes of iht.
METHOD: We followed the handling of 75 consecutive applications for iht. Details were recorded before and after admission to the treatment.
RESULTS: Fifteen patients were referred in order to shorten the period of hospitalisation, and 60 were referred in order to prevent hospitalisation; 59 of the 75 persons admitted for the treatment received iht, and 41 patients finished the six-week module and provided follow-up data. Psychiatric symptoms improved significantly, suicidality was reduced, the caregiver's burden became much lighter and the evaluation by both patient and caregiver was very positive. iht was sufficient to prevent the need for hospitalisation of 75% of the patients referred for reduced hospitalisation, and it was also adequate to prevent the hospitalisation of more than 91% of patients referred for that particular purpose.
CONCLUSION: iht is highly appreciated and is possibly a good alternative to hospitalisation. However, in the future there will have to be randomised, controlled research in order to determine the effectiveness of iht compared to hospitalisation.

Cortisol levels in scalp hair of patients with structural heart disease.

BACKGROUND: Stress is considered a modifiable risk factor for cardiovascular disease. Scalp hair analysis is a tool to assess long-term exposure to the stress hormone cortisol. We aimed to determine the association between hair cortisol concentrations (HCC) and clinical characteristics in patients with structural heart disease. Additionally, we investigated potential predictors for longitudinal change in HCC. METHODS: The study consisted of 261 patients with structural heart disease from a randomized controlled trial of mindfulness training. One sample of scalp hair was used to determine HCC both at baseline and at 12-week follow-up. In 151 patients, HCC was available (mean age: 41.3 years, range 18-65). We investigated the association between HCC at baseline and several physiological measures (BMI, blood pressure, heart rate, respiratory rate, 6-minute walk test), as well as psychological parameters (physical and mental component summary measures (SF-36), emotional distress (HADS), and perceived stress). Additionally, we used these clinical parameters to predict HCC change over time. RESULTS: The median HCC was 22.3 pg/mg of hair (23.5 interquartile range). In multivariable linear regression analyses, an association was observed between log-transformed HCC and BMI (ß 0.171, p=0.037), respiratory rate (ß 0.194, p=0.016), and the physical summary score (ß -0.163, p=0.054). Independent predictors of log-transformed HCC change after 12 weeks were mental summary score (ß -0.200, p=0.019) and diastolic blood pressure (ß -0.171, p=0.049). CONCLUSIONS: In patients with structural heart disease a positive association exists between HCC and BMI. Mental health status may predict a change in long-term cortisol over time.