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1.
J Clin Psychol Med Settings ; 27(1): 127-138, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31087239

RESUMO

For immigrant chronic dialysis patients, religious behavior and religious coping may have a different impact on depressive symptoms compared to native patients. This study aims to describe both cross-sectional and longitudinal associations between religious behavior and coping with symptoms of depression for 281 native and 277 immigrant dialysis patients in the Netherlands. A higher prevalence of depressive symptoms was found in immigrant compared to native patients (49% vs. 36%). No significant cross-sectional or longitudinal associations were found in both groups between religious behavior and positive religious coping with depressive symptoms. Strong significant cross-sectional associations were found between negative religious coping items and depressive symptoms in both groups, while no longitudinal associations were found. So, similar impact of religiousness on the presence of depressive symptoms was found for both native and immigrant dialysis patients. Therefore, these results do not explain the higher prevalence of depressive symptoms found in immigrant chronic dialysis patients compared to native patients.

2.
Tijdschr Psychiatr ; 61(8): 536-543, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31512737

RESUMO

BACKGROUND: Various measures aim to stimulate prosecution of violence and aggression against mental-health workers. Considering a possible increase of inpatient incidents through article 2.3 of the Bill Forensic Care, this is a desirable development. Mental health care and the judiciary seem to have opposing opinions whether the emphasis should lie on care or punishment in handling intramural offense.
AIM: To investigate which arguments judges apply in their trial of intramural incidents, to gain insight into the obstacles which impede awarding punishment during treatment, and to give recommendations for balancing the need for care and the need for punishment.
METHOD: A qualitatively thematic analysis based on semi-structured interviews with eight judges. Themes were based on relevant literature and case reports.
RESULTS: The majority of the judges considered judging intramural incidents complicated because of: 1. insufficient information on possible exclusion of guilt, 2. the fear that punishment will lead to recidivism, and 3. ambiguity on the impact of the crime on the victim. They emphasized that they needed more up-to-date information from the institution. Judges wanted to avert punishment as this may lead to discontinuity of care or worsening of the mental health of the suspect.
CONCLUSION: A verdict can also support a (clinical) mental health treatment. With the arrival of the 'bopz-brigades' (Law bopz: Law on Compulsory Admission to Psychiatric Hospitals) at the Public Prosecution Service, all relevant information from mental health care, police and Public Prosecution can be combined into a claim, leading to a verdict in which care and punishment serve each other optimally.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Crime , Psiquiatria Legal , Transtornos Mentais/terapia , Humanos , Pacientes Internados , Saúde Mental , Prisioneiros/psicologia
3.
Personal Ment Health ; 13(3): 144-154, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31050190

RESUMO

Meaning in life is a motivational force and an existential theme for many people. The concept of meaning comprises purpose, comprehension and mattering. According to the Section III model of personality disorder (DSM-5), lack of meaning, purpose and direction in life is part of personality dysfunction. The present study aimed to determine the association between personality disorder (PD), personality dysfunction and 'lack of meaning, purpose and direction' as a distinct facet of personality dysfunction, using Livesley's self-report questionnaire-the General Assessment of Personality Disorder. This comparative quantitative study showed significant differences in lack of meaning, purpose and direction between a group of patients with PD (n = 126, PD with depression n = 51 and PD without depression n = 75), a group of non-PD patients (n = 76, with depression n = 27 and without depression n = 49) and a control group (n = 444). The PD groups had similar scores as the non-PD patients with depression. Lack of meaning was significantly associated with 'difficulty setting and attaining goals' in all groups, with 'lack of affiliative relationships' in the PD groups and 'sense of inner emptiness' in the PD group without depression and in controls. © 2019 John Wiley & Sons, Ltd.


Assuntos
Transtornos da Personalidade/psicologia , Personalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Adulto Jovem
4.
Tijdschr Psychiatr ; 61(12): 837-844, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31907898

RESUMO

BACKGROUND: In scientific literature, active commitment to a religious community is considered to be a protective factor against suicidal behavior. However, it is assumed that this protective effect does not apply to 'reformed pietists' or strict Calvinists, an orthodox-protestant group in the Netherlands.
AIM: To explore whether the incidence of suicide is higher among reformed pietists than among other Christian patients of Eleos, a Dutch christian institute for mental health care.
METHOD: A retrospective cohort study was conducted over the period 2000-2017. All evaluating reports, which were written after a suicide, were analyzed.
RESULTS: In the period 2000-2017 28 evident suicides were committed. The number of suicides among reformed pietistic patients was about 10 times lower than among other Christian patients.
CONCLUSION: The assumption that reformed pietists run a relatively high risk for suicide does not have adequate grounds. In case of risk assessment, reformed pietistic affiliation might be considered to be more a protecting than a risk-increasing factor for suicide.


Assuntos
Religião e Psicologia , Suicídio/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Suicídio/psicologia , Tentativa de Suicídio , Adulto Jovem
5.
Tijdschr Psychiatr ; 60(9): 637-641, 2018.
Artigo em Holandês | MEDLINE | ID: mdl-30215452

RESUMO

BACKGROUND: After the suicide of a psychiatry resident, the coordinators of her trainee program had to face several questions.
AIM: To articulate some of the main questions and to describe our course of action as a way of 'suicide postvention'.
METHOD: Reflection on an anonymized residency situation.
RESULTS: The central question pertained to the dilemma whether the coordinator, supervisor, or other residents should consider the situation from a therapist viewpoint or as employer-colleague. The last option was formally the most valid, but the dilemma related to other questions, such as about our professional identity as psychiatrists. Postvention occurred in several phases (immediate, recovery, reconstruction) and included several meetings with the residents and supervisors. One meeting was facilitated by the spiritual counseler of the institution.
CONCLUSION: A self-critical approach and our postvention approach seemed to supply a need of attention and care for all residency colleagues involved.


Assuntos
Atitude do Pessoal de Saúde , Hospitais Psiquiátricos , Suicídio/prevenção & controle , Suicídio/psicologia , Humanos
6.
Tijdschr Psychiatr ; 60(8): 511-520, 2018.
Artigo em Holandês | MEDLINE | ID: mdl-30132579

RESUMO

BACKGROUND: Depression strongly increases the risk of suicide. Religion is described as a protective factor against suicide. Considering the emotional blunting associated with depression, it is important to investigate the affective dimension of religion. This dimension is conveyed in God representations.
AIM: To describe what types of God representation occur among Christian patients with major depressive disorder and to determine whether there is a relationship between types of God representation and suicide.
METHOD: Clinical and outpatients with a major depressive disorder (n=155) completed the Questionnaire God Representations and the Paykel Suicide Items. A k-means cluster analysis is applied to examine which types of God representations occur among depressed patients. Whether there is a relationship between the different God representations and suicide is examined by applying a linear regression analysis.
RESULTS: Depressed patients uphold two types of God representation: a positive type (n=82) with positive feelings towards God and where God was experienced as supportive, and a negative type (n=73) with anger and anxiety towards God and where God was experienced as passive. Patients with a negative type of God representation scored significantly higher on suicidality. The severity of depression was the main predictor of suicidality, but God representations were also related with a 4% increase in the explained variance.
CONCLUSION: In Christian patients with major depressive disorder a negative and a positive God representation emerged. Patients with a negative God representation mainly seem to feel abandoned by God. The suicidality is significantly increased in patients with a negative God representation, however, the increase in the proportion of the explained variance is small.


Assuntos
Transtorno Depressivo Maior/psicologia , Religião e Psicologia , Suicídio/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ideação Suicida
7.
Tijdschr Psychiatr ; 59(7): 396-405, 2017.
Artigo em Holandês | MEDLINE | ID: mdl-28703259

RESUMO

BACKGROUND: Emergency psychiatric care in the Netherlands is provided mainly by community mental health services. Although these emergency services vary in their approach per region, they show many similarities: they tend to receive referrals from the same type of agencies and they practice similar techniques of crisis management.
AIM: To identify some of the patterns that appear in the type of psychiatric problems encountered, the type of referral agencies involved and in the intervention strategies practiced by the psychiatric emergency service in Utrecht.
METHOD: We studied the medical records of 938 crisis assessments compiled during five measurement periods between 2009 and 2015. From all these crisis assessments we selected one sample relating to patients coming only from the city of Utrecht - 'model city Utrecht' - and a second sample consisting only of patients referred either by HAP (emergency primary care), the police or a general hospital. Then, by using cross-tabulation and a multinomial logistic regression analyses, we were able to identify associations between the type of referral agency, the type of referral problem and the type of intervention.
RESULTS: Patients referred by the police were more often forcefully admitted (compulsory admission: 27%) than patients referred by general practitioners (6%); most of these patients were then treated as outpatients (83%). Another pattern that emerged, was that confused or aggressive patients were admitted to hospital more frequently than suicidal patients (26%, 29% and 8% respectively).
CONCLUSION: Our study and current trends in the clinical practice operated by the emergency psychiatric services reveal significant correlations between the type of referrals and the type of intervention. However, further research is needed in order to develop the 'best practice' for emergency psychiatric care in the future.


Assuntos
Serviços de Emergência Psiquiátrica , Necessidades e Demandas de Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental , Encaminhamento e Consulta , Plantão Médico , Internação Compulsória de Doente Mental , Intervenção na Crise , Medicina Geral , Humanos , Países Baixos , Polícia
8.
Tijdschr Psychiatr ; 57(7): 480-8, 2015.
Artigo em Holandês | MEDLINE | ID: mdl-26189416

RESUMO

BACKGROUND: Psychiatrists working for the outreach emergency services of mental health institutions are regularly asked to assess whether a suspect being held at a police station should be charged and later prosecuted or be admitted to a mental institution. In other words, is the suspect 'suited for detention'. Often the representative of the judicial system and the psychiatrist from the emergency services then discuss whether the suspect would be better served by care under the mental healthcare system or under the criminal judicial system. Compulsorily admission to a mental health institution often leads to exemption from prosecution. AIM: To determine what procedure (prison or clinic) will provide the suspect with appropriate care; to find out how to ensure that mentally-ill perpetrators of offences are not assigned erroneously to psychiatric care (i.e. they are 'psychiatricised') and thereby exempted from prosecution, and to determine whether the term 'suited for detention' is applicable to such a person. METHOD: Data were derived from semi-structured interviews with experts from the acute mental health services, the forensic psychiatric services and the criminal justice system. All topics were based on a literature review and on study of case histories. RESULTS: A decision by the emergency services to admit a suspect to a mental health institution influences the views of the representative of a criminal judicial system with regards to the possible imprisonment of the suspect. Thinking in terms of 'bad or mad' can influence the judicial system to give a psychiatric slant to offences or crimes committed by psychiatric patients. Psychiatrists' interpretation of proper care and often their lack of knowledge about the current care facilities available in prisons meant that psychiatrists were more likely than their forensic colleagues to assign suspects to mental health care. According to forensic psychiatrists, their colleagues from mental health care services should not be concerned about whether a suspect is 'suited' or 'unsuited' for detention; their main concern should be what kind of care and treatment the suspect urgently requires. CONCLUSION: The role of the representative of the emergency services present at the police station is to decide what type of care is required at that particular moment. Care within the judicial system is an important option; that type of care can be obtained by involving forensic colleagues in the decision. Awareness of the importance of a dual track policy (conviction/punishment or care) should help to prevent unjustified 'psychiatrisation', of both minor and serious offenses.


Assuntos
Internação Compulsória de Doente Mental , Psiquiatria Legal , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Prisioneiros/psicologia , Tomada de Decisões , Humanos , Transtornos Mentais/terapia , Saúde Mental , Escalas de Graduação Psiquiátrica , Encaminhamento e Consulta
9.
Tijdschr Psychiatr ; 57(6): 441-5, 2015.
Artigo em Holandês | MEDLINE | ID: mdl-26073838

RESUMO

BACKGROUND: The type of the agent used for auto-intoxication may increase or decrease the degree of suicidal intent. AIM: To find out whether the type of agent used for auto-intoxication is linked to the degree of suicidal intent at the moment when a patient is given a psychiatric assessment in a general hospital. METHOD: We studied the files of 211 patients who had been assessed following auto-intoxication. The files provided us with information about the type of agent used, the suicidal intent of the patient at the time and about other recent, relevant risk factors. RESULTS: At the time of the assessment, benzodiazepines were the only auto-intoxication agents used which seemed to predict suicidal intent. CONCLUSION: Although the results need to be verified in further studies, it can be concluded that auto-intoxication induced only by benzodiazepines can be seen as a serious expression of an individual's wish to die.


Assuntos
Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Intenção , Tentativa de Suicídio/psicologia , Suicídio/psicologia , Humanos
10.
Tijdschr Psychiatr ; 56(1): 54-7, 2014.
Artigo em Holandês | MEDLINE | ID: mdl-24446228

RESUMO

Body integrity identity disorder (BIID) is a rare condition in which a person, for no apparent physical reason, is tormented by the experience that a body-part, such as a limb, does not really belong to the body. Patients experience an intense desire for the limb to be amputated (a 'desire' formerly referred to as 'apotemnophilia'). We report on a 58-year-old male patient with BIID who froze one of his legs so that he could amputate it himself. A surgeon ultimately intervened and amputated the leg professionally. The patient was extremely relieved and was still experiencing relief at a follow-up three years later.


Assuntos
Amputação/psicologia , Transtornos Dismórficos Corporais/psicologia , Automutilação/psicologia , Humanos , Traumatismos da Perna/cirurgia , Masculino , Pessoa de Meia-Idade
11.
Brain Behav Immun ; 33: 57-64, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23727274

RESUMO

Fatigue in the immune mediated inflammatory disease sarcoidosis is thought to be associated with impaired exercise tolerance. This prospective study assessed fatigue and recuperative capacity after repeated exercise, and examined whether changing concentrations in biomarkers upon exercise are associated with fatigue. Twenty sarcoidosis patients and 10 healthy volunteers performed maximal cardiopulmonary exercise tests on two successive days. Concentrations of cytokines, stress hormones, ACE and CK were assessed before and after the two exercise tests, and 3 days thereafter. All participants completed a sleep diary. Severely fatigued patients showed significant lower VO2 max (p=0.038, p=0.022) and maximal workload (p=0.034, p=0.028) on both exercise tests compared to healthy controls. No impairment of maximal exercise testing was demonstrated during the second cycling test in any group. Fatigue was not correlated with changes in concentrations of biomarkers upon exercise. Severely fatigued patients rated both tests as significantly more fatiguing, and reported significant lower mean subjective night sleeping time during the testing period. Fatigue in sarcoidosis patients cannot be objectified by reduction of exercise capacity after repeated maximal exercise testing, and is not correlated with significant changes in biomarkers. Severe fatigue is only and consistently featured by patient reported outcomes.


Assuntos
Teste de Esforço/efeitos adversos , Teste de Esforço/métodos , Fadiga/diagnóstico , Fadiga/etiologia , Sarcoidose Pulmonar/complicações , Adolescente , Adulto , Idoso , Biomarcadores/metabolismo , Estudos de Coortes , Tolerância ao Exercício/imunologia , Fadiga/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Troca Gasosa Pulmonar/imunologia , Recuperação de Função Fisiológica/imunologia , Testes de Função Respiratória/efeitos adversos , Sarcoidose Pulmonar/imunologia , Sarcoidose Pulmonar/fisiopatologia , Prevenção Secundária , Autorrelato , Índice de Gravidade de Doença , Adulto Jovem
12.
Tijdschr Psychiatr ; 55(4): 233-45, 2013.
Artigo em Holandês | MEDLINE | ID: mdl-23595838

RESUMO

BACKGROUND: In acute psychiatry the prescribed medication is frequently off-label. AIM: To investigate the indications for off-label prescriptions described in the literature and to evaluate the use of off-label medication in the emergency service of Altrecht, Utrecht, The Netherlands. METHOD: We performed a systematic search of the PubMed database and we evaluated all the records of patients examined by the emergency service during two assessment periods (April 2009 and November 2010). RESULTS: The literature makes no mention of the prescribing of off-label medication in acute psychiatry. In general psychiatry, however, off-label medication is reported mainly for atypical antipsychotics. In the emergency service 41% of the medication prescribed during first contacts with patients was off-label. These prescriptions were most often for antipsychotics (54%) and benzodiazepines (38%) . The most important indications were aggression, agitation and sleep problems. If the term ‘off-label’ is interpreted in a broader sense with respect to antipsychotics for psychosis and hypomania, then 33% of the prescriptions appeared to be off-label. If benzodiazepines prescribed for aggression/agitation were not taken into account, then the proportion of off-label prescriptions decreased to 21%. CONCLUSION: We consider it advisable that the reason for prescribing off-label medication should be clearly documented. New medical guidelines could help by summarising current views on the use of off-label medication.


Assuntos
Serviços Médicos de Emergência/tendências , Transtornos Mentais/tratamento farmacológico , Uso Off-Label/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Humanos , Países Baixos , Psicotrópicos/administração & dosagem
13.
Tijdschr Psychiatr ; 55(3): 209-13, 2013.
Artigo em Holandês | MEDLINE | ID: mdl-23512634

RESUMO

A 30-year-old woman who simulated a psychosis and threatened to commit infanticide and suicide was forcibly admitted to an acute psychiatric unit under the Mental Health Act. She was discharged an hour later after confessing that she had feigned illness. In this article we discuss the subject of feigned illness (malingering) and its clinical aspects in the acute psychiatric setting. Early recognition of malingering can prevent unnecessary admissions and iatrogenic damage.


Assuntos
Internação Compulsória de Doente Mental , Simulação de Doença/psicologia , Transtornos Psicóticos/diagnóstico , Adulto , Manual Diagnóstico e Estatístico de Transtornos Mentais , Serviços de Emergência Psiquiátrica , Feminino , Humanos , Transtornos Psicóticos/psicologia
14.
Tijdschr Psychiatr ; 54(9): 785-95, 2012.
Artigo em Holandês | MEDLINE | ID: mdl-22961277

RESUMO

BACKGROUND: Clergy members (CMS) frequently provide support and counselling for people with psychological and psychiatric disorders. There is evidence in the literature that CMS consider themselves to be inadequately trained to recognise psychiatric disorders. AIM: To investigate to what extent CMS are able to recognise psychiatric symptoms. METHOD: CMS were recruited in the south-west of the Netherlands among various denominations (Roman Catholic, strict (orthodox) Protestant, moderate Protestant and Evangelical; n = 143) by means of a regional sampling method. The participating CMS (n = 143) and a control group consisting of mental health care professionals MPHS; n = 73) evaluated four vignettes of psychiatric problems with a religious content: two were about a psychiatric disorder (a psychotic state and a psychotic depression/melancholic state), and two concerned non-psychiatric states (a spiritual/religious experience and a mourning reaction with a religious dilemma). For each vignette the respondents scored the suitability of psychiatric medication, the desirability of mental health care, the severity of the disorder and whether there was a religious or spiritual aetiology. RESULTS: Some CMS were able to recognise psychiatric problems almost as well as the MHPS, but among the CMS the degree of recognition varied according to the denomination. Recognition was relatively poor among Evangelical CMS, but was best among the strict Protestant CMS. Evangelical pastors and strict Protestant CMS tended to interpret the non-psychiatric states as pathological. CONCLUSION: The findings of this study emphasise the need for collaboration between MHPS and CMS and stress the importance of consultation.


Assuntos
Clero/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/diagnóstico , Religião , Antipsicóticos/uso terapêutico , Demografia , Feminino , Humanos , Relações Interprofissionais , Masculino , Transtornos Mentais/classificação , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Países Baixos , Competência Profissional , Religião e Psicologia
15.
Tijdschr Psychiatr ; 51(9): 687-92, 2009.
Artigo em Holandês | MEDLINE | ID: mdl-19760568

RESUMO

National and regional agreements have been reached with regard to time-limits on collaboration between the emergency mental health services and the police. On the basis of 69 emergency cases attended by both the crisis-team and the police in Utrecht, we investigated whether the time-limits had been observed in that city. Of the cases 85% were dealt with adequately within 6 hours (in accordance with the national guideline and 20% within 2 hours (regional norm). The average time needed to reach an emergency case was 1 hour 35 minutes, but was longer when the emergency resulted from substance abuse. The average time required for case-assessment was 1 hour 25 minutes and was longer in cases requiring compulsory detention and in cases involving manic behaviour.


Assuntos
Intervenção na Crise/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Polícia , Adolescente , Adulto , Idoso , Comportamento Perigoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Equipe de Assistência ao Paciente , Controle Social Formal , Fatores de Tempo , Adulto Jovem
16.
Tijdschr Gerontol Geriatr ; 39(5): 182-92, 2008 Oct.
Artigo em Holandês | MEDLINE | ID: mdl-18975843

RESUMO

OBJECTIVE: Self-perceived health describes how a person perceives his or her own health. It is a widely used measure of health status. The aim of this study is to investigate the stability of self-perceived health between 1992/'93 and 2002/'03 of men and women aged 55-64 and to what extent a possible shift can be explained by demographic factors, lifestyle factors and objective health. METHODS: Data of two age-, sex- and region-stratified samples are used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of older persons in the Netherlands. Self-perceived health is defined by the answer to the following question: How would you rate your health in general? with possible answers: 1 = excellent, 2 = good, 3 = fair, 4 = sometimes good/sometimes poor and 5 = poor. In the analyses, answers 4 and 5 are combined because of the small number of answers in the category 'poor'. The difference in self-perceived health between the two cohorts is tested using the chi2-test. Multinomial regression analyses are used to examine which cohort and/or period factors are responsible for the cohort difference. RESULTS: The youngest cohort rated more excellent and poor health than the oldest, and less good and fair health. The youngest cohort had a higher prevalence of chronic illness, functional limitation and depressive symptoms, which negatively affected self-perceived health. The cohort and period factors do not significantly contribute to the explanation of the cohort difference. CONCLUSION: There is a small shift in self-perceived health over time. In comparison with the oldest cohort the self-perceived health of the youngest improved, taken the deteriorated objective health of the youngest cohort into account.


Assuntos
Atitude Frente a Saúde , Nível de Saúde , Autoimagem , Distribuição por Idade , Distribuição de Qui-Quadrado , Estudos de Coortes , Escolaridade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Fatores Socioeconômicos
18.
Eur J Radiol ; 59(1): 3-7, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16781837

RESUMO

BACKGROUND: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma. METHOD: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma. RESULTS: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts. CONCLUSION: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Pâncreas/lesões , Tomografia Computadorizada por Raios X/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Amilases/sangue , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Ultrassonografia
19.
Eur J Ageing ; 3(3): 146, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28794759

RESUMO

Gerotranscendence defines a shift in meta-perspective from earlier materialistic and pragmatic concerns, toward more cosmic and transcendent ones in later life. Population-based studies that have empirically examined this concept using Tornstam's gerotranscendence scale, highlight cosmic transcendence as a core component, which includes a sense of belongingness with past and future generations. Such generative concerns may increase expectations regarding the quality of the bond with one's children in later life. This study examined whether the association between emotional support exchanged with children and feelings of loneliness later in life varied by the degree of cosmic transcendence of the older parent. Data from 1,845 older parents participating in a population-based study living in The Netherlands were analyzed from the 1995/1996 cycle of the Longitudinal Aging Study Amsterdam. Interviews included self-report measures of cosmic transcendence, loneliness, emotional support exchanged with children, health indicators, and marital status. Results indicated that a negative association between loneliness and level of emotional support exchanged with children was more pronounced among older parents with higher cosmic transcendence scores, in particular among the married. It is argued that cosmic transcendence reflects a sense of generativity and an increased emotional dependency on children in later life. Under favorable social conditions (supportive relationships with children and being married) cosmic transcendent views had a positive impact on social well-being in later life. When children no longer met emotional needs of older parents, cosmic transcendence increased feelings of loneliness.

20.
Tijdschr Gerontol Geriatr ; 37(6): 254-62, 2006 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-17214422

RESUMO

The current contribution focuses on the role of religiousness on aspects of mood in the last week of life. After-death interviews with proxy respondents of deceased participants of the Longitudinal Aging Study Amsterdam provided information on depressive mood and anxiety in the last week of life, as well as on a sense of peace with the approaching end of life. Furthermore, the proxy respondents were asked about serious physical symptoms in the last week of life, cognitive decline, salience of religion, and whether the deceased respondent had talked about religion. Other characteristics were derived from the last interviews with the respondents when still alive: depressive symptoms, religious affiliation, church-attendance, orthodoxy, salience of religion, and cosmic transcendence. None of the characteristics of religiousness were significantly associated with depressive mood or anxiety as estimated by the proxy-respondent. A sense of peace, however, was predicted by higher church-attendance, Protestant affiliation (as compared to no affiliation), and the proxy's estimate of the salience of religion. It is concluded that religiousness does not affect depressive mood or anxiety in the last week of life in the current sample. Possibly, religiousness supports a sense of peace, which may be a more existential facet of mood, and which is discussed as relevant in the last phase of life and in palliative care.


Assuntos
Adaptação Psicológica , Envelhecimento/psicologia , Atitude Frente a Morte , Religião e Psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Cuidados Paliativos/psicologia
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