De Tijdelijke Overbruggings Afdeling Amsterdam:ervaringen met grootstedelijke acute opnames

samenvatting De Tijdelijke Overbruggingsafdeling is het voorportaal van de vijf gesloten opnameafdelingen in Amsterdam. Dit artikel is een verslag van de voorlopige analyses van patiënt- en opnamegegevens van de Tijdelijke Overbruggingsafdeling aan de hand van één jaar prospectieve registratie (2002). Na oprichting van de Tijdelijke Overbruggingsafdeling daalde het aantal gastplaatsingen, bij een stijgend aantal inbewaringstellingen; de druk op de (separeercapaciteit van de) gesloten afdelingen nam af; en de wachttijd in de politiecellen daalde aanzienlijk. Deze cijfers suggereren dat de Tijdelijke Overbruggingsafdeling haar bufferfunctie naar behoren vervult

Health and literacy in first- and second-generation Moroccan Berber women in the Netherlands: Ill literacy?

AIM: The present study was aimed at investigating the role of literacy and generation in the self-reported general health status of Moroccan Berber speaking women in the Netherlands. METHOD: Fifty women in our sample (N = 75) were first generation women, from which group 25 were literates and 25 illiterates. Another group of 25 literate women belonged to the second generation. The three groups were matched for demographic characteristics. Questionnaires were administered reflecting all concepts under study. We hypothesized that, within the first generation, illiterates compared with literates would report worse health. Our second hypothesis was that literates of the first generation compared with those of the second generation would have a similar health condition. RESULTS: After controlling for age, having a job, and having an employed partner, the first generation literates compared with the illiterates of the first generation indeed reported significantly better health. Additionally, we did not find any differences in health condition between both literate groups, even after controlling for age, number of children, and marital status. Health complaints that were most frequently reported by both groups, concerned pain in shoulders, back and head. CONCLUSIONS: Our results underline the importance of offering immigrants optimal access to opportunities and facilities that can improve their literacy and reading ability

Comparison of outpatient health care utilization among returning women and men Veterans from Afghanistan and Iraq

<p>Abstract</p> <p>Background</p> <p>The number of women serving in the United States military increased during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), leading to a subsequent surge in new women Veterans seeking health care services from the Veterans Administration (VA). The objective of this study was to examine gender differences among OEF/OIF Veterans in utilization of VA outpatient health care services.</p> <p>Methods</p> <p>Our retrospective cohort consisted of 1,620 OEF/OIF Veterans (240 women and 1380 men) who enrolled for outpatient healthcare at a single VA facility. We collected demographic data and information on military service and VA utilization from VA electronic medical records. To assess gender differences we used two models: use versus nonuse of services (logistic regression) and intensity of use among users (negative binomial regression).</p> <p>Results</p> <p>In our sample, women were more likely to be younger, single, and non-white than men. Women were more likely to utilize outpatient care services (odds ratio [OR] = 1.47, 95% confidence interval [CI]:1.09, 1.98), but once care was initiated, frequency of visits over time (intensity) did not differ by gender (incident rate ratio [IRR] = 1.07; 95% CI: 0.90, 1.27).</p> <p>Conclusion</p> <p>Recently discharged OEF/OIF women Veterans were more likely to seek VA health care than men Veterans. But the intensity of use was similar between women and men VA care users. As more women use VA health care, prospective studies exploring gender differences in types of services utilized, health outcomes, and factors associated with satisfaction will be required.</p

Self-rated health, work characteristics and health related behaviours among nurses in Greece: a cross sectional study

BACKGROUND: Previous studies on self-rated health among nurses have indicated an association of low job satisfaction and stress in relation to poor self-rated health. The relationship between self rated health and the specific work characteristics and health related behaviours of nurses to our knowledge have not been adequately studied. OBJECTIVE: To investigate the health profile of nurses working in hospitals in North West Greece and to examine the associations between self rated health (SRH) and health related behaviours and work characteristics in this group of hospital employees. METHODS: A self-administered questionnaire was distributed to a random sample of 443 nurses working in all the hospitals in North West Greece. Regression analysis was used to examine the relationship of health related behaviours and work characteristics with self rated health among the nurses. RESULTS: A total of 353 responded to the questionnaire (response rate 80%) of which 311 (88%) were female and 42 (12%) male. The mean age (standard deviation) of the respondents was 36 years (5.6) and their mean years of working as nurses were 13.5 years (5.9). Almost half of the nurses' smoked, and about one third were overweight or obese. About 58% (206) of the nurses reported having poor health while 42% (147) reported having good health. Self-rated health was independently associated with gender, effort to avoid fatty foods and physical activity, according to multiple logistic regression analysis. CONCLUSION: The population studied presented a relatively poor health profile, and a high proportion of poor SRH. Though female gender and effort to avoid fatty foods were associated with poor SRH, and exercise and white meat consumption with good SRH, specific work characteristics were not associated with SRH

Adolescent pregnancies and girls' sexual and reproductive rights in the amazon basin of Ecuador: an analysis of providers' and policy makers' discourses

<p>Abstract</p> <p>Background</p> <p>Adolescent pregnancies are a common phenomenon that can have both positive and negative consequences. The rights framework allows us to explore adolescent pregnancies not just as isolated events, but in relation to girls' sexual and reproductive freedom and their entitlement to a system of health protection that includes both health services and the so called social determinants of health. The aim of this study was to explore policy makers' and service providers' discourses concerning adolescent pregnancies, and discuss the consequences that those discourses have for the exercise of girls' sexual and reproductive rights' in the province of Orellana, located in the amazon basin of Ecuador.</p> <p>Methods</p> <p>We held six focus-group discussions and eleven in-depth interviews with 41 Orellana's service providers and policy makers. Interviews were transcribed and analyzed using discourse analysis, specifically looking for interpretative repertoires.</p> <p>Results</p> <p>Four interpretative repertoires emerged from the interviews. The first repertoire identified was "sex is not for fun" and reflected a moralistic construction of girls' sexual and reproductive health that emphasized abstinence, and sent contradictory messages regarding contraceptive use. The second repertoire -"gendered sexuality and parenthood"-constructed women as sexually uninterested and responsible mothers, while men were constructed as sexually driven and unreliable. The third repertoire was "professionalizing adolescent pregnancies" and lead to patronizing attitudes towards adolescents and disregard of the importance of non-medical expertise. The final repertoire -"idealization of traditional family"-constructed family as the proper space for the raising of adolescents while at the same time acknowledging that sexual abuse and violence within families was common.</p> <p>Conclusions</p> <p>Providers' and policy makers' repertoires determined the areas that the array of sexual and reproductive health services should include, leaving out the ones more prone to cause conflict and opposition, such as gender equality, abortion provision and welfare services for pregnant adolescents. Moralistic attitudes and sexism were present - even if divergences were also found-, limiting services' capability to promote girls' sexual and reproductive health and rights.</p

Psychiatric emergency services in Amsterdam: Experiences with acute admissions in a metropolitan area

Problems in the acute sector of psychiatric care are not unique to the Netherlands and at an international level appear to be linked to problems that are significant for big cities. The search for an “acute bed” had become more difficult and patients were being placed and transported through the whole country. The three mental health care institutions in Amsterdam joined forces and opened a gateway facility in order to confront the pressure on admissions. The objective of this facility was to create a buffer for the relief of acute compulsory admissions and thus reduce the period that patients had to stay in police cells and decrease the number of placements outside the Amsterdam region. In this article the goals, patient groups and achievements of this interim facility, called the Temporary Admission Unit (TOA), are described. The TOA has proved to be able to fulfil its promise to function as a buffer towards the secure admission units in Amsterdam. For a small group of patients (13%) a short admission period on the TOA is sufficient and they can be discharged immediately. The average occupancy rate of the beds of 5 (out of 8 beds) means that the TOA can usually guarantee availability of beds for acute admissions. Between 2000 and 2002 the number of guest placements outside Amsterdam has drastically lowered, along with a gradual rise in the number of compulsory admissions. Finally, the waiting time in the police stations has been diminished considerably. The advantages of the TOA are clear. Expensive (nocturnal) ambulance transport can be avoided. The stay in the police cell is reduced and the patient arrives in a facility where psychiatric care is available with greater speed. Contact with a regular therapist and therefore continuity of care guarantees a better situation than when the patient is admitted in a distant facility. The same holds good for family contacts

Ervaringen en wensen van familieleden bij het omgaan met een verzoek om levensbeëindiging in de psychiatrie. Een checklist voor behandelaars

BACKGROUND: In the Netherlands, increasing attention is being paid to psychiatric patients with a request for termination of life. One discussion related to this is the role of the family. However, the experiences and wishes of the family regarding their involvement in dealing with a psychiatric patient's request for termination of life, are not yet well documented. AIM: To investigate the experiences and wishes of families regarding their role in dealing with the psychiatric patient's request for termination of life, and to develop a checklist for physicians to adequately involve the family in the process of dealing with such a request. METHOD: The experiences and wishes of families regarding their role in dealing with a psychiatric patient's request for termination of life were investigated in a focus group meeting with family members. Based on the results, recommendations were formulated for physicians and their feasibility was tested in a dialogue group of family members and caregivers. Finally, the results were discussed in a focus group of family members to develop a checklist for physicians to involve the family in dealing with a psychiatric patient's request for termination of life. RESULTS: Family members prefer that physicians: 1. involve the family in the process and understand the impact of the situation on family members; 2. discuss expectations and explore the wishes of the family; 3. make use of the knowledge and expertise of the family in order to understand the patient in the context of his/her life; 4. support the family and provide after care, and jointly evaluate the process. The recommendations were consolidated in a checklist for physicians about involving the family in dealing with a psychiatric patient's request for termination of life. CONCLUSION: It is expected that application of the recommendations and the checklist will promote adequate involvement of the family in dealing with a psychiatric patient's request for termination of life