76 research outputs found

    Decision making around living and deceased donor kidney transplantation: a qualitative study exploring the importance of expected relationship changes

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    BACKGROUND: Limited data exist on the impact of living kidney donation on the donor-recipient relationship. Purpose of this study was to explore motivations to donate or accept a (living donor) kidney, whether expected relationship changes influence decision making and whether relationship changes are actually experienced. METHODS: We conducted 6 focus groups in 47 of 114 invited individuals (41%), asking retrospectively about motivations and decision making around transplantation. We used qualitative and quantitative methods to analyze the focus group transcripts. RESULTS: Most deceased donor kidney recipients had a potential living donor available which they refused or did not want. They mostly waited for a deceased donor because of concern for the donor’s health (75%). They more often expected negative relationship changes than living donor kidney recipients (75% vs. 27%, p = 0.01) who also expected positive changes. Living donor kidney recipients mostly accepted the kidney to improve their own quality of life (47%). Donors mostly donated a kidney because transplantation would make the recipient less dependent (25%). After transplantation both positive and negative relationship changes are experienced. CONCLUSION: Expected relationship changes and concerns about the donor’s health lead some kidney patients to wait for a deceased donor, despite having a potential living donor available. Further research is needed to assess whether this concerns a selected group

    Disaster Risk Reduction, Climate Change Adaptation and Human Security: A Commissioned Report for the Norwegian Ministry of Foreign Affairs by the Global Environmental Change and Human Security (GECHS) Project

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    The Norwegian Nobel Committee awarded the 2007 Nobel Peace Prize to the Intergovernmental Panel on Climate Change and Al Gore, in an effort to ‘contribute to a sharper focus on the processes and decisions that appear to be necessary to protect the world’s future climate and thereby to reduce the threat to the security of mankind’. In the wake of the 2007 award, the relationship between climate change and security has surfaced as a key concern among national governments and international institutions

    Process evaluation of a stepped-care program to prevent depression in primary care: patients' and practice nurses' experiences

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    Background: Depression is common in patients with diabetes type 2 (DM2) and/or coronary heart disease (CHD), with high personal and societal burden and may even be preventable. Recently, a cluster randomized trial of stepped care to prevent depression among patients with DM2 and/or CHD and subthreshold depression in Dutch primary care (Step-Dep) versus usual care showed no effectiveness. This paper presents its process evaluation, exploring in-depth experiences from a patient and practice nurse perspective to further understand the results. Methods: A qualitative study was conducted. Using a purposive sampling strategy, data were collected through semi-structured interviews with 24 participants (15 patients and nine practice nurses). All interviews were audiotaped and transcribed verbatim. Atlas.ti 5.7.1 software was used for coding and structuring of themes. A thematic analysis of the data was performed. Results: The process evaluation showed, even through a negative trial, that Step-Dep was perceived as valuable by both patients and practice nurses; perceived effectiveness on improving depressive symptoms varied greatly, but most felt that it had been beneficial for patients' well-being. Facilitators were: increased awareness of mental health problems in chronic disease management and improved accessibility and decreased experienced stigma of receiving mental health care. The Patient Health Questionnaire 9 (PHQ-9), used to determine depression severity, functioned as a useful starting point for the conversation on mental health and patients gained more insight into their mental health by regularly filling out the PHQ-9. However, patients and practice nurses did not widely support its use for monitoring depressive symptoms or making treatment decisions. Monitoring mental health was deemed important in chronically ill patients by both patients and practice nurses and was suggested to start at the time of diagnosis of a chronic disease. Appointed barriers were that patients were primarily motivated to participate in scientific research rather than their intrinsic need to improve depressive symptoms. Additionally, various practice nurses preferred offering individually based therapy over pre-determined interventions in a protocolled sequence and somatic practice nurses expressed a lack of competence to recognise and treat mental health problems. Conclusion: This study demonstrates both the benefits and unique demands of programs such as Step-Dep. The appointed facilitators and barriers could guide the development of future studies aiming to prevent depression in similar patient groups

    Special Report on Global warming of 1.5°C (SR15) - Chapter 5:Sustainable Development, Poverty Eradication and Reducing Inequalities

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    The Special Report on 1.5°C assesses three main themes: • What would be required to limit warming to 1.5°C (mitigation pathways) • The impacts of 1.5°C of warming, compared to 2ºC and higher • Strengthening the global response to climate change; mitigation and adaptation options The connections between climate change and sustainable development and efforts to eradicate poverty are discussed throughout the report. This chapter takes sustainable development as the starting point and focus for analysis. It considers the broad and multifaceted bi-directional interplay between sustainable development, including its focus on eradicating poverty and reducing inequality in their multidimensional aspects, and climate actions in a 1.5°C warmer world. These fundamental connections are embedded in the Sustainable Development Goals (SDGs). The chapter also examines synergies and trade-offs of adaptation and mitigation options with sustainable development and the SDGs and offers insights into possible pathways, especially climate-resilient development pathways towards a 1.5°C warmer world

    Patients’ and practice nurses’ perceptions of depression in patients with type 2 diabetes and/or coronary heart disease screened for subthreshold depression

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    Background Comorbid depression is common in patients with type 2 diabetes (DM2) and/or coronary heart disease (CHD) and is associated with poor quality of life and adverse health outcomes. However, little is known about patients’ and practice nurses’ (PNs) perceptions of depression. Tailoring care to these perceptions may affect depression detection and patient engagement with treatment and prevention programs. This study aimed to explore patients’ and PNs’ perceptions of depression in patients with DM2/CHD screened for subthreshold depression. Methods A qualitative study was conducted as part of a Dutch stepped-care prevention project. Using a purposive sampling strategy, data were collected through semi-structured interviews with 15 patients and 9 PNs. After consent, all interviews were recorded, transcribed verbatim and analyzed independently by two researchers with Atlas.ti.5.7.1 software. The patient and PN datasets were inspected for commonalities using a constant comparative method, from which a final thematic framework was generated. Results Main themes were: illness perception, need for care and causes of depression. Patients generally considered themselves at least mildly depressed, but perceived severity levels were not always congruent with Patient Health Questionnaire 9 scores at inclusion. Initially recognizing or naming their mental state as a (subthreshold) depression was difficult for some. Having trouble sleeping was frequently experienced as the most burdensome symptom. Most experienced a need for care; psycho-educational advice and talking therapy were preferred. Perceived symptom severity corresponded with perceived need for care, but did not necessarily match help-seeking behaviour. Main named barriers to help-seeking were experienced stigma and lack of awareness of depression and mental health care possibilities. PNs frequently perceived patients as not depressed and with minimal need for specific care except for attention. Participants pointed to a mix of causes of depression, most related to negative life events and circumstances and perceived indirect links with DM2/CHD. Conclusion Data of the interviewed patients and PNs suggest that they have different perceptions about (subthreshold) depressive illness and the need for care, although views on its causes seem to overlap more

    Coping, family and mastery:top priorities for social science research by patients with chronic kidney disease

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    Background. The value of incorporating patients' perspectives in health care is being acknowledged more and more because such incorporation may improve quality of health care. However, research priorities are mostly driven by professionals. In this study, renal patients were engaged to list priorities for social scientific research in order to complement the professionals' research agenda on kidney diseases. Methods. A qualitative methodology was conducted by a team consisting of researchers and renal patients. Individual and group interviews were held in order to develop a social scientific research agenda from the perspective of patients on dialysis or with a history of dialysis. Subsequently, some current medical literature was scanned to explore whether or not the top priorities in this social science agenda were indeed under investigation by scientists in the field of health research. Results. Respondents prioritized 17 research themes. Three top priorities included research on coping, family life and mastery in the face of demanding treatment. As patients have to adapt themselves permanently to the un-predictability of their disease and different stressors, research on coping receives high priority. The patients' illness affects the family as well and patients therefore indicate that research should focus on their relatives and the family as a social system. Patients often feel their lives are run by the requirements of the medical system. Strategies that help patients to remain independent and keep control over their own life are therefore considered as highly important research topics. Conclusions. Renal patients' social scientific research agenda can be used together with biomedical research agendas, in order to match research with the context and needs of patients. Social scientific research topics should be studied from a holistic perspective as having a disease and living a life are interrelated. This requires intense collaboration between biomedical and social scientific researchers
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