The introduction of Corded Ware Culture at a local levely:An exploratory study of cultural change during the Late Neolithic of the Dutch West Coast through ceramic technology

The introduction of the Corded Ware Culture (3000–2500 BCE) is considered a formative event in Europe's past. Ancient DNA analyses demonstrate that migrations played a crucial role in this event. However, these analyses approach the issue at a supra-regional scale, leaving questions about the regional and local impact of this event unresolved. This study pilots an approach to ceramics that brings this small-scale impact into focus by using the transmission of ceramic technology as a proxy for social change. It draws on ethno-archaeological studies of the effects of social changes on the transmission of ceramic production techniques to hypothesise the impact of three idealised scenarios that archaeologists have proposed for the introduction of Corded Ware Culture: migration, diffusion, and network interactions. Subsequently, it verifies these hypotheses by integrating geochemical (WDXRF), mineralogical (petrography), and macromorphological analysis of ceramics with network analysis. This method is applied to 30 Late Neolithic ceramic vessels from three sites in the western coastal area of the Netherlands (Hazerswoude-Rijndijk N11, Zandwerven, and Voorschoten-De Donk). This study concludes that the introduction of Corded Ware material culture is a process that varies from site to site in the western coastal area of the Netherlands. Moreover, the introduction of the Corded Ware Culture is characterised by continuity in technological traditions throughout the study area, indicating a degree of social continuity despite typological changes in ceramic

Working on and with Relationships: Relational Work and Spatial Understandings of Good Care in Community Mental Healthcare in Trieste

Deinstitutionalization is often described as an organizational shift of moving care from the psychiatric hospital towards the community. This paper analyses deinstitutionalization as a daily care practice by adopting an empirical ethics approach instead. Deinstitutionalization of mental healthcare is seen as an important way of improving the quality of lives of people suffering from severe mental illness. But how is this done in practice and which different goods are strived for by those involved? We examine these questions by giving an ethnographic description of community mental health care in Trieste, a city that underwent a radical process of deinstitutionalization in the 1970s. We show that paying attention to the spatial metaphors used in daily care direct us to different notions of good care in which relationships are central. Addressing the question of how daily care practices of mental healthcare outside the hospital may be constituted and the importance of spatial metaphors used may inform other practices that want to shape community mental health care

Вклад региональных и глобальных факторов в межгодовую изменчивость гидрометеорологических условий прибрежной зоны Черного моря

Выполнен факторный анализ рядов среднегодовых и среднепятилетних значений метеорологических и гидрологических параметров по данным измерений на береговых гидрометстанциях. Получены количественные оценки вклада глобальных и региональных факторов в межгодовую и декадную изменчивость показателей гидрометеорологического режима черноморской прибрежной зоны Украины.Виконано факторний аналіз рядів середньорічних і середньоп’ятирічних значень метеорологічних і гідрологічних величин за даними вимірювань на берегових гідрометстанціях. Отримані кількісні оцінки внеску глобальних і регіональних факторів у міжрічну та декадну мінливість показників гідрометеорологічного режиму чорноморської прибережної смуги України.Factor analysis of the time-series of annual and five-year averaged meteorological and hydrological values measured on shore hydrometeorological stations was performed. Quantitative estimations were obtained for the global and regional factors input to the interannual and decadal variability of the Ukrainian Black Sea coastal zone hydrometeorological regimen indices

The effectiveness of assertive community treatment for elderly patients with severe mental illness: A randomized controlled trial

Background: Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults.Methods: In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat.Results: Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables.Conclusions: These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully.Trial registration: NTR1620

Effectiveness and cost-effectiveness of a nurse-delivered intervention to improve adherence to treatment for HIV : a pragmatic, multicentre, open-label, randomised clinical trial

This trial was funded from public money by the Netherlands Organisation for Health Research and Development (ZonMW; grant number 171002208). Aardex provided support on the development of the study website. We thank all the HIV nurses and physicians from the seven HIV clinics involved in the AIMS study for their input and collaboration (Academic Medical Centre, Slotervaart hospital, and St. Lucas-Andreas hospital, all in Amsterdam; the Leiden University Medical Centre, Leiden; HAGA hospital, The Hague; Erasmus Medical Centre, Rotterdam; and Isala clinic, Zwolle), the study participants, and the Stichting HIV Monitoring (SHM) for their support in accessing the SHM database for identifying patient inclusion criteria and developing the Markov model. Finally, we thank and remember Herman Schaalma (deceased) for his contribution to the study design and grant application.Peer reviewedPostprin

Embracing the Social Nature of Recovery: A Qualitative Study on the Resource Group Method for People With Severe Mental Illness

Objective: The resource group method for people with severe mental illness might provide a useful framework to facilitate patient's empowerment and systematically engage significant others. However, no research has explored the perspectives and experiences of patients and their significant others. This is crucial for better adjustment to the needs of the people using the method. The aim of this study was to develop a useful framework for a deeper understanding of the resource group method and its outcomes. Method: The study used a longitudinal, qualitative multiple case-study design based on grounded theory methodology. During a period of 2 years, the developments and processes in eight resource groups were explored by conducting a total of 74 interviews (e.g., with patients, significant others, and mental health professionals) and 26 observations of resource group meetings. Results: Analysis showed that a well-functioning resource group set the stage for five processes to unfold: (i) experience of support; (ii) acknowledgment of significant others; (iii) activation; (iv) openness; and (v) integration. These processes facilitated recovery both in terms of an arousing curiosity within the patient as well as increasing reciprocity and equality in their social relations. In addition, the method emphasized the uniqueness of each recovery journey, thereby providing a framework to shape recovery-oriented care. The analysis also revealed three hindering factors: (i) embedding and implementation issues; (ii) predominant network; and (iii) tensions inherent in the resource group setting. Conclusion: Working according to the resource group method involves that the person's recovery work becomes a social process that takes place in relation to the social environment and everyday life in which it is important to acknowledge and integrate the needs of significant others in treatment and care. This study provides a first step toward a multidimensional comprehension of the resource group method, the working mechanisms and its influence on recovery for people with severe mental illness

Stigmatisering binnen de ggz:Onderzoek onder cliënten en hulpverleners

Achtergrond: Mensen met ernstige psychische aandoeningen ervaren naast belemmeringen in het sociaal en maatschappelijk functioneren ook de negatieve gevolgen van vooroordelen en stigmatisering. Ook binnen de ggz, inclusief verslavingszorg, komt stigmatisering voor. Doel: Beschrijven van het vóórkomen en de uitingsvormen van stigmatisering door hulpverleners, vanuit het perspectief van cliënten en hulpverleners. Methode: Digitale enquêtes onder leden van het panel Psychisch Gezien (n = 628) en onder hulpverleners (n = 471). Resultaten: Meer dan de helft (54%) van de panelleden had in de afgelopen twee jaar te maken gehad met stigmatisering door ggz-hulpverleners. Zij ervoeren dit vooral door een afstandelijke houding (22%) en door het taalgebruik van hulpverleners (20%). Twee vijfde (40%) van de hulpverleners gaf aan dat stigmatisering regelmatig of vaak voorkwam bij het eigen team. Zowel cliënten als hulpverleners benadrukten het belang van normalisering van psychische problemen, terughoudend gebruik van psychiatrische labels en herstelgericht werken om stigma te verminderen. Conclusie: Stigmatisering door ggz-hulpverleners komt op veel manieren tot uiting, waardoor het een complex en niet-eenduidig probleem is. Hoewel er geen ‘one-size-fits-all’-oplossing is, is normalisering van psychische problemen een belangrijk aanknopingspunt

Short-term surgical complications after radical hysterectomy—A nationwide cohort study

Introduction: Centralization has, among other aspects, been argued to have an impact on quality of care in terms of surgical morbidity. Next, monitoring quality of care is essential in identifying areas of improvement. This nationwide cohort study was conducted to determine the rate of short-term surgical complications and to evaluate its possible predictors in women with early-stage cervical cancer. Material and methods: Women diagnosed with early-stage cervical cancer, 2009 FIGO stages IB1 and IIA1, between 2015 and 2017 who underwent radical hysterectomy with pelvic lymphadenectomy in 1 of the 9 specialized medical centers in the Netherlands, were identified from the Netherlands Cancer Registry. Women were excluded if primary treatment consisted of hysterectomy without parametrial dissection or radical trachelectomy. Women in whom radical hysterectomy was aborted during the procedure, were also

Short-term surgical complications after radical hysterectomy - a nationwide cohort study

Introduction: Centralization has, among other aspects, been argued to have an impact on quality of care in terms of surgical morbidity. Next, monitoring quality of care is essential in identifying areas of improvement. This nationwide cohort study was conducted to determine the rate of short-term surgical complications and to evaluate its possible predictors in women with early-stage cervical cancer. Material and methods: Women diagnosed with early-stage cervical cancer, 2009 FIGO stages IB1 and IIA1, between 2015 and 2017 who underwent radical hysterectomy with pelvic lymphadenectomy in 1 of the 9 specialized medical centers in the Netherlands, were identified from the Netherlands Cancer Registry. Women were excluded if primary treatment consisted of hysterectomy without parametrial dissection or radical trachelectomy. Women in whom radical hysterectomy was aborted during the procedure, were also excluded. Occurrence of intraoperative and postoperative complications and type of complications, developing within 30 days after surgery, were prospectively registered. Multivariable logistic regression analysis was used to identify predictors of surgical complications. Results: A total of 472 women were selected, of whom 166 (35%) developed surgical complications within 30 days after radical hysterectomy. The most frequent complications were urinary retention with catheterization in 73 women (15%) and excessive perioperative blood loss >1000 mL in 50 women (11%). Open surgery (odds ratio [OR] 3.42; 95% CI 1.73-6.76), chronic pulmonary disease (OR 3.14; 95% CI 1.45-6.79), vascular disease (OR 1.90; 95% CI 1.07-3.38), and medical center (OR 2.83; 95% CI 1.18-6.77) emerged as independent predictors of the occurrence of complications. Body mass index (OR 0.94; 95% CI 0.89-1.00) was found as a negative predictor of urinary retention. Open surgery (OR 36.65; 95% CI 7.10-189.12) and body mass index (OR 1.15; 95% CI 1.08-1.22) were found to be independent predictors of excessive perioperative blood loss. Conclusions: Short-term surgical complications developed in 35% of the women after radical hysterectomy for early-stage cervical cancer in the Netherlands, a nation with centralized surgical care. Comorbidities predict surgical complications, and open surgery is associated with excessive perioperative blood loss

Criminal victimisation in people with severe mental illness: A multi-site prevalence and incidence survey in the netherlands

Background: Although crime victimisation is as prevalent in psychiatric patients as crime perpetration (and possibly more so), few European figures for it are available. We therefore assessed its one-year prevalence and incident rates in Dutch severely mentally ill outpatients, and compared the results with victimisation rates in the general population. Method: This multisite epidemiological survey included a random sample of 956 adult severe