Predicting homeless people’s perceived health after entering the social relief system in The Netherlands

Objectives: We explored whether changes in the perceived health of homeless people after entering the social relief system (SRS) in The Netherlands were predicted by housing, income, hours of work, social support, unmet care needs, arrests, physical and mental health, substance use, and experiences of autonomy, competence and relatedness, in addition to perceived health at baseline, demographics, suspected intellectual disability, the duration of homelessness and the company of children in the shelter facility. Methods: A hierarchical regression analysis was used to explore the significant predictors of the perceived health of 344 homeless persons 18 months after entering the social relief system. Results: A decrease in psychological distress and an increase in hours of (paid/voluntary) work as well as competence predicted a better perceived health. Conclusions: Perceived health is not only influenced by objective circumstances related to work and mental health, but also self-determination, as shown by the influence of competence. Services should aim to reduce psychological distress of homeless people, support them in increasing their working hours and focus on strengthening their competence

Youth in transition:Study protocol of a prospective cohort study into the long-term course of addiction, mental health problems and social functioning in youth entering addiction treatment

BACKGROUND: Substance use disorders (SUDs) are prevalent in the general population, tend to follow a chronic course, are associated with many individual and social problems, and often have their onset in adolescence. However, the knowledge base from prospective population surveys and treatment-outcome studies on the course of SUD in adolescents is limited at best. The present study aims to fill this gap and focuses on a subgroup that is particularly at risk for chronicity: adolescents in addiction treatment. We will investigate the rate of persistent SUD and its predictors longitudinally from adolescence to young adulthood among youth with DSM-5 SUD from the start of their addiction treatment to 2 and 4 years following treatment-entry. In addition to SUD, we will investigate the course of comorbid mental disorders, social functioning, and quality of life and their association with SUD over time. METHODS/DESIGN: In a naturalistic, multi-center prospective cohort design, we will include youths (n = 420), who consecutively enter addiction treatment at ten participating organizations in the Netherlands. Inclusion is prestratified by treatment organization, to ensure a nationally representative sample. Eligible youths are 16 to 22 years old and seek help for a primary DSM-5 cannabis, alcohol, cocaine or amphetamine use disorder. Assessments focus on lifetime and current substance use and SUD, non-SUD mental disorders, family history, life events, social functioning, treatment history, quality of life, chronic stress indicators (hair cortisol) and neuropsychological tests (computerized executive function tasks) and are conducted at baseline, end of treatment, and 2 and 4 years post-baseline. Baseline data and treatment data (type, intensity, duration) will be used to predict outcome – persistence of or desistance from SUD. DISCUSSION: There are remarkably few prospective studies worldwide that investigated the course of SUD in adolescents in addiction treatment for longer than 1 year. We are confident that the Youth in Transition study will further our understanding of determinants and consequences of persistent SUD among high-risk adolescents during the critical transition from adolescence to young adulthood. TRIAL REGISTRATION: The Netherlands National Trial Register Trial NL7928. Date of registration January 17, 2019

Facing the stranger in the mirror: Staged complicities in recent South African performances

The staging of complicity has developed into one of the most prevalent trends in recent South Africa theatre. The audience may become aware of their own complicity in injustice, or complicity may feature as a subject to be explored in the play. I will argue that one can identify three broadly defined performance modalities which shape current engagements with complicity. These modalities are identified by the adjectives, 'thick' (as in densely layered, complex, deep), 'reflective' (as in reflecting upon as well as revealing), and 'hard' (in the sense of direct, uncompromising, difficult to penetrate). Rather than signifying distinct categories, these terms are attributed to a cluster of performance dynamics.DHE

Changes in Social Exclusion Indicators and Psychological Distress Among Homeless People Over a 2.5-Year Period

Although homelessness is inherently associated with social exclusion, homeless individuals are rarely included in conventional studies on social exclusion. Use of longitudinal survey data from a cohort study on homeless people in four major Dutch cities (n = 378) allowed to examine: changes in indicators of social exclusion among homeless people over a 2.5-year period after reporting to the social relief system, and associations between changes in indicators of social exclusion and changes in psychological distress. Multinomial logistic regression analysis was applied to investigate the associations between changes in indicators of social exclusion and changes in psychological distress. Improvements were found in various indicators of social exclusion, whereas financial debts showed no significant improvement. Changes in unmet care needs, health insurance, social support from family and relatedness to others were related to changes in psychological distress. This study demonstrated improvements in various indicators of social exclusion among homeless people over a period of 2.5 years, and sheds light on the concept of social exclusion in relation to homelessness

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

Belemmerende en bevorderende factoren voor hulp zoeken bij psychische klachten of verslaving:Focusgroepstudie vanuit meerdere perspectieven binnen de Nederlandse krijgsmacht

Achtergrond Wereldwijd worden miljoenen mensen op het werk blootgesteld aan stressvolle factoren die de kans op het ontwikkelen van psychische klachten en/of verslaving (PK/V) verhogen (bijvoorbeeld militairen, politie, artsen). Maar het zijn ook juist deze beroepen waar men geacht wordt sterk en gezond te zijn. Hierdoor is het soms moeilijker om hulp te zoeken voor PK/V. Zo laat Engels onderzoek zien dat 60% van de militairen met PK/V hier geen professionele hulp voor zoekt. Eerder onderzoek naar hulp zoeken voor PK/V richtte zich met name op het perspectief van militairen met PK/V, waarbij andere belangrijke perspectieven niet meegenomen werden. Daarnaast is dit probleem niet eerder onderzocht binnen de Nederlandse krijgsmacht. Doel Het doel van de huidige studie was de belemmerende en bevorderende factoren voor het zoeken van hulp voor PK/V in kaart te brengen binnen de Nederlandse krijgsmacht vanuit verschillende perspectieven. Methode In totaal hebben 46 mensen deelgenomen aan de studie verdeeld over acht focusgroepen, met drie verschillende perspectieven: vier groepen militairen met PK/V (totaal 20 deelnemers), twee groepen militairen zonder PK/V (totaal 10 deelnemers) en twee groepen zorgprofessionals (totaal 16 deelnemers). De focusgroepen zijn opgenomen en letterlijk uitgeschreven. Vervolgens is met behulp van kwalitatieve data-analysesoftware contentanalyse uitgevoerd vanuit een inductieve benadering. Resultaten Er zijn vijf belemmerende factoren voor het zoeken van hulp gevonden: (1) angst voor negatieve carrièregevolgen, (2) angst voor sociale afwijzing, (3) zorgen rond de vertrouwelijkheid, (4) de militaire werkcultuur en (5) praktische barrières. Ook zijn drie bevorderende factoren gevonden: (1) sociale steun, (2) toegankelijkheid zorgverlening en kennis over waar hulp te verkrijgen en (3) militaire zorgverlening. Ondanks dat het onderzoek zich expliciet richtte op verschillende perspectieven kwamen de visies van de deelnemers sterk overeen. Conclusie De meeste belemmerende factoren voor het zoeken van hulp waren gerelateerd aan stigma (angst voor carrièregevolgen, sociale afwijzing en militaire werkcultuur) en dit werd benoemd door alle drie de verschillende perspectieven. Sociale steun vanuit het thuisfront, collega’s, leidinggevende en zorgprofessionals werd gezien als bevorderend voor het zoeken van hulp. De resultaten van de huidige studie geven richting voor zowel toekomstig (interventie)onderzoek als beleid, om ervoor te zorgen dat meer militairen hulp zoeken voor PK/V

Intellectual disability among Dutch homeless people: Prevalence and related psychosocial problems

Background: There is a higher prevalence of intellectual disability (ID) among homeless people than in the general population. However, little is known about the additional psychosocial problems faced by homeless people with ID. We describe the prevalence of ID in a cohort of homeless people in the Netherlands, and report relationships between ID and psychosocial problems in terms of psychological distress, substance (mis)use and dependence, as well as demographic characteristics in this cohort. Methods: This cross-sectional study is part of a cohort study among homeless people in the four major cities of the Netherlands. Data were derived from 387 homeless people who were interviewed and screened for ID six months after the baseline measurement. Multivariate logistic regression analyses and χ2 tests were performed to analyze relationships between ID, psychosocial problems and demographic characteristics. Findings: Of all cohort members, 29.5% had a suspected ID. Participants with a suspected ID had a higher mean age, were more likely to be male and to fall in the lowest category of education than participants without a suspected ID. Having a suspected ID was related to general psychological distress (OR = 1.56, p<0.05), somatization (OR = 1.84, p<0.01), depression (OR = 1.58, p<0.05) and substance dependence (OR = 1.88, p<0.05). No relationships were found between a suspected ID and anxiety, regular substance use, substance misuse and primary substance of use. Conclusion: The prevalence of ID among Dutch homeless people is higher than in the general population, and is related to more psychosocial problems than among homeless people without ID. Homeless people with a suspected ID appear to be a vulnerable subgroup within the homeless population. This endorses the importance of the extra attention required for this subgroup

Comprehensive Molecular Characterization of Papillary Renal-Cell Carcinoma

BACKGROUND Papillary renal-cell carcinoma, which accounts for 15 to 20% of renal-cell carcinomas, is a heterogeneous disease that consists of various types of renal cancer, including tumors with indolent, multifocal presentation and solitary tumors with an aggressive, highly lethal phenotype. Little is known about the genetic basis of sporadic papillary renal-cell carcinoma, and no effective forms of therapy for advanced disease exist. METHODS We performed comprehensive molecular characterization of 161 primary papillary renal-cell carcinomas, using whole-exome sequencing, copy-number analysis, messenger RNA and microRNA sequencing, DNA-methylation analysis, and proteomic analysis. RESULTS Type 1 and type 2 papillary renal-cell carcinomas were shown to be different types of renal cancer characterized by specific genetic alterations, with type 2 further classified into three individual subgroups on the basis of molecular differences associated with patient survival. Type 1 tumors were associated with MET alterations, whereas type 2 tumors were characterized by CDKN2A silencing, SETD2 mutations, TFE3 fusions, and increased expression of the NRF2'antioxidant response element (ARE) pathway. A CpG island methylator phenotype (CIMP) was observed in a distinct subgroup of type 2 papillary renal-cell carcinomas that was characterized by poor survival and mutation of the gene encoding fumarate hydratase (FH). CONCLUSIONS Type 1 and type 2 papillary renal-cell carcinomas were shown to be clinically and biologically distinct. Alterations in the MET pathway were associated with type 1, and activation of the NRF2-ARE pathway was associated with type 2; CDKN2A loss and CIMP in type 2 conveyed a poor prognosis. Furthermore, type 2 papillary renalcell carcinoma consisted of at least three subtypes based on molecular and phenotypic features