Mental health problems of undocumented migrants (UMs) in the Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care

OBJECTIVE To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems. DESIGN Qualitative study using semistructured interviews and thematic analysis. PARTICIPANTS 15 UMs in The Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached. SETTING 4 cities in The Netherlands. RESULTS UMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the attitude of the GPs and the effectiveness of the treatment. Reasons for dissatisfaction with GP care are an experienced lack of time, lack of personal attention and absence of physical examination. Expectations of the GP vary, medication for mental health problems is not necessarily seen as a good practice. CONCLUSIONS UMs often see their precarious living conditions as an important determinant of their mental health; they do not easily seek help for mental health problems and various barriers hamper access to healthcare for them. Rather than for medication, UMs are looking for encouragement and support from their GP. We recommend that barriers experienced in seeking professional care are tackled at an institutional level as well as at the level of GP.This qualitative study was funded by The Netherlands Organisation for Health Research and Development (ZonMw)

Weight loss in head and neck cancer patients little noticed in general practice

INTRODUCTION: In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors. AIM: We observed patients’ weight courses after specialists’ care and surveyed nutrition-related documentation by general practitioners (GPs). METHODS: From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n=24) and medical records from the year before referral (n=45) and after HNOC care (n=26). An impaired nutritional status was assigned to weight loss =10% within six months or Body Mass Index (BMI

Obstructive sleep apnoea and sexual function in men

Obstructive sleep apnoea (OSA) is associated with sexual dysfunction. Untreated OSA and erectile dysfunction (ED) have both been identified as being indicative of a high risk of developing cardiovascular disease. Treatments for ED, such as testosterone supplementation or PDE-5 inhibitors, and for OSA, such as Continuous Positive Airways Pressure (CPAP) are both readily available. The effects of these treatments on the other associated conditions have not been fully assessed. The efficacy of testosterone supplementation, in untreated OSA, on sexual function and quality of life has not been investigated. PDE-5 inhibitors are an established treatment for erectile dysfunction, however, there is a paucity of information regarding their efficacy in OSA, and there is a theoretical risk of worsening of OSA with their use. CPAP, in some observational and non-treatment or alternative treatment controlled studies, has been shown to improve erection function in men with OSA, however the majority of these studies have been in men with OSA, with and without ED. Two randomised controlled trials investigating the effects of testosterone in untreated OSA (n=67), and the effects of CPAP and a PDE-5 inhibitor in men with OSA and ED using a factorial design (n=61) were performed. Sleep, sexual function and quality of life was assessed. CPAP increased the quantity of nocturnal erections and a PDE-5 inhibitor improved their quality. However, neither CPAP use, exogenous testosterone nor a PDE-5 inhibitor improved subjective erectile function in men with OSA. Post-hoc analysis showed that adherent CPAP use (>4hours per night) increased subjective erectile function and sexual desire, as well as several parameters of quality of life in men with OSA and ED. Testosterone also increased sexual desire in men with OSA

Anticiperende geneeskunde in de praktijk : een onderzoek in een groepspraktijk naar het opsporen van hypertensie en cervixcarcinoom, alsmede naar de compliantie en iatrogene effecten bij de behandeling van hypertensie

Al meer dan vijfentwintig jaar wordt preventie beschouwd als een van de fundamentele deeltaken van de Nederlandse huisarts ... , althans in theorie. De vermaarde Woudschotenconferentie- voor vele huisartsen van nu pure historie- heeft zich hierover destijds duidelijk uitgesproken. Sinds de introductie door Van den Dool (1970) van de anticiperende geneeskunde kunnen wij bovendien beschikken over een specifiek voor de huisarts hanteerbaar kader om deze taak ook werkelijk ter hand te nemen. Uitgangspunt is het gegeven dat iedere huisarts het merendeel van zijn patiënten ten minste eenmaal in de twee à drie jaar op zijn spreekuur ziet- een uitvloeisel van zijn bijzondere plaats binnen het systeem van de gezondheidszorg. Dit contact kan de huisarts benutten door zich niet alleen te bekommeren om de actuele vraag van de patiënt, maar ook om de (verhoogde) risico's die deze op dat moment loopt. Zijn inzicht in deze risico's dankt de huisarts aan de informatie die hij heeft over de voorgeschiedenis van zijn patiënten. Algemene informatie, zoals leeftijd en geslacht, kan aldus leiden tot een preventief onderzoek, maar ook meer specifieke gegevens als vroeger doorgemaakte ziekten, of psychische of lichamelijke kenmerken. Een duidelijk aangrijpingspunt dus ... , althans opnieuw - in theorie. Het inzicht in wat nu precies een verhoogd risico vormt voor een bepaalde ziekte, is uiterst beperkt. Daarnaast is nog weinig bekend over de feitelijke uitvoerbaarheid van de anticiperende geneeskunde. De studies van Van der Feen (1977) en Tudor Hart (1974) zijn vermaard; zij hebben aangetoond dat zij in hun eigen praktijk zeer succesvol konden screenen. De vraag blijft echter hoe andere huisartsen het er afbrengen. Om deze reden lijkt het dan ook interessant het anticiperend screenen van een groep huisartsen te analyseren

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions

Understanding success and failure in innovative Australian resource processing projects

This thesis in concerned with the understanding of success and failure of innovation in resource processing, a sector that is central to the Australian economy. Decline in ore grade, complexity of available ore resources, increases in labour and capital cost, and increased market demand have driven innovation and larger resource processing projects. The outcomes from innovation investment have been disappointing, and not well understood. This thesis aims to understand why so many large resource processing projects fail, and what factors have been critical in other projects that succeed. It proposes a new model for innovation investment, based on public domain data and an outsider view. Five criteria are used in this thesis to classify success and failure of large resource processing projects; that (1) the project and firm made a profit, in failure the project made a loss, (2) the production in the first 36 months of operation is 90% or more of nameplate capacity, while a failure is less than 70%, (3) return on investment is below 105 months, failure above 105 months, average for successful projects is found to be 53 months,. (4) failure sees project and or firm fail, with the plant selling for less than 20% of cost, success sees the project continue to produce at close to capacity, and if sold was value at close to investment, and (5) the successful process is reproduced; in the case of failure it is not. The thesis examines a sample of 67 resource processing projects in Australia initially valued at over $100 million each, over an 18 year interval between 1993 and 2010. The projects totalled$45.3 billion in value with 73% of classified as successful, while 15 projects failed. Four hypotheses are proposed and tested, each respectively relating to one of the following four factors; (1) Firm competence, (2) new process innovation, (3) government involvement in value adding, and (4) information asymmetry and strategic misrepresentation

Citizenship Status and Pressure Group Action

This thesis investigates the intersection between citizenship status and pressure group action. It asks a two-pronged question. First, does variation in citizenship status (to be citizen or noncitizen) produce variation in pressure group action? Second, where there is variation, how is it that citizenship status matters; where there is no variation, how is it that citizenship status (a decidedly political status) does not matter? In response to this two-part question, a two-part theoretical framework has been developed. To answer the question of whether citizenship status matters, an interactive model of action has been developed. This provides a common measure through which similarities and differences in action-paths between citizen and non-citizen pressure groups can be uncovered. It is found that citizenship status does have an effect on pressure group action, notably in a pressure group’s interaction with a) their constituency; b) potential allies; c) other-state political institutions; and d) other-state media. To answer the question of how citizenship matters and does not matter, the idea of the capability mechanism has been developed. This asserts that variation in citizenship status - understood through either a rights or identity framework - produces, reduces, or removes capabilities. This, in turn, shapes action. This model is also used to explain similarities. Both the empirical findings and the theoretical frameworks developed within this thesis are useful for further analysis of the significance of citizen or non-citizen status on one’s relationship to political systems

System reliability-based design of 2D steel frames by advanced analysis

The design of steel frames by geometric and material nonlinear analysis also referred to as -inelastic‖ or -advanced‖ analysis, is permitted by most specifications such as AISC360-10 and AS4100. In these specifications, the strength of a structural frame can be determined by system analysis in lieu of checking member resistances to the specific provisions of the Specification, provided a comparable or higher level of structural reliability. In designing by advanced analysis, the system resistance factor is applied to the frame strength determined by analysis. Provided that the design strength exceeds the required strength, the design is deemed adequate, requiring no further check of individual member resistance. The system-based design of steel structures by advanced analysis leads to a more efficient structural design process and achieves a more uniform level of structural reliability. The main impediment to adopting the procedure in practical applications is the apparent difficulty in assigning an appropriate resistance factor to the structural system. This thesis illustrates the novel framework of the system design-by-analysis approach and how to determine suitable system resistance factors accounting for inherent uncertainties in the ultimate strength of a frame. All key parameters influencing the frame strength are modelled as random and Monte-Carlo type simulations are conducted. New approaches for modelling initial geometric imperfections and residual stresses are introduced. The simulation results for a series of 2D low-to-mid-rise steel frames, which represent typical steel building inventory as well as frames from the literature, are presented obtained according to the proposed methodology. Braced and moment resisting frames are analysed under various load combinations and the system resistance factors are derived for different reliability levels

Bibliography

Regular use of beta2-agonists might result in increased bronchial hyper-responsiveness (BHR) and decreased forced expiratory volume in 1 sec (FEV1). It has been suggested that these possible detrimental effects are not a real deterioration of the disease, but that it might be only a transient (rebound) effect shortly after discontinuing this regular use. Moreover, these effects are thought to occur especially during short-acting and not during long-acting beta2-agonists use. The aim of this study was to invest gate whether a rebound effect (a pharmacological deterioration effect diminishing after several hours) in FEV1 and PC20 (concentration of histamine causing a 20% fall in FEV1 with regard to baseline) occurred after cessation of regular use of beta2-agonists, and whether this occurred both after short-acting and long-acting beta2-agonists. Allergic asthmatic patients (n = 134) were randomly allocated to the use of a short-acting (salbutamol), a long-acting beta2-agonist (formoterol) or placebo for 12 weeks (double-blind, double-dummy). No other asthma medication was allowed, including inhaled corticosteroids. At the start and every 4 weeks later FEV and PC20 were measured, each time at least 12 h after the last doses of study medication, which is in the possible rebound period. To investigate whether a (transient) rebound effect occurred, parameters were additionally measured at least 72 h later after discontinuation of the study medication. After 12 weeks of short-acting beta2-agonist use, a drop was seen in FEV1 from 85.6 (+/- 2.21)% predicted to 78.8 (+/- 2.9)% predicted, measured 15 h (median) after the last doses of medication. This was significantly different compared to placebo. When measured 168 h (median) later FEV1 recovered to 85.5 (+/- 2.4)% predicted, comparable to baseline. PC20 decreased with -1.17 (+/- 0.44) doubling dose after 12 weeks of short-acting beta2-agonist use, measured 15 h after the last doses of medication, which was significantly different compared to placebo. However, 168 h later PC20 recovered slightly with +0.55 (+/- 0.34) doubling dose, but this value was still lower compared to placebo. In contrast, during long-acting beta2-agonist and placebo use no significant changes were seen. In conclusion, the use of short-acting beta2-agonists resulted in a transient (rebound) effect in FEV while the effects on PC20 may point to a real deterioration of the disease. Long-acting beta2-agonist and placebo use showed no changes.We conclude that a mono-therapy of short-acting and not of long-acting beta2-agonists might have deleterious effects in asthma